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The movements of a client diagnosed with a TBI are exaggerated and oscillating. What term BEST describes the client's movements? Spasticity Ataxia Bradykinesia Tremor

Solution: The correct answer is B. The client is exhibiting ataxic movements. A: Spasticity involves a velocity-dependent resistance. C: Bradykinesia involves velocity-independent resistance. D: Tremors are involuntary rhythmic oscillations, although not as exaggerated as those seen in clients with ataxia.

An OTR is working with a client who fell on an outstretched hand and broke the distal radius. Which complication from this type of fracture is the MOST severe? Limited forearm rotation Limited wrist flexion Carpal tunnel syndrome Complex regional pain syndrome (CRPS)

Solution: The correct answer is D. D: CRPS requires the most intensive intervention of all the complications listed. A, B, C: Limited forearm rotation and wrist flexion and carpal tunnel syndrome are possible complications from a distal radius fracture, but CRPS is more severe.

A client with a diagnosis of dementia has memory loss. The OTR® observes that the client has visual hallucinations. In addition, the client has decreased spontaneous motor movements and rigidity. What type of dementia does this client MOST LIKELY have? Frontotemporal dementia Alzheimer's disease Vascular dementia Dementia with Lewy bodies

Solution: The correct answer is D. Distinguishing features of dementia with Lewy bodies are visual hallucinations and Parkinson-like motor symptoms. A, B, C: Frontotemporal dementia, Alzheimer's disease, and vascular dementia all have memory loss as a key feature, but the various types of dementia are categorized on the basis of unique features.

An OTR® is working with a client in the acute phase of Guillain-Barré syndrome. Which client action demonstrates the ability to direct care? Stating that assistance is needed to change position in bed Reporting that less anxiety is experienced with ADL Making a phone call using the phone in the hospital room Telling nursing staff about the home living environment

Solution: The correct answer is A. A client in the acute phase of Guillain-Barré syndrome may not be able to participate directly in activities; asking for help with changing position in bed reflects an awareness of needs and the ability to request assistance. B: A decrease in anxiety is beneficial, but it does not indicate ability to provide direction for care. C: Independent use of the phone does not indicate an ability to direct care. D: Telling nursing information about the home may be beneficial for discharge planning, but it does not demonstrate the client's ability to direct care.

An OTR® is working in early intervention with a toddler with developmental delays. The child is just beginning to actively cooperate during dressing. What is the next "just-right" challenge for this child? Pulling off shoes and socks Locating the armholes of a shirt Pulling down pants with an elastic waistband Dressing with minimal assistance

Solution: The correct answer is A. Around age 1, children begin cooperating during dressing. The next developmental challenge would be to encourage the child to remove shoes and socks. B, C, D: These skills would typically be too challenging for a 1-year-old.

An OTR® works in an outpatient setting with clients with anxiety disorders. Which skills are MOST essential to the needs of this population? Coping skills Energy conservation Memory retraining Creative expression

Solution: The correct answer is A. Clients with anxiety disorders exhibit symptoms of inability to cope with stressors in the environment. B, C, D: These interventions do not address typical issues for people with anxiety disorders

An OTR® is working with a client who has visual field deficits. What implications do those deficits have for driving performance? Difficulty with lane positioning or timing of turns Difficulty adapting to the dark or to the bright lights of oncoming vehicles Difficulty recognizing road signs at a distance Delayed responses to stimuli in the driving environment

Solution: The correct answer is A. Visual field deficits imply an obstruction or occlusion in the field of view; the driver will have problems with maneuvers such as adequately positioning the car in the lane, taking turns smoothly, and avoiding potential hazards in the roadway. B, C, D: These choices pertain to the performance implications of poor visual acuity for driving.

An OTR® has received a consult for a client experiencing lower back pain, particularly after waking in the morning. What is the MOST APPROPRIATE recommendation regarding the client's sleeping? Sleep on back with pillow under knees Purchase a thick, cotton pillow Sleep on stomach with pillow under knees Purchase a pillowtop mattress

Solution: The correct answer is A. When sleeping on the back, the client can put a pillow under knees to reduce strain on the lower back. B: A thick pillow could cause the neck to flex, causing further injury. C: Pillows under knees when sleeping on stomach may increase strain on lower back. D: A firm, supportive mattress is indicated to prevent further injury.

A recently graduated OTR® is designing interventions for a work hardening program seeking accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF). According to CARF, what is the most commonly accepted client-to-staff ratio? 4:1 5:1 6:1 3:1

Solution: The correct answer is B. The most commonly accepted ratio is 5 clients to 1 staff member. A trained professional is required to monitor clients for problem identification and appropriate interventions. 1:1 individual attention is required for the OTR® to complete evaluations and attendance at meetings. A, C, D: The Commission on the Accreditation of Rehabilitation Facilities manual does not dictate a client-to-staff ratio; however, it mandates that an individual has the responsibility and authority to direct care and maintain operation of the program.

Which records would an OTR® most likely want to review for a handwriting evaluation? The student's work samples The student's grades The student's art projects The student's behaviors

Solution: The correct answer is A. Although the OTR may be interested in the child's grades and health records, work samples would likely be most informative during a handwriting evaluation. B, C: Grades and art projects might help the OTR® develop the student's occupational profile, but the work samples would provide the most relevant information related to the child's difficulty with handwriting. D: Behaviors are typically based on observations, not on records.

An OTR® is working with a baby in the neonatal intensive care unit who was exposed to a STORCH infection (syphilis, toxoplasmosis, other infections, rubella, cytomegalovirus, herpes simplex virus-2) at birth. Which STORCH infection would require the OTR® to use universal precautions to prevent the OTR® from contracting an infection when working with the infant and mother? Cytomegalovirus Rubella Toxoplasmosis Syphilis

Solution: The correct answer is A. Cytomegalovirus can be transmitted to the infant before, during, or after birth. The therapist needs to use universal precautions because the virus could remain dormant, and the therapist could contract it. B, C, D: Although it is a good idea to use universal precautions when working with infants in the neonatal intensive care unit, the only condition that puts the therapist at risk is cytomegalovirus.

An OTR® observes that a client with Parkinson's disease has fine motor difficulties when dressing. Which strategy is BEST for improving performance in dressing? Reduce the need for fine motor skills by eliminating clothing fasteners Do fine motor exercises to improve this client factor for ADL performance Engage in sensory reeducation to compensate for fine motor difficulties Use a button hook and zipper pull to manipulate clothing fasteners

Solution: The correct answer is A. Eliminating clothing fasteners is a task modification that decreases the level of performance difficulty. This strategy is also the most readily manageable option for this client, because of the progressive loss of fine motor function. B: Given the progressively degenerative symptoms of Parkinson's disease, remediation of fine motor skills is not likely to succeed, so compensatory approaches are more appropriate. C: Sensory changes do not typically occur with Parkinson's disease; therefore, sensory reeducation would not be beneficial. D: Although adaptive equipment for dressing offers a compensatory approach, limited fine motor skills would likely result in difficulty using a button hook and zipper pull.

During an initial evaluation, the OTR® brings a 7-year-old child with autism to the sensory gym to observe the child's play skills. The OTR® demonstrates a variety of play equipment and tells the child, "I want to see you play in the gym. What would you like to do?" The child is unable to figure out which equipment to use and how to use it. The OTR® suspects that the client may have difficulties in what aspect of play? Ideational praxis Motor organizational praxis Symbolic play Exploratory play

Solution: The correct answer is A. Ideational praxis is the ability to conceptualize and identify a motor goal and ways to achieve this goal. Problems in this area may lead to difficulties in generating independent play. B: Motor organizational praxis is the ability to plan and organize a series of intentional motor actions in response to environmental demands. C: Symbolic play involves pretend play. D: Exploratory play is play that involves exploring the sensory experiences of play without purposeful manipulation of the play object.

Why might a client with early-stage dementia appear rigid in routines? The client may be compensating for memory loss. The client may be compensating for decreased orientation. The client may be compensating for decreased spatial orientation. The client may be compensating for decreased temporal organization.

Solution: The correct answer is A. The client may be aware of memory loss at this stage and compensate by becoming rigid in routines so that the client still appears intact to others. B, C, D: These responses are deficits first noticed in early-stage dementia, but they would not have a direct impact on the client's ADL routine. They would most likely affect IADLs first.

For a client with C5 spinal cord injury (SCI) in the acute phase of rehabilitation, what is the BEST position to place the client's forearms in? Pronation Supination Flexion Extension

Solution: The correct answer is A. The forearm should be pronated because clients with C5 SCI are prone to contractures in their supinators because of their inability to pronate actively. B: Placing the forearm in supination encourages the supination contracture as there is no resistance applied C: Placing the forearm in flexion threatens additional contractures of the forearm flexors D: While placing the forearm in extension is indicated, it does not address the potential supinator contraction

An OTR® is working with a client who is being treated medically with a wound vacuum-assisted closure (wound VAC). What precaution does the OTR need to take during a therapy session with the client with a wound VAC? Do not turn off the wound VAC during treatment. Keep the client in a supine position. Do not have the client ambulate. Avoid moving the extremity with the wound VAC.

Solution: The correct answer is A. The wound VAC should not be turned off without the nurse's knowledge because it can only be turned off for 2 hours within a 24-hour period. B, C, D: Movement is not usually restricted when a client is wearing a wound VAC.

The Occupational Therapy Code of Ethics (2015) states, "Occupational therapy personnel shall treat clients, colleagues, and other professionals with respect, fairness, discretion, and integrity." What principle does this statement directly relate to? Principle 6, Fidelity Principle 1, Beneficence Principle 2, Nonmaleficence Principle 4, Justice

Solution: The correct answer is A. This statement is used in Principle 6, Fidelity, of the Occupational Therapy Code of Ethics (2015). B, C, D: Although the principles of Beneficence, Nonmaleficence, and Justice address how occupational therapists should treat colleagues and other health professionals, this statement is part of Principle 6, Fidelity.

An OTR® is using suspended equipment in working with a child who has vestibular issues. The OTR® is worried that the child might be receiving too much input. What physical indicator suggests that the child might be receiving too much vestibular input? Hyperactive behavior A flushed face An expression of hunger Efficient motor coordination

Solution: The correct answer is A. When providing vestibular input, the therapist looks for warning signs that too much input is being provided. Warning signs include the child's report of nausea or dizziness, blanching, hyperactivity, and lethargy. B, C, D: These options are not associated with autonomic nervous system responses.

An OTR has been working with a client diagnosed with carpal tunnel syndrome. The client's symptoms have diminished, but now the client reports more pain at the elbow in the median nerve area. When a client reports dual sites of impingement of a single nerve without a history of trauma, what condition is MOST likely the cause? Thoracic outlet syndrome Double crush syndrome Ulnar tunnel syndrome Cubital tunnel syndrome

Solution: The correct answer is B. B: Over time, diminished blood flow to a peripheral nerve can result in serial impingements, called double crush syndrome. A: Thoracic outlet syndrome involves the shoulder region. C: Ulnar tunnel syndrome involves the ulnar nerve. D: Cubital tunnel syndrome involves the ulnar nerve.

According to AOTA and the Occupational Therapy Practice Framework: Domain and Process, which clinical occupational engagement treatment session would be considered to include an inappropriate use of physical agent modalities? Application of a hot pack to the hand followed by an activity that involves making a cord bracelet Use of fluidotherapy for the upper extremity followed by passive stretch Use of a transcutaneous electrical nerve stimulation unit for the back during homemaking activities Use of a cold pack to the elbow after a game of checkers

Solution: The correct answer is B. A treatment session consisting of fluidotherapy followed by passive stretch does not include occupational engagement as part of the session. A, C, D: The use of each modality is combined with some form of occupational engagement.

Which class of psychopharmaceutical drugs is mood elevating but may increase suicidal tendencies in young adults and carries a small risk of causing hypomania or mania? Adrenergic receptor drugs Antidepressants Anticholinergics Antipsychotics

Solution: The correct answer is B. Antidepressants have a variety of mechanisms, but all are mood elevating and carry potential for risk of suicide. Mania and hypomania are risks with all antidepressants. A, C, D: These drug classes do not carry a risk for causing mania or hypomania.

For a client with an L2 spinal cord injury, which statement BEST describes the muscle segments below the injury level 1 to 2 months postinjury? Senses are elevated. Muscles are spastic. Sympathetic functions are hypoactive. Muscles are flaccid.

Solution: The correct answer is B. Because the monosynaptic reflex arc is intact but separated from higher inhibitory influences, muscles below the level of injury generally develop spasticity. A: Sensory loss below the level of injury is common. C: Sympathetic functions below the level of injury are hyperactive. D: Although muscles may be initially flaccid for a short period of spinal shock, spasticity regularly develops below the injury.

An OTR® working at an outpatient clinic receives a physician's order for occupational therapy evaluation and intervention for a new client. After the OTR® completes the evaluation, which billing codes for services are appropriate to put into the documentation system? International Classification of Diseases (ICD) CPT Children's Health Insurance Program (CHIP) The Diagnostic and Statistical Manual of Mental Disorders (DSM)

Solution: The correct answer is B. CPT codes are used to denote procedures and services completed in the outpatient setting. A: The ICD are diagnosis codes. C: CHIP relates more to health insurance for children. D: The DSM provides criteria for diagnosing mental illness.

Workers at a meat processing plant are participating in a back injury prevention program. Which factor should be stressed as presenting a major ergonomic risk? Dynamic posturing Forceful exertions Standing position Armrest location

Solution: The correct answer is B. Forceful exertions (e.g., heavy lifting, twisting through the spine) are an ergonomic risk factor. A: Static or nonmoving postures are a risk factor. C: Standing position alone is not a risk factor. D: "Armrest location" is not descriptive enough to identify it as a risk factor.

An OTR® wants to design an intervention activity that will provide a child with proprioceptive input. Which intervention activity would provide this type of input? Encouraging the child to play in a bin of rice or beans Encouraging the child to swing on a platform swing while "climbing" a rope with the hands Encouraging the child to finger paint at an easel Encouraging the child to walk on a balance beam

Solution: The correct answer is B. Proprioceptive input is gained through the child's muscles and joints. "Climbing" a rope would provide this type of input. A, C: These options would provide tactile input. D: This option would challenge motor planning.

An OTR® is working with a client who has difficulties with visual skills as a result of damage to the central nervous system (CNS). Which visual skill is related to CNS damage? Visual memory Stereopsis Figureground Kinesthesia

Solution: The correct answer is B. Stereopsis, or binocular depth perception, is a visual skill that would be affected by CNS damage. A, C: Visual memory and figureground are visualcognitive functions. D: Kinesthesia has to do with the information received from the body in relation to how it moves.

The owner of a construction company asks an OTR® completing work tolerance screenings to notify applicants whether they have been hired on the basis of their screening results. What should the OTR® do? Suggest that the owner revise the written policies for work tolerance screenings to reflect this change in the process Inform the owner that the OTR® will review the results of the completed work tolerance screenings with the owner so the owner can summarize the results with applicants and notify them of the hiring decision. Keep good documentation of the agreement to support the need for this change in the work tolerance screening process. Implement a quality assurance monitoring system to determine reasonable outcomes for this revised process.

Solution: The correct answer is B. The OTR® should remain separate from the hiring process, including notification of hiring decisions, to maintain objectivity and third-party distance. A: The OTR® should remain separate from the hiring process, including related policy development, to maintain objectivity and third-party distance. C: Documentation is essential for follow-up support, but the OTR® should consider the ethical implications before agreeing to the change. D: Quality assurance measures are important in consultation services; however, the OTR® must consider the ethical implications of implementing the revised process.

An OTR is working with a client who has a flexor tendon injury. The referring physician prefers patients to follow the flexor tendon protocol using controlled passive motion. Which movement is indicated? Active movement of the metacarpal joint only Passive extension of the distal interphalangeal joint if the metacarpal and proximal phalangeal joints are flexed Active movement of the distal interphalangeal joint only Passive flexion of the distal interphalangeal joint if the metacarpal and proximal phalangeal joints are extended

Solution: The correct answer is B. The distal interphalangeal joint and proximal interphalangeal joint can be passively extended if the other joints of the digit are flexed to initiate tendon glide and prevent scarring of the tendon. A, C: Joints may only be moved passively in this controlled-movement flexor tendon protocol. D: Because this is a flexor tendon repair, extension needs to closely guarded to prevent flexor tendon rupture.

An OTR® is working with a client who has a dorsal scar resulting in limited metacarpophalangeal (MCP) flexion of the fingers. When fabricating a dynamic MCP flexion splint, what is the correct angle of pull for a finger loop? 30 60 90 100

Solution: The correct answer is C. A 90 angle of pull distributes the pressure most evenly to the proximal phalanx. A, B, D: If the angle of pull is greater or less than 90, the torque is less effective, and skin breakdown may result.

A client fell while skiing downhill and sustained a Type III fracture of the radial head. Which treatment would be MOST appropriate for this type of fracture? Long arm cast for 6 weeks Therapy alone Fragment excision with a long arm cast for 3-4 weeks Fragment excision with a long arm splint for 3-4 weeks

Solution: The correct answer is C. A Type III fracture of the radial head requires removal of the fragmented bone and a cast for 3-4 weeks to ensure proper healing and support. A: A long arm cast for 6 weeks would not be appropriate because that time frame would lead to greater stiffness. B: Therapy alone would not be sufficient for a Type III injury. D: A splint would not stabilize the fracture sufficiently for a Type III injury.

An OTR® is measuring a client for a new wheelchair. The client's hip width is 18 inches. The client does not use any lateral trunk supports but lives in a cold climate and frequently wears bulky clothing. What seat width should the OTR® recommend? 16 inches 18 inches 20 inches 22 inches

Solution: The correct answer is C. A clearance of 1 to 2 inches bilaterally between the hips and the side of the wheelchair is recommended. Two inches will more easily accommodate bulky clothing. A, B, D: 16 and 18 inches do not allow for 1- to 2-inch clearance, and 22 inches is too wide.

An OTR® 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? Upper back Abdomen Elbows Insulin injection site

Solution: The correct answer is C. A decubitus ulcer most commonly occurs at a boney prominence that has been compressed against an external surface for a prolonged period. A, B, D: The upper back, abdomen, and insulin injection site tend to be well padded in people who are obese.

An OTR® is working with a client population with severe intellectual disabilities. What risk factor MOST predisposes this client population to pneumonia? History of smoking Antibiotic overuse Aspiration of food Chest surgery

Solution: The correct answer is C. Among people with severe intellectual disabilities, the most frequent cause of pneumonia is aspiration of food or liquids. A, B, D: Smoking, antibiotic use, and chest surgery are all risk factors for pneumonia in the the general population.

Which game is MOST difficult for a 7-year-old child with autism? Following simple designs using plastic interlocking blocks Fishing for letter puzzles while on a swing Playing Simon Says with a peer Making a sandwich using play dough

Solution: The correct answer is C. Playing Simon Says requires social skills, auditory processing, and praxis skills, which are typical areas of challenge for children with autism. A, B, D: These activities present fewer skill demands for a 7-year-old child.

A client working at a clothing boutique has made progress in completing simulated work tasks but is still unable to resume the prior work status. The OTR® suggests that the client return to work on a light duty schedule. Which of the following outcomes is MOST likely to occur when a client returns to work on light duty? The client learns how to push through the pain. The employer has lower workers' compensation costs. The client's confidence in his or her abilities to complete job tasks increases. The client receives higher ratings on the reevaluation assessment.

Solution: The correct answer is C. Returning to work provides psychological benefits to clients by building their confidence in their ability to complete some job duties and allowing them to participate in the social environment of the workplace. A: The purpose of light duty is not to put a worker back to work when he or she is experiencing pain. B: Although the employer may experience decreased costs, this is not a client-centered benefit. D: Returning a client to work should not be done exclusively to improve reevaluation ratings; it should be done because it is a client-centered intervention approach.

An OTR® is working with a child who was recently identified as having vestibular issues. The OTR® would like to use suspended equipment in the session. What type of vestibular input should the therapist first introduce? Rotational movement Vertical movement Linear movement Continuous movement

Solution: The correct answer is C. Suspended equipment provides the opportunity for children to gain vestibular input. Linear movement is usually tolerated the best and is introduced first. A, B: Rotational and vertical movement are considered to be more intense than linear movement and are likely not the best place to start. D: This option does not specify the type of movement, only the frequency of delivery.

Both standardized and nonstandardized assessments are included as part of an evaluation for a client with multiple sclerosis. Which standardized assessment would be MOST effective in assessing a client's endurance? Nine-Hole Peg Test Sleep Questionnaire Modified Fatigue Scale Multiple Sclerosis Functional Composite

Solution: The correct answer is C. The National Multiple Sclerosis Society recommends use of the Modified Fatigue Scale as a fatigue assessment. A: The Nine-Hole Peg Test does not assess fatigue. B: The Sleep Questionnaire is not a standardized assessment. D: The Multiple Sclerosis Functional Composite measures short-distance walking, hand function, and cognition but does not directly assess fatigue.

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? Active wrist extension splint Active wrist, finger, and thumb extension splint Resting hand splint Dorsal blocking splint

Solution: The correct answer is D. D: The dorsal blocking splint protects the surgery and guards against flexor tendon rupture. A, B: Active wrist extension and wrist, finger, and thumb extension splints are fabricated for extensor tendon injuries. C: The resting hand splint is made for clients who need positioning to prevent deformities, such as in rheumatoid arthritis.

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? Fluid retention Scar management Sensory reeducation Deformity prevention

Solution: The correct answer is D. During the acute phase of the burn, it is important to position the client to prevent the development of deformity and contracture. A: Fluid retention is one of the primary goals for the nurses and physician. B: A scar will not yet be developed in the acute phase. Scar management will be addressed in a later phase of the rehabilitation process. C: If there is any sensory impairment, reeducation will occur at a later phase of the rehabilitation.

An OTR® wants to develop interventions for homeless adults with mental illness to improve independent living skills. Which of the following roles is MOST appropriate for the OTR®? Employment retraining Job searching Housing procurement Room and self-care management

Solution: The correct answer is D. Evidence has indicated that basic life skills training in areas such as room and self-care management, food and nutrition management, money management, and safe community participation leads to increased skill and knowledge in managing these areas. A, B, C: Little to no evidence is available to support work preparation, job retraining, or shelter procurement for the adult who is homeless and has mental illness

An OTR® has been leading a developmental group that is in charge of planning a staff party at an inpatient facility. After a few sessions, the OTR® observes that the group has now bonded with one another and appears united and emotionally supportive of one another. According to Tuckman's theory of group development, at what stage is this group? Forming Storming Norming Performing

Solution: The correct answer is D. In group dynamics, the performing stage is characterized by group productivity derived from a sense of trust, unity, and supportiveness. A: Forming is characterized by dependence. B: Storming is characterized by conflict and competition. C: Norming is characterized by initiation of cohesion

An OTR® is 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? An active realistic myoelectric prosthesis An active realistic prosthesis An passive hook prosthesis A passive realistic cosmetic prosthesis

Solution: The correct answer is D. The client's goal for the prosthesis is cosmetic. The client is a high-functioning one-handed person and does not require an active prosthesis. The additional time and expense needed to develop prosthetic skills is not warranted given the client's current level of functioning. A, B, C: The client does not require an active prosthesis.

What is the BEST compensatory strategy an OTR® can apply to address the on-road performance of a client with visual field deficits? Compensate with extra head turns and frequent eye movements. Use prescription lenses. Impose speed-limit or night-driving restrictions. Train the client in the use of alternative transportation and start the driving retirement process.

Solution: The correct answer is A. All the choices are compensatory strategies, but the best answer to this question is A, which encompasses the most comprehensive approach. B: Lenses should be prescription prism lenses. C: This is a good choice, but it is not the best strategy. D: It is premature to start the driving retirement process in this case.

Performing a functional transfer with a client with CVA, the OTR® blocks the client's affected knee and instructs the client to reach for the desired surface and move toward the stronger side. What transfer technique does this BEST describe? Assisted stand pivot Bent pivot transfer Maximum assist transfer Dependent lift transfer

Solution: The correct answer is A. An assisted stand pivot is used to move a client from one surface to another. B: This transfer involves equal weight bearing between both lower extremities and knees bent. C: Because the client is standing and performing the primary movements required for transfer, the client is not likely requiring maximum assistance from the OTR®. D: In a dependent transfer, the OTR® (or device) is completing the entirety of the work.

An OTR® is evaluating a client with Guillain-Barré syndrome in a hospital setting. Which client factor should the OTR assess FIRST? Sensation Cognition Vision Hearing

Solution: The correct answer is A. Because of the painful sensations that are intially reported with Guillain-Barré syndrome, assessing the client's tolerance for tactile input and sensory abilities is important in determining an appropriate intervention plan. B, C, D: Cognition, vision, and hearing are not affected by Guillain-Barré syndrome.

A COTA® is shifting roles within a skilled nursing facility to become the manager of the therapeutic recreation department. In which way does supervision from the OTR® change? Supervision is no longer needed. Supervision is on an as-needed basis. The OTR® and COTA® meet monthly to discuss clients. The OTR® and COTA® meet quarterly to discuss clients.

Solution: The correct answer is A. Because of their training and education, COTA®s are often well equipped to handle other careers, such as managing a therapeutic recreation department. Because this position does not entail providing occupational therapy services, supervision from an OTR® is not needed. B, C, D: The COTA®, now in a role of an activity director, no longer requires occupational therapyrelated supervision.

An OTR® is asked to consult with a local meat packing plant to establish a work injury prevention program because of an increase in the number of work-related musculoskeletal disorders among employees. For the program to be successful, what should the OTR® FIRST ensure? Complete employee participation Projection of new injuries Anticipated reoccurring injuries Long-term beneficial outcomes

Solution: The correct answer is A. Four characteristics of successful implementation of a successful work injury prevention program are ongoing management support, supervisory support, employee participation, and ongoing support and reinforcement of program. The meat packing plant sought out the services of the consultant, therefore demonstrating a commitment to establishing a culture of safety and wellness for its employees. Employee participation is a key component of success. B, C, D: Although the prevalence and type of work-related musculoskeletal injuries and financial implications are important in determining which type of program to implement, the focus of the OTR® consultant is the process and design implementation of a successful prevention program.

According to the Standards of Practice for Occupational Therapy, which of the following tasks is within the standards of practice for a COTA®? Contributes to intervention plan modification. Documents evaluation results. Determines when services should be discontinued. Revises intervention plan.

Solution: The correct answer is A. The COTA® is able to contribute to modification of the plan, can document intervention, and can select and implement intervention. B: The COTA® contributes to the evaluation process, but the OTR® documents the evaluation results. C: The COTA® and OTR® collaborate on determining when the client is ready for discharge. D: The COTA® is unable to revise an intervention plan independently but is able to contribute to the plan modifications.

An OTR® is performing a physical examination to determine the client's seating and positioning needs before ordering a new wheelchair. What rule of thumb would the OTR® use for the client's ability to sit upright? Minimal hip flexion of 90 Minimal hip flexion of 80 Minimal hip flexion of 70 Minimal hip flexion of 60

Solution: The correct answer is A. The ability to achieve 90 of hip flexion is necessary for postural stability when sitting upright without support. B, C, D: Hip flexion less than 90 will put the client in a partially reclined position, increasing pressure on the sacral area.

An OTR® is attending an individualized education program (IEP) team planning for a 10-year-old child with autism. Which principle BEST contributes to a good IEP? Set academic, functional, and measurable goals achievable within a 6-month time frame To the maximum extent possible, the student must be educated with nondisabled peers Transition planning must begin with an emphasis on future vocational goals and independent life skills To be succinct, the IEP reports only the needs and challenges of the student

Solution: The correct answer is B. A general education environment is considered first because the IEP process includes placement in the least restrictive environment possible. A: IEP goal setting is for an entire academic year. C: Transition planning commences at 16 years. D: The IEP must include the student's strengths as well as needs.

The topic of the February 7, 2013, newsletter MLN Matters, published by the Medicare Learning Network under the Centers for Medicare and Medicaid Services, was related to changes in the criteria for mobility assistive equipment and mobility-related ADLs (MRADLs), which OTR®s working with positioning, seating, and wheelchairs need to know for reimbursement. Which of the following is NOT an MRADL specifically cited by Medicare? Feeding Cooking Bathing Grooming

Solution: The correct answer is B. Cooking is not specifically cited by Medicare; Medicare regulations state that beneficiaries must have significant limitations in tasks such as "toileting, feeding, dressing, grooming, or bathing." A, B, D: Medicare beneficiaries must have significant limitations in tasks such as "toileting, feeding, dressing, grooming, or bathing.

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? The child will be able to cook a simple meal. The child will not be able to walk or speak. The child will not be able to express discomfort. The child will be able to put earrings on independently.

Solution: The correct answer is B. Girls with Rett's syndrome experience a decline in functional skills. Commonly, by the time a girl with Rett's syndrome reaches late childhood, she would no longer be able to walk or talk. A, D: Girls with Rett's experience a decline in functional skills and would be dependent for meals or donning earrings by early childhood. C: The child would likely be able to express discomfort, even if she were nonverbal.

An OTR®; is conducting a cooking group for people with schizophrenia. The OTR writes the following information in a progress note after a treatment session: "Client participated in a 60-minute group cooking session in the hospital kitchen to address attention and task completion secondary to delusional thinking." Where in a SOAP note would the OTR document this information? In the S section In the O section In the A section In the P section

Solution: The correct answer is B. The O, or objective, section records measurable data obtained during the treatment session. A: The S, or subjective, section of a SOAP note gives the client's perspective on his or her condition, treatment, or experience. C: The A, or assessment, section contains an interpretation of subjective and objective information from a treatment session. D: The P, or plan, section outlines the frequency and duration of continued treatment for the client.

A client is being evaluated for a standard wheelchair (K0001), but after the intake interview, the OTR® is concerned that Medicare will not reimburse the cost of the wheelchair. Which of the client's statements could make him ineligible? "I'm unable to ambulate safely with a cane or walker." "We don't have enough room to move the wheelchair between rooms in our home." "I'm unable to push myself up a ramp in a wheelchair." I'm unable to remove the armrest to transfer."

Solution: The correct answer is B. This criterion is one of the minimal criteria to be met for Medicare reimbursement for a mobility device. A: This statement is consistent with the eligibility criteria for a wheeled mobility device. C, D: No eligibility criteria mandate that the client be able to assist the caregiver with a transfer or push a wheelchair up a ramp.

A client sustained a nondisplaced humeral neck fracture after a fall. Which course of occupational therapy would be BEST? Instruct the client in use of a sling with no ROM for 3 weeks Instruct the client in use of a sling with supervised ROM Provide no occupational therapy intervention because the client will have a surgical reduction Fabricate a removable orthosis

Solution: The correct answer is B. With a nondisplaced fracture of the humeral neck, support from a sling and supervised exercise lead to the most desirable outcome. A: A sling without supervised ROM would result in decreased ROM and possible frozen shoulder. C: Nondisplaced fractures do not require surgical intervention. D: Nondisplaced fractures of the humeral neck require a sling, not an orthosis.

An OTR® is working with a client in the active phase of C6 spinal cord injury. What is the MOST IMPORTANT treatment activity to consider? Providing accessibility recommendations Educating on preventative health measures Developing pressure relief methods Recommending durable medical equipment

Solution: The correct answer is C. A high priority for the active phase of rehabilitation is determining a method to prevent decubitus ulcers A, B: Although important, these recommendations are probably best discussed near discharge and are not the highest importance. D: Durable medical equipment should generally be evaluated and ordered when goals and expectations are apparent to the OTR® and client.

Which statement BEST describes settings for intervention under IDEA Part C in early intervention services? All interventions must be provided in the school context. All interventions must be provided in the home context. All interventions must be provided in all natural contexts of performance. All interventions must be provided in the private clinic.

Solution: The correct answer is C. As part of IDEA Part C, all interventions must be provided in all of the client's natural environments. A, B: These statements do not reflect the full range of intervention settings under Part C. D: This choice is inappropriate for early intervention services under Part C.

An OTR is working with a client who punched a wall after an argument. The client presents with inflammation and pain in the right fourth and fifth metacarpals. What type of fracture does this client have? Bennett's fracture Colles fracture Boxer's fracture Kienbock's fracture

Solution: The correct answer is C. C: A boxer's fracture is the result of a clenched fist hitting an object with enough force to break the metacarpophalangeal neck, most commonly seen in the fourth and fifth digits. A: Bennett's fracture is an intraarticular fracture of the thumb metacarpal bone. B: Colles fracture is a common distal radial fracture. D: Kienbock's disease is associated with lunate fractures

Which of the following clients is MOST likely to be a person in the middle stage of Alzheimer's disease? A client who sees imaginary images. A client who forgets how to get to a family members home. A client who is confused by simple directions and recall of recent events. A client who becomes extremely excited over mundane events.

Solution: The correct answer is C. Confusion is commonly associated with the middle stage of dementia. A: Hallucinations are not usually associated with dementia. B. A person will develop forgetfulness as a consequence of early stages of dementia. D. Elation is not typically a symptom of dementia.

An OTR® is providing training in cognitive compensation strategies for a client with multiple sclerosis. Which of the following modifications would facilitate cognitive function? Decrease time spent on an activity to conserve cognitive focus. Use an adaptive bath bench to conserve energy during bathing. Perform cognitively demanding tasks in a setting with minimal distractions. Use strategies to cope with changes in daily activities and routines.

Solution: The correct answer is C. Performing cognitively demanding tasks in a setting with minimal distractions is an example of a cognitive compensation strategy. A: Increasing the time spent on activities improves attention and task completion. B: Use of a bath bench is not a cognitive compensation strategy but an adaptive equipment intervention. D: Emotion-focused strategies best address coping skills to decrease the client's stress and are not as beneficial as problem-solving techniques in compensating for cognitive deficits.

Which test assesses a client's ability to visually select features that differentiate objects? Depth perception Contrast sensitivity Selective attention Peripheral field

Solution: The correct answer is C. Selective attention, also called focal attention, enables a client to visually select features that differentiate objects. It is the ability to disregard irrelevant information or stimuli and attend to what is relevant. A, D: These responses pertain to vision or visual-perceptual assessments. B: A contrast sensitivity test assesses the luminance or color that makes an object distinguishable.

An OTR® is working with a client with orthostatic hypotension. The client becomes lightheaded and complains of blurred vision while sitting on the edge of the bed. What action does the OTR need to take if the client remains lightedheaded? Instruct the client to raise both arms simultaneously. Have the client use a reacher to pick up items rather than bend over. Remove the client's thrombolitic stockings immediately. Elevate the client's lower extremities.

Solution: The correct answer is D. If the client remains lightheaded and his or her blood pressure drops more than 20 mm HG systolic and 10 mm HG diastolic, then the client's lower extremities need to be elevated to return blood flow to the head. A, B, C: These actions will not significantly raise the person's blood pressure or provide greater blood flow to the head.

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

Solution: The correct answer is D. Children with sickle cell anemia may experience pain and may need support to manage their pain. A: Children with sickle cell anemia will likely not have joint problems as a result of the condition. B: Children with sickle cell anemia generally have joint range of motion within functional limits. C: Pursed-lip breathing would be more appropriate for an client with respiratory complications.

An OTR® working in an outpatient mental health setting meets with a client with depression 3 weeks after the client's discharge from the hospital. The client expresses concern about phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI) the client has been prescribed, saying that the drug's negative side effects deplete the client's ability to function. The client plans to stop taking the medication. What is the OTR®'s MOST appropriate response? "Discontinue use of the medication until you see your doctor." "Remember the dietary restrictions related to MAOIs." "Side effects are present in all medications. You just have to get used to them." "Let's get your psychiatrist or a nurse on the phone now so you can discuss your concerns."

Solution: The correct answer is D. Psychiatrists are responsible for medication management for clients with mental illness. Therefore, providing the client the opportunity to inquire about the medication directly would be the most appropriate recommendation. If contacting the psychiatrist right at the moment is impossible, leaving a message with contact information for the client would be the next best alternative. A, B, C: These responses do not address the client's concern about side effects of the medication.

An OTR® is working with a child who has a sensory processing disorder. The therapist would like to assess the child's motor planning using a standardized assessment tool. Which tool would be appropriate for the therapist to use? Sensory Integration and Praxis Test (SIPT) Sensory integration clinical observations Sensory Profile BruininksOseretsky Test of Motor Performance (BOT2)

Solution: The correct answer is D. The BOT2 can be used to assess aspects of fine and gross motor functioning that may be difficult as a result of dyspraxia. A, B: The SIPT and sensory integration clinical observations would provide the therapist with information related to the underlying neurological functions that affect sensory integration. C: The Sensory Profile can be used to gain an understanding of how sensory problems influence a child's participation in daily activities.

The Beverly Foundation, a nonprofit group that promotes new ideas and options for older adult transportation, evaluates transportation programs using the Five As of Senior-Friendly Transportation. Which characteristic of a transportation system is categorized in the Acceptability category? Availability of transportation on evenings or weekends Affordability of the cost of travel Accessibility of the vehicles used for travel Cleanliness of the vehicles used for transportation

Solution: The correct answer is D. The Beverly Foundation categorizes cleanliness of vehicles, friendliness of vehicle operators, and safety of transit waiting areas as components of Acceptability. A, B, C: Availability, Affordability, and Accessibility are other categories of the Five As of Senior-Friendly Transportation as outlined by the Beverly Foundation.

A COTA® has been assigned to treat a new patient. The OTR® has evaluated this patient but has not yet written the necessary documentation for review. How should the COTA® proceed? Do not treat the patient and document in the chart that intervention is on hold pending completion of the evaluation. Review the chart to understand the patient's condition and ask the patient what needs to be addressed as part of treatment. Cotreat with the physical therapist to gain information on reason for admission and special issues, and document accordingly. Discuss with the OTR® reason for admission, precautions, and goals, and proceed, documenting the supervisory visit.

Solution: The correct answer is D. The COTA® may not proceed with intervention implementation until the COTA® has a conversation with the OTR® to learn more about the patient. To choose appropriate therapeutic activities and interventions and modify them as needed, the COTA® must be knowledgeable about the client's goals. In the documentation, the COTA® should describe the discussion with the evaluating OTR® that occurred before treatment. A: Skipping the treatment session could affect billing or reimbursement for the site and is unfair to the patient, who is expecting treatment. B, C: The COTA® must have specific supervision from the evaluating OTR® before proceeding with treatment.

An OTR® wants to design a work performance program based on AOTA's Occupational Therapy Practice Framework: Domain and Process (4th ed.). According to the OTPF-4, what would the therapist NOT include in the program? Interventions including wellness and prevention Consultative services and patient education Restorative interventions and compensatory techniques Client-specific work productivity standards

Solution: The correct answer is D. The occupational therapy process involves provision of occupational therapy interventions and approaches to facilitate work performance with the exception of implementation of work productivity standards. A, B, C: Key services include wellness and prevention services, restorative and compensatory intervention consultation, education, and advocacy and case management.

Seating biomechanics take into account the client's stability, postural support, and mobility needs. When determining seating requirements, what would the OTR® FIRST assess? Head and neck Upper extremities Trunk Pelvis

Solution: The correct answer is D. The pelvis and lower extremities need to be stabilized first for overall postural support, followed by the trunk, and then the head, neck, and upper extremities can be addressed for both stability and mobility needs. A, B, C: A solid base of support must first be established with positioning of the pelvis and lower extremities; the trunk and the head, neck, and upper extremities can then be addressed for both stability and mobility needs.

An OTR® is working with a client who has ventricular tachycardia. The client's vital signs include a heart rate greater than 100 beats per minute. What is the appropriate therapeutic response to this client's situation? Allow the client to rest 10 minutes, then begin an occupational task that focuses on upper-extremity movement. Work with the client in a supported sitting position with the client's legs elevated. Instruct the client in adapting performance of grooming and feeding tasks. Defer the client's participation in occupational therapy until later, because the client is medically unstable.

Solution: The correct answer is D. Ventricular tachycardia of more than 100 beats per minute can cause sudden cardiac death. Therapy should be deferred until the client is medically stable. A: A client with stable angina, not ventricular tachycardia, can be safe resuming therapy after a rest period. B: Supported sitting and leg elevation are unlikely to prevent or improve ventricular tachycardia. C: Continuing occupational therapy can be detrimental to this client's medical condition and may trigger a cardiac arrest.

Which option would NOT be considered a clinical indication for an OTR® to conduct a comprehensive functional capacity evaluation (FCE)? To identify work restrictions To confirm, rule out, or discover diagnosis To screen after a job offer To determine a level of motivation to return to work

Solution: The correct answer is D. Referral for FCE is not used to determine the worker's motivation to return to a preinjury job A, B, & C: These responses are all clinical indications for completion of an FCE.

According to Allen's Cognitive Disabilities Model, to what type of group will clients with active acute symptoms of schizophrenia respond best? Free-choice task and activities group Assertiveness training group Psychoeducational group Directive task and activities group

Solution: The correct answer is D. The presence of active acute symptoms indicates limited cognitive processing. Organized task activities with brief, specific directions are likely to render the greatest success. A, B, C: Advanced challenges, such as independent decision making, educational processing, and choosing the appropriate communication methods, are contraindicated in the presence of these symptoms.

An OTR® is working with a client 3 days post open-heart surgery. The OTR® emphasizes to the client to follow all sternal precautions during exercise and activities for 3 months. Which precaution is part of sternal precautions? Scar massage to the sternal scar Wearing of a sternal splint guard when out of bed Breathing out on exertion Avoidance of one-sided lifting or pulling up

Solution: The correct answer is D. The sternum is broken during open-heart surgery, so the client must avoid one-sided lifting over 10 lb, pulling up (body weight), and other movements that would strain the sternum for 6 to 12 weeks. A: Scar massage is not part of sternal precautions. B: A sternal splint guard is not usually recommended to protect the broken sternum. C: Breathing out on exertion is a breathing technique for clients with chronic obstructive pulmonary disease.

A supervising OTR® hires two newly graduated COTA®s who have different learning styles. One prefers visual learning, and the other prefers a more hands-on approach. Which approach is the BEST way for the OTR to supervise both COTAs? Demonstrate the tasks and have both COTAs return the demonstration. Provide written instructions and protocols and discuss them with the COTAs. Have both COTAs role-play clinical scenarios, followed by discussions. Have one COTA perform new tasks while the other observes.

Solution: The correct answer is D. This approach best addresses the different learning styles of each COTA; the COTA who prefers kinesthetic learning can perform the new task, and the visual learner can observe. A, B: These approaches involve more visual learning techniques, which would be tailored only to the COTA who prefers this style of learning. C: This style is more interactive and kinesthetic and may not be as meaningful for the visual learner.

An OTR® is working with an 8-year-old client with muscular dystrophy who expresses the goal of being able to ride a bicycle with friends. Beyond addressing the client's physical capacities to ride a bicycle, what other intervention would be MOST appropriate? Work with the client on environmental awareness and knowledge of rules of the road for bicycle safety Provide strengthening exercises to boost the client's stamina for riding long distances Advise the parents not to encourage cycling because of the client's condition Suggest that the client use pedal clips to maintain good positioning of the feet while cycling

Solution: The correct answer is A. AOTA's (2010) "Statement on Driving and Community Mobility" specifically suggests a role for occupational therapy in addressing overall safety awareness relative to cycling. B: Strengthening exercises are within the realm of physical capacity for cycling, which the question specifically eliminates. C: The case description provides no indication that the OTR® should warn against cycling. D: The suggestion to use pedal clips addresses a physical component of cycling, which the question specifically eliminates.

Which statement BEST describes supplemental transportation programs? Transportation services for older adults and people with disabilities who cannot use existing transportation options Commercial transportation providers who have specialized training in serving older adults Paratransit services funded by taxpayer money that serve specific regions Transportation services staffed by paid drivers who operate a fleet of limousines

Solution: The correct answer is A. The term supplemental transportation program describes a wide array of volunteer, nonprofit, or community-based transportation options serving older adults and people with disabilities who either are unable to use existing transportation services or desire more flexible travel options. B: Commercial providers are not typically considered to be supplemental transportation programs. C: Supplemental transportation programs are not taxpayer funded and are not typically operated by transit systems. D: Although paid drivers may staff a supplemental transportation program, limousines are not the only vehicle option.

An OTR® is reviewing the measurement properties of a new sensory processing assessment. The test manual indicates that when scores from this new measure are compared with scores from another sensory processing test, the correlation coefficient between the two measures is reported as 0.71 (p < .05). What does this finding mean? A low score on one test is significantly related to a high score on the other test. The score on the new test is significantly related to the score on the other test. There is no significant relationship between the two test scores. There is a statistically significant difference between the two test scores.

Solution: The correct answer is B. A correlation coefficient compares the variables of one measure to the variables of another measure. Correlation coefficients that are closer to 1.00 or to +1.00 indicate a strong relationship between the variables. The correlation of .71, as indicated by the p value, suggests a strong positive correlationa high score on one variable is related to a high score on another variable. A: A negative correlation coefficient would suggest relationship between a low score on one test with a high score on another test, and the coefficient of .71 is positive. This suggests a strong positive correlation; a high score on one variable is related to a high score on another variable. C: Correlation coefficients near .00 suggest no relationship exists between two variables. D: Correlation coefficients near .00 suggest that there may be statistically significant differences between the two test scores. A correlation of .71 suggests a positive relationship between test scores.

An OTR® recently completed a functional capacity evaluation (FCE) on a client who is a piano teacher at a school for the performing arts. The client recently sustained an avulsion injury of the index finger on the client's dominant hand at the level of the distal interphalangeal joint, which resulted in the amputation of the distal phalanx on that finger. What would the results for the FCE completed by the OTR® MOST APPROPRIATELY be used to determine? Impairment rating Disability rating Client's fitness for duty Quantifiable physical loss rating

Solution: The correct answer is B. A disability rating considers the worker's impairment and the impact of the impairment on the client's ability to perform preinjury for any job and considers the unique characteristics of the job. (Impairment rating does not take into account the unique factors relating to worker vocation.) In this case, the client's missing joint affects the ability to play the piano, which is one of the primary demands of the client's position. Amputation of the distal phalanx would render the piano teacher disabled from his or her career. A: An impairment rating relates to the percentage of whole-body function and translates to a final monetary settlement for an injured worker. Impairment rating focuses on permanent quantifiable physical loss related to injury when the client is considered to be at the maximum medical endpoint. Because this client just began the therapy program, the client's medical endpoint has yet to be determined. C: Fitness-for-duty tests are completed by occupational medicine physicians after injury. D: Quantifiable physical loss is not a rating used in work rehabilitation.

An OTR® is working with a client with C5 spinal cord injury. What is the BEST splinting strategy to use to encourage sensory feedback? Use of padded splints Use of dorsal splints Use of hand-based splints Use of dynamic splints

Solution: The correct answer is B. A dorsally based splint will allow for maximal sensory feedback while worn. A: Padded splints limit sensory feedback. C: Although hand-based splints may improve sensory feedback, by removing volar obstruction, the client will be more equipped to experience sensory feedback. D: Dynamic splints prescribe a low-load resistance and generally cover a large surface of the hand and arm.

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

Solution: The correct answer is B. A forearm-based wrist orthosis that maintains the wrist in 30° of extension usually allows the client to extend the fingers for object release using the intrinsic hand muscles. It is also less conspicuous and less costly than a dynamic orthosis. A: A radial thumb spica does not offer full wrist support to prevent overstretch of the forearm extensors. C: An anticlaw orthosis is not appropriate for radial nerve palsy. This orthosis would be used in ulnar nerve palsy to prevent MCP hyperextension. D: Hand-based thumb spica splinting does not support the wrist in a functional position that facilitates extension through the lumbricals.

An OTR® is ordering a wheelchair for a client with bilateral transfemoral amputations. The client does not have prostheses and has no intention of using prosthetic limbs in the future. Based on this information, which design feature would be MOST BENEFICIAL to include as part of the wheelchair prescription? Backrest with vertical zipper Anti-tipping attachments 5-inch (8-cm) diameter pneumatic front casters Adjustable cushioned arm rests

Solution: The correct answer is B. Antitippers reduce the likelihood of tipping the chair backward during weight shifting, and because the client no longer has support through the lower extremities by resting the foot on the floor, balance when repositioning must be considered. A, C, D: None of these design features would be beneficial in improving the support for the client while weight shifting in the wheelchair.

An OTR® is working with a client with a visual impairment who wishes to use public transportation buses. Which accessibility issue should the OTR® advocate for on behalf of this client? Use of a bus that lowers to the ground for boarding Announcement by the driver of the names of stops along the route Reserved seats near the front of the bus for clients with disabilities Discount vouchers for the client

Solution: The correct answer is B. Clients with a visual impairment rely on auditory cues for orientation. Announcing stops orients them to their relative position along the route and to arrival at their destination. A, C, D: A bus that lowers to the ground for entry, reserved seats for passengers with disabilities, and discount vouchers are not primary considerations for a client with a visual impairment, although they do improve accessibility for clients with other concerns.

An OTR® 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 OTR's goal for therapy be with this client? Perform aggressive scar management to eliminate adhesions. Control excessive edema and inflammation. Ensure that no bleeding of the wound is occurring. Educate the client to move the involved limb as little as possible.

Solution: The correct answer is B. During the inflammatory stage of healing, it is normal for a client to experience edema and inflammation; however, the OTR should strive to control excessive edema and inflammation. A: Aggressive scar management is indicated for the later stages of wound healing C: Blood vessels constrict in the inflammatory stage of healing; some blood in the wound is normal and expected. D: The client should begin some type of range of motion program to maintain joint integrity and control excessive edema during the inflammatory stage.

According to the Occupational Therapy Practice Framework, which of the following elements is part of the domain of occupational therapy? Occupational profile Habits, routines Intervention plan Outcomes

Solution: The correct answer is B. Habits and routines fall under the domain of occupational therapy. A: The occupational profile is part of the process of occupational therapy, not the domain. C: An intervention plan is part of the process of occupational therapy. D: Outcomes are part of the process of occupational therapy.

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 neurobehavioral deficit is the patient exhibiting during grooming tasks? Constructional disorder Ideational apraxia Stereopsis Visual agnosia

Solution: The correct answer is B. Ideational apraxia involves a patient using an object improperly or using the wrong tool with the action that is required, such as putting toothpaste on the washcloth or brushing the hair with a toothbrush. A: Constructional disorder occurs when a patient has a deficit in organizing and assembling parts into a whole. C: Stereopsis occurs when a patient is unable to perceive depth in relation to self or other objects. D: Visual agnosia occurs when a patient cannot verbally identify objects from visual input.

Which element of the occupational therapy assessment is essential for a middle school student with oppositional defiant disorder? Cooking evaluation Interview with a parent or caretaker Handwriting assessment Eyehand coordination screening

Solution: The correct answer is B. Intervention with adolescents with oppositional defiant disorder must include the family. A, C, D: Typically, clients with oppositional defiant disorder do not have impairments in the ability to cook or write or coordination deficits.

An inpatient sustained a TBI 1 month ago. The patient currently has good motor function but continues to have moderate deficits in organization, planning, memory, and safety awareness. One of the intervention goals is for the patient to independently prepare a meal. Which food preparation option would be BEST to use as part of an initial kitchen task for progressing toward this goal? Soup and a cold sandwich Juice and cold cereal Slice-and-bake cookies Macaroni and cheese

Solution: The correct answer is B. Juice and cold cereal would require the patient to complete a multistep project that addresses organization and planning while providing for minimal safety concerns, allowing the practitioner to observe patient's safety needs. A, C, D. All tasks in these answers require the use of a stove or oven, which may be too great of a safety risk at this time; until the practitioner has more observation of the patient's safety, these tasks are not the best initial kitchen task.

An OTR® receives a referral for a child who has difficulty with balance and coordination. The OTR® wants to determine whether the child has difficulty with visual-receptive functions. Which assessment method would be appropriate to use for this purpose? Administration of the Developmental Test of Visual Motor Integration Observation of how the child's eyes work together Interview with the teacher to determine whether the child has difficulty with spelling Administration of the Bruininks Oseretsky Test of Motor Proficiency

Solution: The correct answer is B. Observing how a child's eyes work together would provide insight into visualreceptive functions. A, C, D: These methods are ways to assess the child's visualcognitive functions.

A client with reduced visual acuity uses a magnifier to read consent forms but reports that the magnifier is not strong enough. Which response by the OTR® is BEST? Provide the client with a stronger magnifier and determine whether the magnifier is appropriate Refer the client to an appropriate eye care physician to prescribe an updated magnifier Encourage the client to stop using the magnifier until an appropriate magnifier is provided Refer the client to an OTR who specializes in low vision practice to issue a updated magnifier

Solution: The correct answer is B. Optical devices are prescribed by an optometrist or ophthalmologist. A, C, D: The magnifier is an optical device and must be prescribed or changed by an optometrist or ophthalmologist.

A client with Parkinson's disease is experiencing difficulty in executive functioning. The client's spouse would like the client to continue participating in leisure activities. Which intervention would be the MOST appropriate for this client? Recommend environmental modifications. Recommend that the spouse use simple verbal instructions. Provide a facial exercise program. Provide communication aid training.

Solution: The correct answer is B. Providing simple instructions best addresses the client's difficulty in executive functioning. A, C, D: These do not address executive functioning.

An OTR® is working in the burn unit of a hospital. A client has undergone skin grafting to close wounds on the dorsum of the hand. What occupational therapy treatment is MOST appropriate for the 5 to 7 days post skin graft? Instruct client in AROM of the wrist and hand but limit PROM until the staples are removed Fabricate and fit the client with a safe position splint over the dressings Involve the use of the grafted hand in ADLs Perform PROM to the wrist and hand but instruct the client to limit use of the hand outside of occupational therapy treatment

Solution: The correct answer is B. Splinting the hand in the safe position allows the graft to take and the wound to heal and prevents deformities. A, C, D: Once the skin has been grafted, the wrist and hand should be protected for 5 to 7 days until the staples are removed. No AROM, PROM, or functional use of the hand should occur during this time.

A client who is currently receiving occupational therapy services has become unemployed and lost access to health care insurance. The treating OTR®; has received permission to provide pro bono services to ensure that the client continues on the path to recovery. What ethical principle likely informed the OTR's decision in this situation? Veracity Justice Fidelity Autonomy

Solution: The correct answer is B. The principle of Justice refers to the fair, equitable, and appropriate treatment of persons and access to occupational engagement for clients. The client lost access to occupational therapy services as a result of the structure of health care insurance and its link to employment, so the occupational therapist made a decision to facilitate the client's access to a needed resource. A: Veracity relates to the provision of accurate and objective information in representing the work of the profession. C: Fidelity relates to an OTR's treatment of clients and other professionals with respect, discretion, and integrity. D: Autonomy relates to a client's right to to make care decisions based on his or her choices and values.

How does the Occupational Therapy Practice Framework: Domain and Process (4th ed.; AOTA, 2020) define community mobility? As a variety of ways to move about the world and the fit between these means and the client's abilities As moving around in the community using public or private transportation, such as driving, walking, bicycling, oraccessing and riding in buses, taxi cabs, ride shares, or other transportation systems As selecting, testing, or adopting with the client and the client's family or support system the most appropriate transportation options As opportunities for occupational therapists to be involved in broader dialogue with transportation providers, health and human service agencies, and policymakers

Solution: The correct answer is B. This definition is the exact one provided in the Framework. A, C, D: These options are implications of the definition, but not the definition itself.

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? CMC plaster of Paris cast CMC fiberglass cast CMC neoprene wrap support Thicker CMC thermoplastic splint

Solution: The correct answer is C. A neoprene strap provides less support but allows some movement. A, B, D: A plaster of Paris or fiberglass cast or thicker splint will limit movement more than the original splint.

According to the Standards of Practice for Occupational Therapy, which task can the COTA® complete in the evaluation process? Respond to the initial referral request. Interpret and document the evaluation results. Perform delegated assessments using current tools. Make recommendations to other professionals.

Solution: The correct answer is C. COTAs are able to perform assessments delegated by the OTR. A, B, D: These tasks fall within the role of the OTR.

At what stage of Alzheimer's disease (AD) will procedural memory impairments FIRST be noticed? Mild cognitive impairment Early stage Middle stage Late stage

Solution: The correct answer is C. During the middle stage, all memory worsens, including procedural memory. A, B, D: Procedural memory will be intact during the mild cognitive impairment prodromal stage and early-stage AD. During the late stage, all memory is lost.

An OTR® is evaluating a 4-year-old child with autism. At the gym, the child appeared very guarded with movement and does not want to climb the stairs, try the swing, or use the mini seesaw. When the OTR® encourages the child to jump on the trampoline, the child runs to the mother and cries. What is the MOST likely reason for these behaviors? Tactile defensiveness Vestibular bilateral integration problems Gravitational insecurity Dyspraxia

Solution: The correct answer is C. Overresponsiveness to vestibular sensations and avoidance of movements that require changes in position are typical indicators of gravitational insecurity. A, B, D: These choices have no basis in the information provided.

An OTR® in a school system is evaluating a 7-year-old child with behavioral and depressive symptoms. Which tool can the OTR® BEST use to establish an occupational profile for this client? Social Skills Rating Scale Occupational Therapy Psychosocial Assessment of Learning Canadian Occupational Performance Measure Test of Playfulness

Solution: The correct answer is C. The Canadian Occupational Performance Measure is a structured interview used to develop a client's occupational profile. A, B, D: These tools assess psychosocial functioning and social participation skills in various contexts and domains.

An OTR® is working with a client with Alzheimer's disease (AD) in a skilled nursing facility. The client's adult child, who is the client's primary caregiver, appears to be stressed and fatigued and has asked the OTR for advice about how to best manage the parent's progressive decline in function. What would be the BEST approach the OTR could use? Refer the caregiver to a physician for treatment. Refer the caregiver to the social worker for community resources. Provide the caregiver with education about the progression of AD. Suggest that the caregiver use the massage services at the facility.

Solution: The correct answer is C. The most appropriate approach for an OTR® when dealing with caregivers of clients with AD is to provide education about the progression of AD along with strategies to improve the caregiver's self-efficacy in caring for the client. Approaches that integrate dementia education, behavior management strategies, communication skills, environmental modification, stress management, anger management, and coping skills have been shown to be effective. A, B, D: Although suggesting services to the caregiver of a client with AD might be appropriate, the most effective approach that falls within the scope of practice of occupational therapy would be caregiver education.

An OTR® is designing treatment sessions for a client with Type I complex regional pain syndrome (CRPS). Which occupational therapy treatment activities for the affected upper extremity would be MOST appropriate for this client? Instruction in PROM and application of joint mobilization techniques Use of cold packs followed by application of ultrasound Instruction in a stress loading program and incorporation of use of the upper extremity in functional activities Serial casting

Solution: The correct answer is C. The most recognized treatment of complex regional pain syndrome is a stress loading program and use of the upper extremity in functional activities that promote occupational engagement. A: PROM increases pain and swelling and is often contraindicated. B: People with CRPS are often cold intolerant. D: Serial casting does not increase active ROM and may add to joint stiffness.

Which option can be viewed as a critical comprehensive priority for an OTR® who seeks to optimize community mobility for a client? Stay abreast of legislation and policy that influence independence in societal participation, community mobility and alternative transportation options. Attend continuing education seminars, and conferences on transportation to ensure up to date knowledge of community mobility practices. Include community mobility in the initial evaluation and intervention planning; and include actual or simulated practice in using community mobility options. Consult with the driver rehabilitation specialist, transportation providers, and volunteer driver organizations on a regular basis.

Solution: The correct answer is C. This option contains the top two priorities to guide OTR®s in addressing community mobility. A: Having knowledge of legislation and policy will not necessarily optimize the community mobility of a client. B: Obtaining knowledge from conferences is important for professional development but will not, unless it is put into practice, optimize community mobility for a client. D: Consultation with stakeholders is a needed strategy to understand how they operate, but application of that knowledge is necessary to optimize the community mobility of a client.

What assistive technology would be appropriate to recommend to a client who has middle-stage dementia or the client's caregivers? Medication dispensers Medication reminder boxes Door alarms Electric hospital bed

Solution: The correct answer is C. When used in middle-stage dementia, door alarms can be useful in improving safety of the client with dementia and reducing caregiver burden. A, B: Medication dispensers and reminder boxes would be most appropriate in early-stage dementia. D: An electric hospital bed would be most useful during late-stage dementia.

A client presents with decreased memory resulting from dementia. What is the MOST EFFECTIVE strategy for an OTR® to implement to intervene with this cognitive impairment? Chunking or grouping similar items together Repeating information over and over again to oneself Rhymes to recall information Cue cards or signs in key places

Solution: The correct answer is D. Adaptations, as opposed to targeted interventions, are the most effective strategy for decreased memory in clients with dementia. A, B, C: Chunking, repeating information, and rhymes are effective strategies for clients whose memory loss is not progressive in nature.

An OTR® is running a group in an innovative preventive program for parolees. The goal of the program is to assist parolees with establishing or restoring occupational balance and productive occupations. The current group has been meeting regularly for 6 months. The members have good insight, and they understand the goals of the program. What leadership style should the OTR use in this setting? Directive Facilitative Cooperative Advisory

Solution: The correct answer is D. An advisory style would be most appropriate because the group knows its goals and has been established for a while. The OTR can help the group by providing additional knowledge and resources for further action. A: Given this group's characteristics, the directive leadership style would not be appropriate. A directive style is best with clients who have low cognition, low motivation, and low insight. B, C: Given this group's characteristics, the facilitative and cooperative leadership styles would not be appropriate. These leadership styles are best with groups that are in development and with clients with moderate motivation and cognition.

An OTR® is evaluating a client who is functioning at Level 1 of autism spectrum disorder without intellectual impairment (Asperger syndrome). What factor would be MOST likely to limit the client's occupational performance? Memory limitations Poor speech intelligibility Low intellectual ability Habitual behaviors

Solution: The correct answer is D. Autism spectrum disorder is characterized primarily by social interaction problems and habitual behaviors. A, B, C: Most people who fall on the upper end of the autism spectrum (formerly known as Asperger syndrome) have typical or average-range memory, speech, and intellect.

A client is being evaluated for a new wheelchair cushion because a Stage I pressure ulcer developed on the skin over the right ischial tuberosity. The OTR® is using pressure mapping to determine which cushion best redistributes pressure for the client and determines that one type of cushion best redistributes the pressure. However, the client refuses it because it feels unstable. Which cushion type would MOST likely elicit this response? Foam Foam molded Hybrid foam and gel Air filled

Solution: The correct answer is D. Clients often report they feel unstable sitting on an air-filled cushion because the air in the cushion shifts with the client's movements. A, B, C: Foam, foam-molded, and hybrid foam and gel cushions offer more stability; however, they may not redistribute pressure as well as an air-filled cushion.

An OTR® is interviewing a new client who physically presents with a "barrel chest." This appearance is most often associated with what condition? Cystic fibrosis Asthma Collapsed lung Emphysema

Solution: The correct answer is D. Clients with emphysema have hyperinflated lungs, which partially expand the ribcage. A, B, C: Cystic fibrosis, asthma, and collapsed lung affect breathing but do not expand the chest.

An OTR® is working with a 56-year-old client who has recently undergone a bilateral hip replacement. What musculature is the MOST IMPORTANT to focus on in the client's strength training? Shoulder girdle Elbow flexors and extensors Plantar and dorsiflexors Gluteal muscles

Solution: The correct answer is D. Emphasis in rehabilitation should be on maintaining motion and increasing strength of surrounding musculature. Gluteal muscles are inclusive of this group. A: Although the shoulder girdle is important for transfers, the emphasis should be on surrounding musculature. B: Elbow flexors and extensors are important in transfers, but primary emphasis should be placed on musculature surrounding the hip. C: Very little strengthening of the plantar and dorsiflexors will occur during this phase of rehabilitation because it may encourage nonadherence to hip precautions.

Which form of clinical reasoning leads to an understanding of clients as people, is collaborative, and demonstrates the therapist's concern with clients' experiences of their disabilities? Procedural reasoning Conditional reasoning Narrative reasoning Interactive reasoning

Solution: The correct answer is D. Interactive reasoning emphasizes the therapist's effort to understand the client and the client's life experience. A: Procedural reasoning is knowing the "how-to" of the therapeutic process. B: Conditional reasoning involves blending of other forms of reasoning that reflect on interactive and procedural reasoning successes. C: Narrative reasoning guides other forms of reasoning through an understanding of the client's personal narratives.

An OTR® is providing intervention to a client with an anxiety disorder who hyperventilates when faced with difficult work tasks. The OTR suggests that the client use breathing techniques and relaxation breaks during the work day to minimize the client's response to stressful events at work. What frame of reference does this intervention suggest? Cognitive-behavioral Psychodynamic Cognitive disability Behavioral

Solution: The correct answer is D. The behavioral frame of reference relies on the idea that behavior is learned and that it can be unlearned. Introducing relaxation activities and breathing into this client's routine may allow the client to experience more time in a positive state of mind, thus reducing anxiety. A: The cognitive-behavioral frame of reference works on thoughts and reactions related to triggers in the environment. An example of an intervention using this approach is journaling. B: The psychodynamic frame of reference suggests that unresolved childhood events are the reason for dysfunction. A psychodynamic intervention is usually discussion based. C: The cognitive disability frame of reference uses the client's strengths to allow for function. An example of a cognitive disabilities intervention is training caregivers to provide appropriate environmental supports for the client.

An OTR® is providing occupational therapy services to a client in acute care who was diagnosed with a pulmonary embolism. What is the most typical cause of a pulmonary embolism? Deep vein thrombosis Pulmonary hypertension Pulmonary edema Lung cancer

Solution: The correct answer is A. Most pulmonary embolisms are caused by a deep vein thrombosis in a lower extremity. B, C, D: Clients with pulmonary hypertension, pulmonary edema, and lung cancer are not at high risk for pulmonary embolism.

During an intervention session in which a client with unilateral neglect reads single letters across several lines, the OTR® uses a vertical line on the left side of the page to cue the client to read the correct line. Which intervention technique is the OTR using? Patching Attention Anchoring Prisms

Solution: The correct answer is C. Anchoring, a cue on the impaired side to indicate starting position, brings attention back to the neglected side. Vertical anchoring lines are generally used on the left side. A: Patching increases eye movements to the contralateral side, decreasing neglect. B: Attention training increases attention and general alertness to reduce unilateral neglect. D: Prisms shift the visual field toward the intact side, enabling the client to see things on the involved side.

An OTR® is working with a client on manual wheelchair propulsion. The client wants to live at home without assistance and return to all previous functional activities, including working outside the home. During the initial stage, where would be the BEST place for wheelchair propulsion training to take place? Outside of the therapy clinic In the client's home Inside the therapy clinic Out in the community

Solution: The correct answer is C. The initial stage of wheelchair propulsion training should occur inside the therapy clinic because the client can learn how to maneuver the wheelchair on a smooth, uncluttered surface. A: Training outside on various terrains is considered Phase 2 training, which would follow inside training. B: The client's home will have less space for manuvering and will most likely have a floor surface that is more difficult to traverse, such as carpet. Although it is imperative to practice in the home, initial training is best if it is unhampered by furniture and other items. D: Training out in the community is considered the final stage of manual wheelchair propulsion training because it is the most difficult area in which to maneuver.

An OTR® is preparing a forearm splint for a client with a high complete spinal cord injury. What surface of the client's forearm should the base of the splint rest upon? Ulnar Medial Dorsal Volar

Solution: The correct answer is C. The splint should be dorsal, rather than volar to ensure maximal sensory feedback while the forearm is resting on a surface. A: Placing the base of the splint on the ulnar side of the client's arm reduces leverage and decreases maximal sensory ability. B: Placing the base of the splint on the medial side of the client's arm reduces leverage and decreases maximal sensory ability. D: Placing the base of the splint on the volar side of the client's arm largely blocks all sensory feedback.

What is a basic principle of Taylor's Intentional Relationship Model as applied to occupational therapy practice? The therapist defines a successful relationship. It is necessary to keep heart before head. Mindful empathy is required to know your client. Doing issues is central; feeling and relating are peripheral.

Solution: The correct answer is C. This response is Principle 4 of the Intentional Relationship Model. A,B, D: These principles are helpful principles of the therapeutic use of self, but they are not part of the Intentional Relationship Model and are contradictions to its principles.

An OTR® is working with a child with macrodactyly. Which occupation might the child have difficulty with? Eating a sandwich. Talking with a friend on the phone. Ordering at a restaurant. Buttoning shirt buttons

Solution: The correct answer is D. A child with macrodactylyhas overly large digits and may have difficulty with ADLs that require fine motor manipulation. A, B, C: The other options are not relevant to a child with macrodactyly, unless the child were also to have another condition.

An OTR® is working with a child who has sensory integrative dysfunction related to motor planning. According to Ayres Sensory Integration, what type of sensory input would be most supportive in developing this child's motor planning skills? Proprioceptive, visual, and auditory Vestibular, tactile, and olfactory Visual, auditory, and olfactory Tactile, vestibular, and proprioceptive

Solution: The correct answer is D. Children with motor planning problems benefit from vestibular and proprioceptive input. They might also have difficulties with tactile perception. A, B, C: These combinations of sensory input would not be the most effective for a child who has sensory integrative dysfunction related to motor planning, because they do not combine vestibular and proprioceptive input. Auditory and olfactory input are not considered to be among the most salient according to Ayres Sensory Integration.

An OTR® is working with a client with Stage III amyotrophic lateral sclerosis. Which strategy is BEST to help this client maintain the current level of participation in daily activities? Pain management Decubitus ulcer prevention Strengthening activities Caregiver assistance with ADLs

Solution: The correct answer is D. Having the caregiver assist the client with ADLs is the best strategy at ALS Stage III, which is characterized by an increased level of fatigue. A: Pain is not a significant factor until later stages of the disease, particularly Stages V and VI. B: Ulcer prevention is needed in Stages V and VI, when clients are confined to a wheelchair and have limited independence with bed mobility. C: Stage III of the disease is characterized by muscle function loss, and strengthening is no longer beneficial. The focus in Stage III is on active assistive and passive range of motion.

An OTR® is working on life skills training with a client who has Prader-Willi syndrome. Given the nature of Prader-Willi syndrome, which life skills may present more of a problem? Buying a greeting card for a friend and remembering who the intended recipient is. Vacuuming the floor and needing to move light objects to vacuum under them. Going to a movie and sitting through the previews. Preparing a meal and waiting to serve it until lunchtime.

Solution: The correct answer is D. Individuals with Prader-Willi syndrome often present with food-seeking behaviors, which might make waiting to eat until lunchtime difficult. A, B, C: A person with Prader-Willi syndrome may have difficulty with these other functional tasks, but food-seeking behaviors are a hallmark of this condition.

According to the Standards of Practice for Occupational Therapy, what is the role of the COTA® in the screening process? Completing the screening process Initiating the screening process Analyzing and interpreting screening results Providing observations to the OTR®

Solution: The correct answer is D. The COTA® can contribute to the screening process and provide reports of observations to the OTR®. A, B, C: These tasks fall within the role of the OTR® rather than the COTA®

When an OTR® evaluates a client's visual range of view without eye or head movements, what is the OTR® examining? Stereopsis Lateral phoria Visual acuity Visual field

Solution: The correct answer is D. This question presents the textbook definition of visual field. A: Stereopsis pertains to depth perception. B: Lateral phorias refers to the way that the eyes are working together on a horizontal plane. C: Visual acuity pertains to clarity in near and distant vision.

An older adult client with a history of falls and glaucoma is referred to occupational therapy for evaluation and intervention. Which visual impairment should the OTR® expect as a result of the client's glaucoma? Peripheral vision loss Central vision loss Fluctuating vision loss Decreased focusing ability

Solution: The correct answer is A. Glaucoma typically results in peripheral vision loss. B: Central vision loss often occurs in macular degeneration or cataracts. C: Fluctuating vision loss often occurs in diabetic retinopathy. D. Decreased focusing ability is an age-associated vision change that relates to the ability to focus on near objects

An OTR® 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? Putting the computer monitor as low as possible to stretch the neck into flexion while working. Taking frequent breaks during work to move the head. Performing AROM exercises to maintain ROM. Providing a headrest for the work chair to support the head while sitting.

Solution: The correct answer is A. Joint protection principles dictate that clients avoid positions of deformity (neck flexion) and avoid keeping the joint in one position for long periods. B, C, D: These strategies follow principles of joint protection and are thus not contraindicated.

The parent of a 7-year-old child with attention deficit hyperactivity disorder informs the OTR® that the child recently started taking dexmethylphenidate (Focalin). Which side effect of this drug must the OTR watch for? Moodiness and agitation Euphoria Blurred vision Mydriasis and hyperthermia

Solution: The correct answer is A. Of the options, only A is a possible side effect of central nervous system stimulants. B, C, D: These choices are possible side effects of antidepressants.

The Resident Assessment Instrument, part of the Minimum Data Set, is completed in which practice setting as part of Medicare's requirement? Hospice Outpatient Skilled nursing facility Hospital

Solution: The correct answer is C. Completing the instrument is part of the Medicare regulations for skilled nursing facilities. A, B, D: This specific assessment is not completed in the other settings.

An OTR® receives orders to evaluate and treat a client with an incomplete L1 spinal cord injury. Using a top-down approach, what is the BEST way to begin the evaluation? Goniometric testing A manual muscle test A Mini-Mental State Examination An occupational profile

Solution: The correct answer is D. A top-down approach recommends that the OTR® first obtain an occupational history and determine the client's goals. A, B, C: Although these measures may be appropriate later in the evaluation, the top-down approach recommends beginning with an occupational profile

An OTR® is working with a child with hemiplegia on the playground. On the basis of this condition, with which playground activity might the child have difficulty? Watching classmates play kickball. Inviting a friend to play on the swings. Lining up to go in from recess. Playing catch with a ball.

Solution: The correct answer is D. Hemiplegia is often associated with cerebral palsy and affects a person's upper and lower extremities on one side of the body. Bilateral activities, such as catching a ball, may be affected. A, B, C: Difficulty with these tasks is not directly related to hemiplegia.

An OTR® is working with a client who complains of too much heat during an ultrasound treatment to the elbow. Which option is MOST likely to decrease the client's discomfort? Use less ultrasound gel Continue the ultrasound treatment for 5 more minutes Move the ultrasound head more slowly Decrease the intensity of the ultrasound

Solution: The correct answer is D. The greater the intensity of the ultrasound, the greater the elevation in tissue temperature. A, B, C: Using less gel, continuing the treatment, or moving the ultrasound more slowly will result in more heat being generated to the client's elbow.

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? Age 4 Age 5 Age 6 Age 7

Solution: The correct answer is C. The OTR® can expect a typically developing child to master shoe tying at age 6. A, B: A child of age 4 or 5 would not be expected to have mastered shoe tying yet. D: A 7-year-old should be ready for greater challenges.

While an OTR® is working with a client on the grooming task of brushing teeth, the client mentions having to take antibiotics before going to the dentist for any dental work. What condition is MOST likely a part of the client's medical history? Chronic obstructive pulmonary disease Lung cancer Hip replacement Endocarditis

Solution: The correct answer is D. People with a history of endocarditis generally take antibiotics before any dental procedures to prevent an infection from migrating to the heart. A, B: Although people with chronic obstructive pulmonary disease or lung cancer are prone to respiratory infections, they do not need to take antibiotics before dental work. C: People with a hip replacement may be at risk for infection at the operative site, but not from dental work.

In a job demand analysis, what factors are included to accurately assess the overall level of work? Variations in workstation and seat height for different tasks Frequency and distance of overhead reaching and extended reaching Lifting and carrying demands in terms of weight and distance Strength demands, physical demands, and frequency of work tasks

Solution: The correct answer is D. The overall level of work is classified as sedentary, light, medium, heavy, or very heavy by determining the strength and physical demands of the work and frequency of tasks. A, B: These options are part of the job demand analysis but do not provide the overall level of work. C: This option is considered part of the physical demands of the tasks.

A client presents at the occupational therapy clinic with a windswept deformity and needs to be assessed for a new wheelchair and a positioning device. In the documentation required for Medicare, the OTR® uses the term "windswept deformity" and also describes the impairment in body structure as follows: Pelvis rotates posteriorly, increasing trunk flexion Pelvis rotates anteriorly, increasing curvature of the lumbar spine One side of the pelvis is lower than the other Pelvis rotated to one side, resulting in the spine, trunk, and thighs moving to the opposite side

Solution: The correct answer is D. The thighs moving to the opposite side of the rotated pelvis is a classic sign of windswept deformity. A: This describes kyphosis. B: This describes lordosis. C: This describes pelvic obliquity.

An OTR® in an inpatient facility is conducting a cooking activity to teach effective coping skills to a small group of adolescents. A group member becomes frustrated with a teammate and is angry and verbally threatening. What is the BEST response in this situation? "I see that you're becoming upset by your teammate. Let's calm down and breathe for 10 seconds." "You seem to be getting upset by your teammate. Verbally threatening is not a good behavior to show others." "I need you to stop, pause for a while, and calm down." "You seem really upset right now. Would you want to take a minute to calm down or just go back to your room for now?"

Solution: The correct answer is D. When a potentially dangerous situation commences, such as a threat of assault, the OTR® should offer the adolescent choices for effective coping strategies to deal with emotional outbursts. A, B, C: These options do not offer the client good choices of behaviors and may deter participation.

An OTR® recognizes that a client with an incomplete spinal cord injury will be ready for discharge to home in the next few weeks. What is the BEST method to determine the client's occupational performance? A safety checklist A performance review A caregiver interview A home evaluation

Solution: The correct answer is D. When the discharge location is determined, a home evaluation should be performed to be sure that the therapists, client, and caregivers can perform activities in the home and ensure safe and equitable discharge. A: A home safety checklist is an educational tool and does not assess occupational performance. B: A performance review would be completed prior to the determination of discharge. C: A caregiver interview would be completed prior to determination of discharge and would not directly address the client's occupational performance.

An OTR® is observing a client's driving performance in a contained environment; the client is performing tasks and responding to demands involving car controls and car handling or maneuvers. Which testing approach is the OTR® using? Closed route Simulator testing Instrumented vehicle Naturalistic driving

Solution: The correct answer is A. A closed route is a contained environment that allows a client to perform tasks and respond to car handling or maneuvers. B: Simulator testing occurs in a driving simulator; the question states that the client is in a car. C: An instrumented vehicle has cameras and sensors to objectively measure the person's vehicle input and output responses. D: Naturalistic driving occurs in any environment in which the client chooses to drive and includes instrumentation such as video cameras or GPS sensors.

Back pain injury reports from workers at a bicycle manufacturing company have increased. Management is seeking an OTR®'s recommendations for redesigning the work environment using engineering controls, particularly to reduce awkward postures and repetitions on the assembly line. Which recommendation is the BEST engineering control to redesign the work environment for this organization? Place bicycles on a wheeled platform for movement along the assembly line. Slow the speed of the assembly line so workers have more time. Implement stretch breaks every 45 minutes to improve posture. Enforce a work safety policy that requires workers to wear a back support.

Solution: The correct answer is A. A wheeled platform will decrease the frequency of lifting, bending, twisting, and squatting. B: Management will not view positively a recommendation to slow the work process, because it will decrease productivity. C: Engineering controls include workstation modifications, changed work methods, or tool modifications; stretch breaks are not engineering controls. D: Policies and procedures are work practice controls aimed at improving the safe performance of work tasks and are not engineering controls.

An OTR® is working in the school system with a child who has a behavioral disability. The OTR® wants to improve the child's classroom environment to promote more opportunities for success. Which rational intervention (RI) approach would the OTR® use? Facilitation Monitoring Gentle correction Reprimand

Solution: The correct answer is A. According to RI, facilitation is characterized by observing the child and responding to the child's needs by improving the child's environmental supports. B: Monitoring is characterized by visibly observing the child, encouraging the child to engage in appropriate behaviors, and asking the child guiding questions. C: Gentle correction is characterized by altering the environment as needed, reminding the child of the rules, and redirecting the child. D: Reprimand is not a component of RI.

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

Solution: The correct answer is A. For lower-body dressing, the client should be seated on the side of the bed or in a chair with arms. Assistive devices, such as a reacher or dressing stick, may be necessary to maintain hip precautions. B: A low chair may be difficult for the client to stand up from and does not follow hip precautions. C: Sitting with the feet on a stool does not follow hip precautions. D: Water can be a hazard when sitting on a tub bench for lower body dressing.

An OTR® assigned to the stroke unit of an acute care hospital is prioritizing goals and treatment for a patient with a hemiplegic hand. Based on the expected pattern of progression in the acute phase after a stroke, which areas of focus should the OTR consider to enable the patient to overcome barriers to ADL performance? Passive range of motion and positioning of the affected upper extremity, bed mobility Visual and cognition issues, upper-extremity orthotic needs Transfers, therapeutic exercise for upper-extremity strengthening Community mobility, fine motor coordination

Solution: The correct answer is A. In the acute stage of recovery, passive range of motion, positioning of the affected extremity, and bed mobility are critical components in restoring function for ADL performance. B, C, D: Although visual and cognition issues, upper-extremity orthosis needs, transfers, therapeutic exercise for upper-extremity strengthening, community mobility, and fine motor coordination all are areas of concern, in an acute care setting, passive range of motion, positioning of the affected extremity, and bed mobility are areas of focus critical to overcoming barriers to self-care

An OTR®; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The OTR writes the following goal for one group member using the COAST method: "The client will cook a meal before being discharged." How should the timeline (or T) part of this goal be modified to be made MORE measurable? It should specifically reference the anticipated discharge date. It should list the number of weeks in which the goal should be accomplished. It should list the number of sessions that are sufficient to address the goal. It does not need to be modified.

Solution: The correct answer is A. It is appropriate to have a long-term goal reference discharge for the timeline; however, the specific discharge date needs to be included. B, C: The number of weeks or number of treatment sessions does not need to be specified for a discharge-related goal as long as the discharge date is specified. D: The timeline portion of the goal is not specific enough as written.

An OTR® is working with a client who suddenly complains of pressure and tightness in the chest. The client's symptoms resolve with rest and a nitroglycerin tablet administered under the tongue. What condition is the client MOST likely to have experienced during the treatment session? Stable angina Unstable angina Myocardial infarction Atrial flutter

Solution: The correct answer is A. Stable angina usually resolves with rest, nitroglycerin, or both. B: Unstable angina does not resolve with rest or nitroglycerin. It requires emergency treatment. C: Myocardial infarction also requires emergency treatment. D: Atrial flutter is usually treated with other medications, ablation, or cardioversion.

An OTR® is providing home health intervention for a client who recently had bilateral transradial amputations. The client is now learning to use newly acquired prostheses that have voluntary-opening terminal devices. The client's goal is to resume former home maintenance roles. Using the Ecology of Human Performance model, what should be the PRIMARY focus of the intervention? Modification of the environment, tools, and tasks for completion of daily activities Engagement in graded desensitization activities for the residual limbs Instruction about anxiety management techniques to control posttraumatic stress Provision of strengthening and endurance activities specific to activity demands

Solution: The correct answer is A. The Ecology of Human Performance model aims to focus on the interaction of the person, task, and context; therefore, interventions that modify any of these three falls within this model. B: Desensitization activities are a focus of the sensorimotor frame of reference. C: Instruction in stress-reducing techniques are a focus of the rehabilitation frame of reference. D: Strength and endurance activities are a focus of the biomechanical frame of reference.

An OTR® plans to use ecological assessments to evaluate the strengths and weaknesses of a 4-year-old child with autism. Which assessment is a good example of an occupational therapy ecological assessment? Knox Preschool Play Scale Bruininks-Oseretsky Test of Motor Proficiency School Function Assessment Beery-Buktenica Development Test of Visual-Motor Integratio

Solution: The correct answer is A. The Knox Preschool Play Scale is an assessment of play skills that can be used in various performance contexts. B, D: The Bruininks-Oseretsky Test of Motor Proficiency and the Beery-Buktenica Development Test of Visual-Motor Integration are not ecological assessments. C: The School Function Assessment is an ecological assessment for children aged 5-12 years.

An OTR® is using a goniometer to measure active shoulder flexion of a client who is in a seated position. At the start position, where on the client should the axis of the goniometer be placed? Lateral aspect of the glenohumeral joint, just distal to the acromion process Posterior aspect of the glenohumeral joint, slightly inferior to the acromion process Lateral aspect of the humerus, slightly superior to the acromion process Posterior and slightly inferior to the acromioclavicular joint

Solution: The correct answer is A. The axis is placed at the lateral aspect of the glenohumeral joint about 1 inch below the acromion process at the start of the motion. B, C: Placing the axis posterior to the glenohumeral joint or superior to the acromion process is not at the point of motion for shoulder flexion and will result in an inaccurate reading of active shoulder flexion. D: Placing the axis below the acromioclavicular joint will be internal of the acromion process resulting in an inaccurate reading of active shoulder flexion.

Of what is the place-and-train approach an example? Supported employment Transitional employment Job matching The clubhouse model

Solution: The correct answer is A. The place-and-train approach first places the client in a supported employment situation and then trains the client to do the job. B, C, D: These are examples of work participation settings in which OTR®s work, but these settings do not use the place-and-train model.

An OTR® in an outpatient clinic evaluates a client with bilateral primary adhesive capsulitis who is experiencing interrupted sleep patterns and decreased ability to perform ADLs because of pain. Range of motion (ROM) is close to functional but painful throughout the arc. What is the PRIMARY functional focus of occupational therapy intervention? ADL modifications and adaptive equipment education for grooming, bathing, and dressing Electrotherapeutic modalities followed by stretching exercises to facilitate increased ROM Rest, ice, elevation, and compression (RICE) to facilitate functional return Intra-articular corticosteroid injections to allow for better tolerance to stretch

Solution: The correct answer is A. The primary role of OTR includes education regarding modifications and meaningful adaptive equipment choices to facilitate ADL performance. B, C: No evidence at this time supports the efficacy of therapeutic modalities or RICE in enhancing recovery from primary adhesive capsulitis. D: OTRs do not provide corticosteroid injections. Although these injections may be indicated by the treating physician to facilitate ROM, this client is in the freezing phase, indicated by the painful arc of motion. Overstretching in this phase may enhance the inflammatory process and increase the process of capsular fibrosis.

A client sustained a cerebral infarct 3 months ago with hemiparesis in the right lower extremity. The client has been discharged from physical and occupational therapy, walks with a quad cane, and is fully functional in the other extremities. The client completed an on-road driving evaluation and did fine with the use of adaptive devices. What device did the certified driver rehabilitation specialist MOST LIKELY prescribe? Left-foot accelerator Spinner knob on the steering wheel Right Veigel accelerator and brake pedal extension Additional mirrors to decrease blind spots

Solution: The correct answer is A. This device will allow the client to continue to drive and to use the left foot to compensate for the right leg hemiparesis. B: The client has no impairment with the right upper extremity and so has no need for a spinner knob. C: The client cannot use the right leg so pedal extenders will provide no benefit. D: The client has no visual field deficits; therefore, additional mirrors are not necessary.

An OTR® is working with a 5-year-old child with autism to develop in-hand manipulation skills. Which activity is BEST to help this child develop shifting? Separating playing cards Crumpling paper Taking two or more coins from a purse Moving a penny from the palm to the fingers

Solution: The correct answer is A. When separating playing cards, a child uses the tripod grasp to practice shifting skills. B, C, D: These options are activities to improve translation skills.

An OTR® is instructing a client diagnosed with rheumatoid arthritis on the use of energy conservation techniques. During treatment, the client informs the therapist of tingling in the right thumb and index and middle fingers and of night pain in that area of the hand that often keeps the client awake. The client works as a tailor. On the basis of these symptoms, what might the OTR® suspect is causing the client's disorder? Cumulative trauma Orthopedic impairment Autoimmune symptoms Neurological complications

Solution: The correct answer is A. Work-related musculoskeletal disorders are a class of soft-tissue injuries affecting the muscles, tendons, and nerves. They are typically characterized by a slow and insidious onset and are thought to be the result of microtrauma. These disorders account for one-third of all occupational injuries and illnesses in the United States. B, C, D: The responses are not examples of musculoskeletal injuries.

A client with a C6 spinal cord injury (SCI) is performing a dressing task. Which type of equipment would the OTR® most likely give the client to assist with buttoning a shirt? No adaptive equipment would be needed Palmar-cuff buttonhook Extended buttonhook Standard buttonhook

Solution: The correct answer is B. A client with a C6 SCI may not be able to grasp a buttonhook with the fingers, so a palmar cuff would provide the needed grasp. A: Although the client may be able to perform a slight grip through extending the wrist (tenodesis), they would not be able to sustain grip for functional activity C, D: The client's grasp would be too weak or insufficient to hold a standard buttonhook or an extended buttonhook.

An OTR® in home health care is seeing a client who has Stage III Alzheimer's disease. The client lives with an adult daughter and likes to wander around the house and has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no step at the front entrance. The client's daughter is determined to have the client remain at home with her as long as possible. To provide a defined, safe environment for the client to wander in the house, what will the OTR® MOST likely recommend? A deadbolt at the front door A side bolt high on the front door A gated area in the living room, using child safety gates A walk with the client several times a day

Solution: The correct answer is B. A side bolt that is not within reach of the client is one strategy to prevent the client from opening the front door and wandering away from the house without the daughter's awareness. A: A deadbolt should not be used in case the client locks the daughter out when she steps out of the house. C: A gated area can be too confining for the client and increase the risk of a fall if the client attempts to climb out of it. D: Taking a client for a walk several times a day may or may not decrease wandering behavior. If the client is overexhausted from the walks, the risk of a fall when wandering in the house may increase.

An OTR® is working in an outpatient clinic with a child with ADHD. The client reports having difficulty keeping the bedroom neat and tidy without the mother's assistance. On the basis of this condition, which activity demand related to cleaning one's room would be problematic for the client? The mother's expectation that food not be eaten in bedrooms Drawers that are not designated for specific types of clothing A small wastepaper basket Lack of space under the client's bed

Solution: The correct answer is B. According to AOTA (2008, pp. 634), "Activity demands include the specific objects and their properties used in the activity, the physical space requirements of the activity, the social demands, sequence and timing, the required actions or skills needed to perform the activity, and the required body functions and structures used during the performance of the activity." The lack of designated drawers for different types of clothing may prevent the client from keeping the room neat and tidy. A, C, D: These options would not necessarily pose a problem for a client with ADHD and are not directly related to the activity demands of cleaning one's room.

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? Deep breathing and relaxation exercises Activity modification and proper body mechanics Joint protection and pacing techniques Energy conservation and work simplification techniques

Solution: The correct answer is B. Activity modification and proper body mechanics are essential for long-term control of an inflammatory cumulative trauma disorder. A: Deep breathing and relaxation exercises assist in reducing anxiety but will not prevent cumulative trauma disorder symptoms. C: Joint protection and pacing techniques best address symptoms of arthritis. D: Energy conservation and work simplification techniques are recommended for clients with respiratory and cardiac diagnoses.

An OTR® 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 50-year-old client with hypertension and a finger amputation A 77-year-old client with a foot ulcer, diabetes, and shingles A 21-year-old client with a radial fracture and a dog bite An 18-year-old client with a flexor tendon and median nerve injury

Solution: The correct answer is B. Age, diabetes, and a compromised immune system (indicated by shingles) are all factors that delay the wound healing process. A, C, D: These clients are younger and do not have systemic diseases that would interfere with the wound healing process.

What has the AOTA Ethics Commission recommended that occupational therapy authors do to avoid plagiarism in the electronic age? Cite only sources that are no more than 10 years old Use electronic tools to check content for possible plagiarism Provide source citations for all statements in written and oral content Provide source citations for the work of other authors in written documents but not in oral presentations

Solution: The correct answer is B. Because it is challenging to ensure that authors have appropriately cited all sources, use of electronic tools is recommended to ensure that papers and presentations are not plagiarized. A: It is not unethical to use sources more than 10 years old; appropriate source citation helps authors avoid plagiarism. C: It is impractical and unnecessary to provide citations for all statements in a paper or presentation. Knowing and following guidelines for avoiding plagiarism is the solution. D: Source citations are needed whenever an author makes use of someone else's work, whether in written or oral format.

An OTR® is working with a driver poststroke who has poor ocular motor skills. Which compensatory approach is MOST APPROPRIATE for this client? Awareness training Instruction in visual search patterns and efficient scanning techniques Adapting side mirrors to deflect bright lights from other vehicles Using a voice-activated GPS to compensate for way-finding problems

Solution: The correct answer is B. Deficits in pursuits and saccades may lead to an inability to effectively search, track, and locate objects in the driving environment. A: This strategy is for a client with neglect or a visual attention deficit. C, D: These compensatory strategies are for a client with visual acuity impairments.

A client with early-stage amyotrophic lateral sclerosis (ALS) wants to remain physically active and continue to go to the local gym. Which action would the OTR® take? Advise against exercise, which would exacerbate symptoms and accelerate muscle loss; instead, educate the client on fatigue management. Recommend modified workouts that consist of endurance and light strengthening with education on how to prevent overexertion. Agree that the client would benefit from continued physical exercise at the gym. Suggest instead a home exercise program of light calisthenics and stretching.

Solution: The correct answer is B. In the early stages of ALS, smaller distal muscles are weak, but gross proximal muscles have not yet been affected. ROM exercises, light strengthening, and endurance training are all effective at this point. It is important for the OTR® to advise on precautions such as avoiding overexertion, stopping if a client experiences muscle cramps or spasms, and monitoring fatigue. Moreover, the client states a goal is to continue frequenting the gym, which likely also offers social benefits. A: A person with early-stage ALS has not seen major impairments to mobility and would therefore reasonably be able to fulfill client-centered goals such as going to a gym. It is inappropriate and inaccurate to advise against exercise at this stage. C: The OTR® omits education on adaptive therapeutic exercise and precautions D: This option does not meet the client's wishes.

An order came in for a hand splint for a new client. A newly graduated OTR® evaluated the client for the splint. The new OTR® had not made a splint on a client before and requested an experienced OTR® hand therapist's assistance. Which ethical principle did the newly graduated OTR® abide by? Veracity Nonmaleficence Social Justice Fidelity

Solution: The correct answer is B. Nonmaleficence relates to avoiding actions that may cause harm. The newly graduated OTR® did not want to inflict harm by making the splint incorrectly. A, C, D: These principles do not relate to avoiding harm.

An 8-year-old client received a new augmentative and alternative communication (AAC) device to be used in the classroom. The client uses a wheelchair and has limited movement proximally at both shoulders and elbows. To develop the client's operational competence, what would the OTR® FIRST determine? Mounting system for the AAC Type of control interface suitable for the child Vocabulary to be included in the AAC Teachers' availability for AAC training

Solution: The correct answer is B. Once the type of AAC device has been determined, the OTR®'s next step is to determine a compatible control interface that matches the child's physical ability to interact with the AAC. A, C, D: Determining the control interface is the first step. Once that has been determined, the sequential steps are to properly mount the AAC and provide vocabulary selection and training to all parties involved, including teachers in the classroom.

An OTR® is providing back-neck training to workers at a food production service as a primary injury prevention program. The OTR® can expect the target population to consist primarily of which type of worker? Workers with mild back or neck pain Workers with no back or neck symptoms Workers, human resource staff, employers, and family members Workers who need medical treatment for back or neck injuries

Solution: The correct answer is B. Primary injury prevention is aimed at workers who have not experienced symptoms of a work-related injury. A: Workers who have risk factors for injury or who have experienced mild symptoms would receive secondary injury prevention. C: Family members are not direct recipients of vocational rehabilitation services. D: Workers who have experienced nonreversible injuries requiring medical intervention would receive tertiary injury prevention.

An OTR® in a home health setting is working with a client in the kitchen and hears a heated argument between the client's spouse and one of the client's children in the next room. The client begins to cry, indicating that the arguing is causing stress. What action would be MOST reasonable for the OTR® to take? Confront the people in the next room Call the medical social worker and report the incident Drive the client to a shelter Try to resolve the conflict

Solution: The correct answer is B. Referral to an expert in dealing with these matters, such as a medical social worker, is the best course of action; direct intervention is outside the OTR®'s scope of practice. A: Confronting a volatile situation might bring harm to the client or to the OTR®. C: Transporting a client in one's own vehicle would expose the therapist to personal liability and risk. Additionally, removing the client from the home may escalate an already volatile situation and may be a risk to both the client and the therapist. D: Attempting to resolve the conflict is outside the OTR®'s scope of practice.

Which model of practice emphasizes cultural safety, decentralizes the self, and emphasizes restoration of the harmony of the person within his or her surrounding contexts? Culture-emergent model Kawa model Counseling psychology model Person-Environment-Occupation model

Solution: The correct answer is B. The Kawa model, developed in Japan, was designed to create a feeling of safety within the Japanese culture. It emphasizes harmony between the person and her or his surroundings. A: The culture-emergent model stresses development of skills for cross-cultural interactions C: Counseling psychology is a specialty in the field of psychology. D: The PEO model is a model of occupational performance that focuses on the interaction between the person, the person's environment, and the person's desired occupations.

Which group activity would be the MOST appropriate to engage clients in an expressive activity using the psychodynamic approach? Baking chocolate chip cookies Constructing a magazine collage Hiking in the woods Attending a dance performance

Solution: The correct answer is B. The psychodynamic approach makes use of projective media such as clay, magazine collages, painting, and poetry. A: Making chocolate chip cookies using a recipe is a structured activity that does not allow for expression of the individual's personality. C: Hiking is not an expressive activity. D: Attending a dance performance as a passive spectator does not allow for self-expression.

A COTA® is providing intervention to a client with an anxiety disorder who hyperventilates when faced with difficult work tasks. The COTA asks the client about the client's success and failures as a child and begins to discuss how these early experiences might be the reason the client is experiencing anxiety at work. The COTA and the client discuss ways to manage these feelings. What frame of reference does this intervention suggest? Cognitive-behavioral Psychodynamic Cognitive disability Behavioral

Solution: The correct answer is B. The psychodynamic frame of reference suggests that unresolved childhood events are the reason for dysfunction. A psychodynamic intervention is usually discussion based. A: The cognitive-behavioral frame of reference works on the thoughts and reactions related to environmental triggers. Through journaling and reflection, the client can identify triggers that cause the anxiety to escalate. C: The cognitive disability frame of reference uses the client's strengths to allow for function. An example of a cognitive disability intervention is training caregivers to provide appropriate environmental supports for the client. D: The behavioral frame of reference relies on the idea that behavior is learned and that it can be unlearned. Using breathing and relaxation techniques during a stressful event can facilitate a change in response.

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? The client should sleep in the most comfortable position that is pain free. The client should sleep in supine position with a wedge or pillow in place. The client should sleep in prone position with a wedge or pillow in place. The client should sleep in side-lying position.

Solution: The correct answer is B. The supine position with a wedge or pillow in place is recommended to keep the legs abducted and prevent rotation. A: This recommendation may unintentionally encourage noncompliance with hip precautions. C: Lying prone creates undue effort to perform bed mobility and transfer and may encourage noncompliance with hip precautions. Additionally, this position with a wedge pillow may cause back pain. D: Side-lying is not recommended during recovery from hip replacement surgery and may encourage noncompliance with hip precautions.

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? Writing the upper- and lowercase letters of the alphabet without a model Copying a triangle, printing own name, and copying most letters Writing the numerals 110 without a model Copying a pentagon and an octagon, printing own address, and drawing a house with 12 details

Solution: The correct answer is B. Typically, children between the ages of 5 and 6 are able to copy a triangle, print their own name, and copy most letters from a model. A, C, D: These options represent more advanced skills that a 6-year-old would not typically be expected to have mastered.

An OTR® is working with a 5-year-old with autism on developing a toileting routine. Which intervention strategy is most appropriate? Teaching energy conservation techniques to incorporate into the routine Using a picture checklist that depicts the routine Encouraging the child to invite a peer to model the routine Incorporating adaptive equipment and orthotics into the routine

Solution: The correct answer is B. Visual supports, such as picture checklists, have been found to be effective intervention strategies for children with autism. A: Children with autism do not typically experience any complications, such as fatigue or shortness of breath, which would suggest the need for energy conservation technique. C: Although it may be appropriate for a child with autism to watch a peer model other routines, watching a child model this routine would compromise his or her privacy. D: Children with autism, unless they have a comorbid condition, do not usually need adaptive equipment or orthotics to complete toileting.

An OTR® is selecting intervention activities for a young adult client with a diagnosis of accommodative infacility. Which activity will be MOST difficult for this client? Watching sports Reading a book Driving a car Watching a play

Solution: The correct answer is C. Accommodation is the ability of the eye to adjust focus at different distances. Accommodative facility is the speed of focus adjustment and ability to maintain focus over time. Driving a car would be most difficult for this client because looking at the speedometer and then at the road requires adjusting focus at different distances (near distance for the speedometer and farther distance for the road). A, D: Watching sports or a play requires visual tracking or smooth pursuits; accommodative facility would not be challenged. B: Reading a book or other materials requires convergence and ability to focus on an object at near distance; accommodative facility would not be challenged.

A resident in a long term care facility has a severe elbow contracture. The OTR® has just finished applying a bivalved splint to provide low load prolonged stress to the affected elbow. What MUST the OTR® do as part of the care plan for maximizing the effectiveness of this splinting intervention? Supplement the splint wear schedule with high brief-load stretches for 12 minutes at least 3 times per day. Advise the resident that the stretch will be uncomfortable but needs to be tolerated for at least several hours at a time. Provide nursing staff with specific instructions for a graded daily splint-wearing schedule. Ensure the evening nursing shift has documented orders to apply the splint just before the resident goes to sleep.

Solution: The correct answer is C. An extremely tight elbow will require a graded splint wear schedule for maximum comfort, and staff education is essential to ensure compliance with a proper wear schedule. A: High brief-load stretches throughout the day do not achieve elongation of tissues over time and are not beneficial in this situation. B: The resident should not be uncomfortable while wearing the splint because the splint should place a slight stress that is tolerable for the resident over a significant amount of time. D: Low-load stress needs to be applied for a duration of 68 hours frequently so applying the splint just before sleep will not be the optimal wear schedule. Initially, the resident will likely only tolerate 34 hours of splint wear, so use during the daytime will be necessary for optimum progress.

An OTR® receives a referral for a 7th grader diagnosed with oppositional defiant disorder. Which condition that often occurs concurrently with oppositional defiant disorder should the OTR® look for? Depression Conduct disorder Attention deficit hyperactivity disorder Schizophrenia

Solution: The correct answer is C. Attention deficit hyperactivity disorder (ADHD) often occurs with oppositional defiant disorder (ODD), so practitioners conducting an assessment with a client with ODD should always look for signs of ADHD. A, D: Depression and schizophrenia are not associated with oppositional defiant disorder. B: Conduct disorder is more severe than oppositional defiant disorder (ODD). Some children start out with an ODD diagnosis, and when the child's conduct worsens, the diagnosis is switched to conduct disorder and the ODD diagnosis is dropped.

A client with morbid obesity and obstructive sleep apnea is collaborating with an OTR® on improved sleep routines and positioning. What sleep position is optimal for this client? Supine position with head of the bed elevated Supine position with only the client's head elevated Side-lying position with head of the bed elevated Side-lying position with only the client's head elevated

Solution: The correct answer is C. Because of the obesity, the client will be able to breathe better in a side-lying position with the entire upper trunk elevated. A, B, D: The supine postion is not preferred because the weight of the body makes breathing more difficult. Elevation of the entire upper body improves breathing more than elevation of the head only.

An OTR® has just instructed a hip replacement client on a proper sit-to-stand technique from the chair. What is the BEST method to record the client's adherence to hip precautions? Ask the client to demonstrate the activity in the clinic. Ask the client to demonstrate the activity in the client's room. Observe the client in the dining room performing the activity. Ask the client's caregiver to demonstrate how they are performing transfers.

Solution: The correct answer is C. By observing the client, a true level of occupational performance can be recorded. A, B: Although these actions may gauge the client's capacity to learn, they do not provide clinically meaningful information regarding the client's ability to follow directions. D: Although the caregiver's perception of the client's transfers may be accurate, observation of the client would be a more accurate reflection of the client's understanding and implementation of the prescribed precautions.

An OTR® receives a referral for a client who is preparing for hip replacement surgery. The client's caregiver attends the session. How would the OTR® BEST incorporate the caregiver into the session? Ask the caregiver to detail his or her schedule and ability to supervise the client upon release. Ask the caregiver to take notes on the session and provide brief feedback when complete. Ask the caregiver to practice adaptive activities alongside the client. Ask the caregiver to read a manual regarding hip replacement surgery.

Solution: The correct answer is C. Caregivers should be encouraged to practice adapted activities so that they fully understand the impact of prescribed hip precautions. A: Asking about the caregiver's availability will not directly incorporate the caregiver into the session. B: Performing writing assignments may prevent the caregiver from learning the active nature of hip precautions. D: Although a manual or handout may be helpful information, it does not facilitate the caregiver's actively participating in and practicing techniques.

An adult client is receiving home health occupational therapy services from an OTR®. At the initial session, an adult child of the client informs the OTR® that the client's spouse passed away 2 months ago. The adult child states that the client has never been so down, that the client has to be encouraged to go to restaurants or movies, and that the client often cries. How should the OTR® respond? Tell the client's adult child that the client is experiencing depression and should seek psychiatric care. Describe the difference between grief and depression to the client's adult child. Further explore with the client's adult child the extent of the client's sadness and negative moods before recommending a course of action. Ask the client's adult child about any potential physical or psychological abuse the client may have experienced in his or her lifetime

Solution: The correct answer is C. Clinical reasoning dictates the need for further information in this scenario. It is unlikely that the OTR® can make an informed decision and plan a course of action until he or she knows the degree to which the client's behaviors constitute a change from typical behavior. A, B, D: These choices indicate that the OTR® has made an assessment or is developing a picture of the client without having collected the appropriate information to do so.

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? Wear the orthosis only at night to maintain the PIP joint in extension when at rest. Remove the orthosis every hour for passive motion exercises. Wear the orthosis continuously up to 6 weeks. Wear the orthosis during the day, but remove it at night.

Solution: The correct answer is C. Continuous use of the PIP joint extension splint allows the central slip to reestablish tissue continuity and prevents further flexion deformity. A, D: PIP joint extension must be maintained full time, not only in the daytime or nighttime, to allow central slip reestablishment. B: Passive motion of the PIP joint is contraindicated during the splinting phase of conservative treatment.

Which statement BEST describes an important consideration for OTR®s working with clients with dementia and their caregivers? Providing a variety of new occupations creates a sense of well-being for the caregiver and care recipient. A brief respite from caregiving benefits the caregiver but is detrimental to the care recipient. Everyday occupation is central to a caregiver's sense of well-being. Psychologically resisting the inevitability of chronic illness improves satisfaction with caregiving.

Solution: The correct answer is C. Embracing everyday occupation has been shown to improve a sense of well-being in the caregiver and offers a suitable context for caregiving. A, B, D: These choices do not support the principle of use of occupations and activities that are meaningful to the client during occupational therapy intervention.

A client with Parkinson's disease complains of difficulty with bed mobility resulting in difficulty changing position during the night. Which environmental modification BEST addresses this client's difficulties with bed mobility? Put pillows on one side of client to position in side lying. Place a nightlight in the bedroom to improve ability to see during bed mobility. Change to lighter bedding to decrease resistance during bed mobility. Move the bed closer to the wall to provide stability during bed mobility.

Solution: The correct answer is C. Environmental modifications for improving bed mobility include using light bedding (e.g., changing from flannel to satin sheets), using a firm mattress, lowering the height of the bed, and using a bed rail for support. A: Positioning a client in side lying will not address the client's ability to complete bed mobility, because doing so only modifies the client's static position. B: Providing illumination will not address the client's physical ability to complete bed mobility. D: Moving the bed closer to the wall is an environmental modification that, in the case of Parkinson's disease, does not support bed mobility.

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? Beery-Buktenica Developmental Test of Visual Motor Integration Print Tool Handwriting Assessment Minnesota Handwriting Test Peabody Developmental Motor Scales

Solution: The correct answer is C. Only the Minnesota Handwriting Test is a standardized, norm-referenced assessment specific to handwriting. A, D: The Beery-Buktenica Developmental Test of Visual Motor Integration and the Peabody Developmental Motor Scales are commonly used as part of a handwriting evaluation but are not specific to handwriting. B: The Print Tool Handwriting Assessment is not standardized or norm referenced.

Which community mobility situation might pose a challenge for a person with an autism spectrum disorder (ASD) who is hypersensitive to auditory stimuli? Waiting alone at a bus stop on a highway with light traffic Scheduling a ride by entering information into the online database of a taxi service provider Waiting on a crowded subway platform at a time of day when multiple trains are running Bicycling to school in a suburban neighborhood

Solution: The correct answer is C. Precin et al. (2012) noted that oversensitivity to sensory stimuli can be problematic for people with ASD and specifically mentioned loud transportation-related noises as difficult for people with auditory sensitivity. A, B, D: These community mobility situations would not present challenges for a person with auditory hypersensitivity.

An OTR® notes that a client with a left stroke makes many errors when reading and is required to stop and reread sentences frequently. The OTR suspects left hemianopia. Which action should the OTR take? Provide task lighting to promote the client's vision Complete acuity testing to determine whether the client needs glasses Refer the client to an optometrist or ophthalmologist for automated perimetry testing Provide client education materials in large print

Solution: The correct answer is C. Referral of the client to an optometrist or ophthalmologist for perimetry testing is necessary to confirm hemianopia before recommending specific intervention strategies. A, B, D: Hemianopia is a visual field deficit and must be confirmed before making specific recommendations; therefore, recommendations for task lighting, acuity testing, and large-print materials are not appropriate at this time.

A client who has been a participant in a community integration program for adults with mental illness arrives at an occupational therapy group after not being seen for several weeks. The client's mood is noticeably elevated. The client switches from one topic to another in rapid succession and claims to have not slept for 3 days. The psychiatrist describes the client as having manic episodes. What is the BEST course of action for the OTR® to take? Recommend individual sessions to catch up on missed goals during the client's absence. Allow the client to rest, then resume therapy. Resume group therapy sessions as soon as possible and apply cognitivebehavioral methods. Discuss with psychiatrist the possible need for the client to receive medication to improve behaviors.

Solution: The correct answer is C. Resumption in group-based community programming with a cognitivebehavioral approach will help the client reorganize routines and be aware of behaviors. A: Individual sessions are not recommended in community integration programming B: Not resuming daily routines will not help reduce manic behaviors. D: Facilitating medication intervention is outside the OTR®'s scope of practice.

An older adult client with a history of falls and glaucoma is referred to occupational therapy for evaluation and intervention. Which strategy should the OTR® teach the client to compensate for impaired vision due to glaucoma? Use a colorful, patterned tablecloth. Place dinner plate to the left of midline. Rotate head to choose clothing from a closet. Pour coffee into a dark colored mug.

Solution: The correct answer is C. Rotating the head would help the client use the remaining vision to compensate for peripheral vision loss. A, D: These strategies result in less contrast and would make it more difficult for the person with glaucoma to distinguish objects from the background. B: This strategy would not compensate for peripheral vision loss.

The OTR® observes as a client with multiple sclerosis (MS) demonstrates ataxia in the upper extremities when reaching for an item on the table. Which intervention is BEST to modify tabletop activities to control ataxia in task performance? Support the trunk against the table Support the dominant arm on the table Support the arms and trunk against the table Support both arms on the table with no trunk support

Solution: The correct answer is C. Supporting the arms and trunk against the table provides three points of stability against a stable surface, offering optimum support for task performance. A: Trunk support on the table would provide one point of stability when reaching but would not enable the client to compensate for upper-extremity ataxia. B: Supporting the dominant arm on the table provides only one point of stability, which may offer inadequate support for reaching. D: Supporting both upper extremities on the table would provide stability when reaching, but ataxia in clients with MS also affects trunk control, so the client would benefit from stabilizing the trunk as well.

A client has visual acuity of 20/200 in the right eye and 20/400 in the left eye. With what technology will the client MOST likely be able to operate a microwave with a flat panel? A prescribed magnifier Color-coded buttons Raised dots on the panel Task light over the microwave

Solution: The correct answer is C. The client's visual impairment is such that the remaining vision is not adequate as a sensory input, which means using an alternative sensory pathway. Tactile or auditory substitution is common. Putting raised dots on the microwave panel is an example of tactile substitution. A, B, D: These answers use methods to augment the visual sensory pathway; however, the client's visual impairment is such that the remaining vision is not adequate as a sensory input. These options would be suitable if the client had adequate vision to provide sensory input for information processing

An OTR® believes that changing clients' negative beliefs ultimately reduces negative emotional statements and leads to a change in behavior. What is this OTR's main theoretical perspective? Cognitive disabilities Developmental Cognitive Sensorimotor

Solution: The correct answer is C. The cognitive perspective deals with clients' emotional response to experiences and assists them in reframing their behavioral response. A: A cognitive disability perspective focuses on clients' current abilities and does not aim to change clients' emotional response or behaviors, only the environment. B: The developmental perspective focuses on current life expectations and how clients approach situations in the context of those expectations. D: The sensorimotor perspective focuses on controlling or modifying external sensory stimuli to improve clients' ability to function. It regulates responses through physiological, not cognitive, processes.

While completing an FCE on a client referred to a work hardening program, the OTR® suspects the client, who experienced a muscle sprain to the shoulder, is magnifying symptoms. The client has repeatedly made comments to the therapist about experiencing pain during all activities and being unable to return to work because of constant severe pain. The client is 4 months postinjury. Which type of symptom magnification is the client MOST LIKELY exhibiting? The "refugee" The "identified patient" The "game player" The "symptom misinterpreter"

Solution: The correct answer is C. The game player (traditionally known as a malingerer) uses symptoms for positive gain and consciously attempts to convince others of the reality of the symptoms. A, B, D: These three responses are examples of symptom magnification; however, they are examples of subconscious symptom magnification. A: The refugee uses symptoms to avoid an unresolvable conflict. B: The identified patient assumes the role of patient as a lifestyle and sees all accomplishments as being a result of symptoms. D: The symptom misinterpreter responds to physical changes in an extreme manner as a result of unrealistic belief systems or difficulty processing sensory input.

Because information-processing speed may affect a driver's on-road performance, which is the BEST compensatory approach the OTR® can use? Suggest driving cessation. Instruct the client in proper visual search patterns and efficient scanning techniques. Limit driving to familiar areas, simple traffic scenes, and roads with reduced speed limits. Educate the client in rules of the road and signs of the road.

Solution: The correct answer is C. This option will reduce the cognitive load or the information-processing demands of the environment on the client and provide more time for the client to focus on the driving task at hand. A: This strategy is an acceptable but premature strategy for a client with information-processing speed deficits. B: This option is a compensatory strategy for a client with ocular motor skill deficits. D: This option is a compensatory strategy for a novice client.

A student occupational therapist arrives at a facility for Level II fieldwork and discovers that the OTR® supervisor has to take an unplanned leave for the duration of fieldwork. An entry-level COTA® is present at the facility. What options does the student have for appropriate fieldwork supervision at that facility? The student may be supervised by the entry-level COTA as long as the COTA consults with the OTR. The student may be supervised by an OTR who works at another facility. The student may be supervised by an entry-level COTA who works at another facility. The student cannot complete fieldwork at the facility because adequate supervision is not available.

Solution: The correct answer is D. A Level II fieldwork student may be supervised only by an OTR with more than 1 year of experience. Because an OTR with sufficient experience is not available to supervise the fieldwork student onsite, the student cannot complete fieldwork at the facility. A: A COTA may not supervise a Level II fieldwork student. B: Fieldwork supervision must initially be direct line of sight at the facility. C: Fieldwork supervision must initially be direct line of sight at the facility, and a COTA may not supervise a Level II fieldwork student.

An OTR® in home health care is seeing a client who has Stage III Alzheimer's disease. The client lives with an adult daughter and likes to wander around the house and has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no step at the front entrance. The client's daughter is determined to have the client remain at home with her as long as possible. To prevent the client from getting out of bed unnoticed at night, what would the OTR® MOST likely recommend? A nightlight in the room Full bedrails on both sides of the bed A video room monitor A bed alarm system

Solution: The correct answer is D. A bed alarm system will alert the daughter when the client is attempting to leave the bed and is more suitable for use when the daughter is not able to stay in the same room as the client for surveillance. A: Neither a nightlight nor a full bedrail will alert the daughter if the client is getting out of bed. Full bedrails may in fact pose a further danger to the client if the client attempts to climb over the bedrails to get out of bed. C: A video room monitor will require the daughter to stay awake and look at the monitor regularly.

An inpatient who has a C6 spinal cord injury has met all occupational therapy goals and is preparing for discharge to live at home with caregiver assistance. What type of device should the OTR® recommend the patient use to maximize independence during self-care activities at home? Electronic aid to daily living Power wheelchair with head control Wheelchair-mounted mobile arm supports Custom-fitted tenodesis splint

Solution: The correct answer is D. A patient with a C6 spinal cord injury can use a tenodesis splint because he or she will have partial wrist extension. A: An electronic aid to daily living would be used to control the environment electronically by controlling lighting and temperature within the home. This would not be essential for the patient to maximize independence during self-care activities. B: At the C6 spinal cord injury level, the patient will be able to move the upper extremities through the scapula, shoulder, and forearm, so head control would not be needed on a wheelchair. C: Mobile arm supports would be more appropriate for a patient with a C5 spinal cord injury. A mobile arm support would help support the weight of the arm and improve its position for activities.

An OTR® is working with an acute-care client who has a ventricular assist device. Which precaution is essential when engaging this client in occupational activities? Do not administer an exercise stress test to this client. Instruct the client in sterile dressing changes to prevent infection. Educate the client to avoid yearly influenza and pneumonia vaccines. Avoid disconnecting the drive line to the power source during movement.

Solution: The correct answer is D. A ventricular assist device requires a power source to function properly. The drive line connects to the power source. If the OTR is not careful, the drive line can become disconnected during activity. A: OTRs do not generally administer exercise stress tests. B: Clients with burns or open wounds (not clients with a ventricular assist device) are usually instructed in sterile dressing changes by a nurse. C: Clients with a ventricular assist device are educated by nursing professionals, not OTRs, to receive yearly vaccines to prevent influenza and pneumonia.

Many occupational therapy clients who can no longer drive are referred to public transportation programs. Clients from rural areas, however, may not be served by public transportation of any form. Approximately what percentage of the U.S. rural population does NOT have access to public transportation? 5% 25% 50% 75%

Solution: The correct answer is D. According to Eby, Molnar, and Pellerito (2006), about 75% of the rural population in the United States does not have access to public transportation. A, B, C: These percentages differ from reports in the literature.

An OTR is evaluating a client with a brachial plexus injury. When checking upper-extremity movement patterns, what is the GREATEST degree of abduction the OTR should allow on the affected side? 25 45 10 90

Solution: The correct answer is D. Any motion beyond 90 abduction may induce added stress to the brachial plexus and its roots. B, C, D: Range of motion in shoulder abduction below 90 should not place additional stress on the brachial plexus injury.

Many issues arise when a client has difficulty with functional ambulation caused by abnormal gait. What should be the FIRST priority for the OTR® when addressing the issue of functional ambulation? Gait pattern during ambulation Independence with mobility Appropriate ambulation aid Safety throughout ambulation

Solution: The correct answer is D. Client safety and prevention of injury should be the first priorities during any activity, including functional ambulation. With regard to functional ambulation, safety can mean reviewing the client's medical record for current status and precautions, considering the client's physical abilities, and being aware of the external environment. A: Gait pattern, if it is not appropriate, may be an aspect of safety, but it is only one aspect of safety and therefore not the first priority. B: Although the long-term goal for many clients will be independence with mobility, safety in all aspects of functional ambulation, including appropriate distribution and use of an ambulation aid, environmental considerations, and the client's physical ability, must first be addressed before achieving independence. C: The appropriate ambulation aid will be a part of a client's safety during functional ambulation, but it is only one aspect of safety.

A client who has undergone electroconvulsive therapy (ECT) in the early morning arrives for an evening occupational therapy task group in an inpatient psychiatric unit. What is the OTR®'s BEST choice for working with the client at this time? Contact the nursing staff to escort the client back to the client's room. Remind the client of the need for 24 hours of bed rest after ECT. Invite the client to participate in a different group that focuses on reminiscence. Encourage the client to choose one of the available tasks to work on during the group.

Solution: The correct answer is D. ECT is immediately followed by a short, required bed rest, especially if residual symptoms include headache, nausea, and dizziness; regular activities can then be resumed. A: Alerting nurses to remove the client from the group is unnecessary and could cause undue disruption. B: Clients rest immediately after ECT and can then resume regular activities. C: Brief memory loss after ECT might make reminiscence challenging

Which assessments would be considered the BEST format for an upper-extremity functional capacity evaluation (FCE) for an outpatient occupational therapy department currently developing a return-to-work program? Assessment of manual material handling, ADL assessment, ROM, manual muscle testing, sensory assessment, volumeter testing, Visual Analog Scale, and postevaluation questionnaire Subjective interview, sustained grasp assessment, Purdue pegboard, work simulation testing, and computerized resistance testing Initial intake, pain assessment, musculoskeletal evaluation, Crawford Small Parts Dexterity Test, assessments using Valpar work samples Initial intake interview, subjective pain assessment, ADL assessment, musculoskeletal evaluation, physical demand testing, material handling skills, and postevaluation questionnaire

Solution: The correct answer is D. FCE should be individually tailored for each client. Physical demands should gradually increase in resistance and complexity. Evaluation should start with the least physically demanding components, and the evaluator should be aware of test specificity to determine test appropriateness. A: Material handling is the most physically demanding component of testing and is therefore not appropriate as the initial step in an FCE. B, C: Best practice dictates an individual evaluation plan for FCE; therefore, use of the Purdue pegboard and computerized resistance testing may not be applicable to all jobs. A subjective intake interview should be included to promote a client-centered intervention plan and postevaluation questionnaires.

An OTR determines that the client is no longer benefiting from occupational therapy services. The rehab manager insists that the OTR continue to treat the client because the caseload is low and discharging the patient may result in low productivity. What is the BEST next step for the OTR? Trade patients with an OTR who agrees to carry out the rehab manager's treatment plan. Immediately report the manager to the organization's human resources department. Immediately document the request and pursue the topic no further. Ask to meet with the rehab manager to collaborate about the situation.

Solution: The correct answer is D. Fidelity requires the OTR to work with management to address organizational ethics issues affecting the ability to treat on the basis of clinical need (which is required under the principle of Beneficence). A: Transferring the patient to a different therapist does not reconcile the ethical conflict. B: This option is out of proportion to the incident; it escalates the scenario when doing so may not be necessary as a next step. C: This is not the best next step, because it does not address the ethical concerns noted in the scenario

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? Self-feeding using standard eating utensils Coloring pictures in an oversized coloring book Stacking 1-inch (2.54-cm) wooden blocks Pushing an 18-inch- (45-cm-) diameter exercise ball

Solution: The correct answer is D. Once an individual is fit with a prosthetic, use training should begin so the client can understand how to operate and control the prosthetic. The client is able to implement practice with pre-positioning the limb to more effectively approach an object, such as pushing a ball. A, B: Functional training occurs after the client has gained concepts of control and use of the prosthetic as through pre-positioning and prehension control. C: Prehension training occurs after the client is successful with pre-positioning the prosthetic in preparation for grasp or interaction with an object.

An OTR® is working with an infant on learning how to transition from sitting to kneeling. The OTR, the infant, and the caregiver are sitting on the floor of the client's living room. Which activity would be the most appropriate to achieve this outcome? Place a toy on the kitchen table. Place a toy on the caregiver's lap. Place a toy on a table on the other side of the room from the child. Place a toy on a surface that cannot be reached in sitting but does not require the infant to stand.

Solution: The correct answer is D. Placing the toy on a surface that can be reached in kneeling (not sitting), such as a low chair or footstool, would create the next "just-right" challenge. A, C: These options would be too challenging, because they would require the infant to travel to another location. In the case of option C, it would also require the child to stand to reach the item. B: This option would be too easy, because it would not require the child to move from a sitting position to kneeling.

A client recovering from substance abuse disorder is referred for occupational therapy services. What intervention is the OTR® MOST likely to provide? Group psychotherapy Medication management Assistance with locating a new apartment Assistance with finding meaningful ways to spend free time

Solution: The correct answer is D. Substance abuse becomes the primary activity of people with this disorder. Education about and experimentation with alternative uses of time should be a primary focus of intervention. A, B, C: These interventions are typically provided by other disciplines. OTR®s may assist with psychotherapeutic intervention (e.g., group therapy), medication management, or housing acquisition through behavioral training with the client. However, the OTR® rarely has primary responsibility for these interventions.

In what setting do an OTR® and COTA® need to consider the client's Individualized Education Program (IEP) when completing documentation? Mental health Long-term care Home health School system

Solution: The correct answer is D. The IEP is a document used in the school system that discusses the functional and academic needs of the student. A, B, C: The IEP does not relate to these settings because it is used primarily in the school system.

An OTR® is preparing a hip replacement client for returning home alone after surgery. Which recommendation regarding kitchen modifications is the BEST? The client should keep kitchen items as is to prevent loss of mobility and encourage movement. The client should use only the microwave to prepare weekly meals. The client should consider ordering delivered, premade meals. The client should arrange for commonly used items to be located at counter level.

Solution: The correct answer is D. The OTR® should encourage the client to keep commonly used items at countertop level to prevent further injury and decrease fall risk from bending or stretching. A: Keeping the kitchen as is may compromise hip precautions and aggravate injury. B, C: Using only the microwave and ordering premade meals may be contrary to the client's lifestyle and limit occupational performance.

A client who recently experienced a CVA is consulting with an OTR® for a work readiness program. During the initial interview, the client states, "Why should I go back to work?" Which assessment is appropriate for further assessing the client's concerns? Worker Role Interview Work Environment Impact Scale Functional capacity evaluation Work Values Inventory

Solution: The correct answer is D. The Work Values Inventory can help both the client and the OTR® understand the value the client places on work, which is important in identifying the client's motivation to participate in the rehabilitation process. A: The Worker Role Interview provides information to facilitate the client's return to the workplace. B, C: These physical capacity assessments do not address the client's concerns.

A client has central vision loss secondary to macular degeneration. The OTR® plans to teach the client eccentric viewing techniques to compensate for the client's visual loss. What should the OTR® teach the client as the FIRST step of this process? Head positioning for optimal viewing Methods for using a magnification device Scanning exercises across the full field of vision Strategies for increasing blind spot awareness

Solution: The correct answer is D. The first step in eccentric viewing techniques is increasing the client's awareness of the central scotoma, or blind spot. A: The client must first increase awareness of the blind spot before determining the best viewing position for the chosen target. B: The client will learn to track and view through a magnification device once the client has increased awareness of the blind spot and identified best eccentric viewing positions. C: The client practices scanning once the client has increased awareness of the blind spot and practiced using optical devices such as magnifiers.

A client who uses an ultra lightweight wheelchair asks whether the chair can accommodate a wraparound lapboard. The OTR® is not familiar with this type of lapboard. Who on the rehabilitation team would be the BEST person for the OTR® to consult to obtain this information? Another OTR® A physical therapist A rehabilitation engineer A medical equipment supplier

Solution: The correct answer is D. The medical equipment supplier would be the person most familiar with the range of rehabilitation products and their features. A, B: OTR®s and physical therapists have general knowledge of wheelchair accessories but may not have specific knowledge about equipment with unique features. C: Rehabilitation engineers usually design, develop, adapt, test, and evaluate technological features of wheelchairs, not accessories.

An OTR®; has recently had a conflict with a physical therapist who works at the same treatment facility. During a team meeting that includes the client, the OTR says that the physical therapist is using outdated approaches that are ineffective. One of the other team members feels that the OTR has violated an ethical principle and wants to discuss the matter with the OTR after the meeting concludes. Which principle will the team member discuss with the OTR in relation to the OTR's comment? Beneficence Autonomy Justice Fidelity

Solution: The correct answer is D. The principle of fidelity requires that an OTR treat other professionals with respect, discretion, and integrity. By allowing the interpersonal conflict to affect comments during a team meeting, the OTR has not been respectful of the physical therapist's practice choices and has not used appropriate conflict resolution strategies. Principle 6I of the Occupational Therapy Code of Ethics (2015) states that occupational therapy practitioners "shall respect the practices, competencies, roles, and responsibilities of their own and other professions to promote a collaborative environment reflective of interprofessional teams." A: Beneficence refers to the demonstration of concern for others' safety and well-being. B: Autonomy is the concept that practitioners have a duty to treat the client according to the client's desires, within the bounds of accepted standards of care, and to protect the client's confidential information. C: Justice refers to the fair, equitable, and appropriate treatment of persons and access to occupational engagement.

An OTR® evaluating a client listens as the client says, "My pain is really bad, forcing me to stay in bed 24/7, and I am not able to take care of myself at all." Which clarifying response is BEST? "It appears that your pain is really bad, forcing you to stay in bed." "I feel badly that you are experiencing pain 24/7, forcing you to stay in bed." "You poor thing. That's awful! Where is the pain?" "It seems that your pain is so bad you can't get up to go to the bathroom or get yourself food from the kitchen."

Solution: The correct answer is D. This response solicits clarification of what the client meant by "forcing me to stay in bed" by adding to what the client has stated. A, B: Simply restating what clients say using the same words lets them know that the OTR® heard what they have to say but does not encourage them to clarify what they meant. C: "You poor thing" conveys pity but is not effective in clarifying the client's experience or building a therapeutic relationship.

An OTR® is working in outpatient rehabilitation with a client with a spinal cord injury who is interested in using public transportation to engage in part-time work but is unable to use regular fixed-route services. The OTR assists the client in finding out about the eligibility process for paratransit services, and the OTR and client discuss the advantages and disadvantages of using such services. What is one possible disadvantage of using paratransit services from the client's perspective? Paratransit systems typically offer more flexible travel time options than do fixed transit routes. Paratransit operators are trained to assist riders with functional limitations in boarding vehicles. Paratransit systems use smaller and more accessible vehicles than fixed transit routes. Paratransit systems require that reservations be made in advance to use the service.

Solution: The correct answer is D. The requirement by paratransit systems that reservations be made well in advance is a commonly cited disadvantage to paratransit users. A, B, C: More flexible travel time, assistance with boarding, and more accessible vehicles are advantages, not disadvantages, of paratransit systems.

An occupational therapy student is working in a rehabilitation setting that treats many clients with osteopenia. The fieldwork educator requests that the student determine whether a walking program can prevent osteoporosis. What kind of research article would provide the MOST trustworthy evidence to support a walking intervention? A systematic review A randomized clinical trial A cohort study A case-control study

Solution: The correct answer is A. A meta-analysis combines all the current best evidence to provide the most comprehensive information about an intervention. B, C, D: Although these three designs have some ability to show cause and effect, they are single studies and lack the comprehensiveness of a systematic review.

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? Unbuttoning large buttons Lacing a shoe Cutting out shapes with scissors Drawing shapes

Solution: The correct answer is A. A 2-year-old child would likely be working on unbuttoning large buttons. B, C, D: These activities would be too challenging for a 2-year-old.

Which setting is MOST effective for job coaching with an adult client with mental illness? Sheltered workshop environment Outpatient rehabilitation setting Program offering simulated work Workplace with assigned job duties

Solution: The correct answer is D. Support approaches with on-site training are recommended as the most effective setting for job coaching. A, B, C: Training for job placement in settings outside the workplace does not support generalization of skills to the workplace.

Which part of original Medicare covers stays at hospitals and inpatient rehabilitation facilities? A D B C

Solution: The correct answer is A. Medicare Part A covers stays at these facilities. B: Medicare Part D added a prescription drug benefit and is not part of original Medicare. C: Medicare Part B is part of original Medicare but covers outpatient care. D: Medicare Part C or Medicare Advantage is not part of original Medicare.

An OTR® is providing intervention to a medically stable client who sustained upper-extremity partial-thickness burns of the dominant arm, 5% of the total body surface area, 2 days ago. Which intervention BEST represents a typical ADL intervention? Instruct the client in the use of a long-handled spoon and fork and a built-up-handled knife for self-feeding. Instruct the caregiver to assist the client in self-feeding and grooming tasks to prevent pain with movement. Instruct the client in donning and doffing a pressure garment sleeve after applying lotion to the arm. Encourage the client to independently self-feed without the use of adaptive equipment.

Solution: The correct answer is A. A 5% total body surface area burn in one of the upper extremities means that the client has approximately 50% surface area burns to the dominant upper extremity. Edema and bulky dressings in the early stage may interfere with the motion needed for ADLs, and short-term use of adaptive equipment would be indicated. Adaptation to environment and activity can facilitate the client's achieving goals for independence in ADLs. B: Allowing the caregiver to assist the client in ADLs does not encourage active participation in the early stage of recovery. C, : Scar management techniques such as applying lotion and using a pressure garment will not be needed until a later phase of rehabilitation. D. Bulky dressings and pain will interfere with movement, and self-feeding may not be successful without use of an assistive device.

When planning a sensory reeducation program for a client with sensory loss associated with peripheral nerve damage, which intervention would the OTR® use FIRST? Sensory retraining, but only after signs of nerve regeneration are apparent Discriminative sensory reeducation involving graded localization and discrimination tasks Noxious sensory input to facilitate reduction of hyperalgesia Protective sensory reeducation because the client is at risk for injuring the insensate hand

Solution: The correct answer is D. When protective sensation is diminished or absent, client education is initiated first to prevent potential harm from hot and cold or from sharp edges. A: Protective sensory reeducation should begin immediately, before nerve regeneration is apparent, to protect the client from further injury. B: Discriminative sensory reeducation should begin soon after nerve injury. However, protection from further harm is addressed first. C: Noxious input does not reduce hyperalgesia.

An OTR® is completing a functional ambulation task with a client when the client's legs begin to buckle. What is the MOST appropriate way for the OTR to manage this issue? Call for assistance, and put the client in the wheelchair. Lower the client onto the OTR's flexed leg, then down to the floor. Hold the client up with a gait belt until another practitioner can get a chair. Using the gait belt, pull the client into the closest chair.

The OTR may be less prone to back injury by using his or her legs to support or lower the client to the floor. A: The wheelchair might not be within reach or, if it is, might require pulling or twisting the OTR's back to position the chair correctly behind the client. C: Holding a client's body weight, even while using a gait belt, for an extended period of time can be detrimental to the OTR's musculoskeletal system. D: Pulling the client in any way risks injury to both the client and the OTR

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? That the client maintain at least 90 of hip flexion on a shower chair That the client use a long-handled bath sponge to reach the lower legs and feet That the caregiver be instructed in stretches to the lower extremities That the client place one foot at a time on a small stool while washing

Solution: The correct answer is A. A addresses both the balance deficits and the spasticity that interfere with lower-body ADLs. By sitting down to wash, the client reduces the risk of falls, and flexed hips may lessen spasticity in the lower extremities. B: Using a long-handled bath sponge is a compensatory strategy that does not help decrease the pain and discomfort associated with spasticity. C: Stretching helps decrease spasticity, but this option also reduces independence. D: This option is an environmental modification that may promote hip flexion but does not address the balance impairments and may further compromise the client's balance.

An OTR® is planning a community program for clients who have Parkinson's disease. The OTR® knows that group sessions are effective in decreasing the impact of postural instability for clients with Parkinson's disease. Which rationale would the OTR® provide when seeking funding for the program? Clients perceive improved quality of life when attending group sessions. Clients perceive tremors as having more impact on self-care tasks. Clients perceive community support as having a positive impact on their self-care. Clients perceive that they are more able to participate in social activities.

Solution: The correct answer is A. A benefit of group sessions for clients with Parkinson's disease is an improvement in their perception of their quality of life. B: Tremors have a more negative impact on postural stability than on self-care tasks. C: Clients perceive improved quality of life, not improved self-care performance, with group sessions. Self-care performance is addressed effectively through compensatory techniques, whereas postural instability is better addressed in group settings. D: Socialization has not been a reported outcome of group sessions.

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

Solution: The correct answer is A. A client who has had an abrupt change in the body could benefit from encouragement from the OTR to explore ways in which the client's body has changed to encourage problem solving. B: Unless the client's history has other indicators, an OTR is capable of intervening with a client who has concerns about sexual activity. C: Because sexual activity is private, providing educational materials in a group setting would not be appropriate and would reduce the OTR's ability to provide client-centered care. D: A sex surrogate is used to explore sexual dysfunction or sexuality. Other strategies and educational materials would be more appropriate with this client. If the client had ongoing issues, a sex surrogate might be an option.

An OTR® in home health care is seeing a client who has Stage III Alzheimer's disease. The client lives with an adult daughter and likes to wander around the house and has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no step at the front entrance. The client's daughter is determined to have the client remain at home with her as long as possible. The client requires close supervision on the stairs and seems to be very fearful when putting the foot down on each step. To further ensure the client's safety in getting up and down the stairs at the back door, what would the OTR® MOST likely recommend? Yellow contrasting tapes on the edge of each step Installing a ramp with handrails over the steps Teaching the client to use a cane on the stairs Referring the client to physical therapy for stair training

Solution: The correct answer is A. A client with Stage III Alzheimer's disease often begins to experience changes in vision and perception. Having yellow tape on the edge of each step helps to differentiate each step and prevent the client from missing one. B: It is important to maintain what the client can do. Because the client can still walk and manage the stairs, a ramp is not necessary. C: Teaching the client to use a new assistive device such as a cane will be difficult and may even pose further fall risk when the client is not able to use the cane correctly. D: A referral to physical therapy is not indicated at this time because the client does not appear to have strength or balance deficits in negotiating the stairs.

An OTR® is preparing a client with T1 spinal cord injury for discharge to home alone. What is the BEST recommendation for required home assistance? Homemaking assistance for a few hours a day Attendant care for 24 hours a day Attendant care for 12 hours a day

Solution: The correct answer is A. A client with low-level (T1) SCI should be independent in personal care and only require a few hours of homemaking assistance each day upon discharge. B: Attendant care for 24 hours a day may be indicated for clients with higher level SCI injury (C1-C4). C: Attendant care for 12 hours a day may be indicated for clients with C5-C6 SCI injury.

A client reports having difficulty with lower-extremity mobility in relation to getting into and out of bed. What piece of adaptive equipment is MOST appropriate to recommend to this client? Leg lifter Bed ladder Bed rail Trapeze bar

Solution: The correct answer is A. A leg lifter is a device for moving one leg at a time. It can be used to allow the client to manually move the legs over the side of the bed or manually lift the legs into bed. B: A bed ladder is a device on which a person pulls with one or both upper extremities, using each rung in progression until his or her trunk is at the desired position. It does not assist with moving the legs. C: A bed rail can assist with rolling or moving in bed, but does not help move the legs. D: An overhead trapeze bar assists with rolling over, lifting the hips up, scooting the body in bed, or obtaining a long-leg seated position in bed. However, it does not help move the legs.

An OTR® has developed a prevocational program for clients who have an enduring mental illness. Program modules include assessing the advantages and disadvantages of employment, evaluating work and leisure skills, practicing completion of job applications, and learning to write resumes and cover letters. Which frame of reference reflects the design of this program? Cognitivebehavioral Psychodynamic Model of Human Occupation Dynamic Interactional Model

Solution: The correct answer is A. A cognitivebehavioral frame of reference is commonly applied in social and life skills groups where clients can focus on self-regulation through observational learning and modeling of skills. Clients in the group described in this scenario would be able to engage in observational learning and modeling of completing applications, writing letters, and expanding on work and leisure skills through group activities. B: A psychodynamic frame of reference involves clients projecting feeling that they may be unaware of into art or other activities. The activities are used to express emotions. This frame of reference would not apply practical skills training. C: The Model of Human Occupation focuses on skilled performance of activities in context. Group instruction and practice of skills, as described in this scenario, would not fit within this model. D: The Dynamic Interactional Model focuses on multicontextual tasks and environmental conditions that are similar. Consistent cognitive strategies are used throughout intervention activities. The scenario described here does not apply cognitive strategies to facilitate transfer of skills across contexts.

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

Solution: The correct answer is A. A custom seating system is indicated for a client who will likely be a long-time wheelchair user (e.g., a person with MS) to prevent deformity and skin breakdown. B, C, D: Hip replacement, Guillain-Barré syndrome, and acute TBI all are conditions that have a period of healing time. The acute condition needs to be resolved before making a decision about a custom wheelchair system. During healing, a standard wheelchair with appropriate adaptations and reevaluation of such adaptations should suffice.

An OTR® is running a group with clients with schizophrenia in an inpatient psychiatric facility. The group members have low cognitive ability, minimal insight into the condition, and low motivation, and they do not know each other very well. What leadership style would be BEST for the OTR to use? Directive Facilitative Cooperative Advisory

Solution: The correct answer is A. A directive leadership style is most appropriate because the group leader will assume responsibility for the group in all aspects: activity choice, social participation, rule setting, and so forth. The directive approach is best with clients who have low cognitive ability and low motivation. B, C, D: The group members have low cognitive functioning, knowledge of their condition, and motivation. These characteristics require more involvement by the group leader. The facilitative, cooperative, and advisory leadership styles require more participation and responsibility of the group members than they can provide at this time.

Workers' compensation claims resulting from low back muscle strains and sprains have increased at an auto mechanic company, and management asks an OTR® for a consultation on implementing an injury prevention program. Which goal would be reasonable for this program? Reduce costs for the employer resulting from lost work days and workers' compensation claims Promote an atmosphere of intimidation to stop workers from filing injury reports Train workers in the use of back brace supports to reduce injury risk. Initiate a training program that addresses work behaviors to improve back alignment

Solution: The correct answer is A. A goal of any injury prevention program is to minimize employer expenses related to lost time and wages. B: A goal of injury prevention programs should be to provide an environment of support for workers to identify strategies to improve work conditions. C: Back brace supports should be provided on the basis of individual need, not prescribed to all workers. D: The focus of injury prevention programs should be on the process of creating a culture of safety and wellness rather than on specific activities within the injury prevention program. The activities within the injury prevention program may help the injury prevention program reach the goal, but the activity is not the goal itself.

An OTR® uses cognitive-behavioral interventions in psychosocial practice with clients with stress and anxiety disorders. What intervention is the OTR MOST likely to use? Psychoeducation that provides resources and information about the client's illness and ways to cope with it Creative expression using art to free underlying emotions and conflicts Psychotherapy that builds trust in the client-therapist relationship and brings unconscious conflicts to a conscious level Reminiscence to increase awareness of remote memories and thereby improve the ability to recall and recognize

Solution: The correct answer is A. A hallmark of cognitive-behavioral therapy is use of psychoeducation. Evidence supports the benefits of this approach. B, C: Creative expression and psychotherapy that brings unconscious conflicts to the surface stem from psychodynamic-psychoanalytic approaches. D: Reminiscence groups are popular for clients with memory challenges but not for people with stress and anxiety disorders.

A client working as a receptionist in an office reports pain on the left side of the neck. An OTR® observes the client holding the phone between the left ear and shoulder while scheduling appointments. The worker was observed to have 10 calls in 20 min. Which modification is BEST to improve the worker's performance during this task? Wear a hands-free headset for phone calls. Use a built-up writing utensil when taking notes. Align the computer keyboard with the computer monitor. Put foam on the phone handle to decrease neck rotation.

Solution: The correct answer is A. A hands-free headset allows workers to keep the head in neutral position and have both hands available for typing on the computer or writing while on the phone. B: The worker's neck alignment during phone use appears to be the root cause of the worker's pain; a built-up writing utensil will not change neck position during phone calls. C: Keeping the computer keyboard aligned with the computer monitor ensures proper posturing during computer work but does not address the cause of the problem, which is holding the phone awkwardly. D: Some degree of neck rotation is still needed, so this modification will not eliminate pain from awkward posturing.

A goal for a client with traumatic brain injury is to be accurate with orientation to place and time. The client is at Rancho Level IV (i.e., with confusion and agitation). What intervention is appropriate to meet this goal? Have client use a logbook that provides a calendar with the current therapy session schedule Engage the client in a daily self-care routine of showering, dressing, and grooming Allow the client to guide intervention sessions by providing minimal structure to the sessions Organize an orientation group in which the client can share perceptions of orientation

Solution: The correct answer is A. A logbook allows a client to experience passive orientation provided by family or staff. Providing the current therapy schedule in the logbook may increase the client's awareness of timing. B: Providing a structured ADL routine produces stability in the client's daily routine but does not increase the client's awareness of orientation. C: The client is not yet able to self-direct intervention sessions; structure and routine are needed to minimize distraction and disorientation. D: Participating in a group activity to share perceptions is difficult for a client with traumatic brain injury who is disoriented. Group treatments may, however, be used to provide repetition of orientation information for rehearsal and awareness training.

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? Neurodevelopmental Acquisitional Sensorimotor Biomechanical

Solution: The correct answer is A. A neurodevelopmental approach to handwriting would ideally be used for children who have tone issues, poor postural control, poor limb function, poor automatic reactions, and poor proximal stability. These preparatory activities would help mitigate the child's underlying deficits, promote better hand control, and ultimately lead to better handwriting. B, C, D: Although these models of practice would also be appropriate to guide handwriting, the activities presented in the question are aligned with the neurodevelopmental model of practice and not the others.

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® examines the limb but does not see any reddened or open areas. What is this pain MOST likely the result of? A neuroma Phantom sensation Phantom limb A sebaceous cyst

Solution: The correct answer is A. A neuroma is a ball of nerve tissue that occurs when axons attempt to grow back in the distal limb. They can be painful when pressed but are not necessarily visible. B: Phantom sensations are pain and tingling that are perceived by the client to occur in the missing limb. They occur spontaneously and do not require an outside force to be activated. C: Phantom limb is the sensation that the missing limb is still there. It is not painful. D: A sebaceous cyst is a keratin-filled sac caused by irritation of the skin by the torque forces of the prosthesis. They are raised, movable bumps on the skin and are usually painless.

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 positive Gower's sign Abdominal distention Excessive bruising A positive Trendelenburg's sign

Solution: The correct answer is A. A positive Gower's sign may be indicative of DMD. A positive Gower's sign is noted when a child is asked to get up from sitting on the floor and walks the hands up the legs and then moves into a standing position. B: Abdominal distention may be a sign of cystic fibrosis in infants. C: Excessive bruising may be a sign of hemophilia. D: A positive Trendelenburg's sign may be related to hip dysplasia.

An OTR® is baking cookies with a client with apraxia. How would a fading approach to this intervention be described? Providing hand-over-hand feedback with repetition, then slowly reducing tactile cueing as the client more skillfully rolls the dough Allowing the client to roll the dough and place the cookie cutters but the OTR lifts the cut cookies onto the tray Instructing the client with verbal cues in the steps of the process and how to perform each so they are fully understood before beginning Performing tactile cueing on an as-needed basis to prevent the client from becoming frustrated

Solution: The correct answer is A. A remedial strategy to working with people with apraxia is hand-over-hand techniques, in which the OTR physically moves the affected body part; the OTR can then grade the cueing and reduce it over time, which is fading. B: This approach is the reverse of scaffolding, in which the OTR assists the person with the difficult components of the task and allows the person to complete the task. C: This approach describes coaching. D: Performing tactile cueing on an as-needed basis does not address the lessening nature of cues that defines the fading technique.

A worker participating in back-neck rehabilitation is receiving education on proper standing workstations. The worker is required to move 10-lb discs onto a dowel. Which design element should be considered for the client's workstation? Workstation height should allow some elbow extension during the task. The workstation should enable the worker to sit or stand during the task. The workstation should enable the worker to reach overhead during the task. Workstation tools should be placed beyond arm's reach during the task.

Solution: The correct answer is A. A standing workstation is ideal for tasks requiring downward force; heavier tasks should be done with some elbow extension to minimize forces applied to the elbow musculature. B: Sitting is not recommended during heavy lifting tasks. C: Repetitive heavy lifting overhead is not recommended. D: Tools used during tasks should be kept within arm's reach for ease of access.

A large outpatient hand clinic employs certified hand therapists who are either licensed OTR®s or licensed physical therapists. COTA®s are used to efficiently manage caseloads. Which description of the supervision requirement for COTAs working in this environment is MOST accurate? Must be supervised by a licensed OTR in accordance with state licensure and scope of practice for COTAs Does not require supervision if the COTA has a minimum of 5 years of experience treating clients with upper-extremity conditions Can be supervised by a licensed OTR or physical therapist regardless of any other certifications Can be supervised by a licensed OTR or physical therapist as long as the supervisor is a certified hand therapist

Solution: The correct answer is A. COTAs typically require supervision by a licensed OTR in accordance with state licensure and scope of practice for COTAs. B, C, D: COTAs typically require supervision by a licensed OTR, not a physical therapist, regardless of years of experience and other certifications in accordance with state licensure and scope of practice for COTAs.

An OTR® is using Fidler's task-oriented group as a context for treatment to help participants explore healthy ways to deal with conflict. Which of the following activities would be BEST for this group? An activity that is challenging and likely to cause tension among members An activity that is highly structured so participants know exactly what is expected of them A parallel group activity that enables participants to work alongside one another An activity that facilitates participants' success and thus improves their self-esteem

Solution: The correct answer is A. A task-oriented group presents opportunities for participants to practice situations they may encounter in daily life. A group environment in which conflicts are likely to occur can help participants practice resolving conflict in appropriate ways. B: Group activities that are highly structured with clear expectations are less likely to create opportunities for conflict to arise. C: In parallel activities, participants focus on their own project or activity, allowing little opportunity to practice conflict resolution skills. D: Although an activity can build in success and still cause conflict, ensuring success is not essential in a group aimed at improving healthy ways to resolve conflict.

A client sustained a C4 spinal cord injury in a car accident, and the OTR® is recommending a power wheelchair with a sip-and-puff controller. Which of the following options would be best for providing pressure relief to the buttocks by changing orientation in space but not body position? Tilt in space Recline Elevating leg rests Pelvic bar

Solution: The correct answer is A. A tilt-in-space feature rotates the seat around a fixed axis, does not change the client's position, and provides pressure relief for the buttocks. B: A recline feature changes the seat-to-back angle and thus changes the client's position. C: Elevating leg rests do not provide pressure relief to the buttocks. D: A pelvic bar stabilizes the pelvis but has no effect on pressure relief.

A client with a recent hip replacement (posterolateral approach) has been referred to an OTR® for a wheelchair evaluation. What type of wheelchair is the MOST appropriate to maintain hip precautions and preserve mobility? A reclining manual wheelchair A standard manual wheelchair A power wheelchair with hand control A lightweight folding wheelchair

Solution: The correct answer is A. A wheelchair with an adjustable backrest allows a reclining position for clients with posterolateral hip precautions; the ability to recline helps avoid hip flexion greater than 90 degrees. B, D: The rigidity of standard and lightweight wheelchairs does not accommodate hip precautions. C: A power wheelchair does not accommodate hip precautions, nor does it encourage manual mobility.

An OTR is working with a client who presents with digital tenosynovitis in the index finger, or "trigger finger." After the OTR fabricates a splint to support the metacarpophalangeal joint in extension, which exercise should the OTR advise the client to perform FIRST? Hook fist with splint on Hook fist with splint off Full fist with splint on Full fist with splint off

Solution: The correct answer is A. A: Trigger finger is a condition in which edema in the tendon and synovium of the digit results in lack of smooth flexion or extension of the finger. To rest the tendon and prevent snapping as the tendon pulls through the finger pulleys, the MCP joint is blocked by splinting, then gentle pull through with bending and straightening of the distal and proximal interphalangeal joints is recommended 20 times every 2 hours while the client is awake. B: The MCP joint is not supported if the hook fist exercise is performed with the splint off, resulting in increased tendon inflammation. C: A client wearing the MCP extension splint will be unable to make a full fist with the splint on. D: Making a full fist without the splint on will increase tendon inflammation and edema.

Which of the following statements about occupational therapy fieldwork is accurate? A health care professional other than an OTR® can supervise occupational therapy students on Level I fieldwork. Payers are not able to regulate the supervision of occupational therapy students. Initial suggested supervision for Level II occupational therapy students is indirect. An OTR® or COTA® can supervise an occupational therapy Level II fieldwork student.

Solution: The correct answer is A. According to the ACOTE® guidelines, other health care professionals can supervise Level I occupational therapy students. B: Payer sources are able to regulate supervision of occupational therapy students. C: The initial suggested requirements for supervision for Level II occupational therapy students is direct and line of sight. D: A Level II occupational therapy student cannot be supervised by a COTA®.

An OTR® has completed an evaluation of an inpatient who has acute Guillain-Barré syndrome. The patient scored a "3" on all subtests of the Functional Independence Measure. Based on this information, which outcome would be realistic for this patient to achieve prior to transitioning to a skilled nursing facility? Uses energy conservation techniques during daily self-care tasks Completes three sets of a progressive resistive upper-extremity exercise program Independently completes wheelchair transfers using proper body mechanics Demonstrates controlled dynamic trunk movements during IADL activities

Solution: The correct answer is A. According to the FIM score, the patient requires moderate assistance for performing activities. In the acute phase of Guillain-Barré syndrome, the patient may be experiencing muscle belly tenderness and overall fatigue; energy conservation techniques will allow the patient to engage more productively in daily self-care tasks. B: In the acute phase of Guillain-Barré syndrome and with a FIM score of 3, the patient will likely be unable to reach three sets of progressive resistive upper-extremity exercise. C: Progressing from a FIM score of 3 to 7 is unrealistic in the acute phase of Guillain-Barré syndrome. D: Guillain-Barré syndrome typically results in more extreme distal muscle weakness rather than proximal muscle weakness, so addressing trunk control will not be an effective intervention.

A client who has Parkinson's disease reports increased tremors, problems knocking items over while eating, and poor articulation, leading to recent social isolation. Which intervention strategy would be MOST effective for this client? Educate about timing social activities when medication is most effective. Train in facial exercises to improve speech quality and communication. Provide utensils with built-up handles during mealtimes to decrease spills. Suggest a community support group to provide a social outlet.

Solution: The correct answer is A. Activities should be timed during medication "on" times. Determining a client's optimal time of day for activities promotes increased success in occupational performance. B: Facial exercises may help improve communication but do not address increased tremors. C: Adaptive equipment for mealtimes addresses motor impairments but does not address speech concerns. D: A community support group may be an effective intervention once the motor impairment and communication difficulty issues are addressed.

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? Gross motor movements and energy conservation for completion of PADL Fine motor activities and moderate resistance putty exercises to improve BADL Functional splinting and caregiver training for participation in routine ADL Compensatory strategies and assistive devices for childcare activities

Solution: The correct answer is A. 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. 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.

An older adult client with age-related macular degeneration presents for evaluation and demonstrates difficulty reading and signing consent forms. What visual function should the OTR® evaluate first? Visual acuity Tolerance to glare Visual field Visual scanning

Solution: The correct answer is A. Age-related macular degeneration causes loss of central visual acuity, resulting in difficulty discriminating small visual details required for reading and writing. B, C, D: Tolerance to glare and visual field and visual scanning are not characteristic of age-related macular degeneration.

An OTR® is using an adaptive approach with a client returning to work after bilateral carpal tunnel release surgery 6 weeks ago. The client works as a supermarket checker. Which job task modification incorporates an adaptive approach? Handheld barcode scanner Strengthening exercise using 2-pound weight Adjustable-height stool at the cash register Upper body stretching breaks every hour

Solution: The correct answer is A. An adaptive approach supports functional performance through use of compensatory techniques such as changes in activity demand. B, D: These options are restorative approaches. C: This option is an adaptive approach but is not specific to the client's carpal tunnel condition.

An OTR® is working on the playground with a child who has sensory integration dysfunction. The OTR® is trying to foster an adaptive response, which is best described by which statement? The behavioral manifestation of optimal sensory organization that results in an efficient goal-directed action Engagement in rough-and-tumble play and other activities that provide the child with muscle resistance A reflection on primitive neural functions in children with sensory processing problems An individualized plan that provides a specific child with optimal sensory experiences

Solution: The correct answer is A. An adaptive response is the result of optimal organization and leads to efficient goal-directed action. As tasks become more complicated and children continue to demonstrate adaptive response, their sensory integration becomes more effective and efficient. Adaptive responses are thought to lead to changes at the neuronal synaptic level; these changes alter the brain through a process called neural plasticity. B, C, D: These options are not examples of adaptive responses because they do not reflect optimal organization or goal-directed actions.

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? Sip and puff Joystick Chin-activated toggle Proximity-sensing microswitch

Solution: The correct answer is A. Cerebellar degeneration results in loss of balance and coordination. A sip-and-puff control switch would allow control of the power wheelchair without the client needing to use coordination. B, C, D: All of these control switches require some degree of fine motor and upper-extremity coordination to operate. Cerebellar degeneration will result in further decline of coordination, and these would be unusable switches for the client.

A client was referred to occupational therapy because of persistent pain in the neck and shoulder and the recent onset of paresthesia in the right index and middle fingers. The OTR® decides that the symptoms may be work related and proceeds with an onsite ergonomic assessment. What is the purpose of the onsite ergonomic assessment? To identify possible risk factors for the cumulative trauma disorders To identify suitable break times for the client To assess the job appropriateness of the client To educate coworkers in the importance of ergonomics

Solution: The correct answer is A. An onsite ergonomic or worksite assessment is the best method to identify risk factors for work-related injury. Risk factors may include awkward posture, inappropriate layout or physical environment, or inappropriate use of equipment. The assessment is often conducted in the work environment with the worker present performing the job as normally as possible. B: General education of the client on the importance of taking appropriate breaks during work does not require onsite assessment. It can be done in the clinic. C: An ergonomic or worksite assessment is not used to assess the job appropriateness of a worker. D: If the company feels the need for a company-wide ergonomic program, a consultant can be hired to conduct a primary prevention program with all the company's workers.

An OTR® has just fabricated a dynamic splint for an inpatient who had an MCP joint arthroplasty 4 days ago. The patient is being discharged to home and will have home-health follow-up in several days. What information is MOST IMPORTANT for the OTR® include in the patient's discharge instructions? Call the inpatient OTR® with questions about the splint position or fit. Contact the home health OT with any questions about the splint. Remove the splint for short intervals and elevate the hand if swelling occurs. Contact the home health or inpatient OT if there is an increase in redness around the incision.

Solution: The correct answer is A. Any patient provided with a splint should be given thorough written instructions, which include the contact name and number of the practitioner who fabricated the splint. B, D. The practitioner who fabricated the splint should be the follow-up contact person because that practitioner will be the one who is familiar with the patient's status and the design and purpose of the splint that was fabricated. C: Splint wear schedules should be communicated clearly in both oral and written format, although with a joint arthroplasty, the patient will require continuous splint wear.

Which statement accurately describes the eligibility determination for occupational therapy services under IDEA Part C in an early intervention program? Infants and toddlers with established risk because of a diagnosis automatically qualify for Part C services. Infants with marked developmental delays but without a specific diagnosis automatically qualify for Part C services. An OTR® is automatically a member of an evaluation team in early intervention programs. Early intervention is always provided by a multidisciplinary team.

Solution: The correct answer is A. As part of IDEA Part C, all children with established risk are eligible for services. B: A diagnosis is necessary to be eligible for an evaluation. C, D: These statements do not describe eligibility determination.

Which statement BEST describes the role of occupational therapy in an early intervention program under the Individuals With Disabilities Education Act Part C? Occupational therapy is one of 16 primary services provided for children in need of early intervention services. Occupational therapy is a related service provided only as a support to special education services. Occupational therapy is provided as a fee-for-service intervention for children in need of early intervention services. Occupational therapy is primarily a school-based service provided for children in need of early intervention.

Solution: The correct answer is A. As part of IDEA Part C, occupational therapy is listed as a primary service, as are speech and physical therapy and special instruction. B, D: These statements describe special education settings. C: This statement refers to private service delivery settings.

Which symptom may be attributed to typical visual aging changes? Slowing ability to adapt to light and dark Difficulty recognizing and reading facial expressions Increasing color blindness Improving ability to see objects at a close distance

Solution: The correct answer is A. As people get older, they find it more difficult to adapt to light and dark conditions B: This symptom is more typical in someone with macular degeneration. C: Color blindness remains and is not a typical aging change. D: As people age, the ability to see close objects diminishes rather than improves.

An OTR® is working with a client in the active phase of C6 spinal cord injury. What piece of durable medical equipment would be BEST suited for assisting in the client's community mobility? Power recliner with standard arm drive Lightweight folding wheelchair Power recliner with head control Manual rigid wheelchair

Solution: The correct answer is A. At C6, wrist extension is still preserved at some functional level, allowing for the control of a power recliner with standard arm drive. B: Although a C6 client might use a lightweight wheelchair (with adapted wheels) indoors, the client will likely require total assist with this type of chair in the community. C: Head controls are not necessary for propulsion as because a client with C6 injury has shoulder, arm, and some wrist movement. D: A manual rigid wheelchair would not promote community mobility because it is cumbersome to transport and would be difficult for the client to propel.

An inpatient with a C7-C8 spinal cord injury suddenly complains of having a pounding headache, and the OTR® notices the patient is perspiring and appears flushed. Which life-threatening condition is the patient likely experiencing? Autonomic dysreflexia Hypoglycemia Angina Dyspnea

Solution: The correct answer is A. Autonomic dysreflexia is a medical emergency and life-threatening condition caused by a reflex action in the autonomic nervous system. This condition commonly occurs in individuals with injuries above the T4T6 levels. B: An insulin reaction, or hypoglycemia, would appear suddenly with skin appearing moist and pale (not flushed as in this scenario) and no patient complaints of headache. C: A patient experiencing angina would report squeezing, tightness, aching, or burning in the chest and possibly radiating to the arms, jaw, neck, or back. D: Dyspnea involves respiratory distress and is observed as a patient having shortness of breath.

Which is the BEST example of an occupational therapy client population according to the Occupational Therapy Practice Framework? People who have arthritis A group of people A school system A health club

Solution: The correct answer is A. People with arthritis are considered a group of people who have similar problems (arthritis) and can be considered an occupational therapy client population. B: This does not meet the definition of population, because it does not describe a specific group of people within the community. C, D: These are considered organizational clients rather than a population, because they are businesses.

A client can actively flex the left shoulder to only 75° antigravity but can achieve 180° degrees in a gravity-eliminated plane. On the basis of this information, what would the OTR® consider doing NEXT? The OTR should assign a muscle grade for shoulder flexion on the basis of this information and move on to test other joints. The OTR should apply resistance into shoulder extension at the distal aspect of the humerus while stabilizing the scapula. The OTR should apply resistance into shoulder flexion at the distal aspect of the humerus while stabilizing the scapula. The OTR should call the physician to determine whether the client has any precautions for upper-extremity movement.

Solution: The correct answer is A. Because the client cannot achieve 50% active range of motion (AROM) antigravity yet can achieve full AROM in a gravity-eliminated plane, the OTR can assign this client a muscle strength grade of 2+/5 (poor plus) and move on with the assessment procedure. B: If the client could achieve at least 50% AROM antigravity, the OTR could apply resistance into shoulder extension. C: This direction of resistance would not be appropriate because the OTR was checking for strength in shoulder flexion. D: If the OTR had any concerns about motion, the physician should have been contacted before any movement was measured.

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? Reaching into the closet above shoulder level for a pair of pants Using a fork and knife while sitting at the kitchen table Using a toothbrush and dental floss while standing at the sink Reaching for salt and pepper shakers on the table directly in front of the plate

Solution: The correct answer is A. Because the client has increasing strength in the distal joints of the upper extremity, positioning and weight of items will likely be the primary determinants of whether the client has difficulty with a task. Overhead tasks would require significant shoulder strength, which the client does not have. B, C, D: These tasks require only minimal use of shoulder muscles, which are this client's weakest muscle group. Because the client has increasing strength in the upper extremity from proximal joints to distal joints, feeding and reaching for items that are within reach in front of the client should pose less difficulty.

During an initial screening with a client who had a recent TBI, the OTR® asks the client to arrange picture cards in an order that will tell a story. This client arranges the cards in an incorrect sequence. What action should the OTR® take based on the client's performance during this task? Further assess neurobehavioral skills and abilities. Select intervention tasks that require sequencing. Identify modifications for the client to use during self-care. Administer a standardized test of cognitive abilities.

Solution: The correct answer is A. Because the screening was based on a picture card sequencing task, gathering additional information on the client's neurobehavioral skills and abilities related to task performance would be most beneficial. B, C: The OTR® has not gathered enough data through the evaluation process to implement an intervention plan. D: The OTR® may decide that administering a cognitive assessment may be necessary; however, assessing the client's neurobehavioral skills and abilities will provide more essential information for establishing functional goals through the evaluation process and planning for intervention.

Results from a manual muscle test indicate that a client who is in Stage II of amyotrophic lateral sclerosis has Good Minus (4−/5) strength of the intrinsic muscles. The client reports that by the end of a meal, it becomes extremely difficult to hold and manipulate eating utensils. Which assistive device will be MOST EFFECTIVE for the client to use during self-feeding at this stage of the disease process? Foam tubing to build up handles of eating utensils Standard universal cuff with elasticized strap Lightweight plastic eating utensils with contoured grip Wrist support with palmar pocket for inserting utensils

Solution: The correct answer is A. Built-up utensils will allow the client to use less grasp strength throughout the meal and will be effective in compensating for the decreased intrinsic muscle strength. B, D: The client has Good Minus strength in the intrinsic muscles and should be encouraged to continue using available grasp strength. Using a device that eliminates the need for the client grasp such as a universal cuff or palmar pocket wrist support would potentially decrease muscle strength. C: Decreasing the weight of the utensil would decrease the muscle strength needed to lift the utensil; however, the client is still required to use prolonged grasp strength to hold the utensil and would still fatigue with the task.

Policies that severely restrict driver's licensing for older adult drivers but do not simultaneously provide for transportation alternatives affect not only older adults but also the well-being of the local community. Which statement is MOST accurate about these wider effects on the community? Restaurants and businesses in areas with dense populations of older adults suffer financially because they lose customers who can no longer easily travel to them. The Department of Motor Vehicles suffers financially from loss of revenues from the license renewals of older adults. Local K12 schools experience an increased need for bus service when older adults can no longer serve as student carpool drivers. Roadways in areas with dense older adult populations fall into disrepair because of lack of traffic.

Solution: The correct answer is A. Business and restaurants that rely on local patronage but are located in areas of high-density older adult populations risk losing proceeds when local residents can no longer travel to them. B: No evidence indicates that the Department of Motor Vehicles loses revenues because of driving cessation by older adults. C: Most adults who drive school-age children in carpools are younger adults. D: Disrepair from decreased traffic because of driving cessation by older adults is not addressed in the literature on driving cessation.

An OTR® is working on an inpatient unit with a child who has a congenital heart defect. Before admission, the child was able to complete a basic self-care routine. Currently, despite wanting to complete the activities independently, the child requires assistance because of compromised endurance. What compensatory strategy or technique should the OTR® use to minimize the impact of the condition on the child's occupational performance? Pacing of activities Backward chaining of activities Forward chaining of activities Delegating activities

Solution: The correct answer is A. Children with congenital heart defects may want to be independent in play and self-care tasks. Pacing activities and selecting appropriate activities are two ways to promote their independence. B, C, D: These options would not allow the child to complete the activities independently.

A client diagnosed with dissociative personality disorder is admitted to an inpatient psychiatric hospital as a result of suicidal behavior and impulses, severe anxiety, and periods of violence brought on by the emergence of new personalities. How is the OTR® in this milieu therapy setting likely to intervene? Provide a safe, nonthreatening, success-oriented environment to increase the client's sense of control. Offer group therapy opportunities for verbalizing experiences and describing other personalities. Offer group training in development of coping skills. Offer participation in psychodrama groups to encourage catharsis.

Solution: The correct answer is A. Clients in the acute phases of multiple personality disorder require opportunities for safe and supportive exploration of new personalities. B, C, D: These options describe cathartic, verbal, and coping groups, respectively, which are not recommended for clients with multiple personality disorder. Clients with multiple personality disorder will tend to show more severe symptoms when provided with more opportunities to self-express, such as in nondirective cathartic and verbal groups.

A client left employment as an elementary school teacher because of impairments from a stroke 12 months previously and is now interested in pursuing a new occupation. A work skills interest assessment and performance skill measures indicate suitability for work as an administrative assistant. The client needs assistance in entering this new occupation and working with impairments. Which program would BEST provide this service? Vocational rehabilitation Supported employment Community center Employer consultation

Solution: The correct answer is A. Clients who leave a workplace because of impairments can receive assistance from vocational rehabilitation to return to that or another workplace. B: Supported employment provides support to clients with disabilities through training and support at the job site. C: Community centers provide services to certain populations (e.g., clients who are homeless, have mental illness, are living with HIV/AIDS, are in welfare-to-work programs). D: Employer consultation occurs directly through an employer and an organization.

An OTR® is discussing wheelchair options with a client with incomplete T3 spinal cord injury. The client asks whether the purchase of an electric wheelchair should be considered. How would the OTR® BEST respond? Electric wheelchairs are useful for long distances, although a manual wheelchair can promote improved function. Electric wheelchairs are very expensive and may not be covered by primary payer sources. Electric wheelchairs are large and bulky and will prevent accessibility in the home and community. Electric wheelchairs may stunt future progress in rehab.

Solution: The correct answer is A. Clients with T3 spinal cord injury are generally independent in their wheelchair mobility; recommendations include a rigid or folding lightweight wheelchair. B, D: These responses may be untrue and are not immediately relevant to the client's inquiry. C: This statement is not true.

An entry-level OTR® working in an outpatient rehabilitation clinic is evaluating a client who was recently hospitalized for dehydration and subsequently diagnosed with mild cognitive impairment. The client lives alone in an independent living facility. Before admission, the client was independent in ADLs and light homemaking and active in community and social activities, including driving independently. The client reports no crash record and no violations or citations but avoids night driving, highway driving, and driving in rush-hour traffic or heavy rain. By what means would the OTR® MOST APPROPRIATELY gather background information on the client's fitness to drive? Contact the Department of Motor Vehicles to verify the client's driving history, do a chart review, and gather collateral information. Do a chart review, and ask for a copy of the client's driver's license. Do a chart review, and interview a close relative about the client's driving skills and avoidance behaviors. Interview the client about the client's driving experiences and skills.

Solution: The correct answer is A. Collateral and background information from all these sources are necessary to form a comprehensive picture of the client's fitness-to-drive background. B, C, D: These data sources will not provide comprehensive background information on fitness to drive.

A client with traumatic brain injury has a field loss resulting in decreased scanning ability. The client has a goal to improve environmental scanning for tasks such as locating foods in the refrigerator and finding items in the grocery store. What intervention activity would be MOST appropriate for the OTR®; to have the client do? Scan the kitchen cupboards for meal preparation items Cross out horizontal lines on a piece of paper Read a paragraph of standard-size newsprint Use the Dynavision scan board in the clinic

Solution: The correct answer is A. Completing tasks that closely relate to the goal tasks and practicing them in similar environments allows for greater task generalization. B: Completing paper-and-pencil tasks does not generalize to produce improvement in IADL performance. C: Reading does not provide the scanning skills necessary to transfer to tasks requiring scanning of larger environments. D. The Dynavision is beneficial in improving reading and academic work but does not generalize to performance of larger tasks such as grocery shopping and meal preparation.

Each OTR® has a responsibility to respect a person's autonomy, as stated in Principle 3 of the Occupational Therapy Code of Ethics (2015). One way in which this principle is demonstrated is through maintenance of confidentiality. Which of the following examples best illustrates maintenance of confidentiality? Display responsible conduct and discretion when engaging in social networking, including refraining from posting protected health information. Respect and honor the expressed wishes of clients. Facilitate comprehension and address barriers to communication with clients. Promote shared decision making with all relevant stakeholders.

Solution: The correct answer is A. Compliance with HIPAA and using discretion during public communication are related to autonomy and confidentiality. B: This response relates to autonomy but does not demonstrate respect for privacy and confidentiality. C: This response relates to autonomy and its articulation with health literacy but does not illustrate respect for privacy and confidentiality. D: Shared decision making is an important component of autonomy but does not directly relate to confidentiality.

A client with early-stage Alzheimer's disease has increased difficulty with spatial orientation. Which occupational performance area does this difficulty most likely affect? Community mobility Grocery shopping Meal preparation Caring for pets and others

Solution: The correct answer is A. People with early-stage dementia have difficulty with IADLs because of early memory loss and other cognitive impairment. Difficulty with spatial orientation has an impact on their community mobility. B, C, D: Although all other IADLs might be impaired, spatial orientation will affect community mobility the most, making driving unsafe.

A classroom teacher observes that a 7-year-old student consistently has difficulty finishing handwritten assignments and fine motor activities. An OTR® is consulted to assess the student's handwriting skills with a goal of improving classroom performance. After observing the student and collecting writing samples, which task should the OTR® complete NEXT? Assess the student's perceptualmotor processing using standardized testing. Determine the most appropriate desk set-up for the student to complete class assignments. Instruct the teacher on ways to cue the student using kinesthetic learning techniques. Provide worksheets for the student to practice letter formation during study group.

Solution: The correct answer is A. Comprehensive evaluation should include standardized testing in addition to observation and nonstandardized writing samples to determine a need for further intervention and to develop an appropriate intervention plan. Perceptualmotor processing may interfere with handwriting skills and is an appropriate area to assess. B, C, D: The OTR® cannot determine an intervention plan until more information is gathered through the evaluation process including standardized assessments.

A client has a unilateral transradial amputation. The client will be fitted with a prosthetic device in 1 month. One of the client's goals is to be independent with BADL as soon as possible. The client refuses to use the uninvolved hand for toileting tasks, citing cultural reasons. What INITIAL action should the OTR® take in this situation? Talk with the client about using alternative strategies. Have the client practice the task using assistive devices. Revise the client's long-term goals based on cultural limitations. Focus on other tasks that are not impacted by cultural restrictions.

Solution: The correct answer is A. Cultural factors can affect a client's reaction and adjustment to disability and may require time for the client to adjust to the change in body image. Talking with the client allows the practitioner to help the client understand the importance of the prosthetic training program and the role that uninvolved hand use will have in completing basic ADLs. B: Assistive devices may not be needed to complete the task and will still require the client to use the uninvolved hand during toileting. C: The client has a goal to be independent with basic ADLs as soon as possible, so changing the long-term goals to accommodate the cultural limitations will not facilitate meeting the client-centered goals. D: Avoiding the issue that is causing the client conflict will not be beneficial to the client progressing to the prosthetic training program. Therapeutic intervention should facilitate this area of need and adjustment for the client.

An OTR® is treating a client with wrist tendinitis secondary to computer use. Before educating the client on wrist positions to avoid, the OTR® has applied iontophoresis to the affected area. Which medication would the OTR® be MOST likely to use with the iontophoresis? Dexamethasone Acetic acid Lidocaine Magnesium

Solution: The correct answer is A. Dexamethasone is the most widely used medication by therapists using iontophoresis because of its anti-inflammatory properties. B: Acetic acid is used for soft-tissue mineralization. C, D: Lidocaine and magnesium are used to reduce pain.

When fitting a client to a wheelchair, why is it important to ensure that the wheelchair has appropriate seat depth? To distribute body weight along the entire sitting surface To maintain the thighs in a position parallel to the floor To keep the depth of the chair as small as possible To provide support and alignment for the upper extremities

Solution: The correct answer is A. Distributing body weight along the sitting surface (along the entire length of the thigh to just behind the knee) helps to prevent pressure sores on the buttocks and the lower back and to attain optimal muscle tone normalization to assist in prevention of pressure sores throughout the body. B: Wheelchair seat height, rather than depth, determines thigh position in relation to the floor. C: If the seat depth is less than 1 to 2 inches away from the bent knee, the client can be at greater risk for pressure sores. D: Support and alignment for the upper extremities is an objective for armrest height, not seat depth.

A client recently began having difficulty walking and decided to borrow a wheelchair from a family member. However, the client complains that it is difficult to get into and out of the chair because the client's hips are wider than the seat. The client decides to purchase a chair and asks the OTR® for a recommendation on seat width. What should the OTR explain is the MAIN objective for proper wheelchair seat width? To distribute weight over the widest possible surface while keeping the width of the chair as narrow as possible To support the client's body in the wheelchair while maintaining the thighs in a position that is parallel to the floor To maintain proper posture and balance and to provide support and alignment for the upper extremities To provide for maximal function and support of the back while still allowing for change in body positioning

Solution: The correct answer is A. Distributing weight over the widest possible surface prevents too much pressure on any specific area. However, the narrower the width, the easier it is for the client to maneuver through the environment. Trying to find a balance between these two areas is key to good wheelchair selection. B: Supporting the client's body while maintaining the thighs parallel to the floor is the main objective of measuring seat height from the floor. C: Maintaining proper posture and balance and providing support and alignment for the upper extremities are the objectives of measuring for proper armrest height. D: Providing for maximal function and support of the back is the objective of measuring for proper back height, and allowing for changes in body positioning is another objective of measuring for armrest height.

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. What information about the patient is MOST IMPORTANT to document in the evaluation? Factors affecting performance Level of family interaction with the patient Projected time frame for recovery Scores from a standardized perceptual assessment

Solution: The correct answer is A. Documenting factors that affect performance is essential in the initial evaluation because it serves to support the need for occupational therapy services and establishes the areas to be addressed in the intervention plan. B, C, D: Each of these pieces of information may be included in documenting an initial evaluation; however, they are not the most important in establishing the need for occupational therapy services or supporting the intervention plan.

The caregiver of a client with Alzheimer's disease questions the home health OTR® about a recent increase in the client's dosage of donepezil (Aricept) prescribed by the physician. The caregiver is particularly concerned about potential consequences of the increased dosage. What is the OTR®'s most appropriate suggestion for the caregiver? Observe the client for signs of dizziness, which increases potential for falls. Because the medication can cause photosensitivity, keep the client out of direct sunlight. The physician will probably monitor the client closely for potential drug toxicity. Monitor the client's hydration carefully because the drug can cause dry mouth and constipation.

Solution: The correct answer is A. Donepezil is a cholinergic-modulating drug that may improve memory and cognition and reduce negative mood, anxiety, and hallucinations; however, dizziness is a side effect. B, C, D: These side effects are not common with donepezil.

A client reports visual stress, fatigue, and frequent double vision. On evaluation, the client demonstrates asymmetrical eye movement and difficulty moving the eyes together. The client would like to return to continuous reading tasks. Which intervention would be MOST appropriate for the OTR® to recommend? Occlusion under the supervision of a physician Eye exercises to improve eye coordination Additional task lighting when reading Visual search and scanning tasks with mobility

Solution: The correct answer is A. Double vision is eliminated by occlusion, which removes the image presented on one eye; occupational therapy practitioners can implement this intervention only under the direction of a physician. B: Eye exercises are recommended and directed by an optometrist or ophthalmologist. C, D: Additional task lighting and visual search and scanning tasks are not recommended interventions for oculomotor dysfunction.

An OTR®; is teaching a client with stroke compensatory strategies to don a pullover shirt. The client has hemiparesis that limits upper-extremity movement in the affected side. What is the FIRST step the client should be taught? Dress the affected arm by placing the sleeve over the affected arm Put the head through the neck opening by bending the neck forward Place the unaffected arm into the sleeve by placing the sleeve over the unaffected arm Rub the affected arm on the leg to straighten the sleeve

Solution: The correct answer is A. Dressing the weaker side should be the first step in upper-body dressing. B: The arms should be put into the sleeves before the shirt is placed over the head. C: When dressing with hemiparesis, the affected arm should be placed in the sleeve first. D: The arm must be placed in the sleeve before the sleeve needs to be straightened, and the unaffected arm can be used to straighten the sleeve on the affected arm.

An 18-year-old client is admitted to an inpatient psychiatric hospital. The psychiatrist describes an uninterrupted 18-month period of illness that includes visual and auditory hallucinations. What type of issues would the OTR® expect to see when the client attempts to do a task? Behavioral outbursts when frustrated with a project Overassertive, controlling behaviors during group activities Difficulty engaging in problem solving Panic over task choices

Solution: The correct answer is A. During task performance, clients with symptoms of schizophrenia can show elevated levels of frustration during challenging tasks. B, C, D: These behaviors are more indicative of Bipolar I disorder. Bipolar I disorder typically consists of more than one combined depressive and manic episode. Schizophrenia includes symptoms such as hallucinations, delusions, and disorganized speech.

An OTR® is consulting with the physical education teacher regarding a child with asthma. Which statement BEST explains how the OTR® can support the child in maximizing participation in physical education? Educate the child on breathing exercises, stretching, and controlled breathing. Educate the child on sensory and emotional self-regulation. Educate the child on energy conservation strategies. Educate the child on AROM and active assistive ROM exercises.

Solution: The correct answer is A. Educating the child regarding breathing exercises, stretching, and controlled breathing may help to alleviate an asthma attack by helping the child to remain calm and deal with stress. B: Children with asthma do not necessarily have any sensory or emotional self-regulation issues. Although they may need help to deal with stress, there's nothing in this case that suggests the child demonstrates inappropriate externalized behaviors. C: Children with asthma can participate in sports and other physical activities and generally do not need to conserve their energy. D: Children with asthma generally have typical AROM, unless they have another comorbid condition.

A factory worker is seen in an outpatient occupational therapy program to address difficulties with organizing and performing work duties because of depression. The OTR® recommends a job site analysis to facilitate the client's return to work. How does the focus of intervention change in the transition from outpatient services to the workplace? The focus moves from the individual client to the work environment. The focus moves from the client to the employer's policies for task completion. The focus moves from outpatient setting supports to workplace design. The focus moves from client-centered to employer-focused needs and goals.

Solution: The correct answer is A. Environmental supports facilitate the client's return to work. B: The employer's policies may influence task completion, but these policies are not the main focus of intervention. C: Neither component is a relevant focus of intervention. D: Occupational therapy intervention always remains client centered.

An OTR® is developing a job-finding program to assist clients who have an enduring mental illness. How will research findings about supported employment assist the OTR® in the program development process? Enables selection of intervention methods based on objective investigation Promotes the core values of occupational therapy and its roots in the behavioral sciences Supports practice techniques perceived to be beneficial for clients with a mental illness Provides evidence to resolve practice issues with administrators and reimbursement sources

Solution: The correct answer is A. Evidence-based practice is a priority within occupational therapy, and using evidence-based interventions is associated with better outcomes for clients. B: Using evidence to support intervention selections was established in behavioral science research, though the evidence may or may not relate to the core value of occupational therapy. C: Using evidence-based intervention is associated with better outcomes for clients though evidence-based practice techniques are supported with objective information, not perceptions of benefits. D: Research does not necessarily resolve practice issues with administrators and reimbursement sources, though it can be used as evidence to support occupational therapy services.

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? Daily PROM of the joints through full comfortable ROM Daily AROM of the joints through full comfortable ROM Isotonic progressive resistive exercises of the joints as tolerated 3 times a week No exercise program

Solution: The correct answer is A. Exercise to maintain ROM and strength is important for clients with RA. Although as a general principle AROM is preferred, during a flare-up PROM is indicated if pain makes it difficult for the client to do AROM. B: AROM is generally preferred, but this client has significant pain and swelling, making PROM a better choice. C: Isotonic (strengthening) exercises may place too much stress on inflamed joints during a flare-up. D: Clients with RA benefit from daily exercise even during a flare-up, and it should be encouraged.

An OTR® has completed an initial evaluation of a client who has recently been diagnosed with fibromyalgia. What type of client education is MOST IMPORTANT for the OTR® to include as part of the initial intervention? Strategies for integrating relaxation and work simplification into daily routines Guidelines for using upper- and lower-extremity joint protection during ADL Instructions and resources for purchasing assistive devices to use during ADL Methods for improving cardiovascular endurance during daily tasks

Solution: The correct answer is A. Fibromyalgia is a musculoskeletal pain syndrome that is widespread throughout the body. Relaxation training can be used to decrease muscle tension, and work simplification can be used to balance work and rest with activities. B: Joint protection techniques would not be most important for a client with fibromyalgia because symptoms of muscle fatigue and pain are most prevalent. C: Assistive devices may not be most important for the client, and assistive device needs may not be immediately known at the initial intervention until more information is gathered on client performance needs. D: Daily activities are not directly affected by cardiovascular endurance with fibromyalgia as much as pain affects a person's tolerance for daily activities. Cardiovascular exercise may be beneficial in managing fibromyalgia, though improving endurance for daily activities is not of primary importance.

An OTR® is evaluating the occupational performance of a client with Parkinson's disease. Which client factor is MOST relevant to assess? Fine motor skills Deficit awareness Tactile function Vestibular function

Solution: The correct answer is A. Fine motor incoordination often interferes with the ability to perform occupations such as writing, eating, shaving, and manipulating clothing fasteners in clients with Parkinson's disease. B: Clients with Parkinson's disease typically are not affected cognitively and are aware of their deficits. C: Sensory function, including numbness, paresthesia, and texture awareness, is not affected by Parkinson's disease. D: Clients with Parkinson's disease have balance difficulties during occupational performance that are related to postural instability, but vestibular sensation deficits are not the cause of these postural difficulties.

An older adult client who lives independently and has age-related macular degeneration reports difficulty reading small print. The OTR® completes acuity testing and determines that the client has visual acuity of 20/200. What recommendation should the OTR make? Increase illumination and enlarge print Reduce background contrast when reading See an eye care specialist for visual field testing Use occlusion to facilitate reading

Solution: The correct answer is A. For clients with visual acuity loss, increased illumination and enlarged print facilitate reading. B: Background contrast should be increased, not reduced, to promote visibility. C, D: Age-related macular degeneration does not result in changes in visual field or oculomotor function, so visual field testing and occlusion would not be recommended.

An OTR® is leading a group for clients who are depressed and unable to initiate activity or make choices about what to do. Which leadership style would be MOST effective with this group? Directive Facilitative Advisory Co-leadership

Solution: The correct answer is A. For participants who are unable to make choices or direct their behavior, the group leader must structure the group to limit the number of choices. A directive leadership style best ensures participants' success in engaging in the group activities. B, C, D: Facilitative, advisory, and co-leadership styles all require participants to select the activity and share leadership responsibilities. Participants unable to initiate activities or make choices for themselves would not respond well to these styles of group leadership.

A client is being discharged home after spending 2 weeks in rehab after a stroke. She has arrived for transfer safety training. For a wheelchair-to-bed standing pivot transfer, which of the following steps would be FIRST in the sequence of the transfer? Positioning the chair at a 45 angle to the bed Telling the client to scoot forward in the wheelchair. Swinging the footrests out of the way Setting the brakes on the wheelchair

Solution: The correct answer is A. For the client's safety, the wheelchair needs to be positioned with the least amount of space for him to travel. B, C, D: The brakes need to be set and the footrests moved out of the way to prevent the wheelchair from moving and the client from tripping on the footrest. The client would then be instructed to scoot forward in the wheelchair to make the transfer easier. These steps, however, are not the first step.

An OTR® is working with a child on tooth brushing. The OTR® lets the child brush the teeth for a minute. The child fails to brush the majority of the teeth. Next, the OTR® uses the toothbrush to brush all of the child's teeth. What strategy is the OTR® using with this child? Forward chaining Modifying Grading Backward chaining

Solution: The correct answer is A. Forward chaining involves the therapist encouraging the child to complete the first step of the task, and then the therapist completes the rest of the task. B: Modifying might include the use of other materials to complete the task . C: Grading is a way to modify a task and is consistent with adapting a task, or part of a task, to present the next "just-right" challenge. D: Backward chaining is consistent with the therapist's performing the majority of the task and having the child completing the last part of the task.

During an assessment, an OTR asks the client to pinch a pinch gauge and notices increased flexion of the thumb interphalangeal joint. What term is used to describe this type of pinch? Froment's sign Wartenberg's sign Jeanne's sign Ulnar claw

Solution: The correct answer is A. Froment's sign occurs when the flexor pollicis longus compensates for a weak or paralyzed adductor pollicis and flexor pollicis brevis. When a client attempts to pinch, the interphalangeal joint of the thumb flexes more than usual. B: Wartenberg's sign is the little finger held in abduction. C: Jeanne's sign is hyperextension of the proximal phalanx of the thumb when pinching. D: Ulnar claw refers to hand posture with ulnar nerve injury.

A 76-year-old client will be using a wheelchair after discharge from an acute rehabilitation facility. The client has achieved independence in wheelchair mobility on level surfaces but still requires minimal assistance for transfer. The client is planning to move into a daughter's home, which was not the client's previous residence. The OTR® is planning for an onsite home evaluation with the client and the client's daughter. Before the home evaluation, what will be the MOST appropriate action for the OTR® to take? Interview the client and daughter to obtain an appropriate profile and determine role expectations that the client will assume on discharge. Discuss with the client functional mobility limitations and the level of assistance required for toilet transfer as part of fall prevention education. Interview the daughter regarding detailed measurements and the physical layout of the home and acceptance of the necessary home modifications. Provide the client and daughter with information regarding the Americans With Disabilities Act's (Pub. L. 101336) accessibility guidelines for buildings and facilities.

Solution: The correct answer is A. Gathering information on role expectation helps to determine the performance assessments to be completed during the home evaluation (e.g., if the client is expected to do laundry, then accessibility to the laundry room will be assessed during the home assessment). B: Fall prevention education is an ongoing process throughout the course of rehabilitation. C: A rough draft of the physical layout can be obtained before the home evaluation as part of the planning. Detailed measurements will be taken during the home evaluation. D: ADA information is not needed before the onsite home evaluation.

A 12-year-old client has been injured in an automobile crash and wants to access the Internet and social media as well as keep up with schoolwork online. The client's left upper extremity is immobilized. The client has wounds in the right hand and wrist but has some right thumb adduction and limited but improving range of motion in the elbow and shoulder. What is the BEST solution for this client while the client heals? Speech input on a laptop or smartphone Desktop computer with ergonomic keyboard Touch screen with physical pointer Switch-encoding input

Solution: The correct answer is A. Given the client's improving condition, using speech commands with a laptop or smartphone is the best solution while this client heals. Most operating systems include speech accessibility tools. B: The client has use of only one hand, and that use is limited; a full keyboard, regardless of layout, is not useful at this stage of the client's recovery. C, D: The client's injuries do not warrant this level of assistive technology.

A 12-year-old client with cerebral palsy and spastic quadriplegia wants to access the Internet and e-mail on the computer. The client has poor head control and is using a headband to maintain the head in midline. The client is able to turn the head to the right to operate the suction machine using head control input. The client's left upper extremity has no active movement, and the left elbow has 90° flexion contracture. The client is able to flex the right shoulder to 60° against gravity, and the right elbow has trace active movement. The client has no active wrist or finger movement except minimal right thumb adduction. What is the BEST input control for this client? Eye-tracking input Mouth stick control Head pointer Switch-encoding input

Solution: The correct answer is A. Given the client's lack of volitional head control and upper-extremity movement, eye-tracking is the best mode of input. The headband can help steady the client's head for eye-tracking movement for input on a virtual keyboard. B: The client is using a suction machine, which indicates inadequate oral secretion control; therefore, using a mouth stick control is not desirable. C: The client does not have adequate ability to move and steady the head to use a head pointer as an input device. Although the head is stabilized with a headband, the child needs to turn the head to complete suction regularly, so it is not desirable to use the same system for input. Using eye tracking, the child can close the eyes when turning the head for suctioning and cease the input. With a head pointer, the child could have difficulty ceasing input when turning the head for suctioning. D: Switch-encoding input requires the ability to input with at least one finger control. Although the client has some right thumb adduction, it is not adequate to operate a switch-encoding input device.

An OTR®; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The OTR writes the following goal for one group member using the COAST method: "The client will cook a meal before being discharged." Which phrase represents the MOST measurable formulation of the client (or C) element of this goal? "The client will complete all steps of cooking a meal." "The client will understand how to cook a meal." "The client will know how to cook a meal." "The client will do all parts of cooking a meal."

Solution: The correct answer is A. Goals should describe what a client will be able to do after successful occupational therapy intervention. Accordingly, goals should be written using measurable action verbs such as demonstrate, perform, and complete. B, C: Understand and know are not measurable action verbs. D: Do is a vague action verb that is not easily measured.

A home health client has hemiplegia secondary to having had a CVA 1 month ago. The client completes BADL using assistive devices and ambulates in the home with a quad cane. The client requires stand-by assistance for balance when walking outdoors on uneven surfaces. One of the client's goals is to resume a favorite leisure activity of gardening in a small backyard vegetable garden. Which task would be MOST BENEFICIAL to have the client complete as part of the initial intervention for progressing toward the client's goal? Apply adaptive strategies during graded outdoor gardening tasks. Set up a routine maintenance schedule to care for indoor flowers and plants. Practice mobility skills for going to and from a community gardening class. Participate in building planter boxes to establish a raised garden bed.

Solution: The correct answer is A. Graded gardening tasks outdoors will allow the client to progress to performing this leisure activity, and working on outdoor gardening tasks will allow the client to gain skills in the natural context of the activity as long as the practitioner has deemed the activity is safe for the client to perform. B: The client's problem area is in walking outdoors on uneven surfaces, so providing a schedule of indoor activity would not effectively address the client's problem. C: Mobility skills for accessing a community gardening class may not generalize to improved mobility skills in the client's own outdoor garden. Practicing task performance in context would be most beneficial. D: The client's problem area is in walking outdoors on uneven surfaces, so raising the garden bed height would not effectively address the client's problem.

An OTR® who works with adult clients with mental illness attends an introductory workshop on guided imagery. The OTR wants to begin applying the skills obtained from the workshop with clients. For which type of disorder is guided imagery an appropriate intervention technique? Generalized stress disorder Chronic schizophrenia Bipolar disorder with psychosis Schizoaffective disorder

Solution: The correct answer is A. Guided imagery is a type of mindfulness technique that encourages relaxation. It is an evidence-based strategy that has been found to be effective with people with stress-related disorders. The technique allows clients to practice skills in a situation with less pressure than might be encountered in a real situation, which gives them the ability to approach the real-life situation with less anticipatory stress and strategies to cope with stress as it arises. B, D: Guided imagery is most effective with people who have anxiety or stress-related disorders. Clients with psychosis would have difficulty with guided imagery, and both B and D have psychosis as a distinguishing feature. Guided imagery is least effective with people who have any type of psychosis, who would have difficulty following the directions of the activity to create meaningful imagery. C: Guided imagery is most effective with people who have anxiety or stress-related disorders. Although it can be used with people with bipolar disorder, they would have more difficulty attending to the task because of either depression (decline in motivation) or mania (decreased attention).

An OTR® 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? The client imagines using a dressing stick while the OTR describes the process of lower body dressing as the client visualizes completing the activity. 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). The client uses various garments to practice lower-extremity dressing (e.g., shorts, sweatpants). 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.

Solution: The correct answer is A. Guided imagery is an evidence-based cognitive strategy that can facilitate improved motor learning. B: This option is an example of part practice (vs. whole practice) of the task because the task can be broken into discreet steps and practiced step by step until mastered. C, D: These options are examples of a random practice schedule, in which practice of the task is varied by surface or materials to improve long-term retention of the skills.

When an OTR® or COTA® completes documentation, which of the following actions is MOST in compliance with HIPAA regulations for maintaining patient privacy and confidentiality? Positioning computer screens and patient charts out of others' view Collaborating with other therapists in the OTR®'s discipline Maintaining electronic client documents Keeping hard-copy records in a central area

Solution: The correct answer is A. HIPAA helps protect the privacy and confidentiality of patient health records. Ensuring that unauthorized personnel and other patients cannot view patient information helps protect privacy. B: Collaborating with others does not protect privacy. C: Electronic records alone do not ensure privacy; they must be password protected, and other steps must be taken to ensure that only authorized personnel can view them. D: Keeping records in a central area is efficient, but unless the area is kept locked, centralization does not ensure privacy.

A client with low vision was prescribed a handheld magnifier to promote reading. The client reports to the OTR® that the handheld magnifier does not make text clear enough to read. Which recommendation is BEST for the OTR to make? The handheld magnifier should be held at a predetermined distance from what is being read. The handheld magnifier should be held up to the eye to see objects in the distance. With stronger magnification, the field of view is larger and the magnifier is held closer. With weaker magnification, the field of view is smaller and the magnifier is held farther away.

Solution: The correct answer is A. Handheld magnifiers, which are prescribed by an optometrist or ophthalmologist, must be held at a predetermined distance from what is being read. B: Handheld magnifiers are used for reading and are not intended to view distant objects. C, D: These statements, which are irrelevant to the client's difficulty using a single magnifier, are also incorrect; in fact, the stronger the magnification, the smaller the field of view and the closer the magnifier is held to the eye.

An OTR® is treating a client who, because of increased right leg weakness, has recently begun using a right footrest to avoid foot drag during wheelchair propulsion. What would be the benefit of using a heel loop on the footplate of the wheelchair? To prevent the foot from sliding backward To accommodate for ankle flexion To accommodate for preferred knee flexion angle To prevent falls during transfers

Solution: The correct answer is A. Heel loops can be attached to the back of the footplate to prevent the foot from sliding backward, especially when there is decreased control of the foot secondary to leg weakness. B: Adjusting the angle of the footplate, not use of a heel loop, accommodates ankle flexion. C: Angle options for the entire leg rest, not a heel loop, accommodate for the preferred knee flexion angle. D: Footrests that are removable (swing-away) help to prevent trips and falls during transfers regardless of whether heel loops are used.

After stroke, a client has difficulty orienting to relevant visual stimuli on the left side, including food on the plate and grooming items on the counter. The client completes feeding and grooming tasks swiftly and with reduced effort. What symptom would the OTR® report in the client's evaluation results? Hemispatial visual neglect Visual acuity deficit Visual field deficit Motor neglect

Solution: The correct answer is A. Hemispatial visual neglect is the inability to orient to relevant contralateral visual stimuli. It occurs when the left brain is damaged or when there is a lesion in the right hemisphere. This client demonstrates a scanning pattern that is carried out with reduced effort and little or no rescanning. B: Visual acuity is the ability of the eyes to make what is seen sharp and clear. C: Visual field deficit can occur with unilateral neglect; however, this client's swift completion of the task and reduced effort with scanning are neglect behaviors. D: Motor neglect presents as impaired initiation or extinction of movement into contralateral hemispace by either limb.

A client with stroke is in inpatient rehabilitation, and at the start of the intervention session the OTR® is observing as the client sits at the dining table in a wheelchair. The client's hips are extended, and the client is leaning on the unaffected left upper extremity. What should the OTR's FIRST approach be? Reposition the client in the wheelchair with hips flexed at 90° and the upper extremity resting in the lap Transfer the client to another wheelchair that provides a lap tray for upper-extremity support. Transfer the client to a standard chair with arms for positioning in posterior pelvic tilt. Complete the Berg Balance Scale to determine the client's postural needs

Solution: The correct answer is A. Ideal seated posture for a client with hemiparesis is hips flexed at 90° with shoulders over hips and arms relaxed in lap; the upper extremities should not be used to provide support in sitting. B: Clients with hemiparesis need frequent repositioning in sitting to maintain upright posture; supine positioning does not facilitate the return of muscle strength for sitting and should not be the first choice. C: Changing the chair surface does not necessarily improve the client's positioning in the chair. D: The Berg Balance Scale is recommended as an evaluation tool for clients with stroke, but assessment is not the appropriate first approach given the client's current position. Correcting the client's positioning is first priority.

An OTR® has been treating a client with a distal radius fracture. Because normal pain-free range of motion (ROM) may not be possible after this injury, the OTR has refocused efforts on gaining pain-free motion within the client's functional ROM. How would the OTR determine this client's functional ROM? Assist the client in identifying activities the client wants or needs to be able to accomplish with the affected extremity and incorporate practice of these specific activities Measure passive ROM to determine the available range of the affected extremity and then focus on place and hold exercises within that available range Review the evidence to determine specific measurements that correspond to functional ROM and then formulate functional ROM goals for the client Use goniometric measurements of the unaffected extremity to create ROM goals for the affected extremity

Solution: The correct answer is A. Identifying activities with meaning for the individual client allows the OTR to measure functional ROM needed for those activities. B: Passive ROM is not a clear indicator of the client's functional ROM. C: Functional ROM must be determined individually for each client. D: Goniometry of the unaffected extremity does not identify functional ROM for the affected side.

A client has impaired executive functioning secondary to a TBI. During an initial interview, the spouse reports this impairment is disrupting family members' work and school schedules and daily routines. What information is MOST IMPORTANT for the OTR® to gather when evaluating the client's skills? Performance patterns and contexts within the household Results from standardized observational assessments Client's current community living needs and abilities Outcomes of a roles and leisure activity checklist

Solution: The correct answer is A. Identifying performance patterns and contexts of the client would be beneficial information to gather given the spouse's report of client deficits disrupting routines. B: Standardized observational assessments are not indicated from the initial interview because the deficit areas appear to be related to executive functioning. C: Current community living needs and abilities do not seem to be indicated as a deficit area in the initial interview, and the client is living at home with the spouse. D: Assessing roles and leisure activity through checklists was not indicated as a deficit area in the initial interview and so would not be the most important area to gather information about.

A client's family purchased an ultra lightweight wheelchair (K0005) for the client. It has the correct seat height, seat width, and seat depth, but the client has difficulty propelling it. The OTR® asks the client to demonstrate moving the chair forward. What two potential problems would the OTR® FIRST focus on? Location of the axle in relation to the client's center of gravity, seat-back height Height of seat back, position of leg rests Position of leg rests, location of axle in relation to the client's center of gravity Distance of axle from the floor; location of the axle in relation to the client's center of gravity

Solution: The correct answer is A. If the axle is behind the client's center of gravity, the client may not be able to grasp enough of the pushrim during propulsion, making movement less efficient; if the seat back is too high, it can prevent the shoulder extension necessary to contact the pushrim. B, C, D: The position of the leg rests will not have a major impact on propulsion, nor will the height of the axle from the floor.

Believing that treatment was not medically necessary, a third-party payer has denied payment for occupational therapy services. What step should the OTR®; take to appeal the denial of payment? Write an appeal letter that explains the client's need for the occupational therapy services that were provided. Correct technical errors in previously submitted documentation. Write an appeal letter that requests reconsideration of previously submitted documentation. Ask the payer whether a different intervention would better fit the payment guidelines.

Solution: The correct answer is A. If the client's treatment was medically necessary, an OTR's appeal letter should describe and explain the rationale for providing services. The letter should also include a direct request to overturn the decision to deny payment. B: Payment was not denied on the basis of documentation error, so this action would not address the reason for denial of payment. C: Unaltered, the previously submitted documentation does not provide new information on which the payer can consider reversing the decision to deny payment. D: It is the OTR's responsibility to provide justifiable treatment and appropriately document it according to the payer's guidelines. Seeking information about which treatments the payer prefers could be seen as a breach of professional ethics.

An OTR® is working with an elderly client with mild cognitive impairment (MCI) resulting in deficits in information-processing speed. Which pattern can the OTR® expect to see in the driver's on-road performance? Slow recognition of signs, signals, or traffic scenes Difficulty distinguishing between a gray car and the environment on a rainy day Difficulty finding the way to the local grocery store Difficulty manipulating the vehicle controls

Solution: The correct answer is A. Impaired visual information-processing speed is associated with normal aging and mild cognitive impairment. B: Difficulty distinguishing between a gray car and the environment would be experienced with impaired contrast sensitivity C: A person with MCI will very likely remember the way to the local grocery store. D: There is no reason to expect that someone with MCI will have difficulty manipulating the vehicle controls.

A corporate client has hired an OTR® as an injury prevention consultant. How might the OTR's role BEST be described? Educating managers and other employees in ways to control and reduce workplace musculoskeletal injuries and in designing an ergonomic team Evaluating employees and treating those with upper-extremity musculoskeletal injuries Educating employees to be self-sufficient in ADL management after injury Prescribing therapeutic exercise and orthotics for injured employees

Solution: The correct answer is A. In a consultant role, the OTR provides services to the corporate client as whole, not to individual employees of the company. B, C, D: The OTR playing a consultant role does not provide treatment to individual employees.

An OTR® enters the hospital room of an adult client who is recovering from total knee replacement and sees that other people are in the room. What action should the OTR take before beginning an intervention session in order to maintain confidentiality? Ask the visitors to step out of the room for a few minutes, and then ask the client whether he or she wants the visitors to stay or go. Greet the visitors, and then explain the goals of the client's occupational therapy session. Greet the visitors, and then explain that they cannot interrupt the session and ask them to leave. Explain the purpose of occupational therapy to everybody in the room.

Solution: The correct answer is A. In the Occupational Therapy Code of Ethics (2015), Principle 3, Autonomy, states, "Occupational therapy personnel shall respect the right of the individual to self-determination, privacy, confidentiality, and consent." This approach ensures that the client's wishes with regard to the confidentiality of the session are maintained. B: This option does not protect the patient's confidentiality. This option automatically includes persons in the room into the discussion. C: This approach does not respect the patient's autonomy because it presumes that the patient does not want the visitors there. D: This option is not the best use of the OTR's time, may be an imposition on the visitors, and may inadvertently reveal information that should remain confidential; however, it is appropriate to explain the concept of occupational therapy to the visitors if they show interest.

An OTR® is engaged in a casual discussion with a colleague about a client. The OTR conveys that the client is rude and obnoxious but deserves to be treated equally. What is the ethical basis for the OTR's comment? Justice Fidelity Nonmaleficence Veracity

Solution: The correct answer is A. In the Occupational Therapy Code of Ethics (2015), Principle 4, Justice, states, "Occupational therapy personnel shall promote fairness and objectivity in the provision of occupational therapy services." B: In the Occupational Therapy Code of Ethics (2015), Principle 6, Fidelity, states, "Occupational therapy personnel shall treat clients, colleagues, and other professionals with respect, fairness, discretion, and integrity." C: In the Occupational Therapy Code of Ethics (2015), Principle 2, Nonmaleficence, states, "Occupational therapy personnel shall refrain from actions that cause harm." D: In the Occupational Therapy Code of Ethics (2015), Principle 5, Veracity, states, "Occupational therapy personnel shall provide comprehensive, accurate, and objective information when representing the profession."

An OTR is providing education to a client who has undergone surgical nerve repair to the median nerve. The client has a medical background, so when the OTR explains nerve regeneration, which sensation should the OTR indicate is likely to return FIRST? One-point moving One-point discrimination Two-point moving Two-point discrimination

Solution: The correct answer is A. In the realm of nerve healing and testing, the order in which recovery occurs is one-point moving, one-point discrimination, two-point moving, and finally two-point discrimination. B, C, D: In nerve healing and testing, the order in which recovery can be seen is one-point moving, one-point discrimination, two-point moving, and finally two-point discrimination.

Which strategy is MOST appropriate strategy for resolving conflicts in the workplace? Listening effectively when others are speaking Using emotions during the conversation Commenting on staff's strengths and weaknesses Describing how the conflict will be resolved

Solution: The correct answer is A. Listening effectively helps ensure that each person feels heard and understands what others are saying. B: It is best to try to maintain emotional control during conflict resolution so that the focus is on what is being resolved. C: This strategy is not effective for resolving conflicts in the workplace because it focuses on personal issues rather than the ideas that others are stating. D: It is more effective to include others in problem solving to help them feel a part of the solution.

An OTR® is working with a client with Guillain-Barré syndrome who is in the recovery phase. Which intervention BEST addresses the needs of the client in this phase? Instruct the client in energy conservation and fatigue management strategies Start progressive resistive activities for strengthening at the client's greatest level of tolerance Advise the client to use assistive devices as much as possible to avoid fatigue while performing ADLs Provide wrist and finger resting splints to help the client avoid overuse of the hands

Solution: The correct answer is A. In the recovery phase of Guillain-Barré syndrome, taking rest periods without pushing to the point of fatigue is recommended while gradually increasing tolerance for activity. B: Clients with Guillain-Barré syndrome should not be pushed to the point of fatigue, which will occur with strengthening at the highest level of tolerance. C: In the recovery phase, the client should be encouraged to achieve optimal function by gradually increasing tolerance for the number and complexity of tasks, so use of assistive devices would be discouraged. D: The client should be encouraged to use the upper extremities within tolerance for ADLs; use of a resting splint is not indicated.

State laws vary with regard to use of physical agent modalities (PAMs) by OTR®s. When explaining how PAMs fit within the scope of occupational therapy practice in their state, which description of PAMs should OTRs use, provided in the Occupational Therapy Practice Framework: Domain and Process? Interventions to support occupations; methods that prepare the client for occupational performance Occupation-based interventions that are systematically applied to modify specific client factors that may be limiting occupational performance Activities that support performance skills and patterns Preparatory tasks that target specific client factors or performance skills

Solution: The correct answer is A. Interventions to support occupations are described in the OTPF-4 as "methods and tasks that prepare the client for occupational performance are used as part of a treatment session in preparation for or concurrently with occupations and activities or provided to a client as a home-based engagement to support daily occupational performance" (AOTA, 2020, p. 59). B, C, D: PAMs are interventions to support occupations. They are not purposeful activities or occupation-based treatment. Rather, they precede client engagement in purposeful and occupation-based therapy.

An OTR® is reevaluating a client who has received six iontophoresis treatments within a 2-week period. The client reports there has been no change in symptoms compared to the day of the initial physical agent modality administration. What action should the OTR® take with regard to the iontophoresis based on the client's report? Discontinue the use of the iontophoresis until the physician is consulted. Continue to administer the iontophoresis for an additional 56 sessions. Obtain a prescription to increase the medication used in the electrodes. Increase the intensity of the electrical current used with the iontophoresis.

Solution: The correct answer is A. Iontophoresis treatment should be discontinued if the client has not reported at least 50% relief of symptoms. B: Iontophoresis treatment should be discontinued after four to six sessions if the client has not reported at least 50% relief of symptoms. C: Doubling the medication will have no effect on the impact of the iontophoresis treatment. D: Increasing the current may cause discomfort or a galvanic rash (an allergic reaction to the current); current should be set at a client's level of comfort to prevent skin irritation and burning.

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? Evaluation of eating Evaluation of meal preparation Evaluation of knowledge of nutrition Evaluation of feeding

Solution: The correct answer is A. 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). B: The hip fracture would have affected the client's ability to complete meal preparations, but it is not an underlying cause of the malnutrition because the hip fracture is recent and the malnutrition is longstanding. C, D: The client was successfully preventing malnutrition until 4 months ago, suggesting sufficient knowledge of nutrition and feeding skills.

A client with dementia is having difficulty locating the bathroom in the home, which is creating strain for the caregiver. What is the BEST recommendation the OTR® can give the caregiver to assist the client with this task? Use arrows on the walls to indicate the location of the bathroom. Paint the walls near the bathroom bright red to create contrast. Use low lighting in the hallway leading to the bathroom to reduce distraction. Place the names of commonly used bathroom items on the door of the bathroom.

Solution: The correct answer is A. Labeling physical structures with symbols, such as arrows for direction, is helpful to people with dementia. B: Bright colors are not recommended, because they might be overly stimulating for people with dementia. C: Low lighting would not be beneficial, because it might not be adequate for a person to identify items, leading to confusion. D: At the middle stage of dementia, written words may create confusion. Picture labels are more effective.

An OTR® plans to use a top-down approach to assess a 15-year-old child with attention deficit hyperactivity disorder and oppositional defiant disorder. Which top-down frame of reference emphasizes the three "dimensions of doing" at the participation, performance, and skills level? PersonEnvironmentOccupation Model Occupational Adaptation Model Model of Human Occupation Ecology of Human Performance Model

Solution: The correct answer is C. The Model of Human Occupation articulates the three dimensions of doing. A, B, D: The other frames of reference do not use the term dimensions of doing of participation, performance, and skills.

An OTR® who works with adult clients with mental illness attends an introductory workshop on guided imagery. The OTR® wants to begin applying the skills obtained from the workshop with clients. With which of the following clients would it be MOST appropriate for the OTR® to use guided imagery? Clients with generalized stress disorder Clients with chronic schizophrenia Clients with chronic bipolar disorder with psychotic episodes Clients with schizoaffective disorder

Solution: The correct answer is A. Many people respond well to relaxation with guided imagery, but guided imagery alone is contraindicated for people with hallucination potential, such as in schizophrenia, bipolar disorder with psychosis, or schizoaffective disorder. B, C, D: Clients with psychotic disorders will not benefit from imagery techniques because this approach might worsen positive symptoms.

An OTR® working at an outpatient clinic receives a physician's order for occupational therapy evaluation and intervention for a new client. During the first appointment with the OTR®, the client asks, "Will Medicare pay for this?" How should the OTR® answer? Medicare Part B covers 80% of allowable costs after the yearly deductible. Medicare Part B covers 20% of allowable occupational therapy services. Medicare Part A covers 100% of allowable services after the deductible. Medicare Part A covers 50% of the allowable amount for the services.

Solution: The correct answer is A. Medicare Part B covers 80% of the occupational therapy services in outpatient settings after the yearly deductible. B: Medicare B covers 80% of allowable costs after the yearly deductible. C, D: Medicare Part A covers hospital services.

An OTR® provides consultation to a senior activity center, where many clients engage in tabletop games. Which recommendation would be MOST beneficial to promote clients' engagement in this activity? Increase general lighting and provide task lighting Increase clients' visual search and scanning Provide eye exercises for those with low vision Provide rulers or cards for clients to use to underline print when reading

Solution: The correct answer is A. More than 2.4 million adults age 40 or older in the United States have low vision, and age is the single best predictor of low vision and blindness. Increasing the intensity and amount of available light enables objects and environmental features to be seen more readily, reducing the need for high contrast between objects. B: Visual search and scanning patterns are used by people with visual field deficits and would not be appropriate for all senior center clients. C: Eye exercises promote oculomotor function and would not be appropriate for all senior center clients; in addition, they must be prescribed by an eye care provider. D: Rulers and cards are used to underline print for people with visual field loss and difficulty staying on the line. They would not be appropriate for all senior center clients.

As part of an intervention plan, a client with multiple sclerosis has had training in strategies to limit energy expenditure on meaningful activities. The client reports increased fatigue when grocery shopping in the afternoon. Which of the following items is a recognized energy management strategy to address this fatigue? Do grocery shopping in the morning. Maintain a lower body temperature to decrease fatigue. Use adaptive equipment for meal preparation. Participate in a water exercise program to help reduce weakness.

Solution: The correct answer is A. Moving important activities to the morning, when the client's energy is highest, can maximize activity completion. B: Although increased body temperature can increase fatigue, no contextual factor is present that may increase the client's body temperature during the task of grocery shopping. C, D: These are not related to the client's problem.

For a client in the early stages of Parkinson's disease, which area should the OTR® focus on FIRST when completing an occupational profile? Interest in social and leisure activities Ability to feed self in a timely manner Seating and positioning for a wheelchair Availability of a full-time aide or caregiver

Solution: The correct answer is A. People in the early stage of Parkinson's disease are at risk for decreased interest in social and leisure activities and resulting isolation. B: Difficulty with self-feeding, including swallowing, does not typically occur until the intermediate stage of the disorder. C: In the early stage, the client is likely still to be mobile and not to require the use of a wheelchair. D: A client in the early stage of Parkinson's disease is not likely to require a full-time caregiver; assistance with self-care and IADLs typically is not needed until the intermediate stage of the disease.

OTR®s have an ethical responsibility, through the evaluation process, to identify impairments in occupational performance that may correlate with driving risks in clients that may potentially harm other road users. As such, even if they do not have a legal responsibility to report these impairments to the state, reporting because of an ethical concern should occur. This obligation is consistent with which principle articulated in the Occupational Therapy Code of Ethics and Ethics Standards? Principle 2: Nonmaleficence Principle 3: Autonomy and confidentiality Principle 4: Social justice Principle 6: Veracity

Solution: The correct answer is A. Nonmaleficence mandates that "occupational therapy personnel shall intentionally refrain from actions that cause harm" (AOTA, 2010, p. S19), which includes not only protecting the safety of clients but also, by extension, protecting the public from actions that have a high likelihood of causing harm. B: The principle of autonomy and confidentiality expresses the concept that practitioners have a duty to treat the client according to the client's desires, within the bounds of accepted standards of care, and to protect the client's confidential information. C: Social justice, also called distributive justice, refers to the fair, equitable, and appropriate distribution of resources. D: Veracity is based on the virtues of truthfulness, candor, and honesty. The principle of veracity in health care refers to comprehensive, accurate, and objective transmission of information and includes fostering the client's understanding of such information.

A client reports diplopia, or side-by-side double images, and demonstrates asymmetrical pupil sizes and a droopy eyelid. What would be MOST appropriate for the OTR® to evaluate? Oculomotor function Visual acuity deficit Contrast sensitivity Visual field deficit

Solution: The correct answer is A. Oculomotor function is responsible for the symptoms the client is reporting. When images double side by side for near-vision tasks, pupils are asymmetrical, and ptosis (droopiness) of the eyelid occur, cranial nerves may be injured. B: Clients with visual acuity problems most often report blurred vision. C: Clients with decreased contrast sensitivity most often report difficulty going out in the evening because of the challenges associated with maneuvering in low light. D: Clients with visual field deficits most often report bumping into objects, difficulty locating items, and difficulty reading.

A client sustained a peripheral nerve injury 6 months ago and has regained initial perception of moving and constant touch stimulation at the fingertips. The OTR® is selecting activities for a graded tactilekinesthetic training program for the client. Which type of activity would be MOST BENEFICIAL to include as part of this program at this phase of the client's recovery? Manipulating common objects with eyes open then with eyes closed Locating small objects hidden in containers of contact particles Identifying shapes and textures of common objects with vision occluded Rubbing a variety of textures in succession across the fingertips

Solution: The correct answer is A. Once protective sensation and touch sensation have returned to fingertips, intervention includes a variety of stimuli presented repetitively: The client first observes what is happening, then closes the eyes to concentrate on the touch sensation. This process provides feedback to retrain further tactilekinesthetic abilities. B, C: Because the client has initial recovery of movement and constant touch stimulation, the client may not be ready to discriminate textures without the use of visual cues, as required with these activities. D: Clients in sensory reeducation who have initially regained constant touch and moving touch should initially be presented with objects that require manipulation to develop discrimination ability, not passive texture stimulation.

A client has been referred to occupational therapy for a wheeled mobility assessment. The client has a standard wheelchair (K0001), which he can propel, but wants the OTR® to recommend a power wheelchair so that he can visit around the neighborhood with greater ease. There has been no change in his functional status or ability to accomplish activities of daily living (ADLs) at home. His wife states that she is able to push him in the neighborhood if he needs help, but he tells the OTR® that he needs to get out of the house ALONE. Why is the client ineligible for Medicare coverage for a power wheelchair under current regulations? He is able to accomplish ADLs in the home. He prefers, but does not need, a power wheelchair. He does not want caregiver assistance, even though it is available. He wants a power wheelchair to visit in the neighborhood.

Solution: The correct answer is A. One of several criteria for prescription of a power wheelchair is that the client needs the equipment to safely and effectively perform ADLs in the home. B, C, D: These are not factors in determining eligibility for a power wheelchair.

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? The thumb should be splinted in opposition and palmar abduction to facilitate thumb-to-tip prehension. The thumb should not be included in a carpal tunnel orthotic to allow for functional prehension. The thumb should be splinted in opposition and radial abduction to facilitate thumb-to-tip prehension. The thumb should be splinted in extension to limit shortening of the extensor pollicus longus.

Solution: The correct answer is A. Opposition and palmar abduction represent the functional position of the thumb that best allows pinch. B: Chronic median nerve compression, which affects the thumb, severely limits functional prehension. Splinting should address the thumb to maintain a functional position and maintain the first web space. C: Radial abduction does not position the thumb for thumb-to-tip pinch. D: Positioning the thumb in extension shortens the extensor pollicis longus.

A client has just undergone hip replacement surgery. Within what time period should an OTR® generally begin performing out-of-bed activities with the client? 1-3 days 12 hours 12 weeks 1 month

Solution: The correct answer is A. Out-of-bed activity should occur early with hip replacement clients, traditionally between 1 and 3 days postoperation. B: Twelve hours is generally too early to begin out-of-bed activity. C, D: 12 weeks and 1 month are generally well beyond guidelines for beginning out-of-bed activities.

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? Reaching an upper cupboard to obtain a box of cereal Transporting silverware from the dishwasher to the silverware drawer Sweeping the kitchen floor after a meal Making toast using a toaster

Solution: The correct answer is A. 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. B, C, D: Achondroplasia, or dwarfism, would likely not interfere with the client's completing any of these tasks.

An OTR® is planning an occupational therapy intervention focused on leisure exploration for a client with oppositional defiant disorder who likes graffiti, body piercings, and tattoos. Which activity would be MOST appropriate? Making posters with colored markers on poster paper Leather tooling a wallet with premade designs Knitting a blanket following an assigned pattern Freestyle painting a design on the wall in a public area

Solution: The correct answer is A. People with oppositional defiant disorder respond best to moderate, but not too much, structure. The choice of activities should be client centered and should capture the interests of the individual. Making posters allows the client to capture the style of art found in graffiti and tattoos while providing clear boundaries in the form of the poster paper and safe tools. B: Leather tooling involves sharp objects, and a premade pattern might be construed as too restrictive, opening the situation up for conflict if the client refuses to follow the pattern. C: Knitting a blanket would not necessarily be among the interests of a client whose interests include graffiti, body piercings, and tattoos. In addition, the client could use the knitting needles to inflict harm on self or others. D: Freestyle painting in a public area would not be therapeutic because of the opportunities and audience for the client's defiance of authority (i.e., public law, rules established for the activity)

A client with visual field deficit after stroke reports running into obstacles on the left side and says that objects seem to appear and then disappear on the left side. The client also reports that vision is unchanged since the stroke. Which phrase BEST explains the client's symptoms? Perceptual completion Unchanged vision Difficulty with contrast Onset of presbyopia

Solution: The correct answer is A. Perceptual completion is a process whereby the central nervous system of a person with visual field deficit samples a visual array and internally completes a visual scene on the basis of visual information expected to be found in the array. Perceptual completion allows a client with visual field deficit to be unaware of the absences of vision caused by the deficit. B: This client is clearly experiencing changes in vision. C, D: The client's symptoms cannot be explained by loss of contrast sensitivity or by the onset of presbyopia.

An OTR is working with a client who has undergone a carpal tunnel release. The client describes postoperative pain on either side of the carpal tunnel that makes it difficult to grasp objects. What is the term for this type of pain? Pillar pain Chronic pain Phantom pain Complex regional pain

Solution: The correct answer is A. Pillar pain is pain on either side of the carpal tunnel release surgery site. The source of the pain is unknown and may be ligamentous or muscular in origin. B: Chronic pain is pain that lasts longer than 6 months. C: Phantom pain is usually associated with amputation. D: Complex regional pain is hypersensitivity to pain caused by misfiring synapses of the autonomic nervous system.

A school-based OTR® has evaluated a 4-year-old child who has cerebral palsy. Results of the Peabody Developmental Motor Scales Second Edition (PDMS-2) indicate the child is functioning at a 2-year-old developmental level. Which environment is MOST CONDUCIVE for conducting the initial play assessment based on this information? In the classroom with peers and familiar developmental toys In an isolated room with access to age-appropriate computer games At the community playground with sliding, swinging, and climbing opportunities In a therapy room with the OTR® providing the child with a selection of toys

Solution: The correct answer is A. Play is most meaningful when it occurs in context; therefore, the classroom with peers and familiar toys is most appropriate for an initial play assessment. A child's activities cannot be accurately observed unless they occur within the environment where the child plays. B, C, D: Play is most meaningful when it occurs in context; therefore, observing the child's play in an isolated room, at a community playground that may not be familiar, or in a therapy room does not provide a familiar context for the child. A child's activities cannot be accurately observed unless they occur within the environment where the child plays.

An OTR®; is treating a client who is in a vegetative state after a traumatic brain injury (TBI). The OTR has identified the need to use restorative strategies with the client. Which restorative strategy is MOST appropriate for this client? Upright positioning strategies in a wheelchair to normalize muscle tone and facilitate arousal A sensory stimulation program to facilitate return to consciousness A self-feeding program that simplifies the task and provides success for the client A behavioral reinforcement program to reinforce the client's on-task performance

Solution: The correct answer is A. Positioning a client with TBI upright in a wheelchair provides optimal positioning to minimize abnormal tone and increase stimulation of the client's visual and vestibular systems. B: Sensory stimulation should be implemented on a case-by-case basis and is useful in supporting the client's emergence from coma. However, evidence supporting the effectiveness of sensory stimulation programs is not sufficient to warrant their use as a primary intervention. C, D: The client is not at a level of consciousness sufficient to participate in ADLs or to benefit from a behavioral reinforcement program.

An OTR® is treating a client with a nondisplaced radial head fracture and is following the referring physician's order for an immediate mobilization protocol. In which position would the client BEST tolerate early elbow flexion and extension? Supine with the upper arm supported on a folded towel along the torso Seated upright with the affected extremity free to flex and extend alongside the chair Standing with the affected extremity close to the torso Prone with the upper arm supported on a folded towel along the torso

Solution: The correct answer is A. Positioning in supine with the upper arm supported on a folded towel along the torso facilitates gravity-assisted motion of the elbow with support to the affected extremity. Gravity-assisted motion allows for early, nonresistive motion of a stable fracture, which can promote bone healing. B, C: Seated upright with the affected extremity free to flex and extend alongside the chair and positioned in standing with the affected extremity close to the torso are positions to which the client may progress after initial gravity-assisted elbow flexion and extension. D: Prone is an inappropriate position for early elbow extension and flexion.

An OTR® completes a work tolerance screening with a worker at a manufacturing plant. What should be included in the documentation? Weight limits for various job tasks Worker's reported desire to remain in the job Worker's ability to perform ADLs Financial issues the worker experiences

Solution: The correct answer is A. Work tolerance screenings identify limitations in the worker's ability to meet the activity demands of essential job functions, such as weights, distances, forces, angles, repetitions, and tools. B, C, D: Work tolerance screenings address the worker's ability to perform essential job functions, not the worker's subjective reports or occupational profile.

OTR®s have an ethical responsibility, through the evaluation process, to identify impairments in occupational performance that may correlate with driving risks and to inform clients of them even if they do not have a legal responsibility to report them to the state. This obligation is consistent with which principle articulated in the Occupational Therapy Code of Ethics and Ethics Standards? Principle 1: Beneficence Principle 3: Autonomy and confidentiality Principle 4: Social justice Principle 6: Veracity

Solution: The correct answer is A. Principle 1 states that occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services (AOTA, 2010, p. S18). B: The principle of autonomy and confidentiality expresses the concept that practitioners have a duty to treat the client according to the client's desires, within the bounds of accepted standards of care, and to protect the client's confidential information. C: Social justice, also called distributive justice, refers to the fair, equitable, and appropriate distribution of resources. D: Veracity is based on the virtues of truthfulness, candor, and honesty. The principle of veracity in health care refers to comprehensive, accurate, and objective transmission of information and includes fostering the client's understanding of such information.

A statement in the Occupational Therapy Code of Ethics (2015) reads, "Occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services." Which principle is this statement part of? Principle 1, Beneficence Principle 5, Veracity Principle 4, Justice Principle 3, Autonomy

Solution: The correct answer is A. Principle 1, Beneficence, involves the commitment to benefit others and to be concerned with the well-being and safety of service recipients. B: Truth, candor, and honesty are the focus of Principle 5, Veracity. Although all of these traits are beneficial to recipients of services, the principle of Veracity refers to accuracy and objectivity in communication with others. C: Fairness and equity are the focus of Principle 4, Justice. D: Principle 3, Autonomy, although beneficial to service recipients, is separate from Principle 1, Beneficence, and emphasizes protection of privacy and treatment of clients according to their desires under accepted standards of care.

A client with traumatic brain injury is able to live in a supportive home environment and complete light housekeeping and laundry. What area is MOST appropriate for the OTR®; to address next with the client? Practicing shopping skills Establishing a self-care routine Reestablishing skills for washing a car Providing a noise-free environment

Solution: The correct answer is A. Providing community reentry skills training is appropriate once a client has demonstrated the ability to perform ADLs and basic homemaking tasks. B: The client is already able to complete self-care, as indicated by the ability to successfully complete basic home management tasks. C: Washing a car does not support the client's ability to reintegrate into the community through activities such as shopping and going to the bank. D: Environmental distractions should have little to no effect on a client at this higher level of brain injury recovery.

Which suggestion that an OTR® might provide to a caregiver who is living with a client who has Alzheimer's disease (AD) is the BEST? Suggest appropriate activities that can engage the client during unoccupied time and improve daily structure. Suggest that the caregiver allow the client to continue cooking independently with adapted cooking utensils to improve safety. Suggest that the caregiver provide challenge to the client's daily routine by maintaining distance during routine tasks. Suggest modifications to the home environment to include arrows that lead to the bedroom and bathroom.

Solution: The correct answer is A. Providing structure to unoccupied time is an important consideration for clients with AD to prevent behavior problems and maintain quality of life. In addition, structure promotes an increase in goal-directed activity and may aid in more regular sleep patterns. B: Providing education to the caregiver about when it would be appropriate to discontinue certain tasks is important; if cooking is unsafe, it is probably best to do it with supervision. C: Providing too much challenge to a client with AD can be frustrating and lead to an increase in problem behaviors. D: Visual cues could be useful, but structured time would be the best choice because it is a more holistic approach.

A client with multiple sclerosis (MS) is displaying symptoms of depressed mood. The client has been referred to occupational therapy by a physician because of increasing feelings of difficulty with life tasks secondary to depression. The OTR® asks how the client feels, and the client responds, "I just don't feel like I can do anything right." Which strategy would be appropriate for the OTR to implement? Provide tasks that are graded for successful completion Implement energy conservation techniques Provide fine motor tasks to improve motor skills Discuss areas of life in which the client feels unhappy

Solution: The correct answer is A. Providing the client with a task that is graded for successful completion gives the client an opportunity to feel a sense of mastery over the environment. B: Although a client with MS might benefit from energy conservation techniques, the client's statement indicates that the client is struggling with feelings of decreased mastery of the environment secondary to depression. Energy conservation does not specifically address the need identified reflected in the statement. C: Providing fine motor tasks for someone who has MS might be indicated, but it would not specifically address the concern discussed in the question. D: Discussing unhappy feelings would be considered a psychological approach and not necessarily provided by OTRs as a specific intervention strategy. This technique could be used to help develop future interventions, however.

An OTR®; is supervising an occupational therapy student for Level II fieldwork. The OTR comments that the student did not gather complete information regarding a client's occupational history. Which student response is appropriate? "How can my occupational histories be more comprehensive?" "I respectfully disagree with your opinion." "I did the best I could to be thorough." "I thought I asked the client the questions you told me to ask."

Solution: The correct answer is A. Receiving feedback requires being open to the ideas that are presented, asking for clarification, acknowledging mistakes, and avoiding becoming defensive. This response suggests openness to feedback and a willingness to seek solutions and make changes in the future. B: This response is defensive and will not facilitate productive conversations or future improvements. C, D: These responses try to justify the student's actions without acknowledging mistakes or seeking solutions for the future.

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? The client was experiencing morning stiffness during the initial session. The client was experiencing a flare-up during the initial session. The client was experiencing depression during the initial session. The client's performance was improved through training in use of a sock aid.

Solution: The correct answer is A. RA can cause considerable fluctuations in ability because of pain, stiffness, and fatigue. The client was experiencing morning stiffness that limited the ability to manipulate the aid appropriately. B: A flare-up is characterized by signs of inflammation; the client had no signs of inflammation. C: Although depression can reduce occupational performance, it is unlikely that serious depression would be reduced enough from a morning session to an afternoon session to affect performance. D: Although training would improve function, it is unlikely that it alone would improve a client's ability from maximum assist to independence from morning to afternoon.

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? Radial tunnel syndrome Pronator syndrome Carpal tunnel syndrome Anterior interosseous nerve syndrome

Solution: The correct answer is A. 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. B: Pronator syndrome is compression of the median nerve and causes diffuse pain along the medial aspect of the forearm. C: Carpal tunnel syndrome is median nerve compression with pain and numbness into the hand and fist through half of the fourth digit. D: Anterior interosseous nerve syndrome is motor loss of function without sensory disturbance.

With which type of client would it be best practice to allow the proximal interphalangeal (PIP) joints to develop a contracture to facilitate functional grasp? Client with a C6 spinal cord injury Client with rheumatoid arthritis Client with cerebrovascular accident (CVA) Client with cerebral palsy (CP)

Solution: The correct answer is A. Ranging the hand (wrist extension combined with finger flexion and wrist flexion combined with finger extension) of a client with a spinal cord injury preserves a functional tenodesis grasp while encouraging PIP flexion contractures. B: PIP flexion deformities from rheumatoid arthritis result in decreased hand function. C, D: Allowing PIP flexion contractures in clients with CVA and CP limits hand function.

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

Solution: The correct answer is A. Rather than using a tight grip, the client with RA would benefit from modifying the walker (e.g., attaching arm troughs or larger handles) to reduce the grip pressure needed during ambulation and protect the small joints of the hands. B: A principle of joint protection is to limit the burden of heavy items on the small joints of the arms and hands. Sliding is a better option. C: A principle of joint protection is to allow the client to use the large muscles of the back to distribute weight as opposed to using hand and finger joints to carry an object. A backpack is a better option. D: A principle of joint protection is to use modifications that limit tight grasping and patterns that contribute to deformity arthritis. Elastic shoelaces are a better option.

An older adult client has lost significant vision and reports difficulty with reading, sewing, writing, recognizing faces, and responding to social gestures. Which visual deficit is the client exhibiting? Age-related macular degeneration Glaucoma Myopia Presbyopia

Solution: The correct answer is A. Reading, recognizing faces and social gestures, and performing detail work are characteristic functional limitations associated with age-related macular degeneration, which causes loss of central visual acuity and difficulty seeing fine detail. B: Glaucoma alters peripheral vision, not central vision. C: Myopia, where the image of an object is focused at a point in front of the retina and is therefore blurred when it reaches the retina, results in nearsightedness. Myopia can be corrected using a concave lens. D: Presbyopia is a normal age-related change that occurs when the lens of the eye gradually becomes less flexible, thereby reducing the lens' ability to keep images in focus as they come closer. This condition can be corrected using reading glasses.

According the ethical principle of Justice, an OTR® is obliged to be aware of certain laws such as the Americans With Disabilities Act (ADA). An OTR who is also a rehab manager in a long-term care facility has an incoming fieldwork student who is requesting an accommodation for a disability. How should the OTR respond to the request? Work with administration to determine whether the site can reasonably accommodate the request. Deny the request, because the health care environment already accommodates people with disabilities. Work with the student and the student's occupational therapy program to determine specific needs. Refer the question to the facility's human resources department.

Solution: The correct answer is A. Reasonable accommodation for employees with disabilities is required under the ADA, so it is appropriate to attempt to accommodate the fieldwork student. Determining whether the site can accommodate the request, consulting with management as necessary as well as any practitioners who may be affected by the decision, is the best option. B: The current accessibility of the health care environment is irrelevant; what is at issue is whether it is accessible to the fieldwork student. C: The student's request for accommodation may be reasonable, but determining how the facility can best meet the student's needs is not a decision that is solely the OTR's. D: This option is not the best because the OTR should work collaboratively with management rather than abdicate all responsibility for the situation.

The spouse of a client with Alzheimer's dementia tells the OTR® that the client has become more agitated, wanders, resists care, and displays inappropriate and sometimes destructive behavior. The spouse confides that feelings of stress have begun to feel overwhelming. Which occupational therapy intervention is most appropriate? Training the spouse to provide simple, one-step directions and avoid abstractions Role playing with the spouse and the client ways of providing explanations that will clarify the client's confusion. Assertiveness training with the spouse Conflict resolution sessions between the spouse and client

Solution: The correct answer is A. Reducing the complexity of activities and directions can reduce negative behaviors. B, C, D: Expecting clients with dementia to perform complex tasks or follow detailed directions can be stressful and lead to negative behaviors.

Which occupational therapy intervention strategy is MOST appropriate for use with an older adult with low vision? Instruct the client to reduce clutter and improve organization of the home and work environments. Instruct the client in the use of bold, colored patterns on tablecloths. Teach the client to use a medication chart printed in typical-size print (12-point Times Roman). Teach the client how to use the sense of smell to compensate for vision loss.

Solution: The correct answer is A. Reducing visual and physical clutter makes it easier for the client with low vision to find objects and reduces fall risk. B: The use of patterns makes it more difficult for the person with low vision to distinguish an object from the background. The use of contrast makes it easier for the person with low vision to distinguish objects from the background C. This strategy only makes it easier for the person with low vision to manage medications if the chart is large print. D: The sense of smell may help partially compensate for vision loss, but it is helpful to additionally use other senses (such tactile or auditory). This helps supplement the reduced vision and enables participation in tasks and activities.

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? Remove the backrest cushion. Change to an air-filled seat cushion. Raise the seat height. Adjust the axle plate.

Solution: The correct answer is A. Removing the backrest cushion will position the client's pelvis directly over the rear wheel axle, which will make propulsion easier. B: The seat cushion will not affect the client's pelvic position in relation to the rear wheel axle and will not correct the propulsion difficulty this client is having. C: Raising the seat height will not affect the client's pelvic position in relation to the rear wheel axle and will not correct the propulsion difficulty this client is having. D: The client is able to reach the wheels and propel so adjusting the axle plate to make the wheels easier to reach for the client will not reduce the client's shoulder pain with propelling on carpeted surfaces.

A client had a complete median nerve laceration at the wrist of the dominant hand 3 weeks ago. Which intervention activity should be included as part of the INITIAL phase of the client's sensory reeducation program? Instruction in visual compensatory strategies to use during daily tasks Application of deep pressure, rubbing, and tapping of the involved digits Desensitization by rubbing the fingertips with a variety of textures Identification of familiar objects hidden in a bucket of uncooked rice

Solution: The correct answer is A. Safety is a primary focus early on in the intervention for a client with total sensory loss, and the client must be able to compensate for lost sensation. B, C, D: With a complete median nerve laceration, the client will have total loss of sensation, and the client may not be a candidate for sensory reeducation.

For clients who have arthritis, which aspect of an occupational therapy intervention plan is the MOST crucial? Self-efficacy Splinting Compliance with the independent home exercise program Instruction in compensatory strategies for ADL management

Solution: The correct answer is A. Self-efficacy facilitates independent follow-through in the home context. The resulting confidence may ultimately lead to the desired behavior. B, C, D: Splinting, home exercise compliance, and ADL strategies all are important components of an intervention plan for clients with arthritis. Fostering self-efficacy, however, promotes the client's compliance with all aspects of the plan

Which accommodation under the Americans With Disabilities Act would be MOST likely to foster a successful transition to work at a fast-paced office for a high school student with Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome)? Install space enclosures or cubicle walls Widen doorways throughout the office Enlarge signs and elevator controls Prohibit other workers from speaking loudly

Solution: The correct answer is A. Simple alterations to the physical space such as installing cubicle walls are considered reasonable accommodation under ADA and would allow a person who is easily distracted to concentrate on work more successfully by screening out extraneous stimuli from the environment. B, C: Widening doorways and increasing the size of the letters on signs would not affect a person with autism spectrum disorder. D: Prohibiting other workers from speaking loudly is not a practical solution in a fast paced busy office, where talking is essential to the everyday operations of the office environment.

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? Hold a social event for workers in the housekeeping department. Give the client a written reprimand. Place the client in another department. Add duties to keep the client busy.

Solution: The correct answer is A. Socializing and developing relationships with coworkers provide a natural support and opportunities to work along with and mentor with coworkers without disabilities; such activities also assist in learning the culture of a workplace. B: A reprimand is a punishment and does not provide support. C: Changing the worker's department will require new task learning and may not address the reason for the worker's distractibility. D: Additional duties may add to the worker's distractibility and do not offer support to address the behaviors the worker is demonstrating.

A 3-year-old child has increased upper-extremity flexor tone secondary to mild cerebral palsy. The OTR® observes that the child's thumb adducts into the palm during prewriting activities such as coloring a picture. This movement interferes with the child's ability to complete prehensile tasks. Which intervention would be MOST BENEFICIAL to use for initially facilitating grasp and release patterns for fine motor task accomplishment? Provide a soft thumb abductor splint for the child to wear during prewriting tasks. Fabricate a long opponens splint for facilitating tenodesis during fine motor activities. Engage the child in upper-extremity weight-bearing intermittently during a prewriting task. Apply facilitation techniques to the wrist and finger extensors just prior to having the child practice specific grasp patterns.

Solution: The correct answer is A. Soft splints may enhance thumb control when mild increases in tone are present. In a small study with 4 young children, this splint was found to be effective at improving grasp and supination. B: Using a static splint is more appropriate when high tone is present and may interfere with the child's prehension or stabilization of materials. C: When increased tone is present and the child has tightly adducted and flexed thumbs, the practitioner will need to use handling techniques to relax the child's hand prior to weight-bearing activity. Moreover, in a study of children with cerebral palsy, weight bearing was found to increase wrist extension, although it did not improve grasp and release for the children. D: Facilitation techniques for wrist and finger extension would not be beneficial prior to specific grasp patterns, though facilitation in specific movements may be beneficial, such as wrist flexion and extension. These strategies are most effective when the child can follow verbal instructions, and the facilitation must be followed by use of the movements in a functional context.

According to the Standards of Practice for Occupational Therapy, which of the following is a requirement to practice as an OTR® in the United States? Completing licensure, certification, or registration requirements Passing state licensure examination for occupational therapists Graduating from a private occupational therapy program Successfully finishing an independent fieldwork experience

Solution: The correct answer is A. Some states require licensure, some require certification, and some require registration for practicing as an OTR®. B: The certification exam is a national exam, not a state licensure exam. C: The occupational therapy program must be accredited by ACOTE. D: The fieldwork experience must be supervised.

An OTR® is treating a client after surgery for De Quervain's tenosynovitis. The client is employed as a receptionist in a dental office and will participate in a return-to-work program designed by the OTR. Which option would be CONTRAINDICATED for treatment? Application of a resting hand splint at night to stabilize the affected joint Progressive AROM of the abductor pollicis longus and extensor pollicis brevis Instruction in proper body mechanics to avoid wrist ulnar and radial deviation Modifications including use of telephone headset and built-up handled pens

Solution: The correct answer is A. Splints are typically applied during the acute phase of injury. A resting hand splint is not indicated, because the entire hand does not required immobilization. The splint typically prescribed for De Quervain's is a forearm-based thumb spica splint to immobilize the wrist and thumb carpometacarpal and metacarpophalangeal joints, placing the abductor pollicis longus and extensor pollicis brevis at rest. B: The abductor pollicis longus and extensor pollicis brevis are tendons that are within the first dorsal compartment of the wrist. Postoperative treatment will focus on wearing a splint to promote tissue healing followed by gradual progression of AROM. C: Avoiding excessive radial and ulnar deviation is recommended to decrease pain. D: Use of telephone headset and built-up handled writing implements may relieve or reduce stress on thumb and wrist joints.

For a client with multiple sclerosis, which compensatory cognitive strategy would BEST aid in performance of daily activities? Schedule demanding tasks at intervals throughout the day Simplify daily tasks to conserve energy Modify the environment to decrease clutter Decrease visual stimulation to promote focused attention

Solution: The correct answer is A. Spreading demanding tasks throughout the day allows for rest periods to promote cognitive ability. Clients with multiple sclerosis typically have greater cognitive abilities in the morning and after rest breaks. B: Simplifying tasks conserves energy but does not directly address the cognitive demands of task performance. C: Organizing the environment decreases the energy required to complete tasks but does not directly address the cognitive demands of task performance. D: Decreasing visual stimulation may improve visual attention but would not improve the client's ability to focus attention, which is a cognitive skill.

A student in the first grade has illegible handwriting. Results of a standardized assessment indicate the student scored −0.5 standard deviations from the mean on a gross motor subtest and −2.0 standard deviations from the mean on a fine motor subtest. What do these results indicate? Activities to improve handwriting should be included as part of the intervention. Ninety-eight percent of the student's peers would score better on the fine motor test. Fine and gross motor skills are within an acceptable range from the norm. Fine motor and gross motor skills are moderately delayed compared to the norm.

Solution: The correct answer is A. Standard deviations less than −1.5 suggest a need for occupational therapy services; in this case, the gross motor standard deviation does not suggest a delay, whereas the fine motor standard deviation should be addressed through an intervention plan that addresses the student's handwriting. B: Percentile score is not derived or related to the standard deviation; rather, it is derived from the raw scores. The percentile score is what suggests the number of peers that would score better than the client. C, D: Gross motor skills are within an acceptable range from the norm, but fine motor skills suggest a delay.

The local department on aging has asked an OTR® to consult with them regarding transportation options for older adults in the county. At the first meeting, the department director expresses concern that some local older adults are choosing to pay for taxis rather than take the department-provided shuttle to appointments. The OTR® is aware, however, that some transportation experts have advocated taxis as appealing to older adults. Which statement BEST explains the appeal of taxis for older adults? Taxis offer greater spontaneity of travel because they are typically available without advance scheduling. Taxi companies use a wider range of vehicle options for transporting users who are older and have disabilities. Taxis can use routes that larger vehicles cannot travel. Taxis offer greater opportunities for socialization with other users.

Solution: The correct answer is A. Taxis, by definition, provide on-call services to users on an as-needed basis. B: Taxi companies typically use a limited range of vehicle types. C: Taxis use the same routes as other vehicles. D: Taxi services are typically used by people traveling alone.

A client with Parkinson's disease is experiencing bradykinesia and reports decreased ability to move from sitting to standing. What strategy should the OTR® recommend? Consistent use of a short self-cue, such as "rise," each time the client needs to stand Use of a standard walker for transferring between surfaces in the household Strengthening of bilateral lower extremities in collaboration with another discipline Education on the need for a caregiver to be available for functional mobility

Solution: The correct answer is A. Teaching self-cuing is useful in helping clients initiate movement to minimize the effects of bradykinesia. B, C: Use of a walker and strengthening lower extremities do not address the effects of bradykinesia on mobility. D: Having a caregiver present during mobility provides safety support but does not address the effects of bradykinesia on mobility.

An OTR® recommends that a physician conduct a 10-minute in-clinic screening to address a variety of driving-related performance components. Which composite battery would be the BEST choice for such a screening? Assessment of Driving Related Skill (ADReS) Driving Health Inventory Occupational Therapy Driver Off-Road Assessment Roadwise Review

Solution: The correct answer is A. The ADReS is the composite battery developed by the American Medical Association for physician administration. B, C, D: These assessments have not been developed for physician administration.

According to the AOTA Ethics Commission's advisory opinion on balancing patient rights and practitioner values, when is it ethically acceptable for an occupational therapy practitioner to refrain from providing services? When the environment poses a clear threat to the practitioner's safety When a client uses repugnant, harsh, or inappropriate language When the moral values of the client and practitioner are clearly in conflict When the practitioner feels an overwhelming aversion to the client

Solution: The correct answer is A. The AOTA Ethics Commission's advisory opinion reads, "Although there is an overarching professional duty to provide benefit to clients, there may be unsafe situations in which the practitioner may ethically refrain from providing service" (Brandt & Homenko, p. 123). B, C, D: According to the advisory opinion, client behaviors that do not threaten the practitioner's safety, a conflict in values, or the practitioner's opinion of the client are not ethical cause for refraining from providing services.

Which occupational therapy assessment tool for motor and sensory function would BEST be used with the population with spinal cord injury in determining baseline performance? American Spinal Injury Association (ASIA) Scale Canadian Occupational Performance Measure (COPM) Modified Ashworth Scale (MAS) Manual muscle testing

Solution: The correct answer is A. The ASIA Scale is used to determine baseline sensory and motor control performance for clients with spinal cord injury. B: The COPM provides information about the client's perceived satisfaction with performance of daily occupations. C: The MAS assesses muscle tone and would not provide information about sensory function. D: Manual muscle testing is used to grade muscle strength and would not provide information about sensory function.

What is the purpose of the Disciplinary Council as described in the Enforcement Procedures for the Occupational Therapy Code of Ethics and Ethics Standards? To give the Respondent an opportunity to present evidence and provide witnesses to answer and refute a charge To ensure that no additional ethical issues beyond those described by the Complainant are raised To discuss and examine the claim of ethical violation in the absence of the chairperson of the AOTA Ethics Commission To gather members of multiple disciplines affiliated with occupational therapy to judge the validity of the claim

Solution: The correct answer is A. The Disciplinary Council provides a forum for the person against whom the ethical violation charge has been made to respond to the charge. Witnesses and evidence can be presented. B: Additional ethical issues not identified by the Complainant may be raised and considered during the course of the investigation. C: The AOTA Ethics Commission chairperson or a designee presents evidence and witnesses at the Disciplinary Council hearing to support the chairperson's decision or sanction. D: Disciplinary Council members must be AOTA members.

What MUST be addressed as part of the intervention plan for children who meet eligibility for services under the mandates of the Individualized Family Service Plan (IFSP) component of the Individuals With Disabilities Education Act (IDEA, Part C)? Needs of both the child and the family Rationale for providing one-on-one sessions Activities for achieving curriculum-based goals Reasonable accommodations beneficial to the child

Solution: The correct answer is A. The IFSP must contain what services (including frequency, intensity, and method of delivery) are needed to meet the needs of the infant or child and family. B, C, D: It is not required to include rationale for one-on-one sessions, specific activities that will be used, or reasonable accommodations as part of the written IFSP, although information about the child's natural environments where intervention services will be provided must be included. The criteria and procedures to meet the outcomes expected also must be included in the written plan.

When measuring a client for a wheelchair, what are the four basic measurements the OTR® MUST take? Seat width, seat depth, seat height, seat-back height Seat width, seat depth, seat height, footrest length Seat width, seat depth, seat-back height, footrest length Seat width, seat depth, footrest length, seat-to-back angle

Solution: The correct answer is A. These measurements must be provided when ordering a wheelchair. Other measurements are helpful for comfort (e.g., armrest height). B, C: Footrests are adjustable and are not part of the basic required measurements. D: Seat-to-back angle is an adjustment made to an adjustable wheelchair, not a required measurement.

Which assessment should the OTR® administer to assess a client's ability to visually identify forms or objects from incomplete presentations? Motor-Free Visual Perception Test, Third Edition Development Test of Visual Motor Integration Visual Screening Test Depth Perception Test

Solution: The correct answer is A. The Motor-Free Visual Perception Test, Third Edition, assesses the ability to visually identify forms or objects from incomplete presentations. B: This test assesses the client's ability to coordinate observed visual stimuli with motor responses. C: This test assesses a client's visual functions, such as acuity, peripheral fields, contrast, and phorias (ability of the eyes to work together horizontally or vertically) D: This tests assesses the client's ability to judge distance, such as parking in a parking place.

A client with bipolar disorder in an outpatient setting is having difficulty following a medication routine. The client does not understand the physician's orders for the medication and prefers to take medication with some alcohol because it "helps take the edge off." What approach would be appropriate for the OTR® to take on this visit? Provide the client with information about the prescribed medication, dosage and timing, precautions, and side effects. Develop a treatment plan that includes activities to enhance occupational balance and leisure. Instruct the client in breathing and relaxation activities to decrease the feeling of being on edge. Suggest that the client participate in a group facilitated by the OTR titled "Get Your Life Back—NOW!"

Solution: The correct answer is A. The OTR should support the physician's treatment plan and assist the client with medication adherence. If the client is adequately medicated and stable, occupational therapy will be more productive. In addition, medication management could be considered a safety issue. If the client is not able to complete medication management, the client's health and mental health are at risk for decline. B: Occupational balance and leisure are important, but without proper medication, the client will have difficulty reaching the desired goals. C: Breathing and relaxation activities might be a viable option to promote improved control over the client's emotions, but they would be most appropriate after education about medications and dosage. D: A group activity could also be appropriate, but first the client should be adequately medicated and able to follow routines for medication management.

An OTR® is working with a student with a learning disability to improve independence getting to and from community college. Which action represents a scaffolding approach to this intervention? The OTR® helps the student study the bus map to identify the appropriate route and then encourages to the student to look at the schedule to determine the times. The OTR® accompanies the student to and from the school on the bus and points out landmarks to serve as visual reminders of the route. The OTR® outlines what will be expected of the student regarding bus times, schedule, cost, and appropriate behavior on public transportation. The OTR® encourages the student to take the bus with a friend to ensure the student does not get lost.

Solution: The correct answer is A. The OTR® assists the student with one of the more difficult tasks, identifying the appropriate bus route to and from school. The OTR® then allows the student to independently proceed with the public transportation planning. Scaffolding involves the OTR® working with the client on components of the activity that prove too difficult, but the client ultimately finishes the activity independently, thereby improving motivation. B: Accompanying the student temporarily adapts the social environment by the presence of the OTR®. C: Outlining expectations is a coaching approach. D: Taking the bus with a friend is a change to the social environment, but it reduces the student's independence.

A grocery store company hires an OTR® to complete work tolerance screenings for potential employees. The company has no written policies regarding work screening processes. What should the OTR®'s FIRST step be? Assess whether work tolerance screenings can be completed in the absence of written policies Provide a written statement indicating that the organization is required to provide written policies for work screenings Complete the work tolerance screenings as the OTR® would for any organization Offer to write policies for the work tolerance screening process for the organization

Solution: The correct answer is A. The OTR® must consider the potential ethical dilemmas that may arise in the absence of written policies, particularly for applicants who fail the screening. B, C: Employers are not required to have policies for work tolerance screening processes but should be encouraged to establish such policies to ensure fair and objective consideration of job applicants. D: The OTR® should remain separate from the hiring process, including related policy development, to maintain objectivity and third-party distance.

An OTR® working with an adult client with major depression in an inpatient setting assesses the client to determine the impact of occupational and environmental demands on performance of daily occupations. What is most likely to be the OTR®'s PRIMARY theoretical approach to designing an intervention? Modifying the environment or the occupation to reduce demands, address personal goals, and use developed skills Facilitating age-appropriate occupation through motivation and habit formation Exposing underlying conflicts from early childhood relationships that impede current engagement in occupations Challenging ineffective adaptive responses and focusing on enhanced occupational adaptation

Solution: The correct answer is A. The OTR®'s primary theoretical approach is the PersonEnvironmentOccupationPerformance model. B, C, D: These approaches use the Model of Human Occupation, psychodynamic theory, and occupational adaptation models, respectively, as their primary focus.

An OTR® receives a referral for a child who has difficulty with handwriting. The OTR wants to determine whether the child has difficulty with the integrated process of handwriting rather than specific components that support the production of handwriting. Which assessment method would be appropriate to use for this purpose? Print Tool Developmental Test of Visual Motor Integration Canadian Occupational Performance Measure Child Occupational Self-Assessment

Solution: The correct answer is A. The Print Tool is a commercially available assessment for measuring a child's ability to produce handwriting. B, C, D: These tools are not designed to measure the integrated process of handwriting.

Which action relates to the ethical principle of Social Justice? Advocating for clients to obtain needed occupational therapy services Respecting the client's right to refuse occupational therapy services Supervising other individuals in a responsible and appropriate manner Protecting confidential information of colleagues and fieldwork students

Solution: The correct answer is A. This action is the only one that relates to making sure clients are treated fairly and equally. B: This action relates to autonomy. C: This action relates to procedural justice. D: This action relates to fidelity.

Which of the following elements is an important component of the Recovery Model? Peer support and teaching Social-emotional learning Cognitive-behavioral therapy Sensory-motor interventions

Solution: The correct answer is A. The Recovery Model suggests a broad context for intervention, not specific intervention strategies provided by mental health providers. The Recovery Model is a client-centered approach to recovery that encourages the supports necessary for a person to recover within a context that is comfortable for that person. It may include peer support and teaching. B: Social-emotional learning is an approach used primarily in children, not in adults; it is not part of the Recovery Model. C: Cognitive-behavioral therapy is a specific intervention strategy that might be helpful to someone with certain types of mental illness, but it is not part of the Recovery Model. D: Sensory-motor interventions might be used to address specific symptoms of mental illness, but they are not a primary focus of the Recovery Model. The Recovery Model is a broad philosophy that suggests that individuals should choose their approach to recovery from among community supports, peers, and mental health services. It does not advocate specific strategies.

Which assessment would an OTR® administer to assess a client's ability to visually scan information using central and peripheral vision and to process that information in a timely fashion? Useful Field of View Symbol Digit Modalities Test Trail Making Test, Parts A and B Letter cancellation test

Solution: The correct answer is A. The Useful Field of View assesses the ability to visually scan information using central and peripheral vision and to process that information in a timely fashion. B: This test measures divided attention. C: These tests measure set shifting. D: This test measures scanning and selective attention.

Which high school extracurricular activity would a youth with oppositional defiant disorder be MOST likely to succeed at? An art program with well-established boundaries in which students are encouraged to pursue their own interests A chess club in the library in which students participate in tournaments and, when not playing, participate as observers A school basketball team that has the rule that students cannot play in a game if they miss a practice or are tardy or absent from school A science club in which students work together in small groups to prepare science projects for the state science fair

Solution: The correct answer is A. The art program has the fewest rules, the greatest degree of individual choice, and the potential for the least amount of authority or adult direction. B: Although a chess club is structured, which would promote success, the definitive set of rules may provoke the desire to break those rules. C: A high school basketball team requires players to work as a team, obey the rules of the game, and follow the direction of the coach, all of which would challenge the youth. In addition, oppositional behavior from a team member would probably provoke conflict. D: A science project might be a successful experience, but the need to function as an effective team member would present challenges

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? Generalization Transfer Automaticity Acquisition

Solution: The correct answer is A. The client demonstrates generalization, which is the ability to take a strategy used with one task and apply that strategy to a new task. B: Transfer occurs when clients dress themselves at home in the same way they did in their hospital room. C: Automaticity is the ability to perform tasks with little or no contribution of consciousness; this client has not yet demonstrated automaticity. D: Acquisition is a training strategy that relies on conscious control and requires practice and drill exercises. Acquisition is a cognitive strategy, not a method of learning.

A client with traumatic brain injury is at Rancho Level IV (i.e., with confusion and agitation). The client is demonstrating the ability to use mental repetition with cues from the OTR®; during basic self-care routines. The OTR wants the client to be less reliant on verbal cues and able to self-monitor performance during the tasks. What strategy is appropriate for the OTR to use? Have the client estimate and report the difficulty of a task before completing it Provide the client with a verbal description of the client's task performance Organize increasingly complex self-care routines by providing highly structured practice Give consistent, reliable tactile cues throughout self-care completion

Solution: The correct answer is A. The client is already receiving external feedback from the OTR and needs to create internalized feedback mechanisms to decrease reliance on cuing. Self-estimation of task difficulty is one method to generate internal feedback. B: Providing a verbal description of the client's task performance promotes continued reliance on the OTR for feedback on task performance. C: Structured practice sessions require task setup by and continued reliance on the OTR for task performance. D: Tactile cues require continued interaction with the OTR during task performance and continued client reliance on cues.

A client who had a CVA is now being discharged from a hospital setting to home. The client continues to show signs of right-sided weakness and decreased balance. What referral for occupational therapy services is MOST appropriate for the OTR® to make? At home with a home health OTR® In an outpatient center In the acute-care hospital In a subacute rehabilitation hospital

Solution: The correct answer is A. The client is being discharged to home; therefore, continuing occupational therapy services in that setting is most appropriate. B: If the client continues to experience weakness and decreased balance, travel may be complicated. Thus, an outpatient center may not be a safe alternative. C, D: A subacute rehabilitation and acute-care hospital are not appropriate referrals because the client is going home.

An OTR® is performing upper-extremity activities with a client experiencing left hemiparesis. The OTR® notes a decrease in ROM in the left upper extremity. What factors BEST describe this decrease in ROM? Edema, joint contracture, and weakness Edema, muscle tone, and sensation Sensation, muscle tone, and proprioception Sensation, ataxia, and proprioception

Solution: The correct answer is A. The client is most likely experiencing weakness, edema, and contracture of the left upper extremity as a result of the left hemiparesis. B, C, D: Although the client is likely experiencing edema, "muscle tone" is not sufficient to describe hypertonicity or hypotonicity. Sensation may affect the client's awareness of the upper extremity and contribute to decreased ROM, but it does not best describe the decrease. Proprioception simply describes a measure of the arm in space as determined by the client. Ataxia is primarily related to the inability to perform small adjustments for coordinated movement, not gross ROM.

An OTR® is providing intervention to a client with an anxiety disorder who hyperventilates when faced with difficult work tasks. The OTR begins to work with the client on physiological responses and the thought processes leading up to the panic attacks. The OTR suggests that the client begin journaling. What frame of reference does this intervention suggest? Cognitive-behavioral Psychodynamic Cognitive disability Behavioral

Solution: The correct answer is A. The cognitive-behavioral frame of reference works on the thoughts and reactions related to environmental triggers. Through journaling and reflection, the client can identify triggers that cause the anxiety to escalate. B: The psychodynamic frame of reference suggests that unresolved childhood events are the reason for dysfunction. A psychodynamic intervention is usually discussion based. C: The cognitive disability frame of reference uses the client's strengths to allow for function. An example of a cognitive disability intervention is training caregivers to provide appropriate environmental supports for the client. D: The behavioral frame of reference relies on the idea that behavior is learned and that it can be unlearned. Using breathing and relaxation techniques during a stressful event can facilitate a change in response.

Neglect, or visual attention deficits, may be prominent in clients recovering from stroke. An implication for everyday life may be that the client bumps into doorjambs or other obstacles. What are the performance implications of these deficits for driving? Drifting out of a lane and moving too close to other road users or objects Difficulty adapting to the dark or to bright lights from other vehicles Not recognizing road signs in advance Difficulty seeing other road users or objects in a tunnel

Solution: The correct answer is A. The cuts in visual field and visual inattention will result in these behaviors. B, C, D: These difficulties usually result from impairments in visual acuity, not visual attention deficits.

A client with a recent diagnosis of dementia is receiving occupational therapy. The caregivers are most distressed about significant behavioral changes that have occurred since the client was diagnosed. The client has become increasingly impulsive and difficult to redirect. What type of dementia does this client MOST LIKELY have? Frontotemporal dementia Alzheimer's dementia Vascular dementia Dementia with Lewy bodies

Solution: The correct answer is A. The distinguishing feature of frontotemporal dementia is behavioral changes with an increase in disinhibited behavior, decreased social tact, lack of empathy, and lack of interest. B, C, D: None of these dementia categories has behavioral changes as a significant symptom.

An OTR® is providing early intervention services to a 24-month-old child who has a pervasive developmental disorder. The parents' goal is for the child to be able to participate in age-appropriate activities with peers. Which of the following contexts is BEST for promoting progress toward this goal? Organized play group in a community playground Backyard of the child's home with siblings Group session in the occupational therapy clinic with other children Tumbling group for preschoolers in a community gymnasium

Solution: The correct answer is A. The environment is important for supporting a child's play actions; the child perceives the interactions within various environments, then learns to act on those interactions. A play group that is organized will allow the child to be in a natural play environment while learning to adapt to or accommodate peers in interactions. B: The backyard of the child's home and the child's siblings are a comfortable context for the child and will not require adaptation or accommodation of the child's interactions. C: The occupational therapy clinic is not a natural play environment for a child and does not set the child up to interact with age-appropriate peers. D: An activity group such as a tumbling group will not allow for as much peer-to-peer interaction as an organized play group. Moreover, the child will not perceive much control within a tumbling group that is likely directed by a class instructor.

An OTR® working in an outpatient psychiatric setting has been meeting monthly with a closed-membership group of people with depression to promote socialization. Up to this point, the group has been functioning as a parallel group in activities that include making quilted potholders and decorating gingerbread cookies, but the participants are ready to progress to the next level, associative participation. Which activities would be MOST appropriate for such a group? Organize the creation of a large quilted wall hanging for the reception area to which each participant contributes a square Appoint a leader to organize a sale of baked goods Have participants plant seeds in a ceramic pot that they decorate themselves Distribute journals in which participants are to write their own poetry collection

Solution: The correct answer is A. The group can progress from a parallel to an associative participation group by taking an already mastered skill—making a quilt square—and adding the component of cooperation needed to make a community quilt. Participants will still work on their own, but they will need to interact with one another to design the quilt using each participant's square color and size. B: Going from decorating a gingerbread cookie to planning and organizing a bake sale is a huge leap, not a logical next step. C: Planting seeds in individual pots is a parallel group activity. D: Writing poetry in a journal instead of as a group would move the group from a more cooperative and socially demanding activity to a more parallel and less demanding social activity and would fail to foster participants' social skills.

An OTR® is providing consultative services to develop a new occupational therapy department as part of a comprehensive rehabilitation program for a rural regional medical center. When reviewing the impact of the macroenvironment on the organization, what MUST the OTR® consider? Local and national legislative acts and regulatory policies that affect service delivery models Internal resource availability, and service delivery goals of the organization Corporate culture, supply availability, and organizational staffing policies that relate to quality care Organization's vision statement, governance, and internal auditing processes and procedures

Solution: The correct answer is A. The macroenvironment includes the external environment including policy, funding, and political services that impact provision of services. B: These factors would be part of the micro level because they are internal to the organization itself and not related to the broad external environment factors. C: These factors would be part of the mezzo level of factors influencing delivery of services because these factors are the environment external to the organization itself. D: The organization itself is considered the micro level of factors influencing delivery of services.

A dental hygienist is referred to occupational therapy for establishment of a work conditioning program after carpal tunnel release 1 month ago. The client is anxious to return to work but fearful of reinjury. Which intervention is MOST appropriate for the OTR® to include in the client's work conditioning program? Instructing the client in median nerve gliding exercises Instructing the client in ulnar nerve gliding exercises Guiding the client in progressive resistive exercises using therapy putty Writing simulated client progress notes

Solution: The correct answer is A. The median nerve travels through the carpal tunnel. Active exercises of wrist, thumb, and fingers are encouraged 24-48 hours postoperatively. Median nerve glides can be incorporated into a work routine between dental clients to decrease the risk for reinjury B: The ulnar nerve does not travel through the carpal tunnel. C: Progressive grasp and repetitive finger flexion should be gradually introduced once recommended by physician between 3 and 6 weeks postoperation. One month may be too soon in recovery to incorporate it into the program. D: Writing activities require periods of sustained prehension and are not the most appropriate intervention to include as part of a work conditioning program.

What is the MOST severe form of discipline the AOTA Ethics Commission can impose if it determines an ethical violation has occurred? Revoking AOTA membership Censuring the person Writing a letter of reprimand Providing an educative letter

Solution: The correct answer is A. The most severe sanction is permanent denial of AOTA membership. These are milder disciplinary actions or sanctions.

An OTR® claims on a resume an ability to provide physical agent modality treatments. However, the OTR has not completed training in this area or ever provided such treatments. Which ethical principle is the OTR violating? Veracity Nonmaleficence Justice Freedom

Solution: The correct answer is A. The principle of Veracity requires personnel to be honest with claims of ability and professional skills. Personnel must "represent credentials, qualifications, education, experience, training, roles, duties, competence, contributions, and findings accurately in all forms of communication." B: Nonmaleficence is related to refraining from doing harm to individuals. Although this option may lead to potential harm to a client, there is no evidence as of yet that any harm has been done. C: Justice refers to fair and equitable treatment broadly to persons served by occupational therapy. In this scenario, the issue is related to accurate reporting of education rather than treating persons equally. D: Freedom is a core value of the occupational therapy profession but is not an ethical principle. It relates to the personal choices of the client, not the provider's personal freedom.

A client with oculomotor dysfunction and double vision is referred for occupational therapy evaluation. What is the MOST appropriate way for the OTR® to begin this evaluation? Determine possible limitations in daily occupations secondary to double vision Determine the etiology of the oculomotor dysfunction that is causing double vision Provide occlusion for the client to reduce the visual stress caused by double vision Provide eye exercises for the client to reduce the visual stress caused by double vision

Solution: The correct answer is A. The purpose of an occupational therapy evaluation is to determine whether the client is experiencing limitations in daily occupations because of dysfunction, in this case in the client's oculomotor system. B: Determining the etiology of the double vision is the role of the optometrist or ophthalmologist. C, D: Occlusion and eye exercises are intervention approaches for double vision; however, neither would be appropriate for an OTR to prescribe without supervision by an optometrist or ophthalmologist.

An OTR® is asked to provide services to a placebound client. The OTR has limited experience in the setting, yet there are no other qualified practitioners in the nearby region to provide services. What should the OTR do next? Work with the employer to secure ongoing education in this area of practice. Deny offering services to the client because of a lack of content knowledge. Refer the client to a qualified provider in a region that is less accessible to the client. Agree to provision of services immediately so as not to delay treatment.

Solution: The correct answer is A. This response is consistent with the ethical principle of Beneficence. Taking action to improve competency and oversight also further benefits the client without limiting access. B: This option is partially possible, yet may be in conflict with other ethical considerations to not support a client's need for therapy services. C: This option violates the principle of Justice; referral to a less accessible area is not an option. D: This is only partially correct because the choice should not be to agree to services when there is not demonstrated competency.

In the waiting room of an occupational therapy clinic, an OTR® places fliers containing an invitation to worship at the church where the OTR is a deacon. The fliers contain a photo of the OTR and a caption stating, "Come join Deacon [Name], OTR/L, for worship this Sunday." The clinical director finds and removes the fliers. Which statement in the Occupational Therapy Code of Ethics (2015) provides the BEST rationale for removing the fliers? Occupational therapy personnel shall . . . avoid dual relationships, conflicts of interest, and situations in which a practitioner, educator, student, researcher, or employer is unable to maintain clear professional boundaries or objectivity. Occupational therapy personnel shall . . . refrain from actions that reduce the public's trust in occupational therapy. Occupational therapy personnel shall . . . make every effort to promote activities that benefit the health status of the community. Occupational therapy personnel shall . . . respect the client's right to refuse occupational therapy services temporarily or permanently, even when that refusal has potential to result in poor outcomes.

Solution: The correct answer is A. The role of deacon could be perceived as creating situations that make it difficult for the OTR to maintain clear professional boundaries or objectivity. Recruiting parishioners from among the occupational therapy clients suggests a lack of clear professional boundaries. B: Unless the fliers describe controversial or unconventional activities, it is unlikely they would reduce public trust in occupational therapy. C: This statement is not part of the Code of Ethics. D: The right to refuse services does not apply in this scenario.

An OTR® is fabricating a long arm splint for a client who has cubital tunnel syndrome. Which statement provides the BEST rationale for positioning the elbow in this splint? Flexion in 45-60 degrees minimizes stretch of the ulnar nerve where it crosses the elbow. Slight flexion with the forearm in neutral reduces tension of the radial nerve at the supinator muscle. Flexion in 60-90 degrees reduces symptoms of numbness and tingling in the C5-C6 nerve distribution. Flexion in 10-20 degrees minimizes symptoms in the median nerve distribution of the hand.

Solution: The correct answer is A. The role of splinting in cubital tunnel syndrome is to minimize elbow flexion, which will decrease stretch on the ulnar nerve across the cubital tunnel. The appropriate position of elbow flexion is between 45º and 60º. B: The radial nerve is not affected in cubital tunnel syndrome, so splinting does not need to reduce tension for this nerve. C: The appropriate position of elbow flexion is between 45º and 60º, and the splint is to decrease stretch of the ulnar nerve across the cubital tunnel, not for C5C6 nerve distribution. D: Positioning of the elbow does not affect the median nerve distribution into the hand as the median nerve crosses at the volar wrist

A client with advanced amyotrophic lateral sclerosis (ALS) is new to a computerized communication device. On what would the OTR® treating this patient focus? Positioning, to ensure proximal support on a lap tray ROM exercises, to enable the patient to adequately reach the device Trunk strengthening, to enable upright sitting during use of the device Adapting the device with larger buttons and controls, to enable independent use

Solution: The correct answer is A. The simplest and first approach would be to ensure positioning so that the client can see the device and having the neck and shoulder (proximal muscles) stabilized to allow the most distal control. The placement of the device is also important, with a lap tray to secure the device in bed or on the wheelchair. B, C: These are more remedial or restorative approaches that are not appropriate for a client with a progressive disease, especially in advanced stages. D: Adaptations such as larger buttons and controls may be appropriate if proper positioning alone is insufficient for independent use of the device.

An OTR is working with a client with lateral epicondylitis. What is the BEST client education the OTR can offer in terms of wearing a splint for this condition? To wear the splint during any activity that causes pain To wear the splint only at night so that it does not interfere with the client's daily activities To wear the splint 24 hours a day without removing it for any reason until the next occupational therapy appointment To not wear the splint unless the client feels pain

Solution: The correct answer is A. The splint rests the muscle and tendon and protects against pain with activity. B: Wearing a splint at night is appropriate for carpal tunnel syndrome, not lateral epicondylitis. C: Wearing a splint continuously decreases blood flow and oxygen to tissues. D: The splint is to be worn to prevent pain during activities that have been causing pain, not after the pain begins.

An occupational therapy clinic has purchased a new standardized assessment tool. The occupational therapy practitioners are checking the interrater agreement for routinely using the tool. The point-by-point agreement for all raters at the clinic was found to be 70%. What information does this calculation provide? Additional practice for administering and scoring the tool is needed. Minimum acceptable standards for interrater reliability have been met. Service competency for raters using the assessment tool has been attained. The majority of raters administered the assessment tool correctly.

Solution: The correct answer is A. The suggested interrater reliability of a standardized test is 80%; a point-by-point agreement of 70% is generally too low for good interrater reliability and suggests that there are differences in the way practitioners are administering the assessment. B, C, D: The suggested interrater reliability of a standardized test is 80%; a point-by-point agreement of 70% is generally too low for good interrater reliability and would not suggest a psychometrically sound assessment.

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

Solution: The correct answer is A. Therapeutic exercise and activity assist the client with improving strength and function while preventing further complications, including muscle imbalances. B: Skilled services do not include maintenance; an alternative intervention for someone who is unlikely to improve motion would be prevention of future complications. C: Reasons for therapy should never include increasing time in therapy; occupational therapy practitioners should strive to provide efficient care. D: Skilled services such as therapeutic exercise and activity do not include maintenance; in addition, most clients should not be taught compensatory movement patterns for weak muscle groups unless it is indicated (e.g., in the case of amputation) or a plateau in progress has been achieved.

A client, 6 months post-stroke, has made almost a complete recovery except for weakness in the left leg and slight restriction with left ankle plantar flexion. The client has completed an on-road driving assessment, is driving independently, and entering and egressing the vehicle without any problems. The client asks the OTR® what the client can do to stay well and to prevent a decline in driver fitness. What would the OTR®'s BEST answer be? Continue to use the prescribed devices and home exercise program and return within 6 months for a follow-up consultation. Be fitted for a left ankle foot orthotic (AFO). Join a senior center to increase socialization and stimulation. Do hot and cold contrast baths for the left lower extremity.

Solution: The correct answer is A. This answer contains the consultation and advocacy principles needed for health promotion, wellness, and prevention of a decline in the client. B: The client has, during the course of rehabilitation, most likely already be fitted for an AFO. C: Although this option will prevent a general decline in function, it will not prevent a decline in driving function. D: Although the contrast baths may increase circulation and ROM to the affected extremities, they will not help prevent a decline in driver fitness.

During a standardized assessment of developmental motor skills, a 5-year-old child is unable to stack 1-inch (2-cm) cubes as per the standardized instructions. Based on this finding, the OTR® plans to include intervention activities for increasing the child's motor control. Which goal related to this objective would be MOST ACHIEVABLE within a 60-day time period? After playing with toys, the child will clean up the play area by placing five small toys in a container with minimal verbal cues. The child will consistently fasten the bottom three buttons of a front-opening shirt when prompted during dressing activities. The child will score at age level when asked to stack blocks during readministration of the fine motor skills assessment. The child will throw a bean bag onto a target with 90% accuracy from 4 feet (1.2 m) away.

Solution: The correct answer is A. This goal is linked to the child's acquisition of hand skills through engagement in occupational activities and is a reasonable goal in the given time frame. B: Goals must be feasible for the child to accomplish given the current status of hand function. If the child is having difficult stacking 1-inch cubes, it is likely the child is unable to button, and achieving this goal within the 60 days is not reasonable. C: This goal is not relating the acquisition of the child's hand function to engagement in occupational activities, which is necessary in all goals for children developing hand skills. D: This goal does not relate to the development of the child's hand skills in relation to occupational engagement (throwing bean bags at a target is not a direct occupational performance task).

An inpatient had a total hip replacement 2 days ago. The OTR® observes that the patient uses proper hip precautions during bed mobility and when moving from the bed to a bedside chair. What should be the focus of the NEXT intervention session with this patient? Methods for transferring on and off a toilet with a raised toilet seat Grooming and hygiene while standing at the bathroom sink Bathing in a bathtub equipped with a removable shower chair Learning to use a long-handled reacher to complete lower body dressing

Solution: The correct answer is A. This goal progresses the patient's functional mobility by progressing the next most appropriate transfer, which is a commode chair transfer. B: The patient's standing tolerance at this stage of post-op status may be limited for standing at the bathroom sink to complete grooming and hygiene. C: A patient should be confident with commode chair transfers prior to progressing to tub bench transfers because the tub bench transfer is more difficult and requires greater strength and mobility. D: Lower body dressing will be appropriate as the patient gains strength and begins to incorporate the hip precautions into daily activity.

An OTR® is working as part of the school district's response-to-intervention initiative to deliver a handwriting curriculum with the kindergarten teacher. The OTR® is working with a small group of students to remediate their pencil grips. Which grip would require remediation? The pencil rests on the distal phalanx of the radial side of the little finger, and the pads of all five fingers control the movement; the thumb is opposed to the ring finger and the wrist is flexed. The pencil rests against the radial side of the middle finger, and the pads of the fingers control the movement; the thumb is not opposed to the index finger and rests on the distal interphalangeal joint. The pencil rests against the radial side of the ring finger, and the pads of the fingers control the movement; the thumb is not opposed to the index finger and rests on the distal interphalangeal joint. The pencil rests against the distal phalanx of the radial side of the ring finger, and the pads of the fingers control the movement; the thumb is opposed to the index finger.

Solution: The correct answer is A. This grip is not functional and should be remediated. B, C, D: These grips are functional grips. B describes the lateral tripod. C describes the lateral quadruped. D describes the dynamic quadruped. Another functional grip is the dynamic tripod.

An uninsured client asks to be referred to a nontraditional occupational therapy setting where services are billed privately at a reduced rate. What should the OTR® do next? Refer the client as requested, assist in optimizing transition of services, and inform the client about the pros and cons of transfer. Share certain information as a means to protect the client. Decide to not pursue the referral because of the financial loss for the employer. Discourage referral and retain services for the client within the traditional setting

Solution: The correct answer is A. This option provides the client with the most control of the scenario through informative efforts by the clinician. It also upholds the ethical principle of Autonomy. B: This option does not provide enough information for the client to make an effective decision. C: This option puts the needs of the employer above the client and violates the ethical principles of Autonomy and Nonmaleficence. D: This option does not provide enough information for the client to make an effective decision and violates the ethical principle of Autonomy.

An OTR® is completing an evaluation for a client with bilateral knee osteoarthritis (OA). The client has no difficulty ambulating on flat surfaces. Which of the following would be MOST important to assess in the client's home? The client's ability to lift and carry laundry to a basement washerdryer The client's ability to access items hanging in a closet The client's ability to navigate the kitchen during a cooking task The client's ability to access a walk-in shower

Solution: The correct answer is A. With knee OA, the client is likely to have problems with tasks that involving lifting and climbing stairs. B, C, D: These activities require ambulation on flat surfaces, which is less affected by knee OA.

A client has been diagnosed with age-related macular degeneration. Which is the BEST intervention strategy for the OTR® to use in improving the client's independence in meal preparation? Teach the client to use different tactile indicators on a few key microwave buttons. Teach the client to use central vision to see the microwave buttons. Prescribe an optical device for client to use to see the microwave buttons. Instruct the client to lower the general and task lighting in the kitchen and near the microwave.

Solution: The correct answer is A. This strategy would help the client supplement remaining vision with tactile sensation. B: Because central vision tends to be impaired with this condition, this would not be a suitable option. Teaching the client to use sing peripheral vision would be more beneficial. C. Occupational therapy practitioners are unable to prescribe optical devices; however, they can teach clients how to use these devices after they are prescribed by a physician or optometrist. D: Decreasing the lighting would hinder the client from viewing the microwave controls. Increasing the lighting is more appropriate.

An OTR® is teaching a client how to pop a wheelie in a manual chair so that the client can negotiate curbs. What instructions would the OTR give this client? Grasp the hand rims posteriorly and pull them forward forcefully and abruptly, throwing the head back forcefully, if needed. Grasp the hand rims anteriorly and pull them forward forcefully and abruptly, throwing the head forward forcefully, if needed. Grasp the hand rims in the center and pull them forward forcefully and abruptly, throwing the head back forcefully, if needed. Grasp the hand rims in the center and pull them backward forcefully and abruptly, throwing the head forward forcefully, if needed.

Solution: The correct answer is A. To elevate onto the large rear tire, it is necessary to grasp the hand rim as far posteriorly as possible and quickly pull forward. B: Grasping the hand rims anteriorly and pulling forward would push the wheel farther into the ground, not allowing the wheelchair to elevate. C: Grasping the hand rims in the center would make it difficult to get enough force to elevate the large rear tire. D: Grasping the hand rims in the center and pulling them backward would not allow for enough force and would push the wheels in the wrong direction.

A school-aged child has myelomeningocele resulting in symptoms associated with an upper motor neuron bladder. The child is participating in a bowel and bladder program to learn to manage self-toileting tasks. Despite completing intermittent catheterization as recommended, the child continues to have only partial control of bladder function. Frequent bladder leaks result in skin irritation of the perineum and odor. In addition to recommending a follow up evaluation with the child's primary care provider and teaching personal hygiene skills, what action should the OTR® take? Advise the child to wear an absorbent incontinence pad or a youth-size disposable diaper. Suggest restricting the child's fluid intake during the day to limit urine production. Recommend the child apply manual pressure on the abdomen while emptying the bladder. Educate the parent and child about alternative means of collecting the child's urine.

Solution: The correct answer is A. Using an incontinence pad or disposable diaper will provide the child with skin protection by having the pad absorb any leaked urine, and the pad may also minimize odors associated with leaking. B: Restricting fluid intake will make the child susceptible to bladder infections and is not an appropriate recommendation. Note that fluid restriction prior to bowel program sessions will prevent bladder distention; however, it should not be a daily practice. C: Because the child has an upper motor neuron bladder, the training program is focused on developing an automatic response for voiding. Pressure on the abdomen would be a method used for lower motor neuron bladders where the bladder requires assistance to empty because of low tone. D: The child is currently using the least restrictive method of catheterization, and modifying the catheterization schedule or assistive devices to protect from accidents is more beneficial than seeking a more restrictive method that requires surgical intervention.

An OTR® is working with a pediatric client with delayed visual-perceptual skills. Specifically, the child has difficulty with shape, letter, and color identification and recognition. On the basis of this description, with which visual-perceptual skill is the child having difficulty? Visual discrimination Visual memory Visual closure Figureground recognition

Solution: The correct answer is A. Visual discrimination is the brain's ability to process and interpret the features of an object (or other stimuli) related to matching, recognition, and categorization by different attributes. B, C, D: Visual memory, visual closure, and visual figure ground are other important visualperceptual skills, but they do not allow the individual to visually discriminate among key features of objects.

An older adult client who has difficulty completing feeding tasks demonstrates compensatory movements including holding food close, tilting the head when eating, and closing one eye when moving the fork to the mouth. Which factor would the OTR® assess FIRST during evaluation? Visual foundation skills Visual perception skills Environmental factors Motor planning skills

Solution: The correct answer is A. Visual foundation skills, including visual acuity, oculomotor control, visual pursuits, saccades, and visual fields, should be assessed before completing a visual perception evaluation to screen out visual problems. Underlying problems with visual foundation skills may interfere with the accuracy of visual perception testing. B, D: The client's compensatory techniques suggest disruptions in visual foundation skills, which should be screened before assessing visual perception and motor planning. C: Environmental factors do not influence the compensatory movements this client demonstrates.

A client presents with decreased orientation. What is the most effective strategy for an OTR® to implement to assist with this cognitive impairment? Use an orientation poster in a common area with personal and daytime information listed. Provide auditory reminders throughout the day that provide basic personal and daytime information. Provide the client with orientation information only when requested to prevent undue anxiety. Allow the client to establish his or her own routine, even if that means allowing the client to dress for the day in the middle of the night.

Solution: The correct answer is A. Visual reminders are an effective strategy for deficits in orientation. Posting a client's name or picture outside of their room is not a HIPAA violation if the patient or guardian consents. B, C, D: Auditory reminders may be effective, but visual reminders that can be referred to throughout the day are more effective. In general, ignoring orientation deficits in someone is not advisable.

Which client would be MOST appropriate for vocational evaluation? A client with a recent spinal cord injury who wants to pursue a new occupation. A worker who wants to find volunteer opportunities in preparation for retirement An employer who wants to know the essential job functions of a position A work group at a manufacturing plant that needs ergonomic training

Solution: The correct answer is A. Vocational evaluations are most appropriate for people who have never worked or are unable to return to a previous job due to disability. B: Vocational evaluation and rehabilitation are not appropriate for a worker preparing for retirement. C: Determining the essential job functions of a position requires a job demands analysis. D: Ergonomic training does not require vocational evaluation and is typically done through direct consultation.

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? Wartenburg's sign and Froment's sign Visual analog scale and Kirschner's test Tinel's test and Kleinert's rule Allen's test and Phalen's test

Solution: The correct answer is A. Wartenburg's sign is the fifth finger held away from the fourth finger, indicating palmar adductor interossei weakness. Froment's sign is flexion of the interphalangeal joint of the thumb when the client performs a lateral pinch. The flexor pollicis longus is compensating for the adductor pollicis and flexor pollicis brevis. indicating weakness of the ulnar nerve. Wartenburg's and Froment's signs are tests of ulnar nerve compression or cubital tunnel syndrome. B: A visual analog scale is a pain assessment. Kirschner's test is a type of wire used in pinning fractures in the fingers. C: In Tinel's test, tapping along a nerve produces numbness and tingling sensations. Kleinert's rule does not exist; Harold Kleinert pioneered microsurgery in the hand and performed one of the first hand transplants in humans. D: Allen's test assesses ulnar and radial artery status of the hand, and Phalen's test checks for median nerve compression at the wrist.

An OTR® is completing a functional capacity evaluation (FCE) with a client with a history of upper-extremity trauma. During the FCE, the OTR® suspects the client is exaggerating the pain level and is not performing at maximum voluntary effort. Which symptoms would MOST LIKELY lead the OTR® to conclude the client's performance is not at maximum voluntary effort? Client reports that significant pain is present with most activities. Client reports that pain is radiating throughout the upper extremities. Client reports that pain increases with stress. Client exhibits increased heart and respiratory rate with exertion.

Solution: The correct answer is A. When associated with a true pathological condition, pain is not consistently present during most activities. Clients will often respond in predictable manner. B, C, D: Pain typically presents in anatomical areas associated with the pathological condition. Pain typically increases in response to stress related to force and repetition and is accompanied by observable physical responses.

An OTR® is working with a client with C5 spinal cord injury. In which position is it BEST to splint to prevent deformity in the acute stage of injury? Wrist extension, thumb opposition Wrist neutral, thumb opposition Wrist extension, thumb adduction Wrist extension, thumb free

Solution: The correct answer is A. When splinting in acute spinal cord injury, the wrist should be extended with thumb opposition to preserve web space and prevent deformity B: This position may promote shortening of the finger and wrist flexors. C, D: Thumb adduction will contribute to a loss of webspace.

An OTR® is evaluating a patient who underwent an open reduction and internal fixation (ORIF) of the hip and is non-weight bearing. The patient wants to return home but will require a temporary wheelchair to do so. What would be the MOST important concern for this patient in relation to chosing a wheelchair? Overall cost-effectiveness Durability of the product Individualism of the parts Adjustability of the wheelchair

Solution: The correct answer is A. Whether a medical condition is temporary, stable, or progressive will influence a client's wheelchair selection. Someone with a temporary condition will most likely be more concerned with the cost of a temporary wheelchair than with individualism of the parts, the product's durability, or adjustability. B: Durability is of greater importance if a client's condition is chronic and stable and necessitates a full-time wheelchair. C: Individualism of the parts is also of greater importance if a client's condition is chronic and stable and necessitates a full-time wheelchair. D: A wheelchair that permits a range of adjustments would more likely be indicated if the client's condition is progressive.

A sales associate for a pharmaceutical company developed bilateral carpal tunnel syndrome 3 months ago. During an occupational interview, the OTR® finds out that the associate has recently switched from a sedentary office job to a job that requires frequent traveling. On average, the sales associate visits five to seven medical offices per day, using a rolling briefcase that weighs about 15 pounds. The sales associate uses a laptop computer in different environments, often including countertops at medical offices. The associate also uses the laptop at home several hours per day on the kitchen counter. What work-related factor would the OTR® MOST likely describe as the main contributor to the sales associate's carpal tunnel syndrome? Inappropriate height for the laptop computer on different countertops Lifting the rolling briefcase in and out of the car Lifting the laptop computer in and out of the briefcase Excessive and sustained gripping on the steering wheel of the car

Solution: The correct answer is A. Working with a laptop computer at different countertop heights creates static environments for awkward joint posture, especially in relation to static loading of the wrist, and contributes to the carpal tunnel syndrome. B, C: Lifting the rolling briefcase or the laptop computer is not considered repetitive motion because it is not repeated frequently. D: Excessive sustained gripping may lead to other cumulative traumatic disorder but is not usually considered a risk factor for carpal tunnel syndrome.

An OTR® 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? Inflammation, proliferation, and remodeling Coagulation, tension, and scar formation Proliferation, inflammation, and remodeling Tension, coagulation, and scar formation

Solution: The correct answer is A. Wound healing occurs in phases that generally follow the process of inflammation, proliferation, and remodeling. B, D: Coagulation, tension, and scar formation occur during wound healing but do not describe the full phases. C: Proliferation, inflammation, and remodeling are the correct phases listed in the incorrect order.

An OTR® is working with a client who was recently diagnosed with de Quervain syndrome. In addition to the medical treatment of corticosteroid injection, what nonoperative treatment is MOST appropriate for this condition? Forearm-based thumb spica splint Hand-based thumb spica splint Wrist cock-up splint to 10 extension Wrist cock-up splint with dynamic extension assist

Solution: The correct answer is A. de Quervain syndrome is a stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis of the first dorsal compartment, so the thumb and wrist both need to be immobilized. B: The first dorsal compartment at the wrist needs to be splinted in addition to the thumb. C: A wrist cock-up splint to 10 extension would be used for carpal tunnel syndrome. D: A wrist cock-up splint with dynamic extension assist would be used for a radial nerve injury post metacarpophalangeal arthroplasty.

An entry-level OTR® working in an outpatient rehabilitation clinic is evaluating a client who was recently hospitalized for dehydration and subsequently diagnosed with mild cognitive impairment. The client lives alone in an independent living facility. Before admission, the client was independent in ADLs and light homemaking and active in community and social activities, including driving independently. The client reports no crash record and no violations or citations but avoids night driving, highway driving, and driving in rush-hour traffic or heavy rain. During the multidisciplinary team meeting, the referring physician asks the OTR to justify why OTRs are suited to assess this client's fitness to drive. How would the OTR BEST respond? Driving is an ADL included in the scope of practice of occupational therapy and therefore within the OTR®'s domain to assess. OTRs need to extrapolate beyond the walls of the clinic to consider how clients will function in the community; in making such an extrapolation, assessing driving fitness is no different from considering whether a client is fit to live alone. Occupational therapists use clinical reasoning to make determinations regarding a client's IADLs, including driving. OTRs are trained to use clinical tests to assess domains of function. Because driving entails motor, sensory, cognitive, and visual functioning, occupational therapists may make fitness-to-drive decisions on the basis of functional performance of clients.

Solution: The correct answer is B. A, C, D: These answers are partly true, but not the best answers. A: Driving assessment is within the OTR's scope of practice; it is an IADL, not an ADL. C: The OTR should be using clinical reasoning, critical thinking, and best evidence to problem solve whether a client is fit to drive, not just clinical reasoning. D: A comprehensive evaluation, not just assessment of functional performance components, is necessary.

An OTR®; wants to search the literature for rationales related to a sensory integration intervention for clients with dementia. Which is an appropriate question for an evidence-based practice literature review? "What is a sensory integration approach?" "How is sensory integration used with people with dementia?" "What is the efficacy of sensory integration?" "What are the outcomes of sensory integration?"

Solution: The correct answer is B. "Answerable" evidence-based practice questions include key words that link to a specific problem or client population. A: This question represents general information gathering rather than an attempt to find evidence for a specific client or treatment scenario. It would return generic information that may not be useful for specific evidence-based practice issues. C, D: These questions are not directed toward a specific problem or client and would return generic information that may not be useful for specific evidence-based practice issues.

An OTR® wants to teach a home exercise strengthening program to a child with a mild intellectual disability. How should the OTR® modify the home exercise program so that the client can follow it independently? Reduce the number of exercises from 20 to 15 to encourage independence. Incorporate simplified vocabulary and pictures to encourage independence. Model the home exercise program and allow the child to follow along to encourage independence. Pair the child with a peer who has a similar home exercise program to encourage independence.

Solution: The correct answer is B. A child with a mild intellectual disability might be able to read between the second-grade and seventh-grade levels. Simplified words and pictures may allow the child to follow the home exercise program with greater independence. A, C, D: These strategies may be appropriate for use with a child with an intellectual disability, but are not directly related to helping the child in this scenario gain independence with the home exercise program. The child will not be able to access the adult model or the peer from home. In addition, reducing the number of exercises will not automatically enable the child to follow the program more effectively.

Why should fall prevention strategies be implemented with clients with middle-stage dementia? Declines in temporal orientation may cause anxiety and confusion, leading to falls. Declines in judgment of distance, direction, and ground surfaces may increase risk of falls. Declines in sequencing cause disturbed gait patterns, leading to an increased risk of falls. Hallucinations or delusions coupled with overall motor decline may lead to an increased risk of falls.

Solution: The correct answer is B. A client with middle-stage dementia will have decreased judgment along with decreased performance skills that may lead to falls. A: Temporal orientation will be impaired in those with middle-stage dementia but is not likely to be the primary cause of falls. C, D: Motor abilities, such as gait, tend to remain intact in clients with middle-stage dementia, unless they have other comorbid conditions

An OTR® needs to choose an assessment for a client experiencing fibromyalgia that provides information on the client's sleep patterns, level of fatigue, cognition, and mood changes. Which assessment can BEST provide this information? Canadian Occupational Performance Measure Daily activity log Referral for a sleep study Visual analog scale

Solution: The correct answer is B. A description of a typical 24-hour day will provide information about when a client is in pain, fatigued, or frustrated and what activities aggravate or improve functional performance. A: The Canadian Occupational Performance Measure is used for setting treatment goals in conjunction with the client. C: A sleep study would detect sleep patterns only. D: A visual analog scale would assess pain level only.

An OTR® consultant is hired to perform a job demand analysis for the assembly-line workers in a meat-processing factory. What areas will the OTR® MOST likely be measuring and reporting on? The ordering, assembly line, and documentation processes Height of the table, cutter and tool design, and vibration frequency of the automated tools Administrative hierarchy, lines of command, and ratio of supervisors to workers at the factory Job description, lifting requirement for the tasks, and the training process.

Solution: The correct answer is B. A job demand analysis is an objective evaluation of each task of a job, taking into consideration the physical environment in which the job occurs. The workstation's dimension and layout, equipment, tools, and any other factors that can affect workers will be documented. The ergonomic risk factors are also considered in a job demand analysis. A, D: This information is gathered before the start of a job demand analysis to guide the therapist through the analysis. They are not areas that require assessment by the OTR®. C: Administrative information is not assessed in a job demand analysis.

An OTR® is working with a client with severe kyphosis secondary to osteoporosis. What is the primary cause of kyphosis in osteoporosis? Pathological deterioration of the vertebrae of the cervical spine Pathological deterioration of the vertebrae of the thoracic spine Pathological deterioration of the vertebrae of the lumbar spine Pathological deterioration of the neck of the femur

Solution: The correct answer is B. A kyphosis is an abnormal rounding of the upper back. In the case of osteoporosis, it is caused by compression fractures of the vertebrae weakened by the osteoporotic condition. B, C, D: A kyphosis is defined as a rounding of the upper back, not of the neck, lower back, or hip.

An OTR® is evaluating a 16-year-old adolescent with major depression and suicide precautions in an inpatient facility. Which source of information will BEST enable the OTR® to document the intensity, severity, and duration of this client's symptoms? Observation during occupational performance A life events inventory of the client Interviews with caregivers Interviews with roommates in the facility

Solution: The correct answer is B. A life events history can provide an accurate history of the client. A, C, D: Perspectives of others and observations supplement direct history taking with the client.

An OTR® is working in an inpatient setting with veterans who have upper-extremity amputations. Each morning the rehabilitation team, consisting of physician, nurse, psychologist, social worker, OTR, physical therapist, and orthotist, come together to discuss their patients' clients' progress toward the goals set within their individual disciplines. What type of team is this? Transdisciplinary team Multidisciplinary team Interdisciplinary team Allied health team

Solution: The correct answer is B. A multidisciplinary team is an interprofessional team composed of individuals representing the professional disciplines that serve the client. A: Transdisciplinary teams function without discipline-centered boundaries. C: Interdisciplinary teams set goals and engage in intervention collaboratively across the disciplines. D: Allied health teams are not a recognized, definable type of team collaboration.

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? Apply paraffin followed by joint mobilization techniques Fit the client with a prefabricated dynamic PIP extension assist splint Instruct the client in flexion blocking exercises Fabricate a customized dynamic PIP extension assist splint

Solution: The correct answer is B. A prefabricated dynamic PIP extension assist splint will improve PIP extension and takes less therapy time to fit than to custom make this splint. A: Heat and joint mobilization can increase ROM temporarily, but long-term improvement of the PIP flexion contracture requires dynamic splinting. C: Flexion blocking exercises increase flexion, not extension. D: Fabricating a custom dynamic splint takes longer than fitting a client with a prefabricated splint.

The OTR® is treating a client who presents with hemiplegia from a cardiovascular accident. The client's hand is flaccid. To fabricate a custom resting hand orthosis, in what position should the OTR® place the wrist and metacarpophalangeals (MCPs)? Wrist at 10 flexion and MCPs at 0 flexion Wrist at 25 extension and MCPs at 55 flexion Wrist at 45 flexion and MCPs at 10 flexion Wrist at 60 flexion and MCPs at 0 flexion

Solution: The correct answer is B. A resting hand orthosis keeps soft tissue positioned in optimal mobility with flexion of the MCPs at 45 to 60; 55 would accomplish this, and 25 of slight extension would maintain the wrist in a position that would not compromise the median nerve. A, C, D: MCPs at 0 of flexion would shorten the collateral ligaments and increase potential for flexion stiffness and wrist positioned in flexion would compromise the median nerve.

An OTR® asks a client with impaired balance to dust and polish a bookshelf in standing position without upper-extremity support. The OTR notes no loss of balance during reaching and bending tasks. How would the OTR® appropriately grade the activity to provide the just-right challenge? Add bilateral weights to the client's wrists. Reduce the client's base of support. Have the client stand on a tilt board. Remove the client's assistive device from the work area.

Solution: The correct answer is B. A therapeutic activity in which the OTR is addressing balance in someone with deficits would likely begin with the client in a wide base of support, or with the feet hip- to shoulder-width apart. If the client can successfully participate in this IADL task with a wide base of support, the OTR may upgrade the task and have the client move the feet closer together, narrowing the base of support and increasing the challenge. A: Adding wrist weights would do little to further challenge balance. C: A tilt board may be too advanced for this client before trialing other balance challenges. D: Removing the assistive device from the work area may increase the client's anxiety.

A new client is unable to sit up on the edge of the bed or stand without assistance. The OTR® has decided to address bridging in bed. Why is this a functional activity for an OTR to address? Bridging is used to complete supine-to-sit transfers. Bridging is used to assist with lower body dressing in bed. Bridging is used to complete lower-extremity strengthening in bed. Bridging is used improve trunk control for sitting balance.

Solution: The correct answer is B. Bridging is a movement strategy used to complete functional activities in bed, such as using a bed pan or pulling pants over the hips. A: Although bridging helps in laterally moving to the side of the bed, it is not required to complete supine-to-sit transfers. C: Bridging can be used as an exercise to improve lower-extremity strength, but increasing lower-extremity strength is not considered a functional activity. D: Repeated use of bridging can be used to improve trunk control secondary to increasing strength in the lower back and hips, but it is not considered a functional activity.

An OTR® has completed a screening of fine motor skills with all of the students enrolled in a kindergarten class. The results indicate that five students in the class are functioning in the lower 25th percentile. What INITIAL action should the OTR® take in response to these findings? Compare the screening results of these students to standardized achievement test scores. Discuss the students' results and potential follow-up options with the classroom teacher. Document that scores for each of the students are within normal limits. Recommend scheduling a comprehensive occupational therapy evaluation for each of the students screened.

Solution: The correct answer is B. Additional information that is relevant to the child's development and performance in school will help to establish the accuracy of the screening findings. A: Standardized achievement scores are not psychometrically sound and can be misleading in understanding performance. C: Documenting incorrect scores would be unethical. D: A basic screening of fine motor skills in large groups of children is done to determine whether children need further testing. Comprehensive occupational therapy evaluation may be warranted after gathering additional relevant information from the child's teachers, parents, and caregivers to determine whether further evaluation is needed.

Which occupational therapy group would benefit MOST from a highly directive and authoritative leadership style? A group of preschool children exploring sensory experiences A group of adolescents attending a gang prevention group in an alternative education setting in which they have been placed for behavioral issues stemming from a diagnosis of oppositional defiant disorder A group of middle-aged clients in an outpatient day treatment setting who are learning to manage their depression following inpatient hospitalization A group of healthy older adults in an apartment complex exploring ways to stay fit and healthy

Solution: The correct answer is B. Adolescents, particularly those diagnosed with oppositional defiant disorder, need boundaries, and an authoritative leadership style is critical to successfully managing this group. A: Children engaging in exploratory sensory experiences should be allowed to direct their activity choices whenever possible. C: An outpatient treatment facility is designed for clients who have stabilized enough to live independently, so these clients can be more self-directed and would not require an authoritative or directive leader. D: Although elements of a voluntary group for well elders may require the OTR® to be more directive at times, such as during an exercise session, overall the group focus should be client centered.

An OTR® is hired as a consultant to design a productive modified-duty program for a small manufacturing plant. Which element should the OTR® NOT incorporate into the program design? Focus on maintaining injured employees in a productive work capacity while facilitating progressive recovery. Provide opportunities for injured workers to interact with coworkers in the context of the work environment. Identify designated staff to be trained to monitor a worker's adjustment and tolerance to work tasks. Ensure that the demands of an assignment are within the stated restrictions of the employee's abilities.

Solution: The correct answer is B. Although opportunities to interact with coworkers provide the injured worker the benefit of socialization and exposure to the work environment during recovery, they are not the primary focus of modified duty programs. A, C, D: All these components should serve as guidelines when establishing a productive modified-duty program.

An OTR® suspects that an OTR colleague is falsifying treatment session documentation in order to comply with documentation deadlines. If true, this constitutes a breach of the ethical principles of Veracity and Justice. What is the BEST next step for the OTR take? Report the person to the state regulatory board. Approach the person directly to refute the claim. Report the person to the rehab manager. Contact the human resources department.

Solution: The correct answer is B. Approaching the person directly is most appropriate; it is the most respectful approach, and the OTR may be incorrect about the OTR's behavior. A, C: Reporting to the state regulatory board or to the rehab manager is premature. The Enforcement Procedures for the Occupational Therapy Code of Ethics and Ethics Standards (2010) state that practitioners "should first pursue other corrective steps within the relevant institution or setting and discuss ethical concerns directly with the potential Respondent before resorting to AOTA's ethics complaint process" (p. S3). D: Human resources personnel are not responsible for handling ethical breaches, although if the appropriate investigation affirms that the colleague is falsifying documentation, there would be grounds for terminating the employee.

A client is experiencing headaches at work owing to increased neck and shoulder tension resulting from prolonged computer keyboarding. The client's job duty requires 6 hours of typing on an average workday. What is the BEST stress management approach for the OTR® to suggest to this client? Work hardening program to increase endurance for prolonged keyboarding Frequent stretching breaks at the computer station every 30 minutes of keyboarding Assertiveness training to advocate for having extra personnel to assist with the client's work Decreased work hours per workday but spread to 6 workdays per week to catch up

Solution: The correct answer is B. Aside from ergonomic workstation modification to prevent straining the neck and shoulder during keyboarding, moving away from the static posture of keyboarding and performing different stretching exercises at the workstation is also important. A: Increasing the worker's endurance in keyboarding is inappropriate because prolonged keyboarding will lead to a longer period without a change in posture and therefore increase the risk of repetitive injury. C, D: Advocating for extra assistance or work hour changes requires the support of and agreement from management. These kinds of recommendations are not common in the early phase because they are beyond the scope of reasonable accommodation in a workplace.

A client who has schizophrenia is attending an adult mental health day treatment program. During a task-oriented group the OTR® observes that the client has difficulty understanding the concept of completing the multiple steps involved with developing a monthly personal budget plan. Which Allen Cognitive Level BEST describes this client's level of function based on this observation? 3 (Manual Actions) 4 (Goal-Directed Actions) 5 (Exploratory Actions) 6 (Planned Actions)

Solution: The correct answer is B. At Level 4, the client would be able to complete quick tasks and model single-step completion. Routine tasks would be independent for a client. A: At Level 3, clients are able to engage in simple tasks that have repetitive actions with limited choices, and a client at Level 3 would require assistance for personal budget planning. C: At Level 5, clients are able to improve actions through trial and error and are able to complete several steps at a time, whereas the client in this scenario is having difficulty completing multiple-step tasks. D: At Level 6, a client would handle unlimited steps in an activity including diagrams and written directions and would be independent with personal budget planning.

Which task might a person with early-stage dementia have difficulty performing, in light of typical psychosocial and cognitive abilities present during this stage? Completing the morning ADL routine consistently Balancing a checkbook Maintaining social interaction with family Cooking a simple meal

Solution: The correct answer is B. Balancing a checkbook is a higher level cognitive task that will most likely be difficult for a client with early-stage dementia. Typically, people with early-stage dementia have the most difficulty with IADLs that require executive function, such as money management and driving. Other IADLs and ADLs become impaired as the disease progresses. A: A morning ADL routine will be maintained by people with dementia until the middle stages. C: Social interactions will begin to deteriorate during the mild stage, due to memory loss. Marked loss of social interaction will occur during the middle stage, when the client has also lost sense of time. Late-stage dementia is characterized by minimal interaction and verbalization. D: The ability to plan for and cook for others will begin to decline in the early stage, but the ability to cook a simple meal will be maintained into the middle stage of dementia.

In which of the following groups is group process the MOST important? An open-membership group for people with stroke that meets weekly, in which the OTR® demonstrates self-ROM and then participants range their own extremities to demonstrate that they understand the correct procedures A closed-membership group for war veterans that meets daily to facilitate coping with the impact of posttraumatic stress disorder by engaging in expressive media and discussion and reflection A diagnosis-specific group for patients with arthritis that meets weekly to measure ROM and monitor pain control A group for students in an after-school program who are receiving tutoring in math skills

Solution: The correct answer is B. Because discussion among peers is a principal component of this group, group process is essential to the effectiveness of this intervention. People with posttraumatic stress disorder often find it helpful to share their experiences with others who have had similar experiences, and the group process is often effective in this context. A: Self-ROM can be mastered without the benefit of a group process. C: Patients with arthritis can perform ROM exercises and monitor pain without a group process. Although participants may find it helpful to talk to others who have arthritis, the outcomes articulated can be achieved without a group. D: The success of this group is not dependent on students' ability to interact with one another; students can improve their math skills without interacting as a group.

An OTR® is working with a client who is unable to drive. The OTR is educating the patient on the benefits of a fixed transit system in comparison with a paratransit system. What might these benefits include? Fixed transit is easier to use independently than paratransit. Fixed transit is more economical than paratransit. Fixed transit does not take as much strength as paratransit. Fixed transit requires less cognitive training than paratransit.

Solution: The correct answer is B. Because fixed transit systems are on a scheduled route with specific stops, they cost less to use than paratransit systems, which have an obligation to provide origin-to-destination services. A: Because fixed transit systems require the ability to efficiently get to a stop and onto the vehicle safely, as well as the ability to manage the system (e.g., handle money, understand transfers), many older adults or people with disabilities are nervous about traveling alone on fixed transit systems. C: It takes more strength to manuver a fixed transit system, because a rider has to physically get to a stop rather than be picked up at a point of origin. D: A fixed transit system is considered to require more cognitive skills than paratransit, because the rider needs to read and understand a schedule and manage money on the spot.

An OTR® is preparing to discharge a client who recently underwent hip surgery. The client is planning to ride home in a very small car with bucket seats. What is the BEST recommendation for the client's circumstances? Suggest the client put the leg up on the dashboard to ensure its stability. Suggest an arrangement for alternative transportation to limit stress on the hip. Suggest the client place a trash bag on the bucket seat to allow for easy sliding. Suggest the seat back be folded entirely down to increase client mobility.

Solution: The correct answer is B. Bucket seats in small cars should be avoided. A: Placing the leg on the dashboard will offend precautions and be a danger to the client. C: Although the trash bag may assist in the client's mobility, it does not address seat height, which could compromise hip precautions. D: Placing the seat back down may decrease stability for the transfer.

A client with advanced amyotrophic lateral sclerosis (ALS) presents with a stiff forward-flexed neck that is at risk for developing a contracture and impairing social participation. Which intervention would the OTR® use to BEST prevent a contracture? A physical agent modality such as diathermy or ultrasound Caregiver training on gentle neck stretching and how to help don a soft cervical collar A home exercise program of isometric neck exercises in all planes Education on proper positioning at rest and during functional tasks

Solution: The correct answer is B. Because of ALS's progressive nature, many of the interventions for clients with ALS focus on patient and caregiver education to address the increasing symptoms and preventing secondary complications such as contractures. Caregiver training on gentle neck stretching and how to help don a soft cervical collar is the most appropriate because using the collar will help maintain the neck in a neutral position, and gentle stretches to the neck will lessen stiffness and discomfort. A: Using a physical agent modality, is more of a remedial approach that is not the most appropriate for someone with a rapidly declining health condition. C: For someone with advanced ALS, isometric exercises would also not be the best choice. D: Education is a key component of intervention; however, if the neck is at risk for developing contracture, it is likely already weakened and will need additional support.

An OTR® is evaluating a client in the plateau phase of Guillain-Barré syndrome in a hospital setting. Which symptom is the OTR MOST likely to observe? Unilateral pain in a lower extremity Inability to communicate vocally Confusion from short-term memory loss Hyposensitivity to tactile input

Solution: The correct answer is B. Because of paralysis of muscles in the head and neck, spoken communication is often impaired in the plateau phase of Guillain-Barré syndrome. A: Guillain-Barré syndrome is symmetrical (bilateral) in its presentation; therefore, evaluation of only one side of the body is not appropriate. C: Cognitive impairments are not typical with Guillain-Barré syndrome. D: Hypersensitivity, rather than hyposensitivity, is typical in the plateau phase of Guillain-Barré syndrome.

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

Solution: The correct answer is B. Because of the change in their center of gravity, clients with bilateral amputations are more likely to tip over backward during weight shifts. Rear antitipping devices are necessary for safety. A: Clients with lower limb amputations cannot use footrests and require residual limb supports. C: Padded swing-away armrests may increase comfort but are not necessary for safety. Clients with bilateral amputations are more likely to tip over backward during weight shifts, so rear antitipping devices are necessary for safety. D: Wheel-lock extensions will improve the ease of locking the brakes but are not necessary. Clients with bilateral amputations are more likely to tip over backward during weight shifts, so rear antitipping devices are necessary for safety.

A client was provided with an ultra lightweight wheelchair. Because the client is at risk for falls, the drop seat was tilted posteriorly to help prevent the client from getting out of the chair; also, because of the client's short stature, the axle was moved forward to make it easier for the client to propel the chair. What two accessories would the OTR® recommend to improve the client's safety while using the wheelchair? Solid rubber casters, antitippers Antitippers, brake lever extenders Brake lever extenders, flip-up footrests Flip-up footrests, antitippers

Solution: The correct answer is B. Because the client's center of gravity is now behind the axle and the drop seat is tilted posteriorly, the client is more vulnerable to tipping backward in the chair; thus, the OTR® would recommend antitippers. The OTR® would recommend brake lever extenders because the tilt of the drop seat and the client's short stature will make it difficult for the client to access the brake levers. A, C, D: Solid rubber casters and flip-up footrests will have no impact on the client's safety while using the wheelchair because they do not hinder him from getting out of his chair.

A client with middle-stage Huntington's disease (HD) is displaying fatigue during lower body dressing tasks. What would be an appropriate intervention strategy for the OTR® to use with this client? The OTR should engage the client in an intense cardiovascular exercise routine. The OTR should encourage the client to take frequent breaks during lower body ADL tasks. The OTR should train the client in the use of lower body adaptive equipment such as a sock aid. The OTR should educate the client's caregivers on appropriate assistance to provide to the client during dressing.

Solution: The correct answer is B. Because the client's primary complaint is fatigue, taking rest breaks would be appropriate. A: Given that HD is a progressive loss of motor control, an intense exercise routine would most likely be too difficult for the client. C: Incoordination and decreased motor control would make learning adaptive equipment difficult. D: Although caregiver education would be important, encouraging independence in ADLs as the client is able is still important to reduce caregiver burden and stress.

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? Resting hand splint Intrinsic plus splint Cone antispasticity splint Dorsal flexor tendon repair splint

Solution: The correct answer is B. Burns to the dorsum of the hand require the metacarpophalangeal joints to be splinted in 70-90 degrees of flexion to prevent clawing of the fingers and shortening of the tendons and ligaments. This type of splint is also referred to as an antideformity splint or a safe position splint. A: A resting hand splint is for support or immobilization. C: A cone antispasticity splint is used for clients with cerebrovascular accident, traumatic brain injury, or cerebral palsy. D: A dorsal flexor tendon repair splint is used for clients with flexor tendon repair

An OTR® is providing intervention to a 4-year-old with developmental delays and is working on sorting. What outcome would be the result of a goal for this child if the intervention focused on sorting eating utensils according to type and size? To be able to note key features or attributes and relate them to what is already kept in one's memory To be able to categorize objects by similarities and to note differences To be able to note the similarities among objects To be able to determine the spatial relationship between objects

Solution: The correct answer is B. Being able to sort by type and size would support the child's ability to categorize objects on the basis of similarities and to note differences among objects. This skill is an important precursor to successful participation in ADLs and educational occupations. A, C, D: Recognition (the ability to note key features or attributes and relate them to what is already kept in one's memory) and matching (the ability to note the similarities among objects) are perquisites to categorization and the would likely not be the final outcome of the intervention..

A client with recent hip replacement surgery (posterior approach) is concerned about how to shampoo hair while not able to use the shower at home. What recommendation from the OTR® will most appropriately address the client's concern? The client may shampoo the hair while standing in the shower, covering the hip with a plastic bag. The client may shampoo the hair while standing at the kitchen sink. The client may shampoo the hair while in a wheelchair at the bathroom sink. The client may shampoo the hair while using a handheld nozzle in the shower.

Solution: The correct answer is B. Bending forward at the kitchen sink does not require as much hip flexion as bending forward at a typical bathroom sink; many clients are able to wash hair at the kitchen sink without compromising hip precautions. A, D: Showers should not be considered in the early stages of wound healing. C: This approach could generate more hip flexion than allowed by standard hip precautions.

An OTR® continues to work with and charge for services with a client after all goals are met and there is no further need for occupational therapy services. This behavior is unethical. Which Occupational Therapy Code of Ethics (2015) principle best describes this situation? Nonmaleficence Beneficence Justice Veracity

Solution: The correct answer is B. Beneficence is the principle that occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services. Beneficence hold personnel accountable to integrity for goals related to treatment. Principle 1H of the Occupational Therapy Code of Ethics states, "Occupational therapy personnel shall terminate occupational therapy services in collaboration with the service recipient or responsible party when the services are no longer beneficial." A: The ethical principle of Nonmaleficence states that occupational therapy personnel shall intentionally refrain from actions that cause harm. This item is unrelated to causing direct harm (although unneeded services do have the potential to cause harm). C: The ethical principle of Justice is about promoting fairness and objectivity in providing occupational therapy services. D: The ethical principle of Veracity is the principle that occupational therapy personnel shall provide comprehensive, accurate, and objective information when representing the profession. Principle 6D states that personnel shall ensure that documentation for reimbursement purposes is done in accordance with applicable laws, guidelines, and regulations.

A client with Stage 2 Parkinson's disease (PD) is working with the OTR® on facial expressions and social skills. Which biofeedback tool would the OTR® use to appropriately address these areas? Instruct the client in exercises that focus on facial movement and expression. Advise the client to practice different facial expressions in a mirror. Teach caregivers how to provide cueing to enhance the client's facial expressions. Suggest support groups for the client to attend to receive empathy from other people with PD

Solution: The correct answer is B. Biofeedback includes "procedures or techniques that are used to provide an individual with an auditory or visual cue or 'feedback' to learn and gain volitional control over a physiological response" (Radomski & Trombly, 2008, p. 543). Using a mirror offers clients real-time visual feedback to make adjustments and fine-tune facial movements. Moreover, clients with PD benefit from external cues as a treatment approach. A: Exercises specifically focused on facial muscles are a good biomechanical technique but not necessarily biofeedback. C, D: These strategies are helpful but take away the client's independence in addressing this task and do not necessarily provide auditory or visual cueing.

What is an effective way to assist a client who has early- to middle-stage dementia with a complex task? Suggest that the caregiver complete difficult components of the task. Break the task into manageable steps and provide verbal or visual cueing. Remove the materials necessary for the task until the client forgets about it. Change the location where the task is performed so that the client can relearn the task.

Solution: The correct answer is B. Breaking a complex task into manageable steps while providing some type of cueing (whether simple verbal or visual cueing) allows a client with dementia to perform a task more independently and with less frustration. A: Having the caregiver complete parts of the task might be appropriate at the later stages of dementia. In the earlier stages, the client with dementia might become defensive if the caregiver provides too much assistance. C: Removing the items would not be acceptable, especially if the task is routine. It also does not address the goal of providing clients with dementia with appropriate goal-directed activities that promote quality of life. D: If the location of the task is changed, it might be more difficult for the client to transfer those remaining skills to the new location. Relearning tasks is not usually an option for clients with dementia.

A client with dementia presents with decreased attention. What is the most effective strategy for an OTR® to implement to assist with this cognitive impairment? Encourage the client to persist in the task despite fading concentration. Break the task into manageable steps and provide them one by one to the client. Provide the client with self-talk strategies that allow the client to maintain attention to the task. Provide contrasting visual cues to enhance interest in the environment to improve attention.

Solution: The correct answer is B. Breaking the task into manageable steps allows the OTR® to control the task and provide the "just-right" challenge to the client to maximize attention to the task and to reduce frustration. A: Persisting in a task despite fading attention may lead to increased frustration and anxiety or production of a product that is not of good quality. C: Self-talk is more effective for executive function deficits. D: Increasing visual attention to the environment might be stimulating but would not automatically lead to an increase in attention to task.

Although fitted with an ultra lightweight wheelchair (K0005), a client with bilateral above-the-knee amputations is prone to losing sitting balance and falling forward when propelling the chair. The position of the axle is in front of the pelvis. The OTR® needs to find a balance between stability and the effectiveness of arm propulsion. Because the chair is a K0005, which solution will the OTR® MOST likely suggest? Move the axle forward so that the client's center of gravity is behind the axle Move the axle back so the client's center of gravity is over the axle and add antitippers Exchange the client's pushrims for ones that have knobs for easier pushing Make no changes to the axle but add antitippers to prevent falls

Solution: The correct answer is B. By moving the axle backward, compromised stability will be offset by the antitippers, but movement efficiency will be increased during propulsion and the client's center of gravity will no longer be at the front of the wheelchair, thus reducing the risk of falling forward. A: Moving the axle forward will place the client's center of gravity further back in the chair, increasing the risk of a backward fall. C: Knobs are not needed on the pushrims because the client has good grasp. D: Antitippers are used alone to prevent backward falls, and the client has been falling forward.

An OTR® is working with a child with juvenile rheumatoid arthritis (JRA). The child is having difficulty implementing the school-based therapist's energy conservation recommendations at home. Which strategy would help the child consistently apply energy conservation techniques? Provide training to the child's sibling related to the ROM program. Provide the child with a second set of textbooks to keep at home. Provide training to the school nurse on how to assist the child with managing pain. Provide the child with a color-coded folder to put homework in.

Solution: The correct answer is B. Children with JRA benefit from energy conservation techniques that put less stress on their joints. Allowing the child to have a second set of textbooks would mean that the child would not need to transport heavy books to and from school, thus protecting the joints. A: Training the child's sibling on a ROM program does not relate to energy conservation techniques. C, D: Both options are related to school; however, the child would be passive in C, and D would not address the child's challenges related specifically to JRA.

An OTR® is working on postoperative discharge plan for a school-age child with neurofibromatosis. The OTR® recommends that the parents move the child's clothes from the top drawer so that the child can access them independently. Why might the OTR® make this recommendation? Children with neurofibromatosis have weakened shoulder girdles and reduced upper-extremity strength. Children with neurofibromatosis are of short stature and have skeletal anomalies. Children with neurofibromatosis have decreased sensation and often drop things. Children with neurofibromatosis have difficulty initiating routines.

Solution: The correct answer is B. Children with neurofibromatosis are of short stature and have skeletal anomalies. Because of their reduced height, they may benefit from environmental modifications that allow them to reach objects independently. A: Children with neurofibromatosis may have strong shoulder girdles and functional shoulder strength. C: Children with neurofibromatosis may not have decreased sensation, unless they have a comorbid condition. D: Children with neurofibromatosis may not have difficulty initiating routines, unless they have a comorbid condition.

A 10-year-old child sustained a Zone 2 flexor digitorum profundus tendon laceration and underwent primary repair. Which flexor tendon repair protocol represents best practice standards? Active mobilization approach Immobilization approach Passive mobilization approach Controlled early active mobilization approach

Solution: The correct answer is B. Children younger than age 12 are usually placed on an immobilization protocol because of their low maturity level and low ability to comply with the exercises and precautions of other protocols. A, C, D: Immediate or early mobilization protocols involve glide of the tendon in the early phases of postoperative healing. Children under age 12 may not have the maturity level or ability to understand precautions and adhere to exercise guidelines.

What piece of adaptive equipment is MOST useful for a client with an incomplete T2 spinal cord injury? A weighted spoon A long-handled sponge A plate protector A button hook

Solution: The correct answer is B. Clients with a T2 spinal cord injury will need assistance reaching and washing immobile lower extremities. A: A weighted spoon is generally indicated for tremors. C: A plate protector is not indicated for a client with this type of injury. D: A button hook is generally used for clients with dexterity issues or low vision.

An OTR® is conducting the first session of an occupational therapy group for adolescents with oppositional defiant disorder in an inpatient behavioral treatment center. Which activity is a priority? Assess individual members' likes and dislikes Set ground rules with clear expectations Do an ice breaker using a large parachute Identify the time-out chair for participants who misbehave

Solution: The correct answer is B. Clients with oppositional defiant disorder need clear rules about what behaviors are acceptable and not acceptable. Expectations for participation in the group need to be made explicit. A: The OTR® should assess participants' likes and dislikes as part of the occupational therapy profile before deciding whom to include in the group. The OTR® may also survey participants once the group has started to determine what topics or activities they prefer. C: An ice breaker with a large parachute would not be a good choice for the initial group session for clients with oppositional defiant disorder, who are likely to be unable to work together effectively so early in their treatment. D: Behavioral intervention should be individualized, and a time-out chair may not be the best consequence for all participants. A time-out chair, which is typically used for younger clients, would infantilize these participants.

An OTR® is conducting a cooking activity in an outpatient occupational therapy group in a community mental health setting. One of the group members is an adult with obsessive-compulsive disorder (OCD). During meal preparation, the client washes hands repetitively and excessively each time the client touches a food item, which delays the group's progress in the activity. What should the therapist do to help the client more efficiently perform the task? Assign the client to a role that does not involve touching food. Remind the client of triggers for compulsive behavior and recommend use of latex gloves for the activity. Encourage the client to use utensils to avoid touching the food. Assign the client the role of teaching and managing hygienic cooking behaviors.

Solution: The correct answer is B. Cognitivebehavioral therapy approaches to OCD include helping the client overcome the tendency toward compulsive behavior by identifying the triggers to a compulsive episode, planning a strategy for overriding the compulsion, and continuing to do the activity or task. A, C: Avoidance, either by not coming to group or not touching the food, is not a preferred approach because it does not help the client address and eventually manage the compulsion. D: Assigning a related overseer's role may overemphasize the focus on the root of the problem.

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 OTR® to take to address the client's edema? Pneumatic pump and cold packs Cold packs and compression glove Deep retrograde massage and elevation A bulky dressing for the arm

Solution: The correct answer is B. Cold packs cause vasoconstriction, so they are appropriate to use for edema reduction. Compression will facilitate small molecule absorption by the venous system. A combination of the two is the best strategy to reduce edema. A: Pneumatic pumps are rarely indicated by occupational therapy practitioners. Other edema management techniques are usually adequate. C: Retrograde massage should be light, not deep. D: Bulky dressings are typically applied postsurgically and usually discontinued after no more than 1-2 weeks, unless medically necessary and ordered by the physician.

When conducting an on-road assessment, which elements should the driver rehabilitation specialist consider? The client's performance in his or her own vehicle on a predetermined road course Client-centered principles and the client's context as referenced in the Occupational Therapy Practice Framework Parking lot, residential, suburban, urban, city, rural, and highway contexts The client's ability to engage in conversation or adjust controls (e.g., air conditioning) while driving

Solution: The correct answer is B. Conducting an assessment according to client-centered principles and the client's context is consistent with the Occupational Therapy Practice Framework: Domain and Process (2nd ed.; AOTA, 2008). A: A test vehicle, insured by the provider of services, should be used. C: Not all clients will need to drive in all aspects of traffic. D: Conversations need to be kept to a minimum during the on-road assessment.

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? Signs and symptoms of Marfan's syndrome Signs and symptoms of congenital cerebral palsy Signs and symptoms of fragile X Signs and symptoms of erythrocytosis

Solution: The correct answer is B. Congenital cerebral palsy is often a result of prematurity. Infants born between 26 and 32 weeks gestation are at high risk for cerebral palsy because of the likelihood of experiencing a cerebrovascular accident at or around the time of birth, placental abruption, fetomaternal hemorrhage, placental infarction, and maternal exposure to teratogens. A, C, D: These conditions are not associated with placental abruption.

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? Poor bladder control Poor tolerance of passive range of motion Poor balance Poor feeding and vomiting

Solution: The correct answer is B. Congenital syphilis may result in osteochondritis at the joints, other bone anomalies, dental anomalies, and visual and auditory deficits. PROM may be painful. A, C, D: These conditions are not associated with congenital syphilis, unless another condition is comorbid.

A team of OTR®s begins to recognize the need for a program to promote work participation for the young adults with mental illness they serve. Which statement MOST accurately reflects the evidence about developing such a program? Prevocational training sufficiently prepares clients with mental illness for work. Supported employment programs with a "place-and-train" perspective are more effective than other vocational approaches. Transitional employment placement through a clubhouse model is a time-honored method for increasing job placement. Sheltered workshops are useful programs for advancing work participation

Solution: The correct answer is B. Current rehabilitation focus is on the place-and-train supportive employment approach, and evidence supports its use. A, C, D: Prevocational training, transitional employment, and sheltered workshops use the classic train-then-place methodology. Because of the emphasis on preparatory skills in these settings, opportunities to transfer skills to actual work settings yield a lower percentage of employment.

While participating in an occupational therapy activity group, a client becomes highly confrontational with other clients in the group for no apparent reason. The client then tells the OTR® that if the client continues self-mutilating behaviors, his or her family will no longer allow the client to live at home. Documentation from the psychologist indicates that the client has behaved this way for years. What diagnosis does this client MOST likely have? Narcissistic personality disorder Borderline personality disorder Paranoid personality disorder Posttraumatic stress disorder (PTSD)

Solution: The correct answer is B. Diagnostic symptoms for borderline personality disorder are self-mutilation and destruction, unstable mood, and fears of abandonment that lead to instability. A: Narcissism is characterized by self-centeredness and grandiosity but not typically by self-destructive behavior, self-mutilation, and fear of abandonment. C: Paranoid personality disorder is characterized by long-standing suspicion and mistrust. D: PTSD is characterized by anxiety, hypersensitivity, intrusion, arousal, and avoidance.

A client with acute rheumatoid arthritis (RA) is referred for an initial evaluation by an OTR®. Before the flare-up, the client had been living independently at home. The client uses a walker for mobility. Which of the following evaluations would be MOST appropriate to use with this client during this session? Jamar dynamometer Canadian Occupational Performance Measure (COPM) Manual muscle testing Functional mobility

Solution: The correct answer is B. During an acute RA flare-up, clients' joints are inflamed and unstable, and they should avoid placing stress on them. The COPM is a self-report interview that provides important information on function without placing any stress on joints. A, C, D: During an acute RA flare-up, clients' joints are inflamed and unstable, and they should avoid placing stress on them. These evaluations require forceful hand exertions that will place stress on the joints.

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)? Grasping and releasing different-sized blocks Using scissors to cut paper Typing on a computer keyboard Brushing teeth

Solution: The correct answer is B. During the functional training phase, a client is learning to incorporate the TD as a functional assist. Bilateral activities that require one dominant extremity (the hand) and one functional assist (the TD) are the best tasks for practice. Using scissors to cut paper requires the TD to be the functional assist (holding the paper). A: This task is more appropriate for the training phase, in which a client learns the basics of how to grasp and release objects. C: Typing does not require grasp and release. A TD is not a good choice for touch typing. D: Tooth brushing is a unilateral task and requires more mobility than a prosthetic hand is likely to have. This task would be performed by the unaffected hand.

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? Preparing a stovetop meal Putting on socks and shoe Showering in standing position Shopping at a grocery store

Solution: The correct answer is B. During this activity, the patient may flex the hip greater than 90, which is a contraindication for a posterolateral approach hip replacement. A, C, D: The risk of the patient internally rotating the hip, adducting the legs, or flexing greater than 90 at the hip is minimal with standing tasks such as meal prep, showering, and shopping at the grocery store.

An occupational therapist is working with a child with dysgraphia on school work. Which intervention strategy might the OTR® use? Provide the child with a magazine that is of high interest and at his reading level Provide the child with a copy of partially completed notes so that he only has to fill in key words Provide the child with a lab partner during science experiments Provide the child with a calculator

Solution: The correct answer is B. Dysgraphia is a learning disability associated with difficulty producing written language. This option is correct because it requires that the child focus on writing less during instruction. A: Providing high-interest reading material might be appropriate if the child had a reading disability. A reading-related learning disability is called dyslexia. C: Providing the child with a lab partner would not be necessary and would not address the needs of the child's condition. Difficulty with learning science has no specific name. D: Providing the child with a calculator would be appropriate if the child had difficulty in math. A math-related learning disability is called dyscalculia.

OTR®s can assist caregivers of clients with Alzheimer's disease (AD) with reducing stress and burden by providing what type of intervention? Habit training to improve independence in ADLs Education related to the progression of AD Environmental modifications to the home Recommendations related to assistive technology

Solution: The correct answer is B. Education related to the progression of AD would be the most important intervention because such knowledge would allow the caregiver to have more control in choosing what types of intervention would be appropriate for the client and would, in turn, reduce caregiver stress. In addition, they would learn to distinguish the normal progression of AD from abnormal progression to advocate for better care of the client with AD. A: Habit training would not be an appropriate intervention strategy for clients with AD, because it is likely to be ineffective. New learning diminishes as the client progresses through the stages of dementia. C, D: Environmental modifications and assistive technology would be appropriate interventions for clients with AD; however, caregiver education is more important because it puts the caregiver more in control when collaborating with the OTR®.

An OTR® is 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? To desensitize the residual limb To develop a tapered distal end To reduce phantom sensations To protect the limb during healing

Solution: The correct answer is B. Elastic bandages and elastic shrinkers are used to optimally shape the residual limb for prosthetic use. A, C, D: Although an elastic bandage may assist with these problems, it is used primarily for shaping.

For clients with a neurodegenerative disease who are experiencing fatigue that impedes occupational performance, which recommendation is BEST? Cease performing all activities that affect energy levels Implement environmental accommodations Prioritize the daily routine based on the caregiver's needs Avoid ROM exercises to preserve energy

Solution: The correct answer is B. Environmental accommodations allow clients to maintain their current lifestyle as much as possible while preserving energy for occupational performance. A: Clients with neurodegenerative diseases do need to make accommodations as the disease progresses, but the benefit of removing activities from clients' daily routines to preserve energy must be balanced against the possible negative impact on their role performance and sense of self-efficacy. C: Recommendations should be client centered and should not address only the caregiver's needs. D: ROM exercises should be implemented within a client's activity tolerance and should not be avoided.

An OTR® is establishing reasonable accommodations for a client with autism. The client is employed as a dining room attendant in a restaurant. The client does not exhibit any physical limitations but does exhibit decreased appropriateness when socializing with others and will perform stimulatory behaviors when stressed. The essential job functions include refilling condiment containers, filling customer drink orders, ensuring restrooms are clean for customers, carrying dirty dishes from dining room to kitchen, wiping table tops and chairs, and setting tables with silverware and glassware. Which accommodation is MOST appropriate for the OTR to recommend? Provide the client with a task list to assist with prioritizing job duties. Use role-play scenarios and training videos to demonstrate acceptable behavior in the workplace. Make the employee attend social functions with coworkers to promote socialization away from the work site. Provide written expectations and require the client to take frequent rest breaks to reduce stress.

Solution: The correct answer is B. Essential job functions are defined as job duties fundamental to the position the individual holds or desires to hold as opposed to functions that are marginal. Reasonable accommodations may include altered work schedule and duties, facility modifications, purchase of adaptive equipment or assistive technology, or modifying or designing a new product. Use of role-play scenarios and training videos to provide guidelines for acceptable workplace behaviors is the most appropriate choice because the client has decreased appropriateness when socializing with others. A: Use of a task list does not address the client's socialization skills and self-stimulating behaviors during times of stress. C: Requiring attendance at social functions is likely to increase the client's stress level. D: Rest breaks should be provided as needed but may not be required. Written expectations will not promote socialization skills.

An OTR® is establishing reasonable accommodations for a client diagnosed with fibromyalgia. The client has been employed as a bookkeeper for a small website design company. The client's symptoms include fatigue, disturbances in sleep pattern, chronic headaches, and skin and temperature sensitivity. Essential job functions include filing, maintaining records of expenses using a computer accounting system, reconciling and balancing accounts, and managing the payroll for the company's eight employees. Which accommodation is MOST appropriate for the OTR® to recommend? Permit the client to set temperature controls and ventilation for the entire workplace. Suggest the client schedule periodic rest breaks away from the workstation and use relaxation techniques to avoid fatigue. Accommodate the client with a telephone headset to eliminate fatigue and the repetitive motion of lifting the telephone from the cradle. Provide the client with a computer with access to work accounts so that the client can work from home on a flexible schedule.

Solution: The correct answer is B. Essential job functions are defined as job duties fundamental to the position the individual holds or desires to hold, as opposed to functions that are marginal. Reasonable accommodations may include altered work schedule and duties, facility modifications, purchase of adaptive equipment or assistive technology, or modifying or designing a new product. Fibromyalgia is a complex, chronic condition that causes widespread pain and fatigue and a variety of other symptoms. Deep muscular pain is the most common symptom of fibromyalgia. The pain associated with fibromyalgia varies according to the time of day, weather, sleep patterns, and stress level. Use of scheduled rest breaks and relaxation techniques would assist the client with avoiding fatigue and completing essential job functions. A: Permitting the client to set temperature and ventilation for the entire workplace potentially affects all employees. Providing separate work-area controls and ventilation, redesigning the work area to promote ventilation, or modifying the dress code for the client would be client-specific modification. C: Accommodating the client with a telephone headset to eliminate the repetitive motion of lifting the telephone from the cradle may reduce fatigue; however, phone use is not listed as an essential job function. D: Allowing an individual with a disability to work at home may be a form of reasonable accommodation. The Americans With Disabilities Act (ADA) requires employers with 15 or more employees to provide reasonable accommodation for qualified applicants and employees with disabilities. Because the company has 8 employees, this accommodation may be an undue hardship for the employer.

An OTR® is establishing reasonable accommodations for a client employee as a tax auditor. The client has recently been diagnosed with posttraumatic stress disorder (PTSD) characterized by panic attacks as a result of being stalked and harassed by a disgruntled taxpayer. The essential job functions include auditing financial records to determine tax liability; information gathering; analyzing finances to determine net worth or reported financial status and identify potential tax issues; conferring with taxpayer or representative via phone or in person to explain the issues involved and the applicability of pertinent tax laws and regulations; and participating in informal appeals hearings on contested cases. Which accommodation is MOST appropriate for the OTR® to recommend? Recommend that the employer allow the client to play soothing music using a digital music player and a headset throughout the work day to relax and reduce stress. Provide the client with a telephone with a caller ID function, call blocking function, or both so that the client can screen callers in advance. Institute a policy for employees to participate in daily meditation and yoga classes. Hire a full-time security guard and install a surveillance system throughout the workplace.

Solution: The correct answer is B. Essential job functions are defined as job duties fundamental to the position the individual holds or desires to hold, as opposed to functions that are marginal. Reasonable accommodations may include altered work schedule and duties, facility modifications, purchase of adaptive equipment or assistive technology, or modifying or designing a new product. PTSD is a debilitating condition that can occur after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that can trigger PTSD include violent personal assaults such as rape or mugging and natural or human-caused disasters, accidents, or military combat. Many people with PTSD repeatedly reexperience the ordeal in the form of flashback episodes, memories, nightmares, or frightening thoughts, especially when they are exposed to events or objects reminiscent of the trauma. As a result of being stalked and harassed while performing job duties, this client may benefit from use of caller ID to screen calls in advance of answering the phone. A: Recommending that the employer allow the employee to play soothing music using a digital music player and a headset to relax and reduce stress would affect the client's ability to perform essential job functions. C: Instituting a general policy for employees to participate in daily meditation and yoga classes may not be appropriate. The client may benefit from exploring these options individually. D: Depending on the size of the company, hiring a full-time security guard and installing a surveillance system throughout the workplace may be undue hardship on employer.

An OTR® is establishing reasonable accommodations for a client diagnosed with osteoarthritis in the left shoulder. The client is employed as a plumber. Essential job functions include reaching, bending, crawling, lifting, pushing and pulling, using tools, and lifting materials weighing 25-50 lb. Which accommodation is MOST appropriate for the OTR® to recommend? Provide the client with modified-handle tools to reduce torque on the shoulder joint. Allow the client a flexible work schedule and use of leave time as needed. Ensure materials and equipment are within functional reach. Recommend use of wheeled cart to transport tools.

Solution: The correct answer is B. Essential job functions are job duties fundamental to the position the individual holds or desires to hold. Reasonable accommodations may include altered work schedule and duties, facility modifications, purchase of adaptive equipment or assistive technology, or modifying or designing a new product. Allowing the client a flexible work schedule and use of leave time is the most appropriate choice. Flexibility will provide the client with the opportunity to vary the work schedule on the basis of symptoms. A: Modified-handle tools would be appropriate if the client had arthritis of the hands. C: Ensuring materials are within reach at all times may not be feasible because plumbers must access pipes in hard-to-reach areas. D: A wheeled cart may not permit the client access to all locations and may add to lifting requirements.

A Complainant is a person filing an ethical complaint with the AOTA Ethics Commission. What condition must a Complainant fulfill? Be a member of the American Occupational Therapy Association Identify in writing the person against whom the complaint is directed (i.e., the Respondent) Attach all supporting documentation to the formal complaint Inform the Respondent that he or she is submitting a formal statement of complaint

Solution: The correct answer is B. Established procedures for filing a complaint mandate identification in writing of the person against whom the complaint is being filed. A: Any individual, group, or entity within or outside of AOTA may initiate a complaint. C: If supporting documentation is lawfully available, providing it to the AOTA Ethics Commission is desirable and helpful. However, when it is unlawful to submit documentation, the complaint can be filed without it. In such cases, the Complainant must submit supporting material outlining what happened and when and what ethical principles were allegedly violated, in addition to the complaint form. D: It is the responsibility of the Ethics Commission to inform the Respondent that a complaint has been submitted against him or her.

An OTR®; is treating a client for agoraphobia and feels frustrated that the client is not making faster progress. The OTR discusses the client's case with a work colleague over lunch at a fast-food restaurant. The OTR does not use the client's name but does verbalize verbatim statements made by the client. What can you conclude about the ethical nature of the OTR's conversation? The OTR behaved ethically: Confidentiality was preserved by omitting the client's name, and the OTR shared information only with a colleague who also works at the treatment facility. The OTR did not behave ethically: Confidentiality was not preserved, because the OTR shared specific details in a public place without the client's permission. The OTR behaved ethically: By seeking feedback from a colleague without mentioning the client by name, the OTR demonstrated a desire to find solutions that would enable successful treatment. The OTR did not behave ethically: By seeking feedback from a colleague in a public location instead of a private one, the OTR did not preserve confidentiality.

Solution: The correct answer is B. Ethical standards, as well as the Health Insurance Portability and Accountability Act, prohibit the sharing of confidential information regardless of the form of communication. Principle 6A of the Occupational Therapy Code of Ethics (2015) states that "occupational therapy personnel shall preserve, respect, and safeguard private information about employees, colleagues, and students unless otherwise mandated or permitted by relevant laws." Information sharing is only permissible between people who have decision-making responsibilities or when the OTR believes that a client is in imminent danger. A, C: The OTR shared confidential information in a nonprivate location with a person who was not involved in decision making related to the client's case, which is unethical. D: The nature of the location where the information was shared (public vs. private) only partially explains the unethical nature of the OTR's behavior; the OTR also shared confidential information with a person who was not involved in decision making related to the client's case.

A client with autism spectrum disorder wants to seek employment after graduation. The OTR® on the transition team receives the referral for evaluation. What should the first approach to evaluation include? Upper-extremity strength and coordination assessment to determine physical abilities Interview with the client to determine what type of employment the client wants to seek On-site job evaluation to determine supports needed for a therapeutic work environment. Referral of the client to a job coach for more direct consulting services

Solution: The correct answer is B. Evaluation of vocational interests through top-down approaches such as interview, situational observation, and activity analysis should be the first step in evaluation. A: Identifying occupational performance issues resulting from performance skills is secondary in transition services. C: Identifying supports that may be needed in the work environment is important in transition services but is not the first step in the evaluation process. D: Transition services are provided through the individualized education program as part of the Individuals With Disabilities Education Act, and referral to a job coach for evaluation would not be the first step in evaluation.

An OTR® designs a treatment session focused on using constraint-induced movement therapy within the context of an art project. Why does the OTR® anticipate that this treatment will be effective? Because the OTR® is inhibiting the child's tone Because the OTR® is forcing the child to use the affected extremity Because the OTR® is using a familiar task Because the child is encouraging the development of efficient habits

Solution: The correct answer is B. Evidence has supported the use of constraint-induced movement therapy, or forced-use movement therapy, for children with hemiplegia. This technique involves the therapist restricting the child's ability to use the unaffected arm, thereby forcing the child to use the affected arm during functional tasks. Working on an art project may help encourage the child's participation and make the therapy more enjoyable. A: Tone inhibition would likely result in decreased spasticity but would not increase function of the affected arm. C: The use of a familiar task may be helpful, but it would not directly relate to increasing functional use of the affected extremity. D: Habit training might lead to better performance with the task but would not necessarily lead to increased function of the affected extremity.

An OTR® in an adult day treatment program decides to use a group intervention with clients with schizophrenia who live in a supported living environment with 24-hour supervision. The OTR believes that a sensorimotor approach would help the clients reach their goal to increase independence in overall function and goal-directed activity in the home context. What would be an appropriate group activity that uses the sensorimotor approach? Discussing task performance Exercising to music Using a sensory room Baking cookies

Solution: The correct answer is B. Exercising to music is used in sensorimotor approaches to enhance motor learning and sensory functioning. It can be used by the OTR to improve skills for daily living and has been recommended as an evidence-based approach for people with schizophrenia. A: Discussing task performance would be a cognitive-behavioral approach to intervention. In addition, because this group requires 24-hour supervision, group members are unlikely to have the insight that would allow such a discussion as the focus of a group intervention. C: Using a sensory room would not be appropriate as a group intervention, but it might be indicated for one-on-one sessions. D: Baking cookies does not fall under the sensorimotor approach. The sensorimotor approach focuses on short-term tasks that can be accomplished in a short period of time. Baking cookies consists of multiple steps and would be too time consuming to be used as a sensorimotor approach.

An OTR® is working with a client who recently underwent a radical mastectomy, chemotherapy, and radiation for breast cancer. What specialized skill must the OTR® have to effectively manage this client's occupational therapy treatment? AROM techniques to the shoulder Manual lymphatic drainage techniques Activity analysis Energy conservation techniques

Solution: The correct answer is B. Lymphedema is a primary symptom that interferes with occupational performance after radical mastectomy. Effective treatment of lymphedema requires specialized knowledge of lymphatic drainage techniques. A, C, D: AROM techniques to the shoulder, activity analysis, and energy conservation techniques are occupational therapy treatment skills used for clients with many diagnoses and thus are not specialized skills for treatment post radical mastectomy.

A client with Parkinson's disease has difficulty initiating performance of ADLs. Which intervention is BEST for this client? Written directions for steps in an unfamiliar task External cues and repetition for resuming task completion Consistent self-cuing for resuming task completion No external cuing and use of problem solving to resume tasks

Solution: The correct answer is B. External cues, including simple verbal instructions, and rehearsal of movements are beneficial in improving a client's ability to resume task completion, including initiating task performance. A: Visual cues may be useful in task performance for clients with Parkinson's disease, but these cues should be short and simple. Written directions do not provide support for difficulty initiating a task and therefore are not recommended. C: Self-cuing requires the client to initiate the activity, which is the challenge for this client; self-cuing would therefore not be effective. D: External cuing is needed to initiate task performance when resuming tasks; relying solely on problem solving will not be effective.

The client, a nondriver, lives in a fourth-generation family homestead in a remote area and was referred to occupational therapy services after sustaining an above-knee amputation. The client is extremely concerned about community independence and being able to go shopping, attend church services, and make social visits to friends. The client has a strong emotional attachment to the homestead. The OTR® considers a variety of ideas regarding the client's community mobility. Which assumption or strategy would the OTR® INCLUDE? The client should consider relocating to an area with adequate alternative transportation options. The client requires an evaluation to assess the intersection of the client's capabilities with a variety of mobility options. To ensure independence in mobility, the OTR® will maximize the functional mobility of the client. The OTR® will set the client up with paratransit.

Solution: The correct answer is B. For this client to be independently accessing community mobility, the client requires an occupational therapy evaluation. A: The client is living in a fourth-generation homestead, and relocation will probably not be an option because of the client's emotional attachment to the homestead. C: Maximizing functional mobility is not adequate for ensuring independence in community mobility. D: Paratransit as the only community mobility option, although important, will not meet the multiple community mobility needs of the client.

Which of the following symptoms is characteristic of the early stage of Alzheimer's disease (AD)? Visual hallucinations Forgetfulness Confusion Elation

Solution: The correct answer is B. Forgetfulness is characteristic of the early stage of AD. A: Hallucinations are not usually associated with dementia. C: Confusion over directions and recall of events is common in the middle stage of Alzheimer's disease. D. Elation is not typically a symptom of dementia.

What is the MOST appropriate way in which an OTR® can address functional ambulation with a client? By creating an exercise program that increases strength, therefore improving ambulation By helping the client with valued roles and activities associated with ambulation By decreasing the use of assistive devices during daily ambulation activities By assessing whether an orthosis is necessary for a client with ambulation dysfunction

Solution: The correct answer is B. Functional ambulation integrates ambulation with ADLs and IADLs. Using an occupationally based approach, an OTR can focus on functional ambulation based on the client's valued roles and activities. A: Although muscle strengthening to improve ambulation is important, it is not functional in and of itself. Physical therapy usually focuses on basic strengthening and ambulation. C: Ambulation is not directly related to the use of assistive devices used in ADLs. Mobility devices are used during ambulation, but the physical therapist usually makes recommendations for any increase or decrease in assistive device use. D: Physical therapists usually evaluate and make recommendations for orthoses in relation to ambulation.

An OTR®; is working with a client who has cognitive deficits after a stroke. The OTR wants the client to be able to complete transfers when the client discharges to home. What strategy should the OTR use to enhance the client's ability to transfer at home? Complete multiple transfers in the client's hospital room throughout the day Address transfers in the client's hospital room, the clinic treatment area, and the hospital recreation room Provide the client with visual feedback on trunk posture by having the client sit in front of a mirror during toileting Practice bridging in the client's hospital room bed to increase trunk extension

Solution: The correct answer is B. Generalization involves the ability to use skills and complete tasks in different contexts. Tasks should be practiced in varied contexts. A: Completing transfers in the same context does not support varied practice and will not lead to skill generalization. C: Visual feedback may promote improvement in sitting balance during toileting but will not support transfer skills. D: Bridging may increase strength for transfers but will not generalize to the skill of transfers, which need to be practiced in context.

A client is a hands-dependent sitter. What goals would the OTR® have for such clients when providing a positioning and seating system? Support the upper extremity and hands for activities Support the pelvis and trunk to free the hands for activities Provide armrests to support the arms and hands for activities Provide a lapboard to support the client and free the hands for activities

Solution: The correct answer is B. Hands-dependent sitters require the use of one or both hands to maintain an upright seated position. Positioning must begin with the pelvis and trunk; if they are supported, the client will not need to use the hands to sit upright. A, C, D: Hands-dependent sitters require the use of one or both hands to maintain an upright seated position. Because the pelvis and trunk must be supported first to enable the client to sit upright without use of the hands, supporting the upper extremities and hands or using a lapboard to position the client are only cosmetic solutions.

An older adult client complains that objects appear distorted—for example, straight lines look wavy. The client has difficulty reading and makes frequent mistakes when reading but is able to navigate busy and crowded environments using peripheral vision. Which visual deficit would the OTR® suspect? Glaucoma Macular degeneration Cataract Diabetic retinopathy

Solution: The correct answer is B. Macular degeneration results in a gradual loss of ability to see objects clearly. Objects appear distorted in shape and straight lines look wavy or crooked, creating difficulty with reading. A: Clients with glaucoma experience loss of peripheral vision and often report difficulty with mobility. C: Clients with cataract most frequently report blurred or hazy vision and reduced intensity of colors. D: Clients with diabetic retinopathy see spots or floaters in the field of vision, have blurred vision, and have a dark or empty spot in the center of the visual field.

An OTR® works at a skilled nursing facility that provides wheelchairs for clients who need them. As a result, the facility has a room full of wheelchairs of various sizes. The OTR is often expected to find the wheelchair that best fits each new client, which requires determining whether the seat depth is appropriate for that client. Where should the front edge of the wheelchair seat be in relation to the client's hamstrings? 5 to 6 inches proximal to the posterior side of the bent knee 1-2 inches proximal to the posterior side of the bent knee At the knee crease on the posterior side of the bent knee 1-2 inches distal to the posterior side of the bent knee

Solution: The correct answer is B. Having the seat of the wheelchair very close to the bent knee without touching it allows for the client's body weight to be evenly distributed, which prevents pressure sores, while still allowing for knee clearance from the edge of the seat upholstery. A: Having the seat 5 to 6 inches proximal to the posterior side of the bent knee would not distribute body weight along the entire length of the thigh. C: Touching the bend of the knee would not allow for clearance to bend the knee for comfort and mobility using the lower extremities. D: Having the seat crossing the knee joint would not allow the knee to bend properly.

An OTR® is working with a client in the active phase of C8 spinal cord injury. What is the BEST method of preventing heterotopic ossification in the client? Low-load prolonged stretch Maintenance of joint ROM High-low limited stretch Application of leg wraps

Solution: The correct answer is B. Heterotopic ossification refers to the growth of bone in abnormal anatomic locations and is best prevented with joint ROM and medication routine. A, C: Stretching alone is generally not adequate to increase full joint ROM. D: Leg wraps do not address ROM and are more appropriate for preventing orthostatic hypotension.

An OTR® 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 reacher An abductor wedge A sock aid A tub bench

Solution: The correct answer is B. Hip precautions for an anterolateral approach are no external rotation, no adduction (crossing legs or feet), and no hip extension. An abductor wedge will prevent external rotation and adduction of the hips. A, C, D: These pieces of equipment prevent hip flexion, which is not a precaution for an anterolateral approach.

Ocular motor skills may impair a client's ability to scan a busy intersection or to effectively maneuver a vehicle in an unfamiliar area. What are the performance implications for driving? Difficulty seeing gray cars on a rainy day Increased time to identify objects in and along the road along with eye fatigue. Tendency to drift out of a lane and move too close to other road users or objects Difficulty seeing other road users or objects inside a tunnel

Solution: The correct answer is B. Impaired pursuits, saccades, and scanning may cause the client to stare at a road scene for a longer duration than expected, causing eye strain or fatigue. A: This difficulty usually occurs for a client with impaired contrast sensitivity. C: This tendency usually occurs with neglect or visual attention deficits. D: This difficulty usually occurs for a client with visual acuity impairments.

What advantage does using a functional motion assessment provide an OTR® when evaluating a client? The OTR can learn specific information about range of motion (ROM) in multiple joints. The OTR can assess range of motion (ROM), strength, and motor control in a natural environment. The OTR can assess range of motion (ROM), motor control, and caregiver needs. The OTR can use pencil-and-paper tasks to assess sensory function.

Solution: The correct answer is B. In a functional motion assessment, an OTR observes a client during functional tasks to assess ROM, strength, and motor control in a natural environment. The OTR can also observe cognitive function, awareness, and sensory deficits. A: A functional motion assessment does not provide specific information about ROM, only a general idea for further evaluation. If the OTR discovers a ROM deficit, the OTR should use a goniometer for exact measurements. C: Although a functional motion assessment can assess ROM and motor control, caregiver needs are best assessed through interview with the caregiver. D: The functional motion assessment is not a pen-and-paper task; rather, it involves a functional task, such as dressing or preparing a light meal.

A client with Alzheimer's disease (AD) reports getting lost when going to a daughter's apartment. The client's daughter has been living in the same apartment building for more than 10 years, but she lives 3 hours away from the client. In what stage of dementia is this client? Mild cognitive impairment Early Middle Late

Solution: The correct answer is B. In the early stage of AD, higher level executive functions that affect IADL performance are the first observed signs of the disease process. A: People with mild cognitive impairment will have less consistent patterns of loss than is found in AD. Those with mild cognitive impairment will be able to carry on conversation and may have intact IADLs abilities. C: People with middle-stage dementia will also continue to have skills in habitual ADLs and routines. They can maintain conversation, but they will have lost the ability to complete most IADLs. D. People in late-stage dementia need assistance for all areas of function, both ADLs and IADLs.

An occupational therapy student on Level II fieldwork came to the fieldwork site drunk and attempted to treat clients. The student was reported by the supervisor and found in violation of the NBCOT® Code of Conduct. What is the most severe sanction the student could receive? Public censure Ineligibility for certification Failed fieldwork Letter of reprimand

Solution: The correct answer is B. Ineligibility for certification is the most severe discipline because the student would be unable to become certified as an OTR®. A, D: Public censure and a letter of reprimand are lesser sanctions; they would still allow the student to complete the fieldwork and be eligible for certification. C: If the student failed fieldwork, he or she could still take another fieldwork and be eligible for certification.

An OTR® is working with a client who fractured the distal radius 3 weeks ago. Within what time frame can controlled AROM be initiated if the fracture is healing secondarily? 1-3 weeks postinjury 3-6 weeks postinjury 6-9 weeks postinjury 9-12 weeks postinjury

Solution: The correct answer is B. Initiation of controlled AROM can begin between 3 and 6 weeks postinjury if the fixation of the fracture is adequate. A: The fracture may not tolerate AROM this early, and edema and pain will result if AROM is initiated. C, D: These time ranges may be too late to prevent scar adhesions from forming at the fracture site.

A manager at a clothing manufacturing plant hires an OTR® as a consultant to improve injury management in the company. Which goal would be the MOST reasonable for this program? The program will reduce injuries related to work-related musculoskeletal disorders. The organization will control the severity and incidence of work-related musculoskeletal disorders. Management will drive the program by making decisions on wellness activities to be implemented. Workers will improve performance, becoming more efficient and increasing productivity.

Solution: The correct answer is B. Injury prevention programs aim to control work-related musculoskeletal disorders by implementing processes focused on identifying risk for musculoskeletal problems, providing skill training for management and worker evaluation of risk factors, and developing effective controls for identified risk factors. A: Reducing injuries may be a secondary effect of an injury prevention program; workers must always be encouraged to report injuries, so the organization's focus should not be on reducing injuries. C: Effective injury prevention programs involve collaboration between management and workers. D: A secondary effect of injury prevention programs may be that workers improve performance because of improved work processes.

A client with multiple sclerosis indicates in the occupational profile that cleaning the home is an important IADL. The client has good balance and fair plus (3+/5) upper-extremity strength, is independent with self-care using adaptive equipment, and needs stand-by assistance for showering due to lack of endurance. The client easily becomes fatigued when cleaning. Which intervention is MOST important to include in the intervention plan? Upper-extremity strengthening program Energy conservation strategies Cognitive rehabilitation techniques Workstation modifications

Solution: The correct answer is B. Instruction in energy management strategies and activity techniques is used to address fatigue in clients with multiple sclerosis. A: Strength in the upper extremities is not a significant factor limiting the client's occupational performance. C, D: These approaches are not applicable to the client's goal of being able to clean the home.

An OTR® is working with children with autism in an early childhood intervention program. Which practice BEST reflects an integrated developmental model of assessment for these children? Use of the most appropriate standardized assessments Observation of the children's function in various contexts Observation of the children without their parents to see their natural behaviors Use of an unfamiliar examiner to provide more objective results

Solution: The correct answer is B. Integrated developmental assessment incorporates multicontextual sources of information. A, C, D: These practices are not consistent with the principles of the integrated developmental model of assessment.

A 6-year-old child with moderate autism has poor interoceptive sensory skills. Which occupation may be MOST significantly affected? Handwriting Toileting Reading a book Playing a video game

Solution: The correct answer is B. Interoception is the ability to perceive information from inside the body. Children with autism spectrum disorders typically have difficulties with toileting because of insufficient ability to perceive the need to urinate and eliminate. A, C, D: These choices do not necessarily require effective interoceptive skills.

Which role is the AOTA Ethics Commission charged with? Maintaining and reviewing AOTA's governance documents Issuing advisory opinions on the interpretation and application of the Occupational Therapy Code of Ethics (2015) Informing and educating all students enrolled in occupational therapy academic programs about the Code of Ethics Determining AOTA's strategic direction

Solution: The correct answer is B. Issuing advisory opinions is one of several roles the Ethics Commission is charged with. A: Maintaining and reviewing AOTA's governance documents is the role of the AOTA Bylaws, Policies, and Procedures Committee. C: The Ethics Commission informs and educates the AOTA membership. It is not specifically charged with educating all occupational therapy students. D: Determining AOTA's strategic direction is the role of the AOTA Board of Directors.

An allegation of ethical misconduct is submitted against an occupational therapy practitioner. The AOTA Ethics Commission determines that the alleged behavior may not be a true breach of the Occupational Therapy Code of Ethics (2015) warranting sanctions, but the behavior is not in keeping with appropriate standards of practice. What action is the Ethics Commission MOST likely to take? Issue a reprimand to the Complainant for submitting a false ethics claim Send a letter to educate the Respondent, the Complainant, or both about standards of practice and professional behavior Temporarily suspend AOTA membership of the Complainant Report conclusions and sanctions applied to both the Complainant and the Respondent in official AOTA publications

Solution: The correct answer is B. It is part of the role and responsibilities of the AOTA Ethics Commission to educate the membership on issues related to the Code of Ethics. Educative letters can be issued as a final action to Complainants, Respondents, or both to clarify the issues involved in an ethics complaint. A, C, D: Because a determination of unethical conduct was not made, reprimand, suspension of AOTA membership, or reporting of outcomes in official publications are not necessary or appropriate.

An OTR® receives a referral to complete a job demand analysis on a client who is a diesel mechanic. At the job site, what should the OTR® do FIRST? Assess the design of the workstation. Conduct interviews with staff at the work site. Assess the client's material handling skills. Complete force gauge measurements on all equipment.

Solution: The correct answer is B. Job demand analysis looks to define the essential actual job demands. It often includes questionnaires, interviews, observation, and formal measurements and is conducted in the actual work environment. OTR®s are recommended to use objective means to gather information, because interview may not be considered the most accurate means to determine job demands. Clinicians often use interview in conjunction with functional capacity evaluation and job description. Interviewing staff is therefore an appropriate first course of action, because the OTR® must determine which tasks are considered essential to job performance. A, D: Ergonomic evaluation does not have same focus as a job demand analysis. The primary focus of ergonomic evaluation is on work practice and risk for injury resulting from postural or manual material handling. C: The referral is not for a functional capacity evaluation; therefore, the OTR® does not have orders to assess the client's material handling skills. Assessment of the client's material handling skills is a component of functional capacity evaluation, not job demands analysis. The OTR® should complete force gauge measurements on all equipment for essential job functions after interview and observation within the real work environment.

A client is being considered for a power wheelchair, because her functional status has deteriorated and she is unable to move around her home. She currently has a wheelchair that her family purchased for her at a drug store. According to the Healthcare Common Procedure Coding System (HCPCS) for durable medical equipment, including wheelchairs and their accessories her current standard wheelchair would have which HCPCS code? K0005 K0001 K0002 K0007

Solution: The correct answer is B. K0001 is the code for a standard chair, which is the most basic, least adjustable wheelchair and meets the minimal standard for Medicare. A: A K0005 is an ultra lightweight wheelchair that is fully adjustable. C: A K0002 is a standard one-arm drive wheelchair that can be operated with one hand. D: A K0007 is an extra-heavy-duty wheelchair for clients who weigh more than 300 pounds.

The caregiver of a client with middle-stage dementia requests assistance from the OTR®. The caregiver wants to ease the client's morning personal care routine. What is the BEST recommendation related to the bathroom environment that the OTR® can provide to the caregiver? Paint the bathroom a bright yellow. Use labels for hot and cold on the faucets in the bathroom. Use low levels of light to reduce eyestrain. Keep all bathroom items clearly visible to the client.

Solution: The correct answer is B. Labeling physical structures with symbols, such as arrows for direction, is helpful to people with dementia. A: Bright colors are not recommended, because they might be overly stimulating for people with dementia. C: Low lighting would not be beneficial, because it might not be adequate for a person to identify items, leading to confusion. D: Leaving items out and visible might create too much visual clutter, which can increase confusion in people with dementia.

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? Ask the client for permission to call the supervisor and request 3 to 4 weeks off for his arm to heal. Identify environmental modifications to help the client complete work tasks without aggravating symptoms. Give the client a tennis elbow strap and a stretching home exercise program and follow up in 1 week. Suggest the client keep an ice pack at work, and instruct the client to ice the arm on breaks.

Solution: The correct answer is B. Lateral epicondylitis is a repetitive strain injury. The client is likely experiencing these symptoms as a result of job tasks that require repetitive gripping and supination. The best approach is to discuss environmental modifications with the client and implement strategies during the work day to decrease symptom aggravation caused by job tasks. A: Although taking time off would alleviate the client's symptoms, it will not solve the underlying problem. Moreover, the client has indicated that taking time off is not a good option. C: This intervention takes a passive approach to the impact the client's work environment has on the client's symptoms. D: Ice will help provide with immediate relief but will not solve the underlying problem.

An OTR® is developing a program for clients who are scheduled to have hip replacement surgery. What is MOST IMPORTANT for the client to learn before returning home? Identification of home hazards associated with falls Hip precautions and proper transfer techniques Proper use of prescribed adaptive equipment Community mobility options and public support

Solution: The correct answer is B. Learning hip precautions and proper transfer techniques are important in preventing the aggravation of an injury. A: Although identification of home hazards is important, the immediate risk of injury to the client involves transfer techniques. C: Although proper use of adaptive equipment is important, the client must first understand hip precautions to correctly use adaptive equipment. D: Community mobility is not an immediate concern of safety or reinjury.

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? Use deep heat while stretching the client's stiff joints. Use superficial heat before or during a passive stretch. Use superficial heat or deep heat without stretching the client's stiff joints. Use a different modality for this problem.

Solution: The correct answer is B. Mild heat before or during a passive stretch will give the best results and increase range of motion and circulation, because the heat will have a soothing effect and decrease discomfort. A: Deep heat is indicated for contractures, scarring, pain, and muscle spasms, not for generalized stiffness. C: Use of heat should always be paired with some type of movement, stretch, or activity. D: Heat is indicated when an OTR wants to increase motion and circulation and a client complains of aching pain.

An OTR® is working with a child with autism spectrum disorder who has a hard time engaging in positive social behaviors in the cafeteria. Which intervention strategy would be most appropriate to help the child learn how to behave in the cafeteria? Using proximity control Modeling the desired behavior Giving the child a break Giving the child a time out

Solution: The correct answer is B. Modeling the desired behavior and reminding the child of the behavioral expectations are two examples of gentle corrections that could be made in this situation. A, C, D: These strategies would not provide the child with a clear understanding of the expectations that need to be followed in the cafeteria

An OTR® is using an Ecology of Human Performance Model to help a child with attention deficit hyperactivity disorder improve handwriting efficiency. Which intervention strategy is MOST consistent with this approach? Use movement-based activities to help the child improve focus and attention during structured tasks Use highlighted ruled paper to enable the child to stay within boundaries when writing Facilitate the child's development of strategies to develop mastery of handwriting tasks Strengthen the child's hand muscles to improve pencil grasp

Solution: The correct answer is B. Modifying or adapting task tools is an intervention strategy of the Ecology of Human Performance Model. A: Movement-based activities are a sensory integration strategy. C: Strategies to develop mastery are part of the Occupational Adaptation Model. D: Strengthening hand muscles is part of a biomechanical approach.

An OTR® is adapting the environment to reduce the incidence of repetitive strain injuries among office workers. To maximize the effectiveness of the ergonomic program, what would the OTR® be MOST likely to include? Visual reinforcement with signs posted around the office and workstations Empowerment of the workers and creation of a positive group-safety culture A series of lectures and videos showing bad versus good workstation ergonomics Education of supervisors in how to identify noncompliant workers

Solution: The correct answer is B. Motivation is a big factor for change to occur. Creating a sense of teamwork allows for mutual support to accomplish goals together. A, C: Visual reinforcement, lectures, and videos are teaching methods, but they do not ensure buy-in and follow-through by the workers. D: A focus on identifying noncompliant workers may create feelings of negativity and resentment from the workers regarding the program.

An OTR® is seeing a client 1 day post laminectomy surgery for back pain. What would the treatment session MOST likely emphasize? Instruction in use of a transcutaneous electrical nerve stimulation unit for pain relief Instruction in log rolling and sitting and standing postures Use of an ambulation device during functional activities Scar management techniques

Solution: The correct answer is B. Normal spinal alignment needs to be maintained post surgery. A: Pain in laminectomy patients is usually controlled through medication. C: Physical therapy primarily instructs clients in the use of ambulation devices. D: Scar tissue has not yet formed 1 day post surgery.

An OTR® has been working on an oncology unit of a hospital for several years and has begun to acknowledge signs of risk for burnout. How can the OTR® MOST effectively prevent burnout? Take notes home at the end of the day to finish after work hours Engage in personally meaningful activities to promote life balance Attend an oncology conference at least once a year Meet once a month with other OTR®s who work in oncology

Solution: The correct answer is B. OTR®s, as well as clients, can use stress management techniques and wellness activities as strategies to promote life balance and avoid burnout. A, C, D: Taking work home, attending conferences, and meeting with other OTR®s fulfill professional behavior and development guidelines but do nothing to prevent career burnout.

An OTR® is working with a client with newly diagnosed osteoporosis. The client's insurance will only cover one community evaluation. Which of the following would be the MOST important environmental evaluation to complete? An evaluation of public transportation for accessibility An evaluation of the home for fall risk An evaluation of a home computer network for ease of use An evaluation of the workplace for accessibility

Solution: The correct answer is B. People with osteoporosis are prone to fracture with falls. Reducing fall risk at home is an important part of preventing injury. A, C, D: These other evaluations are important for full participation in the physical and virtual community; however, prevention of harmreducing fall risk at homeshould be the first priority for assessment and intervention.

A client with middle-stage Alzheimer's disease (AD) presents with new behavioral concerns in a long-term care facility. The OTR® is asked to evaluate the client and make recommendations. The OTR® observes the client during routine activities in the facility. What should the OTR® do next? Use the Assessment of Motor and Process Skills (AMPS) to assess motor and praxis skills in the client's current context. Interview family members to complete the client's occupational profile. Establish rapport with the client by assisting the client in activities run by the recreational therapist. Provide the client a challenging activity to assess attention and emotional regulation skills.

Solution: The correct answer is B. Observation and interview are the primary methods of assessment recommended for clients with AD. After observation, it would be important to interview family and caregivers to complete the assessment. A: Although using the AMPS might be helpful with clients with early-stage dementia who are living at home, it might not be as helpful with clients living in a long-term care facility and at a later stage of the disease. C: Establishing rapport would be important, but it would probably not be the next step in the assessment process; observation and interview are recommended as the primary means of assessment for clients with dementia. D: Giving a client with dementia too difficult a task during the assessment process would not be advisable; observation and interview are recommended as the primary means of assessment for clients with dementia.

An OTR® works in a clinic for clients with low back pain. What is the BEST way for the OTR® to evaluate the client's spinal postures? Use a self-report questionnaire Observe the client performing ADLs, IADLs, and work-related tasks Take AROM, PROM, and muscle testing measurements of the trunk Send a questionnaire to the client's employer

Solution: The correct answer is B. Observing faulty postures during ADLs and other occupations will give the OTR® the best evaluative information. A, C: The physical therapist is most likely to ask a client questions or take measurements. D: An employer-completed questionnaire might yield information on administrative practices but will not provide detailed information about a particular client.

A client with schizophrenia is admitted to an inpatient psychiatric unit after an episode of combative behavior at the garage where the client works. The client was hallucinating and hit a coworker with a screwdriver. The client is nonverbal and slightly agitated during the occupational therapy assessment. What type of assessment strategy can the OTR® use in this situation? Interviewing the client with yes-and-no questions Observing the client's functional behaviors in the hospital Interviewing the client's boss about work behaviors Using a standardized assessment like the Canadian Occupational Performance Measure (COPM)

Solution: The correct answer is B. Observing the client during functional tasks would be appropriate to make conclusions about the client's current level of functioning because the client is unable to actively participate in a structured assessment. Knowing the client's current functional status will assist the OTR in developing appropriate goals and interventions. A: Because the client is nonverbal, responding to questions would likely be difficult and could increase anxiety and agitation. This strategy would not be recommended because the client is already combative. C: This strategy would not be appropriate at this time because the OTR would not obtain the necessary information to provide adequate interventions. The client is in an inpatient setting, and the primary focus at this stage would be to support the client until the client is stabilized. D: The COPM is not appropriate at this time, because the client is nonverbal.

A client was recently diagnosed with multiple sclerosis and has been referred to occupational therapy for evaluation. When assessing the client's occupational performance, which information should the OTR® consider? ADL assessments completed on the first visit Observations of the client's performance over a period of time Results of specific measures, such as the manual muscle test Observation of the client's routine early in the morning

Solution: The correct answer is B. Observing the client over a period of time allows the OTR® to identify variability in endurance and fatigue a client with MS may experience. A: Assessments completed on the first visit may not accurately reflect a client's current abilities because of the significant impact of decreasing endurance and increasing fatigue on occupational performance. C: Client skills (e.g., motor and praxis skills, sensoryperceptual skills, emotional regulation, and cognition) provide information about factors that may influence occupational performance. However, assessing client skills does not directly assess occupational performance. D: Variability in endurance and fatigue throughout the day means that a client's performance early in the morning may not provide an accurate picture of the client's functioning.

An OTR® is establishing an occupational therapy group in a state correctional facility for clients with schizophrenia who are the parents of small children. What area of focus would be MOST important for a group in this setting? Psychoanalytic intervention Skills in performing ADLs and IADLs Strength and endurance training Visualmotor skill remediation

Solution: The correct answer is B. Occupational therapy in the criminal justice system focuses primarily on community reentry. Skills in ADLs and IADLs, including child care, are essential to community reentry. For these clients, assessing parenting skills would be a focus of the occupational therapy evaluation process. A: The psychoanalytic approach is not commonly used in occupational therapy groups for incarcerated people and would be outside the occupational therapy scope of practice. C: Strength and endurance training is not an appropriate intervention for these clients. D: Although these clients may have unidentified visualmotor issues, the intervention emphasis in this setting is on community reentry.

An OTR® is leading an initial group craft activity for patients on a behavioral health unit. After introductions of the leader and members, what is the NEXT step for promoting cooperation and understanding of the activity? Demonstrate the steps involved in completion of the craft activity. Explain the purpose of the group and verbalize expectations. Orient members on the safe use of equipment needed to complete the project. Provide samples of the craft project at various stages of completion.

Solution: The correct answer is B. Once introductions are made in a group setting, the purpose of the group should be clearly explained so clients know what the expectations of the group include. A: Initiating the activity selected for the group session occurs after the purpose and outline of the group session are explained to the group. C: Orienting clients to the safe use of equipment occurs when the activity steps are discussed and demonstrated, so the clients need to know the group expectations before proceeding to activity steps. D: Clients need to know the expectations of the group and the steps of the activity before seeing project samples occurs.

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. What additional information is MOST IMPORTANT to obtain as part of the initial evaluation in order to select intervention activities? Contexts for preferred leisure and social activities Performance skills displayed during activities of daily living Types of architectural barriers within the patient's home Upper-extremity strength based on a manual muscle test

Solution: The correct answer is B. Once occupational performance analysis has been initiated, identifying performance skills of the client during activities of daily living would be beneficial information to gather. A: Contextual information may be beneficial to further understand the client's occupational needs but is not the most important information to obtain. C: Home assessments are not a first priority when seeing patients in the acute care environment and are generally deferred until the inpatient rehabilitation setting. D: Manual muscle testing is not indicated given the information that was gathered in the initial self-care evaluation, and in this situation assessment of muscle tone over muscle strength is indicated.

A COTA® has established service competency for administration and scoring of the Mini-Mental State Examination. Which supervision is the MOST APPROPRIATE for the OTR® to provide? Close supervision on an ongoing basis to ensure maintenance of service competency Minimal supervision to periodically recheck that service competency is maintained Supervision on an as-needed basis per the COTA®'s request to fine-tune service competency None, unless otherwise indicated by the facility, state law, or licensing changes

Solution: The correct answer is B. Once service competency is established, the supervising OTR® should periodically recheck to ensure maintenance. A: This approach provides too much supervision. C: This supervision is not structured or deemed appropriate by the supervising OTR®. D: Periodic check-ins are warranted.

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

Solution: The correct answer is B. Osteoporosis is closely linked to hip fractures because of the decreased bone density in the neck of the femur. A, C: Although athletes and people with diabetes may be susceptible to hip fracture, a more direct link is reported in clients with osteoporosis. D: Although dementia may be associated with fall risk, little evidence exists for an increased risk of hip fracture.

A client working as a transcriptionist for a law firm experiences neck pain. The pain begins on Mondays, increases over the course of the week, and diminishes over the weekend. An OTR® completes an ergonomic evaluation of the client's workstation. Which explanation for the pain is BEST? The transcriptionist is using lightweight writing tools. The transcriptionist is experiencing glare from overhead lighting. The transcriptionist uses an adjustable chair. The transcriptionist is using a hands-free headset.

Solution: The correct answer is B. Overhead lighting problems can contribute to awkward posturing at workstations. A: Lightweight writing tools should not increase the physical effort for a worker and should not pose an ergonomic risk. C: Workstation chairs should be adjustable to allow customization to the individual worker. D: Hands-free headsets should be adjustable and have sufficient padding so as not to cause head or ear pain when worn for long duration.

A client who presents at a hospital occupational therapy clinic for an evaluation is crying because the client will not be able to go home in time to attend the wedding of a family member. Which response BEST communicates empathy? "Why don't you come back later when you are feeling better?" "You seem upset that you are going to miss the wedding." "Life goes on. It will be OK." "You need to stop crying so we can complete your occupational therapy session today."

Solution: The correct answer is B. Paraphrasing what a client says is an effective strategy for demonstrating empathy. A, C, D: These options do not acknowledge the client's concern about missing the wedding, a major life event. Although these responses acknowledge that the client is upset, they do not acknowledge why.

A young adult patient who has a C5-C6 spinal cord injury is preparing for discharge from the inpatient rehabilitation facility. The patient plans to live at home and receive assistance from the spouse and hired caregivers. Which referral should be initiated prior to discharge from the facility? Vocational counseling Outpatient rehabilitation Independent living center Driver's rehabilitation

Solution: The correct answer is B. Patients are often referred to outpatient rehabilitation once they have met their inpatient rehabilitation goals. Patients with spinal cord injury continue to gain strength and increase independence during the first year of injury, so continuing intervention in another setting is most appropriate. A, D: The outpatient rehabilitation therapist will address community integration needs of the patient, including referrals to vocational counseling and driver's rehabilitation. C: An independent living center is not needed in this situation because the patient is returning home with spouse and hired caregivers.

A summer picnic has been planned for clients in a day treatment program for people with mental illness. Before leaving, what medication-related precaution should the OTR® review with the clients? Effects of combining alcohol with psychotropic medications Need to protect oneself from direct sun when taking psychotropic medications Increased likelihood of ataxia after consuming typical picnic foods for people using monoamine oxidase (MAO) inhibitors Need to take medications before leaving for the picnic to avoid losing them

Solution: The correct answer is B. Photosensitivity is a side effect of many psychotropic medications. Avoiding direct exposure to sun is essential. A: Avoiding alcohol when taking certain medications is necessary, but it would not be the main issue to discuss with the group before a picnic. C: Although it is true that typical picnic food may include items that people on MAO inhibitors cannot eat, ataxia is not listed as a result of this drugfood interaction. D: It may not be appropriate for patients to take medications before leaving for the picnic because of timing or need to take medication with food.

An OTR® is working with high school students who have autism spectrum disorder (ASD). Which statement BEST represents a model for travel training relative to public transportation use for these clients? The travel training program should be classroom based to build students' confidence in their ability to successfully travel in the community using public transportation. The travel training program should provide a combination of classroom instruction and repetitive community-based practice to build students' confidence and competence in using public transportation. The travel training program should be largely classroom based, with one practice session actually using public transportation to balance the students' need for practice with the financial constraints of the program. The travel training program should consist of providing the students with a bus schedule, accompanying them to the bus stop, and ensuring that they safely board the bus three times to ensure they are competent to ride independently.

Solution: The correct answer is B. Precin et al. (2012) noted that travel training is most successful for students with ASD when it combines classroom- and environment-based learning opportunities and builds in frequent repetition of skills. A, C, D: These answers do not describe effective models for travel training.

Which characteristic of a general education classroom would promote access to the general education curriculum of a student diagnosed with Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome)? Large classroom size Predictable transitions Teacher's gender Low level of structure

Solution: The correct answer is B. Preparing students with autism spectrum disorder for transitions (e.g., from math activities to reading activities) is a fundamental strategy in managing the classroom environment to facilitate their engagement. Because all students benefit, preparation for transitions is considered best practice in an inclusive classroom setting. A, C, D: Class size, teacher's gender, and level of structure would not necessarily promote access to the general education curriculum for a student with autism spectrum disorder. Although smaller size might make a classroom more effective, preparation for transitions would have a much greater impact.

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

Solution: The correct answer is B. Primary healing is when a surgeon can secure bone fragments using a plate, screws, or both. When bone is secured in this way, healing is more stable at an earlier stage. This stability allows the OTR to guide the client through AROM and PROM as soon as therapy is indicated. A: With primary healing, the client will not be placed in a cast, because the screws or plate secures the bone. C: ROM should begin as early as possible with all clients who have a fracture. However, the type of ROM and joints for which it will be prescribed will differ, depending on the type of healing set in place by the physician and the time since the fracture. Age will have an impact on healing, but not on the prescription of early ROM exercise. D: Strengthening should not be prescribed until there is evidence that the bone can withstand high muscle forces across it (which should be directed by the physician).

The OTR® has a client whose job involves typing for 5 hours each day, answering phones, and filing. This client has been referred to occupational therapy because of numbness and tingling in both hands and wrists, primarily the index and middle fingers. The client's hands also fall asleep at night, which causes the client to have diminished sleep. What condition does this client MOST likely have? Ulnar nerve injury Carpal tunnel syndrome Lateral epicondylitis Radial nerve injury

Solution: The correct answer is B. Primary symptoms of carpal tunnel syndrome are numbness and tingling in the median nerve distribution (which includes the index and middle fingers). It is common in people who have jobs that involve repetitive movements in the hands and wrists. In addition, especially in early stages, clients will complain that the symptoms wake them at night, most likely because of positioning of the wrist and forearm. A: Clients with ulnar nerve injury will complain of loss of grip function with significant difficulties in fine motor tasks because the ulnar nerve innervates the muscles that allow for strength in the hand and simultaneous movements that require a strong grip. The arches of the hand will be visibly impaired as well. C: Lateral epicondylitis is commonly caused by repetitive motions with gripping and supination. Clients will likely have pinpoint pain at the lateral epicondyle. D: Wrist drop is a distinguishing feature of radial nerve injury because the innervation from the radial nerve supplies the extensors in the forearm.

A client was referred to occupational therapy because of persistent pain in the neck and shoulder and the recent onset of paresthesia in the right index and middle fingers. The OTR® decides that the symptoms may be work related and proceeds with an onsite ergonomic assessment. After the ergonomic assessment, the OTR® determines that a simple change in the set-up of the computer station could help to reduce the client's symptoms. What change to the computer monitor would MOST likely alleviate the client's neck and shoulder discomfort? Position the monitor a minimum of two arm lengths away from the client. Position the monitor at eye level and one arm length away from the client. Tilt the monitor up so that the client is looking at the lower half of the screen. Recommend that the client use a large type size of no less than 16 points

Solution: The correct answer is B. Proper ergonomic principle recommends the monitor be approximately one arm length away and the top one-third of the monitor be at the user's eye level. A: One arm length away is the recommended ergonomic set-up. C: Tilting the monitor up means that the client will need to extend the head to look at the upper half of the screen, which may cause more neck and shoulder discomfort. D: Enlarging the type size may help to decrease strain on the eyes and sometimes neck and shoulder discomfort. However, less information will be displayed on the screen and, depending on the work, may not be suitable for the client.

A client with traumatic brain injury is demonstrating agitation. What strategy would minimize the client's frustration and confusion? Provide tactile stimulation by tapping the client's upper extremity Tell the client orientation information about his or her location and what will occur in session Ask the client to state why he or she is in the hospital Have the client complete a fine motor task as a distraction

Solution: The correct answer is B. Providing passive orientation information and preparing the client for what to expect in the session will provide the client with a sense of familiarity, decreasing confusion and agitation. A: Tactile stimulation produces increased awareness of the affected upper extremity and may increase the client's agitation as he or she tries to process the stimulation. C, D: Challenging the client's cognitive abilities or motor skills may lead to greater confusion and frustration, thereby increasing the client's agitation.

A client has C6 complete tetraplegia. Which hand functions would this client be expected to demonstrate? Limited grasp to pick up an item with the proximal and distal interphalanges Ability to pick up an object by stabilizing it between the palms of both hands Inability to use the hands for any functional tasks or object manipulation Ability to manipulate the power control of wheelchair using the tips of the fingers

Solution: The correct answer is B. Radial wrist extension allows the client with C6 tetraplegia to stabilize the hands for compensatory grasp activities such as picking up a bottle or sliding an object to the edge of the table. A, D: A client with C8 tetraplegia would be able to demonstrate movement of the extrinsic finger muscles and thumb flexors to flex proximal and distal interphalanges to grasp objects. C: Clients with C1 to C5 spinal cord injury lack the wrist movement and finger innervation to functionally use both hands. Clients with injury at the C5 level are able to use the hands for feeding and other tasks when wrist supports and adaptations for grasp such as universal cuffs are included.

An OTR® is assessing a new client who has a distal radius fracture. Functional outcome reporting is required by the facility. Which approach to functional outcome measurement is MOST consistent with client-centered care? Quantitative range of motion measurements, to ensure that quantitative measures are used to facilitate functional return A range of quantitative and qualitative measures, to assess clinical outcomes Standardized assessment tools, to ensure payment by third-party payers Qualitative assessments such as the Disabilities of the Arm, Shoulder and Hand (DASH), as a disease-specific measure for the upper extremity

Solution: The correct answer is B. Research on qualitative and quantitative measures suggests that practitioners should assess clinical outcomes from both a qualitative and a quantitative perspective and that subjective information plays a crucial role in maximizing therapeutic outcomes. A: Quantitative measures such as goniometry have demonstrated poor reliability and decreased responsiveness compared with client self-report measures of function. C: Research has shown a less than optimal relationship between client self-report of quality of life and health care provider ratings from quantitative measures. Third-party payers are increasingly relying on self-reporting from patients in determining coverage. D: The DASH is a region-specific (not disease-specific) measure. Its focus is too narrow to characterize dysfunction; additional assessments are needed.

A client has been diagnosed with age-related macular degeneration. The client enjoys knitting but is having difficulty seeing the design being knitted. What strategy should the OTR® use to facilitate the client's ability to continue knitting? Have the client choose a design with low contrast. Have the client rotate the head and trunk to the side. Have the client use built-up handles on the knitting needles. Have the client use knitting needles the same color as the yarn.

Solution: The correct answer is B. Rotating the head and trunk to the side would allow the client to use the remaining peripheral vision to see the pattern. A and D: These strategies would make it more difficult for client because the client may have difficulty with contrast sensitivity. C: This strategy does not relate to the client's vision condition.

A school-age child has a sensory integrative disorder and is participating in occupational therapy. During a session, the child is sitting on a platform swing and the OTR® is gently rotating the swing clockwise. When the OTR® stops the swing, the child reports feeling sick and becomes pale. What action should the OTR® take during future sessions to prevent these symptoms from recurring when the child participates in this activity? Lower the swing so it is a close to the ground as possible. Move the swing back and forth in a slow, linear motion. Provide firm proprioceptive input just prior to the swing activity. Have the child roll forward and backward in a carpet-lined barrel.

Solution: The correct answer is B. Rotational swinging is a more intense form of vestibular input. Linear motion provides a less intense form of vestibular input and may reduce the child's symptoms in response to vestibular input. A: Changing the height of the swing will not reduce the intensity of the vestibular input received through the rotation of the swing, although it would be an effective modification for gravitation insecurity. C: Proprioceptive input inhibits the effect of vestibular input; therefore, the swinging activity would be ineffective. D: This activity will still provide vestibular input through rotation and will not prevent the child's symptoms.

An OTR® has been working on increasing the concentration and attention span of an 8-year-old child with autism who is distractible during handwriting activities in the classroom. Using a sensory integration approach, which environment is the BEST to address concentration and attention skills? An isolated room free from any kind of distraction A small classroom with two other children and soothing music A small corner of a sensory gym where two other children are swinging A quiet corner in the child's classroom with a chalkboard divider

Solution: The correct answer is B. Sensory integration techniques emphasize the use of naturalistic environments for intervention. Using a small classroom where two other children are doing handwriting tasks is the most naturalistic environment similar to an actual classroom without unnecessary sensory stimulation. A: A distraction-free room is not a naturalistic environment. C, D: These environments provide more stimulation than necessary for the client to focus on handwriting tasks.

A client did not attend the occupational therapy session because of an illness. According to the Guidelines for Documentation of Occupational Therapy, what is the BEST type of documentation to note nonattendance in a timely manner? Reassessment report Service contact Plan of care Monthly progress report

Solution: The correct answer is B. Service contact would be the best type of documentation because it can be completed as soon as the nonattendance occurs. A: The reassessment report is written based on results of the reassessment. C: The plan of care discusses the goals and treatment to be provided during intervention. D: The monthly progress report would not be documenting in a timely manner (as close to the occurrence as possible).

An OTR® in an outpatient setting is treating a client who underwent repair of multiple flexor tendons in Zones 2 and 3 approximately 6 weeks ago. The dorsal blocking splint has been removed, and the client is beginning to actively move the digits. The client is eager to return to work as a carpenter, and the OTR is revising the goals with the client. Which goal for this time period is MOST appropriate? Increase passive wrist and digit composite extension to improve flexor tendon length Increase digital active range of motion to facilitate holding a washcloth during bathing Increase grip strength to maintain grasp on woodworking tools String 25 beads of various sizes and shapes to improve fine motor coordination

Solution: The correct answer is B. Setting realistic, meaningful goals and revising them as the client progresses is a critical component in treating traumatic injuries. At 6 weeks after operative tendon repair, the client may be ready for light, nonresistive functional activities that promote active flexion. A: Adding too much force at this stage may result in rupture of the repairs. C: At 6 weeks after repair of flexor tendons, strengthening is contraindicated. D: This goal has no functional component or intrinsic value to the client.

An OTR®; is positioning in bed a client who has weakness on one side of the body resulting from a traumatic brain injury. Which position is MOST appropriate for the client? Supine with head supported on a pillow with arms abducted Side lying with affected extremity on top placed on a pillow Supine without a pillow to support head with arms abducted Side lying with affected extremity on top resting on abdomen

Solution: The correct answer is B. Side lying allows for normal postural positioning to minimize the effects of increased muscle tone. The use of a pillow under the top upper extremity allows the shoulder to be positioned in neutral. A, C: Supine position is likely to increase extensor tone, which does not support the goal of normalizing muscle tone. If a client needs to be positioned in supine, a small pillow should be used to keep the head in midline. D: Side lying allows for normal postural positioning to minimize the effects of muscle tone. When the affected extremity is positioned on top, it should be supported on a pillow to prevent horizontal adduction.

An OTR® is addressing meal preparation with a client who recently sustained a fracture of the left humerus and is currently in a splint and sling. The client uses a straight cane for functional mobility. How should the OTR instruct the client to remove items from the oven during meal preparation? Stand directly in front of the oven, open the door, reach in with the right arm, pull out the food, and place it on top of the oven. Stand to the left of the oven, open the door, reach in with the right arm, pull out the food, and place it on top of the oven. Stand to the right of the oven, open the door, reach in with the right arm, pull out the food, and place it on top of the oven. Stand directly in front of the oven, open the door, reach in with a reacher using the right arm, pull out the food, and place it on top of the oven.

Solution: The correct answer is B. Standing to the left of the oven allows the client to open the door easily with the right hand and remain as close as possible to the food item being retrieved when pulling it out of the oven. A: Standing directly in front of the oven creates a bigger space between the client and the food item being retrieved, which means the client would have to bend farther forward, creating a bigger risk of falling. C: Standing to the right of the oven would require the client to rotate to get the right arm in a position in which lifting the food item would be possible. D: Reachers are not typically used to retrieve hot items from an oven, because they are generally made of materials that could melt in extreme heat and rarely can hold the weight of an item coming out of an oven.

A cabinetmaker is referred to occupational therapy with a recent onset of stenosing tenosynovitis of the right middle and ring fingers. The client has a history of rheumatoid arthritis. As part of the ergonomic education, what will the OTR® MOST likely include? Prevent static wrist positioning, hold tools close to the fulcrum, and use a thick protective glove. Reduce use of excessive gripping force, prevent contact stress, and implement task rotation. Stenosing tenosynovitis is common in rheumatoid arthritis; no ergonomic education is needed Switch to manual tools to reduce vibration from power tools and conduct a regular tool check for wear and tear.

Solution: The correct answer is B. Stenosing tenosynovitis (trigger finger) is a condition associated with prolonged or high repetitions in forceful gripping. All of these modifications prevent or eliminate exposure to forceful gripping. A: Holding tools closer to the fulcrum requires more force exertion. A longer handled tool can help to decrease force exertion. Static positioning should also be avoided. C: Clients with rheumatoid arthritis might have a higher incidence of stenosing tenosynovitis but might still have other work-related risk factors leading to it. D: Vibration is a risk factor for other cumulative trauma disorder but does not necessarily contribute to stenosing tenosynovitis.

An OTR® is working with 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 OTR® advise the client to avoid? Sustained elbow extension Sustained elbow flexion Sustained wrist extension while making a fist Sustained wrist flexion while making a fist

Solution: The correct answer is B. Sustained elbow flexion provokes symptoms of cubital tunnel syndrome. A, D: Neither position will exacerbate the client's symptoms; elbow flexion is what aggravates cubital tunnel symptoms. C: Sustained wrist extension while making a fist will provoke lateral epicondylitis (tennis elbow) symptoms.

A client in the late stage of Parkinson's disease presents for an occupational therapy evaluation. Which of the following symptoms can the OTR® expect to see? Resting tremor, spasticity, tingling sensations Resting tremor, rigidity, oral motor deficits Spasticity, paralysis, decorticate posture Spasticity, rigidity, impaired respiratory muscles

Solution: The correct answer is B. Swallowing difficulties become apparent in the late stage of the disease because of impairments in the oral motor muscles as motor control becomes further compromised. Resting tremor is a symptom that manifests in the early stage of Parkinson's disease and continues throughout the disease course. Rigidity often onsets in the early stage of Parkinson's disease and progresses in severity in later stages. A, C, D: Tingling sensations (paresthesia), decorticate posture, and impaired respiratory muscles do not occur with Parkinson's disease. Spasticity does not typically occur with Parkinson's disease.

A client underwent a rotator cuff repair 8 weeks ago and is complaining of pain that is interfering with daily activities. Which type of electrical stimulation might the OTR® use to help alleviate the client's pain? Neuromuscular electrical stimulation (NMES) Transcutaneous electrical nerve stimulation (TENS) Functional electric stimulation (FES) Electrical stimulation of severed nerves (ESSN)

Solution: The correct answer is B. TENS uses electrical current to decrease pain. A: NMES is used to improve range of motion and strength and to facilitate muscle contractions, not to decrease pain. C: FES is an implanted device that facilitates muscle contractions in people who have nerve dysfunction. D: ESSN is not a modality.

Which type of payer provides health coverage for the military? Children's Health Insurance Program TRICARE Medicare Federal Employees Health Benefit Program

Solution: The correct answer is B. TRICARE provides health coverage for the military. A: The Children's Health Insurance Program provides coverage for children and families who cannot qualify for Medicaid and cannot afford health insurance. C: Medicare does not provide coverage for the military; however, it provides coverage for most older adults. D: The Federal Employees Health Benefit Program does not provide coverage for the military. It provides coverage for federal employees.

An OTR® is working with a child who dislikes having hair washed, playing in sand, and shaking hands. What type of sensory dysfunction might this child have? Somatodyspraxis Tactile defensiveness Gravitational insecurity Hyporesponsivity

Solution: The correct answer is B. Tactile defensiveness is characterized by difficulty making sense of or interpreting tactile input. The child in this scenario might feel that the tactile input outlined in this option is noxious. A: Somatodyspraxia is characterized by difficulties with motor planning. C: Gravitational insecurity is characterized by an extreme fear during what would typically be considered benign movement. D: Hyporesponsivity is characterized by an underresponsivity or high threshold for certain stimuli.

A client who has schizophrenia stopped taking prescribed antipsychotic medications 2 weeks ago and is experiencing rhythmic tongue movements, grimacing, and lip smacking. What neurological condition is associated with these symptoms? Postural hypotension Tardive dyskinesia Increased hypoglycemia Tyramine reaction

Solution: The correct answer is B. Tardive dyskinesia involves facial movements and writhing motions of the tongue and fingers as a result of antipsychotic medication. A: Postural hypotension is a possible side effect of antipsychotic drugs; however, it does not result in the movements described in the scenario. C: Hypoglycemia involves a drop in blood sugar, which may be a result of antipsychotic medications. This side effect does not result in the movements described in the scenario. D: Tyramine reaction is a side effect of antipsychotic drugs; however, it does not results in the movements described in the scenario

A 30-year-old construction worker has developed work-related right biceps tendonitis. In the past 2 weeks, the client has primarily been working on the drainage system, which requires sawing a lot of metal pipes. What risk factor should be closely assessed during a worksite evaluation? Handle size of the hand saw Sawing repetitions per minute Length of the saw blade Diameter of the metal pipes

Solution: The correct answer is B. Tendonitis is a musculoskeletal injury resulting from repetition. A high-risk repetition rate for the elbow is more than 10 repetitions per minute. A, C, D: These options are risk factors that contribute to cumulative trauma disorder but are not specific to biceps tendonitis.

According to the Model of Human Occupation (MOHO), occupational therapy intervention will best benefit adult clients with mental illness through which of the following approaches? Understanding the interaction between the client's perceived level of task mastery and the demands of the environment Understanding the client's dimensions of occupational participation and performance Understanding how the environment can be adapted, modified, and restored to enable effective performance Understanding how the client uses sensory information in the environment

Solution: The correct answer is B. The "dimensions of doing" is part of MOHO. A: This approach is based on occupational adaptation theory. C: This approach is based on the Ecology of Human Performance model. D: This approach is based on the sensory integration model.

An OTR® is working with a 6-year-old child with attention deficit hyperactivity disorder on self-monitoring energy and arousal levels inside the classroom. Which intervention is BEST to use for this goal? Train the parent to use a sensory diet to help the child remain calm throughout the day. Use the ALERT Program to train the child to self-regulate. Train the child to use breathing and relaxation techniques when feeling hyperactive. Provide a therapy ball for seating in the classroom.

Solution: The correct answer is B. The ALERT Program teaches children self-monitoring skills for arousal and energy levels in order to self-regulate. A: A sensory diet is an intervention to help with sensory processing. C: Breathing and relaxation techniques do not help with self-monitoring of arousal and energy levels. D: A therapy ball may help the child attend while seated but will not address the self-monitoring skills.

The Children's Health Insurance Program provides coverage for which group of people? Children who are disabled and are able to be mainstreamed into a regular school classroom Children and families whose income is too high for Medicaid but too low to afford private insurance Children whose parents are disabled and are unable to work and therefore afford health insurance Children ages 03 who are disabled and living in a long-term care residential facility

Solution: The correct answer is B. The Children's Health Insurance Program covers children and families who are unable to afford private insurance but unable to qualify for Medicaid because their income is too high. A, C, D: The Children's Health Insurance Program does not cover these groups.

A client working as a machine operator was diagnosed with right shoulder tendonitis related to overuse during work activities. The worker's English proficiency is limited. When preparing to complete an assessment of the worker's upper-extremity strength and coordination, which considerations should the OTR® take into account? The worker does not want to be touched by an OTR of the opposite sex because of cultural beliefs and the language barrier. The Disabilities of the Arm, Shoulder, and Hand (DASH) assessment may be applicable because it has been translated into the worker's native language. The worker is likely to be unmotivated to participate in occupational therapy because of the language barrier and fear of job loss because of the injuries. An assessment of the work environment (e.g., on-site job analysis) must take into consideration the worker's culture.

Solution: The correct answer is B. The DASH has been translated into several languages, and cross-cultural validity has been established. A: An OTR should not assume that a client experiencing a language barrier will also have gender concerns. C: An OTR should not assume that a client experiencing a language barrier will have certain values and motivations regarding occupational therapy. D: Work environment assessments are not influenced by the worker's culture, because they measure aspects of the physical environment, such as light, temperature, work surface structures, tools, and the number of workers.

The results of a functional capacity evaluation for a client 3 months after carpal tunnel repair reveal that the client performs manipulation of small objects one-third to two-thirds of the time in the capacity of a medical lab technician. At what frequency would the OTR® rate performance of manipulation tasks according the Dictionary of Occupational Titles (DOT)? Consistent Frequent Occasional Constant

Solution: The correct answer is B. The DOT defines as frequent an activity or condition that occurs one-third to two-thirds of the day. A: Consistent is not a frequency rating used by the DOT. C: The DOT defines as occasional an activity or condition that occurs as much as one-third of the day. D: The DOT defines as constant an activity or condition that occurs as much as two-thirds to a full day.

What is the primary focus of the Joint Commission? Researching new methods of intervention Improving health care services Relicensing OTR®s and COTA®s Identifying an organization's strengths and weaknesses

Solution: The correct answer is B. The Joint Commission's focus is more on improving health care services by facilitating effective and safe services. A, C, D: These responses are not the primary focus of the Joint Commission accrediting body. Its focus is on improving health care services by facilitating effective and safe services.

Which intervention strategy would be MOST appropriate for a child with thoracic kyphosis? Teaching a child to don pants with a reacher Teaching a child how to perform toilet hygiene while wearing a Milwaukee brace Teaching a child how to self-feed while using a plate guard Teaching a child to bathe while using a tub chair

Solution: The correct answer is B. The Milwaukee brace is recommended for children with kyphosis or a posterior convexity. A, C, D: A child with thoracic kyphosis would likely be able to don pants without the use of adaptive equipment, eat without the use of a plate guard, and bathe without the use of a tub chair, unless he or she had a comorbid condition.

In treating a client with low vision who is experiencing difficulties with night driving and reading road signs, what is the OTR®'s FIRST step? Report the client to the state licensing body and ask the Medical Advisory Board to investigate this case. Consult with the client's physicians, optometrist, and other health care providers. Discharge the patient to the ophthalmologist or optometrist to provide intervention and recommend that the client not drive. Discharge the client from occupational therapy and refer the client to a low vision specialist for general rehabilitation.

Solution: The correct answer is B. The OTR should work with the multidisciplinary team to develop the best treatment options for the client. A: There is no reason to prematurely report a client with low vision to the state licensure body. C, D: There is no need to discharge the client to the ophthalmologist or optometrist or from occupational therapy, and it is premature to suggest stopping driving. The OTR® should work with the multidisciplinary team to provide the best driving or community mobility outcomes for the client.

An OTR® is working with a client diagnosed with depression who does not seem to care about fulfilling the roles as a parent to teenage children and friend to a person who also is struggling. Additionally, this client does not show an interest in returning to work or singing in the choir at church. Which assessment would help the OTR® explore a hypothesis that the client is devaluing these roles? Work Environment Impact Scale Role Checklist Comprehensive Occupational Therapy Evaluation Performance Assessment of Self-Care Skills

Solution: The correct answer is B. The Role Checklist assesses the value the client places on each of 10 different roles. A: The Work Environment Impact Scale is related to work. C: The Comprehensive Occupational Therapy Evaluation assesses behaviors related to occupational performance. D: The Performance Assessment of Self-Care Skills measures the independence, safety, and adequacy of clients' ability to care for themselves.

Which strategy should the occupational therapy practitioner keep in mind when preparing a handout for an older adult with low vision? Print the handout in regular-size type on light-colored paper. Use a large, dark font on white paper. Make sentences short and use a vocabulary appropriate for 8th graders. Keep the handout to only one page and place it in a notebook.

Solution: The correct answer is B. This strategy uses the principles of contrast (dark font on white paper) and enlargement and magnification (enlarging font), which makes it easier for the client with low vision to read. A: This strategy makes it difficult for the client to read because the type is not enlarged and the contrast may not be sufficient. C, D: These strategies do not relate to the client's low vision.

A client with stroke is demonstrating deficits in visual-perceptual skills. One of the client's goals is to gain independence in dressing. What activity would be appropriate for the intervention session? Drawing a clock diagram on paper Putting on a button-front shirt Copying a pegboard design from a pattern Completing a bed-to-chair transfer

Solution: The correct answer is B. The client can remediate visual-perceptual skills through task-specific practice in choosing the shirt from the closet, identifying the top and bottom of the shirt, and locating the sleeve. A: Use of paper-and-pencil tasks does not generalize to functional task performance. C: Bottom-up approaches based on purposeful activities do not generalize to functional task performance. D: Transfers may not allow the client to use visual-perceptual skills at the level required for a dressing activity.

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 OTR® safely do with this client NEXT? Ask the client to complete some light housekeeping tasks so that the OTR can assess IADL skills. Ask the client to stand up so that the OTR can assess the client's balance and ability to ambulate. Ask the client to do light hygiene tasks while seated at the edge of the chair. Ask the client to perform high-level balance tasks, such as standing on one foot while catching a ball.

Solution: The correct answer is B. The client demonstrates adequate strength to stand. The OTR can safely proceed to assess sit-to-stand transfer and stand the client with assistance. If the client demonstrates good balance in static standing, the OTR can then proceed to ambulation with the client. A: Light housekeeping would be too high level; the OTR must first assess the client's balance and ambulation skills. C: Although the OTR might want information about the client's ability to do light hygiene tasks, it is important for the client to do the tasks in his or her preferred position (sitting or standing) to assess real performance. D: High-level balance should not be assessed until static standing and ambulation have been assessed.

An OTR® is working with a client in the active phase of a T2 spinal cord injury. The client reports a terrible headache and is sweating profusely. What is the BEST method to address the client's symptoms? Check blood pressure and alert nurse. Bring upright and remove restrictive clothing. Recline quickly and elevate legs. Bring upright and apply abdominal binder.

Solution: The correct answer is B. The client is likely experiencing autonomic dysreflexia, a serious and life-threatening condition. The client should be placed upright, restrictive clothing should be removed, and the bladder should be voided (or catheter tubing checked for obstruction). A: Although the nurse should be alerted and blood pressure checked, it is more important to address the immediate need. C: Reclining and elevating legs will exacerbate the problem because it will increase blood pressure. D: Application of an abdominal binder will increase blood pressure.

A frail older adult client who uses an ultra lightweight manual wheelchair with a foam cushion comes to the clinic complaining of low back pain. The client's caregiver indicates that the skin on the client's coccyx is very pink, and there is concern about skin breakdown. The OTR® observes that the client's seated position is stable without supports, the client's upper extremities rest on the armrests without the shoulders hiking, the feet rest on the foot plates bilaterally, and the hips are at a 45° angle, which keeps the knees higher than waist level. The client indicates that this sitting posture is usual and is maintained most of the day. What intervention would the OTR® try INITIALLY to relieve the client's pain and protect the skin? Add an adjustable-tension back support so that the client can lean back further Lower the footrests so that the thighs are level with the seat of the chair and the feet rest flat on the footrests Replace the client's foam cushion with a gel cushion Analyze how pressure is distributed on the pelvis using pressure mapping

Solution: The correct answer is B. The client's footrests are too high, resulting in increased pressure at the ischial tuberosities and the coccyx. When the hip joint is maintained in flexion, the pelvis is prone to tilt posteriorly, increasing pressure in the lumbar region. Lowering the footrests distributes pressure more evenly over the thighs. A, C: The client's footrests are too high, resulting in increased pressure at the ischial tuberosities and the coccyx. When the hip joint is maintained in flexion, the pelvis is prone to tilt posteriorly, increasing pressure in the lumbar region. An adjustable-tension back support will further complicate the client's poor positioning, and replacing the foam cushion with a gel cushion will not address the postural problem or the pain resulting from pressure on the coccyx. D: Pressure mapping is an assessment, not an intervention; it illustrates how pressure is distributed across the sitting surface.

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

Solution: The correct answer is B. The client's physical and cognitive status must be thoroughly assessed before deciding whether a transfer can be safely performed. Physical abilities will tell the OTR® how much the client might be able to help with the transfer, and cognitive status will tell the OTR how much the client might understand during the transfer. Cognitive status will also affect the technique and cueing used during the transfer. A: The ability to complete ADLs would be an indicator of transfer ability, but it would not be a decisive factor. C: The surface is important to consider while transferring but should not directly affect the safety of the transfer. D: The amount of space between surfaces is important to consider while transferring, but it will not directly affect the safety of the transfer.

An OTR®; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The OTR writes the following goal for one group member using the COAST method: "The client will cook a meal before being discharged." Which sentence represents the MOST measurable formulation of the occupation (or O) element of this goal? "The client will cook an entrée and side dish." "The client will cook an entrée using a four-step recipe." "The client will cook chicken soup." "The client will cook independently."

Solution: The correct answer is B. The occupation element of the goal should contain specific and measurable information that relates to the problem statement written for the client. A, C: The difficulty of cooking an entrée and side dish or chicken soup depends on the recipe that is being followed; therefore, these sentences do not provide enough information to make the occupation measurable. D: This sentence provides no additional information about the occupation that is to be undertaken.

An entry-level OTR® working in an outpatient rehabilitation clinic is evaluating a client who was recently hospitalized for dehydration and subsequently diagnosed with mild cognitive impairment. The client lives alone in an independent living facility. Before admission, the client was independent in ADLs and light homemaking and active in community and social activities, including driving independently. The client reports no crash record and no violations or citations but avoids night driving, highway driving, and driving in rush-hour traffic or heavy rain. To address the client's community mobility needs and safety, which option is the MOST APPROPRIATE next step for the OTR®? Provide an educational intervention on fitness to drive. Discuss the importance of a comprehensive driving evaluation. Introduce the use of alternative transportation options in the community. Recommend serious consideration of driving cessation

Solution: The correct answer is B. The comprehensive driving evaluation is optimal to ensure the client's fitness to drive and to reduce the client's risk of being involved in an adverse event after discharge. A: Evidence indicating that an educational intervention carries over to crash reduction in older drivers is limited. C: Although alternative transportation is a strategy used for people with mild cognitive impairment, it is not considered the best strategy and should be introduced with a conversation about driving cessation and a community mobility plan. D: Driving cessation is premature as a strategy for this client.

An OTR® is preparing a job demand analysis report for a furniture manufacturing company. The report includes several recommendations to decrease risk factors for musculoskeletal cumulative trauma disorders at work. For administrative controls, the OTR® recommends the implementation of task rotation every 4 hours of work. What recommendation will MOST likely be included under the engineering controls? Job rotation through different workstations Raising the table height of the assembly line by 3 inches Implementing factorywide stretching exercises during breaks Introducing high-speed, high-vibration power tools for speedy assembly

Solution: The correct answer is B. The goals of engineering controls are to provide proper design of the work environment, tools, and processes. Adjusting the height of the workstation is one example of engineering controls. A: Job rotation is an example of an administrative control. C: Implementing factorywide stretching exercises is an example of work practice controls. D: Using high-vibration power tools can be a risk factor contributing to cumulative trauma disorders, not reducing them.

A worker is returning to precision assembly work after being treated for cubital tunnel compression at the left elbow from prolonged pressure on surfaces. What is the MOST appropriate height for this client's workstation? Above elbow height Just below elbow height 4 inches below elbow height 8 inches below elbow height

Solution: The correct answer is B. The ideal position for precision assembly is to position the workstation above elbow height, but for a worker with recent nerve compression at the elbow, it is important to set up the work environment so as to not induce further prolonged pressure at the elbow. Therefore, the workstation should be just below elbow height, eliminating all pressure at the elbow. In this case, use of a magnifying device will allow for precision in assembly, compensating for the lack of close proximity. A: Positioning above the elbow will increase pressure on the elbow as the worker rests the elbows on the surface. C, D: Positioning the workstation 4-8 inches below elbow height will be too low for any precision assembly work.

What is the most important safety recommendation for clients with middle-stage Alzheimer's disease (AD)? Do not allow this client to complete ADLs independently because the client might not dress appropriately for the weather. Do not leave this client alone because the client might get lost, even in a familiar environment. Provide this client with activity to engage the client throughout the day to minimize behavioral disturbances. Provide this client with redirection to minimize behavioral outbursts and prevent self-injurious behaviors.

Solution: The correct answer is B. The most important safety issue would be leaving a client with AD alone, because the client might become lost or confused, even in familiar environments. A: Dressing is not an immediate safety concern unless the client will be going outside. C: Providing activities is good practice but is not necessarily a primary safety intervention. D: Redirection is a good practice but not necessarily a primary safety intervention.

While performing PROM for a client with stroke, the OTR®; notes that the client's shoulder is resistant to flexion beyond 90°, although the client reports being pain free. What does this finding suggest? Shoulder subluxation is inhibiting movement. The scapula is not gliding to produce full flexion. The humerus is locked in against the acromion. Spasticity is preventing the shoulder from reaching full range.

Solution: The correct answer is B. The muscles supporting the scapula have likely shortened from disuse and are limiting the full range of shoulder motion. Both the humerus and the scapula must move to support full shoulder motion. A: Shoulder subluxation would limit ROM because of the pain it causes, but this client is without pain. C: Mechanical joint limitations such as the humerus hitting the acromion during PROM would result in painful motion. D: Spasticity limits full ROM when velocity is a factor in movement; slow passive movement with a limitation in motion suggests that soft tissue shortening of muscles is limiting the range.

A client sustained a burn injury to the hand 1 year ago and has returned to occupational therapy for scar management. The client has been wearing a compression glove as originally prescribed and asks the OTR® if the glove is still necessary. Which factor is MOST IMPORTANT for the OTR® to consider prior to advising the client to discontinue glove wear? Documented changes in volumetric measurements since beginning therapy Physical characteristics of the scar and the stage of wound healing Client's overall psychological adjustment to the burn scars Improvements in composite finger ROM and scar sensitivity

Solution: The correct answer is B. The primary outcome when using a compression glove is to decrease scar tissue formation and improve the appearance of a scar, and this is assessed through physical characteristics of the scar. Once the appearance of the scar along with the stage of wound healing are considered, the determination of continued compression glove use can be made. A: Volumetric measurements are used to assess edema in an extremity and would not be a reasonable measure for scar management. C: The client's psychological adjustment to the burn scars should be addressed by the practitioner; however, this information is not essential in determining the discontinuing of a scar management glove. D: Although ROM and scar sensitivity may be secondary effects of glove use in scar management, the primary outcome when using a compression glove is to decrease scar tissue formation and improve the appearance of a scar.

An OTR®; is worried that occupational therapy services will not be approved by a third-party payer for a particular client. Given previous experiences with the third-party payer and knowledge of what services the payer typically allows, the OTR omits some information from the documentation so that the client's services appear more reimburseable. What ethical principle has the OTR violated by adjusting the documentation in this way? Beneficence Veracity Justice Nonmaleficence

Solution: The correct answer is B. The principle of veracity requires that the OTR provide accurate and objective information in representing the work of the profession. Veracity requires timely, accurate documentation of services provided. Any deviation is both unethical and illegal. The OTR's license may also be in jeopardy. A: Beneficence refers to the demonstration of concern for others' safety and well-being. C: Justice refers to the fair, equitable, and appropriate treatment of persons and access to occupational engagement. D: Nonmaleficence requires that occupational therapy professionals refrain from behavior that could cause harm.

A 6-year-old child has hypotonia and poor sitting balance. Which activity would be MOST BENEFICIAL to include in the initial intervention for facilitating the child's active trunk extension? Gentle rocking on a 22-inch (56 cm) diameter ball in a supine position Going down a ramp in a prone position on a standard-size scooter board Rolling forward and backward in a 20-inch (51 cm) diameter carpet-lined barrel Sitting upright and spinning in a ceiling-suspended net hammock

Solution: The correct answer is B. The prone position will facilitate an active trunk extension posture as the child works to hold the head and limbs away from the ground. Though this activity provides movement, the child's body position is starting from a point of stability in prone. A: The supine position may provide passive trunk extension. For this child with hypotonia, they will be working more on active trunk flexion with this activity as well as receiving linear vestibular input. C: Rolling in a barrel provides dynamic input with vestibular stimulation; however, the child will not be challenged to engage trunk extension or flexion given the dynamic nature of the task. D: In this activity, the child is asked to sit while dynamic input is provided to the sitting, a task that the child will likely be unable to engage in if sitting balance is poor.

An OTR® is providing intervention to a client with an anxiety disorder who hyperventilates when faced with difficult work tasks. The OTR asks the client about the client's successes and failures as a child and begins to discuss how these early experiences might be the reason the client is experiencing anxiety at work. The OTR and the client discuss ways to manage these feelings. What frame of reference does this intervention suggest? Cognitive-behavioral Psychodynamic Cognitive disability Behavioral

Solution: The correct answer is B. The psychodynamic frame of reference suggests that unresolved childhood events are the reason for dysfunction. A psychodynamic intervention is usually discussion based. A: The cognitive-behavioral frame of reference works on the thoughts and reactions related to environmental triggers. Through journaling and reflection, the client can identify triggers that cause the anxiety to escalate. C: The cognitive disability frame of reference uses the client's strengths to allow for function. An example of a cognitive disabilities intervention is training caregivers to provide appropriate environmental supports for the client. D: The behavioral frame of reference relies on the idea that behavior is learned and that it can be unlearned. Using breathing and relaxation techniques during a stressful event can facilitate a change in response.

A client is being discharged from a rehab facility. During the discharge interview, the OTR® asks questions such as, "Who is available to assist the client in each physical context the client needs to be in?" "When are they available?" "Who will check the Roho cushion and reinflate it as needed?" "Who will clean the cushion cover?" Under which assessment category do these questions fall? Physical context Social context Physical skills context Equipment context

Solution: The correct answer is B. The social context includes people who support and assist the client in multiple environments. A: The physical context focuses on the characteristics of the physical environments in which the client will need to use the wheelchair. C: The physical skills context refers to the client's physical ability to maintain posture and stability, adjust positions, and propel the wheelchair. D: The equipment context refers to the technology the client currently has or needs.

An OTR® is working at an after-school program connected to a women's homeless shelter. The OTR® is engaged in a conversation with the mother of a 10-year-old boy; she says that the child has recently lost quite a bit of weight and is excessively thirsty. To which specialist should the child be referred? Pediatrician Endocrinologist Neurologist Audiologist

Solution: The correct answer is B. These factors, along with polyuria and dehydration, are common signs of Type 1 diabetes. Onset is usually around age 10. The appropriate referral would be to an endocrinologist. A: A pediatrician would refer the child to an endocrinologist. C: A neurologist would be the appropriate referral if the OTR® had neurological concerns (e.g., cognitive, learning, or motor concerns stemming from an upper motor neuron or lower motor neuron incident). D: An audiologist would be the appropriate referral if the OTR® had concerns regarding the child's hearing.

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? Continue occupational therapy intervention knowing that developmental progress due to maturity is still possible. Discuss alternative classroom modifications and adaptations with the student's teacher. Request the special education team schedule an interim meeting to modify the student's IEP. Send a letter to the student's parents informing them that occupational therapy is no longer beneficial to their child.

Solution: The correct answer is B. The student's response to occupational therapy intervention and teacher data is important in implementing an effective intervention plan. The intervention plan appears to need modification on the basis of the student's response. A: The practitioner must continuously gather data to inform the intervention decisions on the basis of student response and teacher data. Continuing occupational therapy intervention without any modification at this point would indicate that the practitioner is not attending to this information. C: The intervention plan is modified before changing the goals in the IEP because the goals may not be the problem; rather, the practitioner may not have implemented the right intervention yet or the student's status has changed and requires modification of the intervention. D: Discontinuing occupational therapy services is not the appropriate response without gathering more information. The practitioner must collect necessary systematic data to inform intervention decisions and support the best outcomes for the student.

An older adult client with a history of falls and glaucoma is referred to occupational therapy for evaluation and intervention. What strategy should the OTR® use to reduce the client's risk of having a fall? Using low-wattage glare free lightbulbs Placing contrasting color stripes on each stair edge Encouraging client to look forward when ambulating Securing a beige throw rug on the beige carpet

Solution: The correct answer is B. The use of contrast would make it easier for the client to see each stair tread. A: This strategy would make it more difficult and unsafe for the client to ambulate because of the inability to see obstacles clearly. C: Because the client has deficits in peripheral vision, the client needs to scan the environment for obstacles when ambulating. D: A beige throw rug on a beige carpet has minimal contrast and would be difficult for the client to see.

Why is it important to review the validity of an assessment tool before using it? It identifies whether two OTR®s using the tool with a particular client would have the same results. It determines the extent to which the tool measures what it is intended to measure. It measures the amount of change that occurs over a period of time in an individual. It describes the outcomes that would be achieved by using specific intervention strategies.

Solution: The correct answer is B. The validity of a tool indicates whether the tool actually measures what it is expected to measure. A: This answer is related to reliability rather than validity. C, D: These answers do not relate to validity but may relate to specific outcome measures.

A client recovering from stroke changes head position when viewing objects and people on the left side, bumps into objects and door frames on the left side when walking, and consistently misplaces feeding items placed on the left. What is the MOST important aspect of vision for the OTR® to assess during evaluation? Visual acuity Visual field Contrast deficit Oculomotor function

Solution: The correct answer is B. These clinical observations suggest a reduced visual search pattern, characteristic of visual field deficit secondary to left hemianopia. A: Clinical signs of a visual acuity deficit would include an inability to see small visual detail, including nutrition information on food labels. C: Clinical signs of a contrast deficit include an inability to distinguish and identify faint features of objects (e.g., identifying rice on a white plate). D: Clinical signs of an oculomotor deficit include reduced speed, control, and coordination of eye movements, often resulting in diplopia. Diplopia can affect reading, driving, and functional mobility.

An entry-level OTR® working in an outpatient rehabilitation clinic is evaluating a client who was recently hospitalized for dehydration and subsequently diagnosed with mild cognitive impairment. The client lives alone in an independent living facility. Before admission, the client was independent in ADLs and light homemaking and active in community and social activities, including driving independently. The client reports no crash record and no violations or citations but avoids night driving, highway driving, and driving in rush-hour traffic or heavy rain. What battery of assessments is MOST APPROPRIATE for the OTR® to use in assessing this client's fitness-to-drive skills? Rules-of-the-road recognition; Motor-Free Visual Perception Test, Third Edition; finger-to-nose test Trail Making Test, Part B; Useful Field of View; and Mini-Mental State Examination ROM, manual muscle strength, and family interview Color discrimination, contrast sensitivity, and depth perception

Solution: The correct answer is B. These clinical tests selected to screen for the client's driving ability are consistent with the client's diagnosis of mild cognitive impairment. A, C, D: There is no indication that these combinations of tests are best to address mild cognitive impairment. A focuses on rules of the road, perception, and coordination; C focuses on physical function; and D focuses on visual functions.

A physician has referred a client to an outpatient setting for an occupational therapy evaluation and intervention. The client has late effects from a stroke that occurred approximately 10 years ago. The OTR® is determining the appropriate intensity of therapy services for this client. Which intensity is MOST appropriate? 3 times per week 45-minute sessions 4 weeks Once a month

Solution: The correct answer is B. This answer is the only one that relates to intensity. A, B, D: These answers relate to frequency or duration rather than intensity.

A client with T1 spinal cord injury exhibits headache, sweating, congestion, hypertension, and bradycardia. What is the client MOST likely experiencing? Spasticity Autonomic dysreflexia Orthostatic hypotension Hypertonia

Solution: The correct answer is B. This combination of symptoms describes autonomic dysreflexia. The symptoms would prompt an OTR® to sit the client upright and remove any noxious stimulus. A, D: Spasticity and hypertonia describe muscle conditions. C: Orthostatic hypotension is characterized by a drop in blood pressure.

A client sustained a cerebral infarct 3 months ago with hemiparesis in the right lower extremity. The client has been discharged from physical and occupational therapy, walks with a quad cane, and is fully functional in the other extremities. The client who completed an on-road driving evaluation required adaptive equipment. The certified driver rehabilitation specialist followed a comprehensive approach. What tasks would such an approach include? Practice driving in a test vehicle, in traffic, via a fixed route with moderate traffic and moderate speeds. Practice driving in a restricted environment or on the driving simulator to provide training to the client in the use of adaptive equipment. Consult the AAA's brochure Smart Features for Older Drivers to identify appropriate personvehicle fit features for a person with stroke. Practice driving in the client's environment and incorporate destinations of choice to travel to.

Solution: The correct answer is B. This method will ensure training and compensation for the client's right leg hemiparesis in a safe environment. A, D: The challenges of this environment exceed the ability level of the client. C: This strategy is too general and does not require the intervention of a CDRS.

In the United States, the dominance of the automobile as a mode of transportation has implications for public transit and, by extension, community mobility. What is the most comprehensive explanation of the impact on transit? Reliance on transportation by any means other than the private automobile is uncommon in all environments. Public transit options, despite legislation such as the American With Disabilities Act of 1990 (Pub. L. 101336), are primarily geared toward a fixed-route system. The urban sprawl phenomenon in the United States creates challenges for operational efficiency and financial solvency of transportation systems. Misconceptions about alternative transportation and stigma associated with medically necessary services limit the use of such transportation options.

Solution: The correct answer is B. This option represents the most comprehensive explanation of this phenomenon. A: Reliance on transportation by means other than private automobile is uncommon in most environments, excluding some urban environments that offer adequate alternative transportation options. C: The vastness of geographic space in the United States creates challenges for operational efficiency and financial solvency of transportation systems. D: This statement has an element of truth but is not the most comprehensive choice as a stand-alone option.

An OTR® is evaluating a student's desk for the optimal position for handwriting. Which option describes the optimal desk position? The desk should be positioned at least 3 inches away from the child's abdomen and allow for shoulder internal rotation and forearm supination. The desk should be positioned 2 inches above the child's flexed elbows when the child is seated in the chair with the feet on the ground. The desk should be positioned 1 inch below the child's wrist when the child is standing with both feet on the floor. The desk should be positioned so that the part closest to the child is angled up and the writing surface slopes downward.

Solution: The correct answer is B. This position allows for weight shifts and postural adjustments as well as optimal muscle synergy and symmetry during seatwork. A, C, D: These options are not in line with good positioning for handwriting.

An OTR® is asked by the OTR's manager to educate two people with Parkinson's Disease (PD) about the use of adaptive equipment as part of the organization's mission to serve the health of indigent community members. The manager asks the OTR not to bill for the services and to offer them pro bono. Is this practice ethically sound? No; the practice is supported by the ethical principle of justice, but it violates reimbursement laws. Yes; the practice is supported by the ethical principle of justice and does not violate organizational policies. Yes; the needs of people with PD outweigh the risk of not providing education. No; occupational therapy is provided in a market-based system, so a monetary transaction must take place.

Solution: The correct answer is B. This practice is supported by the principle of Justice. Offering pro bono services in this situation upholds a society in which everyone has an equitable opportunity to achieve occupational engagement, and it addresses barriers to accessing occupational therapy services within the parameters of organizational policies. A: No reimbursement law requires a monetary transaction. C: This option may relate to justice but does not describe the specifics of this situation. D: This statement is not accurate and not reflective of an ethical analysis

A client arrives for an occupational therapy evaluation. Partway through the session, the client begins to cry, because the client's beloved cat had suddenly become gravely ill and was euthanized earlier that day. Which response by the OTR® communicates a professional use of empathy? "Why don't you come back later when you are feeling better?" "It's so hard to lose a pet." "You just need to get another cat, and you'll feel better." "You need to calm down so we can complete your occupational therapy for today."

Solution: The correct answer is B. This response best communicates empathy; it validates the client's feelings in a nonjudgmental manner A: This response does not demonstrate empathy. It ignores the client's response and could make a therapeutic relationship more challenging because the client might not trust the therapist to listen to the client's concerns. C, D: These responses do not demonstrate empathy. They are dismissive and will diminish the OTR's ability to form a strong therapeutic relationship with the client, because the client will feel that his or her concerns are not taken seriously.

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

Solution: The correct answer is B. Thrombolytic agents are the first line of treatment in the acute management of CVA to dissolve the clot that is blocking the flow of blood through its vessel. A: Anticoagulants are second in the line of treatment to prevent new clots from forming. C: Antiplatelet treatments work in the same manner as anticoagulants to prevent clots from forming and are also considered a second line of defense. D: Nonsteroidal anti-inflammatory drugs are often contraindicated for patients with CVA.

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? Typically once or twice per week for 1 year Typically once or twice per week for 2 years Typically 3 or 4 times per week for 1 year Typically 3 or 4 times per week for 2 years

Solution: The correct answer is B. Treatments typically last between 45 and 60 minutes, once or twice per week, and continue for about 2 years. A: The duration of treatment is too short; it typically continues for 2 years. C, D: The frequency of treatment is too high; sessions typically take place once or twice per week.

An OTR® has been asked to give a presentation on ergonomics to the local carpenters union. What factor is MOST associated with the onset of lower back pain? Low job satisfaction Poor physical fitness High anxiety High socioeconomic status

Solution: The correct answer is B. Typically, back pain results from poor physical fitness, obesity, lack of strength and endurance, and poor body mechanics. A, C: Low job satisfaction and anxiety can occur as a result of back pain; they should be considered in an occupational profile, but they do not directly relate to onset. D: Lower socioeconomic status is a predictor of incurring back trouble.

An OTR® is working on toileting with a 3-year-old child with autism. The child is delayed approximately 1 year with toileting skills. When is it likely that this child can be expected to completely master this skill? Ages 4-5 Ages 6-7 Ages 8-9 Ages 9-10

Solution: The correct answer is B. Typically, children are able to be independent with toileting, including washing hands and completing clothing management, between age 4 and 5. If the child is a year behind, he will likely master the skill between age 6 and 7. A, C, D: Although some children may completely master toileting before or after the ages of 4 and 5, this range is typical for skill development.

A client with Parkinson's disease has experienced a significant decrease in participation in activities in the home. The OTR® finds that this decrease in activity is related to the client's postural instability and the caregiver's fear that the client will fall. Which intervention is BEST to restore this client's participation in home activities? Refer the client to another profession to address mobility Instruct the caregiver in ways to assist the client's participation in activities Train the client in energy conservation techniques to improve posture Assist the client in finding new activities to be involved with at home

Solution: The correct answer is B. Use of specific cuing methods and clear verbal and visual instructions may facilitate improved motor movements for activity participation. A: A referral to another discipline such as physical therapy may be beneficial to address postural instability; however, occupational therapy should first address increasing the client's participation in activities. C: Fatigue may be causing the client's postural instability, but the first area to address to improve postural stability in clients with Parkinson's disease is to improve movement through cuing. D: The client has lost participation in roles and activities that were previously important. Those activities should be resumed with modifications before the client takes on new activities.

An OTR® is working with a high school student with juvenile rheumatoid arthritis (JRA). The OTR® suggests that the student stop using the arms and hands to carry heavy textbooks to class and instead use a backpack. What type of strategy did the OTR® recommend? The OTR® recommended an energy conservation strategy. The OTR® recommended a joint protection strategy. The OTR® recommended a work simplification strategy. The OTR® recommended a pacing strategy.

Solution: The correct answer is B. Using a backpack instead of arms and hands to carry heavy books will put less stress on the student's hand joints and is in line with a joint protection strategy. A, C, D: The other strategies are not associated with using a backpack; however, they may be appropriate strategies to use with a client with JRA.

A client with visual field deficit secondary to glaucoma reports difficulty locating grocery items when shopping. Which intervention using a remediation approach would be MOST appropriate? Solicit assistance from employees in the store Use wider head turns in an organized search pattern Initiate slower head turning to promote accuracy Position head to one side to increase the visual field

Solution: The correct answer is B. Using a remediation approach, the focus of the intervention is on increasing the speed, width, and organization of the visual search pattern so the client can completely search the visual fields. A: Soliciting assistance is a compensatory approach and does not promote independent task performance. C, D: Slower head turning and static positioning of the head do not promote visual search strategies.

An OTR® is working on sitting balance at the edge of the bed with a client who has had a CVA with residual left-sided hemiplegia. The client requires minimal assistance to maintain static sitting because of lateral leaning. How can the OTR® BEST adapt or modify this activity to improve sitting balance? Prop a wedge and pillows behind the client. Allow the client to bear weight on the left forearm on a small stool. Position the client's hips in more of an anterior pelvic tilt. Instruct the caregiver on proper hand placement to support the client

Solution: The correct answer is B. Weight bearing on the affected side will provide lateral support and can help reduce tone. This positioning technique changes the physical demands of static sitting to improve participation in the task. A: A wedge and pillows provide additional back support, thereby decreasing the sitting demands and not addressing the lateral loss of balance. C: An anterior pelvic tilt may be a better position if the client is experiencing posterior loss of balance. D: Caregiver training is not the best answer at this time because the OTR® is working to improve sitting balance, not to maintain this level of assistance.

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? Muscle tightness Muscle weakness Joint contractures Joint adhesions

Solution: The correct answer is B. When lag is present (i.e., AROM is less than PROM), it indicates a problem with muscle weakness because the joint cannot move actively as far as it can move passively. A: Muscle tightness is usually the cause when PROM remains unchanged after repositioning the joints proximal to the one being tested. For example, in testing the elbow joint, when shoulder position affects PROM at the elbow, it indicates muscle tightness in the group of muscles that cause less PROM in the elbow. C: Joint contractures may be a factor when PROM is the same as AROM in the joint being tested. D: Joint adhesions also may be a factor when PROM is the same as AROM in the joint being tested.

An OTR® receives a referral to evaluate a client who has early-stage Huntington's disease (HD) at the client's home. The OTR® begins by asking the client basic questions. What should the OTR® remember about communicating with clients who have HD? Use open-ended questions to allow the client to give rich detail about the client's needs. Use close-ended questions to prevent frustration caused by difficulty in word retrieval. Use observation as a primary source of information from the client. Use the caregivers to provide the majority of the client's history.

Solution: The correct answer is B. With a client with early-stage HD, it is important to use close-ended questions that require yesno responses or use a list of choices to prevent frustration associated with word retrieval problems. A: Using open-ended questions would not be a wise choice, because clients with HD may have difficulty with word retrieval. C: Observations, although helpful, will not take the place of communicating with the client with HD. D: Talking to the caregivers will be helpful, but it is important to be client centered in approach by gathering as much information at possible from the client before talking with family or caregivers.

An OTR® is a member of a comprehensive team of occupational rehabilitation professionals who treat clients in a return-to-work program accredited by the Commission on the Accreditation of Rehabilitation Facilities (CARF). Which type of return-to-work approach does the team use? Work simulation Work hardening Work conditioning Work therapy

Solution: The correct answer is B. Work hardening involves an interdisciplinary approach and is the only type of program listed that can obtain CARF accreditation. A: The primary focus of a work simulation program is usual and customary work. C: Work conditioning typically involves one discipline and focuses on restoration of neuromusculoskeletal function. D: Work therapy involves work tasks to improve function during the acute rehabilitation phase of recovery.

An OTR® is working with a child on toilet training. The child is 2½ years old and has an intellectual disability. Which of the following strategies is appropriate to include during intervention? Encourage the child to wash his hands after using the bathroom Encourage the child to try buttoning and unbuttoning pants Encourage the use of a toileting schedule Encourage the use of a potty chair

Solution: The correct answer is C. Children are typically physiologically able to get on a regular toileting schedule at age 2½. A, B: These skills are usually mastered after age 2½; a child with an intellectual disability may need more time to master them. D: Introducing a potty chair may not help the child generalize the skill to a regular toilet.

A client who fell from a roof while at his roofing job suffered a traumatic brain injury and is unable to return to his job. The worker has identified computers as an interest and is enrolled in a work readiness program. Which vocational skill activity would MOST likely be part of his work readiness program? Typing class to maximize typing efficiency Work-related tasks using a computer aimed at assessing aptitude Completion of job applications for computer-based jobs posted in newspapers Ergonomic training for optimal positioning at computer workstation

Solution: The correct answer is B. Work readiness programs aim to identify a person's skills and interests to develop his or her readiness for work and to achieve the person's goals related to work. The client has expressed an interest in working with computers, and work-related tasks in this area will help the client identify skills and aptitudes in this area. A: The typing class would prepare a person for a specific job and would occur after the work readiness program. Work readiness explores the client's potential and interests based on current skills and aptitudes and is followed by referral to vocational rehabilitation through the state department for job training assistance. C: Job placement is pursued following the work readiness program through vocational rehabilitation services. D: Ergonomic training is provided when the client is hired so recommendations can be specific to the work environment.

A client was involved in a car accident and sustained an incomplete injury at the T12 spinal cord level. Before the injury, the client was employed as a heavy equipment operator. After some discussion, the client and OTR® determine it is no longer feasible for the client to return to this occupation. The client is interested in exploring other options for employment. What program would the OTR use to MOST appropriately assist the client in identifying vocational options? Vocational rehabilitation program Work readiness program Ticket to Work program Community-based program

Solution: The correct answer is B. Work readiness programs help individuals who want to work identify vocational options that match their interests, skill, and abilities. A: Vocational rehabilitation programs are run by state- and federally funded agencies that provide job training and placement services to people with disabilities. C: The Ticket to Work program is not an example of a return-to-work program. D: Community-based programs are not focused on matching vocational interests, skills, and abilities.

An OTR® has received a referral to establish a work conditioning program for a client employed as a roofer. The client has a history of low back sprain. When implementing a work conditioning program, which intervention is MOST appropriate to reduce the client's risk for reinjury? Completing a job demand analysis at the job site Instructing the client in proper body mechanics Improving the client's heavy material handling skills Modifying the client's work schedule to part time

Solution: The correct answer is B. Work-related musculoskeletal disorders (WSMDs) are a class of soft-tissue injuries affecting the muscles, tendons, and nerves. They are typically characterized by a slow and insidious onset and are thought to be the result of microtrauma. WSMDs account for one-third of all occupational injuries and illnesses in the United States. Poor body mechanics may be a contributing factor and result in repeated microtraumas; therefore, instructing the client in proper body mechanics should be included in the treatment plan. A: Poor workstation design and work process design may be contributing factors to an increased risk for WSMDs; however, a job demands analysis looks to define the actual demands of a specific job and does not address risk for reinjury. C: The heavier the material handling demands of a job are, the greater the risk for injury is; however, the material handling demands may not be the most likely cause of injury. D: Modifying the client's work schedule to part-time status is not the most appropriate intervention to reduce risk for reinjury.

An OTR® is concerned that a worker participating in a back-neck school program may be magnifying symptoms. On assessment measures, the worker inconsistently reports pain throughout body mechanics training activities. The worker often refuses to complete tasks, citing pain as the reason. Which reason is the MOST likely for the worker to magnify symptoms? The worker is satisfied in the worker role and lacks motivation to complete tasks. The worker fears increased pain from task completion. The employer is supportive and is encouraging the return to work. The worker values work and perceives work as a source of motivation.

Solution: The correct answer is B. Workers may increase their pain reports in an attempt to avoid an increase in pain after task completion. A: A worker who is satisfied with his or her role would not lack motivation to complete tasks. C: A supportive employer who is encouraging the return to work would not cause a lack of motivation. D: A worker who values work would not have a reason to magnify his or her symptoms and avoid work

An OTR is working with a client who has sustained injuries in a knife attack. The injury to the flexor tendon is in what is known as "no man's land." The stitches in the fingers are between the distal palmar crease and the proximal interphalangeal joints. In what flexor tendon zone are the injuries located? Zone I Zone II Zone III Zone IV

Solution: The correct answer is B. Zone II of the flexor tendon system has been called no man's land because excessive scarring makes it difficult to get good results from a repair. A, C, D: Zones I, III, and IV of the flexor tendon system do not have the overlap of the flexor digitorum profundus and the flexor digitorum superficialis to increase scarring and decrease tendon gliding.

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? Cold spray Neuromuscular electrical stimulation (NMES) Transcutaneous electrical nerve stimulation (TENS) Iontophoresis

Solution: The correct answer is C. A TENS unit will best aid the client in reaching the treatment goal of pain control. A: Cold spray is used to treat trigger points and increase passive stretch of a muscle tendon unit. B: NMES is best used to facilitate muscle contraction. D: Iontophoresis is used to control inflammatory conditions.

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? Low median nerve injury High median nerve injury Ulnar nerve injury Radial nerve injury

Solution: The correct answer is C. 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. A, B: Low and high median nerve injury can result in ape hand deformity and decreased tip pinch, respectively. D: Radial nerve injury can result in wrist drop deformity and decreased finger, thumb, and wrist extension.

A client is recovering from an exacerbation of rheumatoid arthritis and is participating in outpatient occupational therapy. The initial evaluation indicates decreased active ROM of bilateral wrists and hands, bilateral ulnar drift, moderate edema, and a pain rating of 7 out of 10 on the visual analog scale. The client currently depends on the spouse to assist with all ADL, but has a goal to increase independence with self-care tasks. Which of the following statements would be BEST to include as a short-term goal in the client's intervention plan? Control MCP joint ulnar deviation by the end of the second session using bilateral hand-based splints during self-feeding. Increase active ROM of the digits to within functional limits for independence with grooming by the sixth occupational therapy session. Subjective report of pain during dressing tasks will decrease by 2 levels on a visual analog scale within 2 weeks. Verbalize daily use of joint protection techniques during oral hygiene tasks within 2 weeks.

Solution: The correct answer is C. A client reducing pain levels during dressing directly incorporates the evaluation results and client's goals for a measurable, objective outcome. A: Splints should be used with rheumatoid arthritis to support function, and providing hand-based splints during self-feeding may interfere with task performance. B: Increasing AROM is contraindicated with rheumatoid arthritis because of pulling that may occur on the joint, thereby increasing joint deformity. Supporting task performance with splinting or assistive devices would be a more appropriate intervention outcome. D: A variety of teachinglearning techniques are needed to ensure the behavioral changes necessary to incorporate joint protection. Verbalizing may be one method, but client demonstration of techniques would be a better measure.

Based on the outcomes of a needs assessment for a retirement community, an OTR® plans to offer a program to promote the residents' adjustment and support participation in the community. What information should the OTR® gather as the FIRST step toward implementing this program? Capacity of the community to offer a variety of social and leisure programs Public transportation options available to residents of the community Performance patterns, skills, and client factors of potential participants Volunteer opportunities available in the community for elder residents

Solution: The correct answer is C. A community profile is created to give the practitioner information about the participants, their condition, and the context. The engagement in occupation is understood through performance skills, performance patterns, and client factors. A: The community capacity to offer social and leisure programs is determined through the needs assessment so the OTR® has this information already. B: Public transportation options are determined through the needs assessment so the OTR® has this information already. D: Volunteer opportunities are determined through the needs assessment so the OTR® has this information already.

An OTR® is screening the functional muscle strength of a client who has generalized weakness. When showering seated on a tub bench, the client is unable to wash the opposite side of the body but can wash the same side of the body when the caregiver places a bar of soap in the client's hand. Which functional muscle grade of the upper extremities is the client demonstrating, based on these observations? Poor Plus (2+/5) Good (4/5) Fair Minus (3−/5) Normal (5/5)

Solution: The correct answer is C. A fair minus (3−/5) muscle grade indicates the client is able to move the upper extremity through less than full range of motion against gravity and would be unable to reach the opposite side of the body. A: Poor Plus (2+/5) muscle grade indicates the upper extremity moves through full ROM in a gravity-eliminated plane and tolerates minimal resistance before breaking. Because seated on a tub bench requires upper-extremity motion against gravity and the client is able to wash the same side of the body with the upper extremity, a greater than poor plus muscle grade is indicated. B: Good (4/5) muscle grade indicates the upper extremity moves through full ROM against gravity with moderate resistance; the client would not have difficulty washing the opposite side of the body. D: Normal (5/5) muscle grade indicates the upper extremity moves through full ROM against gravity with maximal resistance; the client would not have difficulty washing the opposite side of the body.

An OTR® is planning a feeding session with a client with a C5 spinal cord injury (SCI). Which feeding utensil or adaptive equipment would be MOST APPROPRIATE to introduce during the session? An electric self-feeder Utensils with built-up grips Mobile arm support Tenodesis orthosis

Solution: The correct answer is C. A mobile arm support is best for a client with a C5 injury because the client would most likely show shoulder muscle activity along with biceps and upper trapezius. A: An electric feeder would be required for a client with a higher level SCI, but not for a client with a C5 SCI because the client would most likely show shoulder muscle activity along with biceps and upper trapezius. B: A client with C5 injury does not have finger or wrist movement, rendering built-up grips ineffective. D: Tenodesis implies wrist movement, a capability generally not associated with C5 injury.

An OTR® is working in an outpatient setting and observes a COTA® setting up electrical stimulation on a patient with a significant cardiac history, including a pacemaker. What action should the OTR® take? Discuss the situation with the COTA® after the session to learn the rationale for performing this treatment. Alert the rehabilitation manager to the situation at the OTR®'s earliest convenience. Stop the COTA® from proceeding, check the evaluation and treatment plan and, if needed, review physical agent modalities and appropriate use. Ensure that the COTA® is using the proper settings and frequency.

Solution: The correct answer is C. A pacemaker is a contraindication for using electrical stimulation. Thus, this treatment is inappropriate and should be stopped immediately. Perhaps the COTA® misread the evaluation and treatment plan or did not have the appropriate understanding of physical agent modalities; therefore, supervision around this area should occur. A, B, D: The COTA® proceeds with the treatment, therefore putting the client in harm's way because the electrical impulses could interfere with the function of the pacemaker.

A client has been using a wheeled walker for many years but has begun to complain that arthritis in the right hand is making it difficult to grasp the walker for any extended period of time, making functional ambulation difficult. Which recommendation would BEST help maintain this client's mobility? Use a wheelchair for the majority of functional activities. Add bilateral forearm troughs to the current walker. Add a padded grip to the right side of the walker. Use a cane on the left side during all activities.

Solution: The correct answer is C. A padded grip can be used on a walker to increase grip for someone with marked hand limitations. It allows the client to have the least restrictive device but still remain safe. A: Compared with a walker, a wheelchair is too restrictive a form of mobility for a person who has not complained about falling or fatigue. B: Because the client complains of arthritis only in the right hand, putting bilateral forearm troughs on the walker would be more restrictive than necessary. D: A cane is not as stable as a walker. If the client has needed the stability of a walker for many years, a cane is not likely to be appropriate now.

With the Allen Diagnostic Module, an OTR® measures a client at an Allen Cognitive Level (ACL) of 4.0. The OTR is working with the client in an adult day treatment center. When the OTR is designing intervention activities, what type of project is appropriate for this client? Any project with mostly familiar steps; no more than two steps of the task should require new learning. A project that is unstructured; the client should be given opportunities to find and revise errors. A project that is set up with a model final product; simple instructions should be provided, along with supervision. A project that encourages relatively independent planning and organizing to complete; none of the steps should require new learning.

Solution: The correct answer is C. A person with an ACL of 4.0 can perform only simple tasks and will have difficulty with problem solving. A model with clear instructions should be provided along with supervision for cues and guidance when needed. A: This approach would be more appropriate for a client with an ACL in the low 5s, because a client with an ACL of 4.0 will have difficulty with problem solving. B: This approach would be more appropriate for a client with an ACL in the mid-5s, because it is unstructured and forces the client to search for and revise errors. D: This approach would be appropriate for a client with an ACL in the high 5s, because a client at this level should be able to independently plan activities.

What is the first course of action the AOTA Ethics Commission takes when it receives an ethics complaint? It conducts a full investigation. It imposes a sanction or discipline. It starts a preliminary assessment. It writes an educative letter.

Solution: The correct answer is C. A preliminary assessment would be conducted before a full investigation, educative letter, or imposition of a sanction or discipline. These actions occur at later stages of the complaint process, if at all.

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? Neurodevelopmental Acquisitional Sensorimotor Biomechanical

Solution: The correct answer is C. A sensorimotor approach to handwriting would include the incorporation of a variety of sensory experiences, different media, and novel instructional materials during a handwriting intervention session. It would also include offering the child multiple different writing tools, writing surfaces, and positions for writing. A, B, D: Although these models of practice would also be appropriate to guide handwriting, the activities presented in the question are aligned with sensorimotor model of practice.

A client with Down syndrome recently began working at a small pizza restaurant. The job duties include keeping the tables clean and restocked with condiments and napkins. The employer reports that the client is disorganized in completing tasks. In addition, when the client becomes frustrated, which occurs often, the client's behavior offends the other workers. Which intervention would be MOST practical in job coaching with this client? Implement a monthly consultation meeting for all workers at the restaurant to discuss their concerns with employee performance. Prevent work injuries for the client by enrolling the client in an ergonomic training program with the other workers. Adapt the job duties by providing the client with a checklist of duties and having the client mark off tasks as they are completed. Provide cognitive retraining to teach the client strategies for sequencing job duties for improved organization.

Solution: The correct answer is C. A task adaptation (i.e., checklist) provides the least restrictive support to enable this client to remain in this job. A: A monthly employee meeting may allow coworkers to get to know the client better but would not provide support to improve the client's work performance. B: The client is not experiencing symptoms of work-related musculoskeletal disorders. D: Cognitive retraining is a restorative intervention; environmental adaptations will be more effective for a client with Down syndrome.

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? 1-3 days postsurgery 4-9 days postsurgery 10-12 days postsurgery 4-8 weeks postsurgery

Solution: The correct answer is C. A tendon repair is typically at its weakest 10-12 days postsurgery during the fibroplasia phase, in which collagen is just beginning to be laid down to strengthen the repair. 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® completes a job demand analysis for the job requirements of a printer position. The OTR® determines that the job requires 95% of time spent in standing; the pacing of the job is predetermined by the printing rate of the machine, and the worker lifted as much as 30 pounds occasionally and 15 pounds frequently. According to the definitions of overall level of work, what type of work is the printer position? Sedentary Light Medium Heavy

Solution: The correct answer is C. Because of the amount of standing required, the job would not be considered sedentary work. Frequently lifting more than 15 pounds defines the level of work as medium. A: Because the job requires 95% of time in standing, it will not be classified as sedentary work. B, D: These work classifications are determined by the force exertion required and the frequency of the job demands.

An OTR® has been treating a client who sustained a chemical burn to both hands 6 months ago while cleaning up a spill at the adhesive manufacturing plant where the client is employed as a janitor. The client has been participating in a work conditioning program for the past 6 weeks and has made gains in all areas. The client plans to transition back to full-time, full-duty employment within the next 2 weeks. The OTR® included instruction in proper body mechanics as part of the client's treatment program to reduce the client's risk for reinjury. What type of intervention would this treatment program be considered? Primary intervention Secondary intervention Tertiary intervention Wellness intervention

Solution: The correct answer is C. A tertiary prevention program occurs after the worker sustains an injury, illness, or disease. It includes treatment of medical problems and attempts to restore maximum function in the workplace and prevention of injury, illness, or disease-related complications. A: Primary programs focus on protecting healthy workers against a targeted condition before the condition occurs. B: Secondary programs emphasize early detection and intervention with asymptomatic workers at risk for work-related medical problems or treatment of workers with mild medical symptoms or reversible stages of injury. Comprehensive injury prevention programs incorporate all three phases of prevention programs (primary, secondary, and tertiary) and may include worksite and ergonomic interventions. D: Because the client is receiving services as a result of an existing injury, the focus of the program is to help the client regain maximum function and prevent further injury.

What is included when using a top-down approach to reduce risks in jobs? Work hardening program to increase endurance Maintaining neutral spine alignment in lifting Involving managers in work simplification Individual workstation ergonomic assessment

Solution: The correct answer is C. A top-down approach includes systemwide changes and management support of the change process. A, B, D: These options are bottom-up approaches that focus on addressing the person's risk for the job task.

An OTR® is working with a client with amyotrophic lateral sclerosis to address interosseous muscle wasting and atrophy in the dominant hand and to promote self-feeding. Which compensatory strategy would be MOST beneficial? Weighted utensils Built-up foam grip Universal cuff with a D-ring Hands-free options

Solution: The correct answer is C. A universal cuff compensates for loss of finger extension and facilitates grip to allow the client to hold utensils. A: The client's progressive loss of upper-extremity and grip strength indicates that weighted utensils would be too difficult to use during self-feeding. B: A built-up foam grip would require the client to grasp and release the utensils, but atrophy of the hand muscles would not allow the client to grip the foam, even if it is built up. D: The client is still able to use the hand and upper extremity for self-feeding, so selecting a hands-free option would not allow for optimized client participation in feeding.

An OTR® is working with a child on locating a link on a web page. The OTR® observes that the child has difficulty with visual scanning. Before moving forward with this intervention activity, what other visual skill should the OTR® assess? Visual cognition Visual memory Visual attention Visual recognition

Solution: The correct answer is C. According to Warren's hierarchy of visualperceptual skills development, visual attention is foundational to visual scanning. The OTR® should determine whether the child has good visual attention before moving on to the more complicated visual scanning task. A, B, D: According to Warren's hierarchy of visualperceptual skills development, pattern recognition, visual memory, and visual cognition take place after visual scanning.

Although the driving performance of a client with a small body size may not necessarily be impaired, what may this person experience? Poor visual acuity Poor stopping distance Poor accelerator and brake reach Difficulty merging on and off the interstate

Solution: The correct answer is C. All of these choices hold true for a person with a small body size. A: Size is related to poor visibility, not poor visual acuity. B: Stopping distance is related to driving habits, not to a person with a small body size. D: Difficulty merging usually occurs when a person has cognitive challenges.

An OTR® receives evaluation orders for a client who has recently experienced a traumatic brain injury. The client only opens the eyes when the OTR® applies a mild pinch to the client's arm. What score should the OTR® give the client on the Glasgow Coma Scale (eye-opening response category)? 7 3 2 4

Solution: The correct answer is C. Because the client is currently responding to pain only, the OTR® would give the client a 2 for the eye-opening response category. A: The Glasgow Coma Scale has no Level 7. B: Level 3 requires the client to respond to verbal command or speech. D: Level 4 requires the client to open the eyes and to blink at baseline.

What is the AOTA Ethics Commission's position on online social networking? Ethical guidelines do not apply to the use of online social networking during personal time. Discussion of clients between two occupational therapy practitioners on online social networking sites is appropriate as long as no names or other identifiers are used. Active participation in online social networking sites is subject to the same ethical constraints during both personal and professional time. Accepting a fieldwork educator's invitation to become Facebook friends is useful to the student-educator relationship.

Solution: The correct answer is C. Although personal and professional activities are typically regarded as separate entities, with personal time exempt from the expectations imposed on professional time, the AOTA Ethics Commission has stated that in the case of online social networking, ethical considerations extend into occupational therapy practitioners' personal life because of the ethical duty to preserve the confidentiality of work-related information and the inability to control who may view posts, including patients. It is important for practitioners to maintain professional boundaries and to be extremely careful about any online social networking posts; confidentiality is impossible to maintain (e.g., posts can be shared without knowledge), and patients can read personal posts, leading to information that probably should not be shared when engaged in a professional relationship. A: The AOTA Ethics Commission has stated that in the case of online social networking, professional ethical guidelines do apply to personal time. B: Even in a private online discussion between two practitioners, any information posted has the potential to be available to others; therefore, posting work-related information is considered unethical behavior. D: The Ethics Commission has discouraged use of online social networking sites for professional communication, such as that between a fieldwork educator and student, because communications between them could expose confidential information to the public.

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? Shift weight into an anterior pelvic tilt, place the right hand on the wheelchair armrest, and point the heels away from the bed. Shift weight into an anterior pelvic tilt, place the right hand on the OTR's back, and point the heels toward the bed. Shift weight into an anterior pelvic tilt, place the right hand on the wheelchair armrest, and point the heels toward the bed. Shift weight into a posterior pelvic tilt, place the right hand on the wheelchair armrest, and point the heels toward the bed.

Solution: The correct answer is C. An anterior pelvic tilt moves the center of mass over the center of the client's body. Heels should point toward the surface to which the client is transferring for easier pivot. Pushing up from the wheelchair armrest assists in the transfer. A: Weight shift and hand placement are correct, but having the heels pointing away from the surface to which the client is transferring would make the pivot more difficult. B: Weight shift and heel placement are correct, but placing the client's hand on the OTR's back may throw both the client and the therapist off balance and create the risk of injury. D: Hand and heel placement are correct, but weight shifting into posterior pelvic tilt moves the center of mass back toward the buttocks.

A OTR® consultant to a retail store corporation's ergonomics team notices an increase in back pain complaints for workers in the stockroom. The OTR® should present which activity as the next step for intervention? Report all workers who have complained of back pain to management. Implement a modified duty program for all workers in the stockroom. Provide an in-service to educate workers on ergonomics. Begin an exercise training program to improve workers' health

Solution: The correct answer is C. An in-service would provide secondary injury prevention for workers reporting mild symptoms related to work tasks. A: Successful implementation of an injury prevention program requires management support and worker participation in a cooperative partnership. B: Modified duty programs are developed for individual workers on the basis of medical treatment recommendations. D: The effectiveness of exercise programs in preventing injuries has not been established.

An OTR® is evaluating a 12-month-old child for home-based early intervention services. During the evaluation, the child's mother reports that the child has recently been diagnosed with anemia. The OTR® observes that the interior of the house is in need of repair and notes peeling paint and wallpaper. Which action is most appropriate for the OTR® to take? Alert the child's mother to attend quickly to bleeding episodes because the child's blood may not clot normally. Encourage the child's mother to provide the child with more vitamin Drich foods and monitor how much milk the child drinks on a daily basis. Alert the child's mother that anemia may be indicative of lead poisoning and to consult a physician as soon as possible. Alert the child's mother that anemia may be indicative of chronic pulmonary disease and to consult a physician as soon as possible.

Solution: The correct answer is C. Anemia may be an indicator of lead poisoning. A: Hemophilia is associated with clotting difficulties. B: Anemia may also be related to a deficiency of iron-rich foods. D: Anemia and chronic pulmonary disease are not generally related.

A client who is being seen by both occupational therapy and physical therapy requires an ankle-foot orthosis to prevent foot drop while walking and completing standing ADLs. In this situation, what is the OTR® responsible for regarding lower-extremity orthoses? Evaluating the client for the need for an orthosis Adjusting the orthosis when it does not fit Teaching the client to don and doff the orthosis during dressing Gait training after orthosis application

Solution: The correct answer is C. Because they are part of a normal ADL routine, donning and doffing orthoses during dressing is within the OTR's area of practice. A: Normally, a physical therapist completes a gait evaluation. During that time, if the client has a gait disturbance, an orthosis (along with ambulatory aids) can be recommended. B: An orthotist is a specialist who creates and adjusts orthosess. If an adjustment needs to be made, the orthotist should make it. D: Although an OTR should reinforce gait training by following the physical therapist's recommendations, it is not the OTR's primary focus in therapy.

An OTR® who is a certified hand therapist is responsible for supervising a new COTA® in an outpatient hand clinic. What is the purpose of the supervisory process, as defined by AOTA? To ensure that COTAs treat only clients with diagnoses about which they have extensive knowledge To ensure that COTAs practice within their scope of practice with regard to state licensure laws To ensure the safe and effective delivery of occupational therapy services and to foster professional competence and development To provide evaluative feedback on an ongoing basis to the supervisee

Solution: The correct answer is C. As stated in the Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services (AOTA, 2014), "Within the scope of occupational therapy practice, supervision is a process aimed at ensuring the safe and effective delivery of occupational therapy services and fostering professional competence and development" (p. S16). A: All practitioners must understand the diagnoses of clients with whom they work; this understanding occurs outside the supervisory process. B: All practitioners must understand scope of practice and state licensure laws; this understanding occurs outside the supervisory process. D: Feedback should be descriptive rather than evaluative. Descriptive feedback clearly states specific information that allows the receiver of the feedback to self-assess. Evaluative feedback is general in nature and does not promote critical reflection.

A client with dementia quits bathing routines before completing them and has difficulty measuring shampoo and lotion. The areas of the body that are usually washed are more distal (hands, arms). The client might attempt to wash the back, but not consistently. At what stage is this client, according to the Allen Cognitive Level Screen? 4.0 3.8 3.6 3.4

Solution: The correct answer is C. At Level 3.6, the client will be able to wash most distal portions of the body and those that are easily seen but will not always follow the sequence thoroughly. The client may quit before completion and may have difficulty with measuring soaps, lotions, and deodorant. A, B: At Levels 4.0 and 3.8, the client will typically recognize the need for a bath and will bathe thoroughly as long as no major problems develop during the bathing process (i.e., lack of soap). D: At Level 3.4, the client will typically wash only areas easily seen and reached. The client may wash one area repetitively and may forget to rinse or dry off.

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? Lace shoes. Put on mittens. Remove coat. Put on socks.

Solution: The correct answer is C. At age 2, a child should be able to doff a coat after fasteners have been unfastened; the child should also be able to remove shoes if not tied; begin to help with pulling down pants; and locate armholes in shirt. A, B, D: A typically developing 2-year-old would not be expected to complete these skills independently.

An OTR® is working with a client who is about to undergo a second lower-extremity amputation. The client did not use a wheelchair with the first amputation but wants to purchase one now for occasional mobility if lower-limb prostheses are not available. What is necessary for wheelchair safety for a client with bilateral lower-extremity amputations? Reclining back rest Elevating leg rests Rear antitippers Wedge cushion

Solution: The correct answer is C. Because a person who has undergone a bilateral lower-extremity amputation has a different weight distribution when seated, the wheelchair is more likely to tip backward with less weight in the front. Antitippers prevent this. A: Reclining in the chair would further increase the posterior weight distribution and increase the chances of tipping backward in the wheelchair. B: Elevating leg rests are not necessary for someone who has undergone bilateral lower-extremity amputations. A residual limb support may be placed on the wheelchair as needed. D: A wedge cushion would push the client's hips further back in the chair, again increasing the posterior weight distribution.

A client diagnosed with C7 spinal cord injury requires a functional capacity evaluation to determine whether the client can perform the job of accountant. Which of the following abilities would be MOST appropriate to assess? Mathematical reasoning Speech clarity Finger dexterity Selective attention

Solution: The correct answer is C. Because accountants often type on computer keyboards, finger dexterity is an ability used in the job, as defined by the O*NET Occupational Information Network. A C7 spinal cord injury could affect finger dexterity. A, B, D: Mathematical reasoning, speech clarity, and selective attention all are abilities needed for the job of accountant; however, they are not likely to be affected by a C7 spinal cord injury.

An OTR® wishes to prioritize the focus of intervention for a client with Guillain-Barré syndrome in the acute inflammatory phase. Which factors should the OTR evaluate? Sensory loss, pain, cognitive impairment Pain, fatigue, cognitive impairment Pain, fatigue, swallowing problems Rigidity, pain, swallowing problems

Solution: The correct answer is C. Because ascending paralysis is typical of Guillain-Barré syndrome, evaluation consistently addresses pain, fatigue, and swallowing problems. This constellation of symptoms best fits the clinical reasoning for prioritizing issues to be evaluated. A, B: Cognition remains intact with Guillain-Barré syndrome and therefore does not typically require evaluation. D: Rigidity does not occur with Guillain-Barré syndrome and therefore does not typically require evaluation.

An OTR® is working with a child with ADHD who is transitioning from elementary school to middle school and discussing the child's concerns with the educational team. Given the child's condition, with which occupation might the child need support? Meeting a new friend Initiating a routine Listening to instructions or conversations Forming a bond with more than one teacher

Solution: The correct answer is C. Children with ADHD typically have difficulty paying attention to details and may miss important information that is conveyed verbally, such as with instructions or conversations. A, B, D: A child with ADHD would likely not have difficulty with these occupations unless the child also had another diagnosis.

An OTR® is working with a client in an area of practice for which the OTR has not demonstrated competence. The client requires a seating and positioning evaluation for a wheelchair. This is not an area for which the OTR has any experience. The OTR refers the client to an OTR with experience in this area. Which ethical principle is the OTR following? Justice Nonmaleficence Beneficence Fidelity

Solution: The correct answer is C. Beneficence includes actions intended to benefit others. Concerns for safety for service recipients are beneficial actions. Taking care to make sure that decisions are made which relate to training and competence. A: The principle of Justice addresses fairness amongst all who receive services B: The principle of Nonmaleficence addresses not causing harm to others. D: The principle of Fidelity addresses treating others with respect and integrity.

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? Red or inflamed tissue Hypertrophic scar tissue Black or yellow tissue Keloid scar tissue

Solution: The correct answer is C. Black, necrotic tissue and yellow, possibly infected tissue need to be removed for healing to occur. A: Red or inflamed tissue is healing appropriately. B, D: Hypertrophic and keloid scar tissue has already healed.

An OTR® wants to design interventions aimed at improving the executive function of clients with schizophrenia. Which of the following statements is an important consideration in designing such interventions? Adapting activities leads to successful executive function. Teaching cognitivebehavioral techniques improves executive function. Practicing strategies for learning and teaching activity-specific routines is a potentially promising intervention. Neither practicing strategies for learning nor teaching activity-specific routines is an effective intervention approach

Solution: The correct answer is C. Both occupational goal intervention strategies, which provide learning methods, and an activity training approach to habitualization of specific routines increase some aspects of executive functioning. Although more research is needed, both strategies show promise. A: Adapting activities to reduce cognitive demands will not improve executive function skills. B: Cognitivebehavioral therapy is not used for executive function skills training. D: This statement is untrue.

An adult with posttraumatic stress disorder (PTSD) is admitted to an inpatient psychiatric unit after a suicide attempt. What would be the BEST initial intervention for an OTR® to attempt with this client? Individualized assertiveness training Reality-orientation group Relaxation-focused group Daily routine group

Solution: The correct answer is C. Brown and Stoffel (2011) list relaxation as one of the primary interventions for people with PTSD. A, B, D: The other choices are intervention strategies that will be helpful once the client's arousal levels are stabilized.

An OTR® is treating a 77-year-old client who requires a resting hand splint. Which splint characteristics are MOST important in addressing the natural aging process of skin and adipose tissue? Use colored splints and no moving parts Use D rings and mark where straps go Use soft straps and thick padding Label the splint with client's name and leftright and topbottom instructions

Solution: The correct answer is C. C: As a person ages, the skin thins, and adipose tissue is lost. Soft straps and padding add comfort and prevent skin breakdown. A: Colored splints are easier to locate in white institutional bedding. B: Using D rings and marking straps makes it easier for the client to don and doff the splint independently. D: Labeling the splint can compensate for cognitive deficits.

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? Show the client DIP flexion and extension exercises to perform daily for 2 weeks. Advise the client to limit playing basketball for 3 weeks to give the tendon time to heal. Splint the client's DIP joint in full extension continuously for 6 weeks. Refer the client to the orthopedic doctor for surgery.

Solution: The correct answer is C. C: The DIP terminal tendon is delicate and requires continuous splinting to prevent extensor lag of the tendon. A: The client should not move the DIP at all for 6 weeks to protect the tendon. B: The client should not play basketball for 8 weeks to ensure tendon healing. D: Mallet finger is generally not operated on unless a bone fracture also is present.

An OTR is teaching discriminative sensory reeducation techniques to a client who has had a median nerve surgical repair. Which method is BEST for reeducation of discriminative sensibility? Educate the client to avoid working around machinery. Advise the client to use vision to compensate for sensory loss. Educate the client to identify items by touch both with and without vision on a daily basis. Educate the client to avoid temperatures below 60.

Solution: The correct answer is C. C: This visualtactile matching process is part of a discriminative sensory reeducation program. A, B, D: Avoiding machinery and low temperatures and using vision to compensate for sensory loss are all approaches for protective, rather than discriminative, sensory reeducation.

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? Application of heat to the affected area A home program of resistive pinching exercises A hand-based thumb spica splint An AROM stretching program

Solution: The correct answer is C. CMC joint pain and weakness is often caused by instability of the thumb metacarpal on the trapezium, leading to joint subluxation. A hand-based thumb spica splint will support the thumb as a functional post, allowing the client to complete pain-free activities. A: Heat will reduce pain but not improve stability. B: Strengthening is often contraindicated for CMC joint arthritis because of the stress it places on the joints. D: Although AROM may reduce pain and potentially maintain the web space, it will not address the underlying instability of the thumb joint.

An OTR® is working with a child who has scoliosis with a curve of 70°. The child would like to engage in sports activities. On the basis of this medical condition, which factor would most likely limit the child's ability to participate in sports? The need to wear a therapeutic brace Weak abdominal muscles Cardiopulmonary function Ability to manage pain

Solution: The correct answer is C. Children with a scoliosis curve between 65 and 80 may have reduced cardiopulmonary function. A: The need to wear a brace would likely not have an impact on the child's ability to participate in sports. B: Although weak abdominal muscles may be present, cardiopulmonary issues become the primary concern with children who have significant curvatures because they impact life functions. D: Scoliosis is usually not painful.

An OTR® is assessing a client with a peripheral nerve injury affecting sensation in the nondominant hand. The client is a chef and is eager to return to work. Using monofilament testing, the OTR determines that the client has diminished protective sensation. Which recommendation BEST fits this client's occupational profile? Wear a glove to protect the affected hand from cold weather. Use equipment with soft, textured grips to maximize gross grasp and in-hand manipulation during kitchen tasks. Protect the affected hand from exposure to sharp items and to cold or heat. Avoid using sharp tools to prevent injury to the affected hand.

Solution: The correct answer is C. Client education for diminished protective sensation includes information about avoiding extreme temperatures and testing temperature with the affected hand. The client is a chef and therefore is unable to avoid exposure to knives. The client may be educated about specialized steel mesh gloves that can be worn to protect the insensate hand during cutting tasks. A: A glove would protect the hand from temperature changes but not from sharp objects; both considerations are necessary for the client's work-related goal. B: Enlarged handles would more evenly distribute grip forces for better control of kitchen tools during use, but this recommendation does not address protecting the affected hand secondary to sensory loss. C: Avoiding sharp cutting tools does not address the client's work-related goal.

A client with stroke is receiving occupational therapy services to increase independence with feeding, grooming, hygiene, and toileting. What should the OTR®; FIRST consider in determining the client's needs? The client's safety in doing independent transfers The client's swallowing ability The client's base of support for upright postural ability The client's upper-extremity mobility

Solution: The correct answer is C. Clients with stroke often experience postural imbalance and difficulty making postural adjustments during activities. Assessing the client's base of support is the first consideration in determining sitting and standing ability for ADLs. A: Transfers are essential to the client's ability to complete ADLs; however, postural ability in sitting and standing must be assessed before initiating these transfers. B: Determining swallowing ability is part of assessing the client's feeding skills, but seated posture is the first area to assess in feeding. D: Although upper-extremity mobility is an important factor in determining ADL ability, postural stability provides the basis for a client's ability to move the extremities for ADLs.

Through what type of interventions is the field of occupational therapy MOST likely to be successful in demonstrating a population impact on the problem of cocaine and amphetamine abuse disorder? Restorative Adaptive Preventive Consultative

Solution: The correct answer is C. Cocaine and amphetamine substance abuse disorder has been shown to be considerably resistant to intervention, be it restorative, adaptive, or consultative. Working in communities to prevent development of cocaine and amphetamine use is, therefore, the most likely avenue to successfully reducing this disorder. A, D: Some restorative and consultative procedures may be helpful at times, but those procedures showing some effectiveness are not typically within the realm of occupational therapy. They are also not typically aimed at affecting populations but rather at individuals. B: Adaptation is not a mechanism of intervention for substance abuse disorders.

An OTR®'s guiding framework about improving the lives of clients with mental illness is that changing clients' negative beliefs about experiences and situations ultimately reduces negative emotional states and behaviors. What is the OTR®'s main theoretical perspective? Psychoanalytic Developmental Cognitivebehavioral Occupational

Solution: The correct answer is C. Cognitivebehavioral therapy focuses on changing how one thinks about behavior to change the behavior itself. A: Psychoanalytic theory focuses on deep-seated, early life relationships. B: Developmental theory uses stages of development to explain behavior. D: An occupational perspective would incorporate the use of activity as a means of influencing behavior.

An OTR® is using cognitive-behavioral therapy strategies to help an adolescent client with attention deficit hyperactivity disorder regulate behavior so the client is able to get to work on time. Which strategy is related to cognitive-behavioral therapy? Encouraging the client to take a movement break when the client begins to feel off task while getting ready for work. Encouraging the client to set an alarm clock so that the client is able to get up for work on time. Encouraging the client to visualize completing the prework routine without getting distracted and arriving to work on time. Encouraging the client to call the boss when the client is running late instead of sneaking in through the back door.

Solution: The correct answer is C. Cognitivebehavioral therapy techniques include challenging automatic thoughts, reducing cognitive distortions, challenging underlying beliefs and assumptions, visualization, controlling recurrent thoughts, and self-monitoring (or controlling) behavior. A, B, D: These options might be appropriate to use with a client with ADHD; however, they are not aligned with cognitivebehavioral therapy.

What does best practice dictate for a newly graduated OTR® who wants to administer a functional capacity evaluation (FCE)? The OTR® should have knowledge of the physical demands and aptitudes that pertain to the upper extremity as defined by the U.S. Department of Labor. The OTR® should appreciate the range of recovery consistent with various pathological conditions. The OTR® should defer evaluation of the client to a clinician with several years' experience. The OTR® should have knowledge of the worker's compensation system, Americans With Disabilities Act of 1990 (Pub. L. 101336) regulations, accommodations, and unions.

Solution: The correct answer is C. Completion of an FCE is not recommended for entry-level or novice clinicians. New graduates should attend conferences, access resources, and network with colleagues to become familiar with terminology and regulations and enhance skills and knowledge. A, B, D: Knowledge of all of these areas is recommended before administering an FCE, because the evaluator should refer to the U.S. Department of Labor regarding upper-extremity physical demands as national standards. FCE is the most demanding form of upper-extremity evaluation, requiring the evaluator to objectively qualify a client's functional capacity as it affects performance from legal, social security, insurance, and worker's compensation.

To ensure appropriate and professional management of ethical complaints, what does the AOTA Ethics Commission strive to do? Complete an investigation within 15 days of notifying the Respondent that it is being conducted Disclose all details of complaints to AOTA members Maintain strict rules of confidentiality in every aspect of the Ethics Commission's investigational work Follow legal proceedings of the state in which the complaint was filed

Solution: The correct answer is C. Confidentiality guidelines are set and strictly enforced by the AOTA Ethics Commission and are applied to all parties involved in the complaint. A: Investigations are typically completed within 90 days unless an extended amount of time is warranted because of complexity or extenuating circumstances. B: The appropriateness of disclosure of information is carefully analyzed to ensure the utmost confidentiality. Disclosure of all details to AOTA members is a breach of confidentiality. D: Proceedings of the AOTA Ethics Commission are unrelated to state legal proceedings.

An OTR® is assessing a client who is in an active state of mania. The client has difficulty concentrating on the assessment procedure and displays disruptive behavior, telling the OTR that the OTR is "stupid" and "asking dumb questions." The OTR tells the client, "I would like to help you, but I will not tolerate this behavior. You are not being nice to me right now, and I deserve to be treated better than this." Which interpersonal strategy does the OTR's statement exemplify? Validation Limit setting Confrontation Reframing

Solution: The correct answer is C. Confrontation, in which the practitioner identifies the client's behavior in an effort to help the client self-manage it, is an appropriate interpersonal strategy when dealing with clients with mental illness. Confrontation may include limit setting. A: Validation affirms the client's perspective; an example of validation in this case would be, "Yes, some of my questions are dumb and make me appear stupid." B: Limit setting creates boundaries for the client's behavior; in this case, an example of limit setting would be, "If you say this to me one more time, I will not work with you any more today." Confrontation may include limit setting, but this particular example did not use limit setting. D: Reframing gives the OTR an opportunity to take a client's perceived negative quality and reinterpret it as a positive trait. For example, the OTR could reframe the client's anger as something positive, for example, by saying, "I am glad that you are being assertive about your feelings." Because the client is directing anger toward the OTR, reframing is not an appropriate option in this example.

An older adult client is having difficulty locating curbs, stairs, and objects in low-lit areas within the home environment. Which area is MOST relevant to assess during the evaluation? Peripheral vision Working distance Contrast sensitivity Task lighting

Solution: The correct answer is C. Contrast sensitivity can limit a person's ability to locate curbs, stairs, and objects in low light within the home environment. Contrast enhancement makes objects more visible by increasing the contrast between foreground and background. A: Peripheral vision usually is not necessary to locate curbs, stairs, and objects in low light. B: Working distance is closer than the activities for which this client reports difficulty and is considered when working with optics, including the use of bifocals and trifocals. D: Task lighting is used for a specific task and is positioned appropriately. Task lighting may not be beneficial for the tasks of locating curbs, stairs, and objects in low light.

A young adult client with anorexia nervosa is referred to occupational therapy after an episode of depression for which the client was briefly hospitalized. The client presents with concerns about using time meaningfully to reduce both depression and urges to binge and purge. What is the MOST appropriate initial plan for the OTR® to develop with this client? Client will enroll in a master swimming program to encourage continuation of a sport in which the client was previously active. Client will choose a different restaurant each day and eat lunch or dinner alone there. Client will explore volunteer options and allow the OTR® to accompany the client to the first volunteer meetings. The OTR® will enroll the client in a support group for people with anorexia nervosa.

Solution: The correct answer is C. Control of life decisions is an underlying issue for people with anorexia nervosa. Therefore, exploring options that the client could choose and then accompanying the client to explore how to make the choice work would be the most appropriate initial step. A: Extreme exercise such as a master swimming program could exacerbate the calorie-burning behaviors related to the disease. B: Eating alone is not the best choice for a person with anorexia nervosa because it encourages maladaptive eating behavior. D: The OTR®'s enrolling the client could spark negative control issues. Giving the client choice and allowing for independent decision making improves compliance.

An OTR® reviews the cancellation test form in a client's chart. The form indicates that the client crossed out all letter Ms. What does this test assess? Visual acuity Literacy Spatial neglect Ocular motor control

Solution: The correct answer is C. Cross-out assessments are used in visual scanning and can be beneficial in detecting spatial neglect or visual field impairments. A: Visual acuity/clarity is more precisely measured with multiple alternate visual tests, such as the Snellen Eye Chart. B: Literacy would best be tested by sample-reading skills, not necessarily with a letter cross-out assessment. D: Ocular motor control is best assessed by observing the client's eyes for movement deficiencies when focused on an object, in light changes, and in tracking.

An OTR® consultant is educating a group of supervisors from a furniture manufacturing company about common work-related risk factors for cumulative trauma disorder. What are some of the PRIMARY physical risk factors that the OTR® would explain to the supervisors? Regulated temperatures, noise and lighting Body mass index greater than 25 Forceful exertions, repetition, and excessive vibration Older age, being female, and lower socioeconomic group

Solution: The correct answer is C. Cumulative trauma disorder is a group of conditions that develop slowly over time from repeated microtrauma to the body. It is also known as repetitive strain injury when the body or muscles are engaged in an awkward position or used repeatedly. Hence, forceful exertions, especially performed in a repetitive manner, and excessive vibration from the use of power tools are risk factors for clients working in a furniture manufacturing company. A,: These options are possible solutions to reduce risk factors for cumulative trauma disorder. B,D: Cumulative trauma disorder is not specific to age, sex, body type, or socioeconomic group.

A client has been referred to the occupational therapy clinic to be assessed for a new wheelchair and positioning support system. Currently, the client has a standard wheelchair with a custom-contoured cushion shaped to support a spinal deformity associated with scoliosis. The OTR® considers several options with the client but again recommends a custom-contoured cushion? What is the most important reason for making this recommendation? The cushion requires little maintenance. The cushion does not change shape. The cushion can be molded to fit the client and support him in a stable position. The cushion is made of lightweight materials

Solution: The correct answer is C. Custom-contoured cushions are molded to fit a specific client and support the client and any deformities in a stable position. A, B, D: These options are advantages of custom-contoured wheelchair cushions, but not the most important.

An OTR® is fitting a client with a pelvic deformity and minimal dynamic sitting balance impairments to a new wheelchair. The client lives alone and must be able to independently get the wheelchair and all accessories into and out of a car for community mobility. What type of cushion would be MOST appropriate for a client with this issue? Gel filled Air filled Custom-contoured foam Alternating pressure system

Solution: The correct answer is C. Custom-contoured foam is often necessary for clients who need accommodations for deformities of the pelvis or spine. It increases surface area coverage, reduces shearing, and increases postural control. A: Gel-filled cushions contour well to the body but are heavier than custom-contoured foam, making them more difficult to independently manuver into and out of a car. B: Air-filled cushions are lightweight but do not support postural control the way custom-contoured foam cushions do. D: Alternating pressure systems are self-contouring but provide unsteady sitting balance.

The extremities of a client with brain injury in an acute care unit are in a position of spastic extension, adduction, and internal rotation. The client is displaying symptoms of which condition? Decorticate rigidity Torticollis Decerebrate rigidity Athetosis

Solution: The correct answer is C. Decerebrate rigidity involves the client's lower and upper extremities in a position of spastic extension, adduction, and internal rotation. A: Decorticate rigidity involves upper extremities in spastic flexed position with internal rotation and adduction and the lower extremities in spastic extended position with internal rotation and adduction. B: Torticollis is a dystonic posture of the neck. D: Athetosis involves slow movements of the face, tongue, or limbs.

The director of rehabilitation asks a newly hired OTR® to provide occlusion to a client who is experiencing diplopia to enable the client to more fully participate in rehabilitation. Which action should the OTR take FIRST in response to this request? Provide occlusion to the client and notify the director that the task has been completed Refuse the director's request, because occlusion is inappropriate for an OTR to provide Explain to the director that occlusion can be provided only under the direction of a physician Refer the request to another OTR with more experience in oculomotor function

Solution: The correct answer is C. Diplopia causes perceptual distortion that creates confusion for the client and limits participation. Diplopia can be eliminated using occlusion, usually by covering part or all of one eye. OTRs can apply occlusion only under the direction of a physician. A, B: Providing occlusion to the client, unless under the direction of a physician, is beyond occupational therapy's scope of practice. D: Occlusion can be applied by an OTR only under the direction of a physician; therefore, referring this request to another OTR would be inappropriate.

What is an effective strategy to improve the ability of a client with dementia to find the client's bedroom in a long-term care facility? A unique symbol that is familiar to the client The client and the client's family in a recent photo A photograph of the client labeled with the client's name A symbol in the client's favorite color

Solution: The correct answer is C. Displaying a photograph of the client would be the best option because the other options would rely on the client's memory. A, B, D: Although external aids have been found effective with clients with dementia, a photo of the client would be most effective because it does not rely on memory.

Six weeks after a wrist sprain, a client was diagnosed with complex regional pain syndrome (CRPS), Type 1. The client is employed as an electromechanical equipment assembler. The client is able to perform all ADLs and light meal preparation. The client reports previously enjoying baking and being unable to bake since the injury. The client's pain increases to 6 or higher on a 0-10 scale while using the hand. The skin presents with mild discoloration of the dorsal surface of the wrist. What should the OTR® FIRST include when establishing the client's work conditioning program? Kneading bread dough Upper-extremity PROM exercises Stress-loading tasks Progressive resistive exercises

Solution: The correct answer is C. During Type 1 (traumatic stage) CRPS, treatment should focus on management of pain and edema along with AROM. The most recognized therapeutic intervention for CRPS is a stress loading program. A: Although baking is former occupation in which client engaged before the injury, the resistance of the bread dough may add to the client's pain and discomfort. B, D: PROM and progressive resistive exercises must be used with care and are often contraindicated because of risk for increased swelling and pain

An OTR® receives orders to evaluate and treat a client in the acute phase of spinal cord injury. What is the OTR®'s INITIAL role during this phase? Evaluation of the client's ADL ability Evaluation of the client's strength Evaluation of total body positioning Evaluation of possible discharge location

Solution: The correct answer is C. During the acute, immobilized phase of spinal cord injury, the OTR® initiates total body positioning to prevent problems associated with body functions (ROM) or body structures (skin). A, B: ADL ability and strength are not initially measured in the acute phase because of mobility constraints. D: Discharge is not considered in the acute phase, because the client may be in traction or wearing mobilization devices. Movements of the spine and neck are contraindicated.

During a commode-to-bed transfer, the client begins to slip from the OTR®'s grasp. What action is best for the OTR® to take? Continue with the transfer, and try to get the client to the bed as quickly as possible. Have the client return to the commode. Ease the client to the floor, then get assistance. Call for help, and get the attention of the client's nurse.

Solution: The correct answer is C. Easing the client to the floor protects both the client and the therapist from injury. A, B: Trying to move the client too quickly or reverse the transfer can result in injuries to both the client and the OTR®. D: Help may not arrive in time to assist, resulting in the OTR®'s dropping or injuring the client.

An OTR® at an assisted-living facility has received multiple referrals for clients with Alzheimer's disease (AD) who are having a decline in functional ability in personal hygiene and grooming. When intervening with these clients, the OTR® observes that they have more residual ability than the referral or staff report indicates. What might the OTR® do next? Talk to the physician about making appropriate referrals. Screen all the residents with AD in the facility to see whether the OTR® might be able to intervene. Plan an in-service for staff about AD and how to set up the environment for maximal function. Provide intervention to the clients for whom the OTR® received referrals and call the families with an update.

Solution: The correct answer is C. Education about the disease process in AD is an important intervention tool that an OTR® can provide. An in-service to all staff at the facility will provide them with the tools necessary to deal with perceived declines in function and intervene independently to ultimately improve the residents' quality of life. It will also provide the staff with pathways to make appropriate referrals to the OTR® in the future. A, B, D: If a systemic problem is noted in a facility, it is important that an OTR® recognize a need that might have been overlooked. These options do not address that need.

An OTR®; is supervising an occupational therapy student for Level II fieldwork. The OTR notices that the student did not gather complete information regarding a client's occupational history. Which comment BEST represents effective feedback from the supervising OTR regarding this error? "You missed some information when you were recording the client's occupational history." "In the future, you need to ask better questions about the client's occupational history." "In the future, you may want to use a checklist to ensure that your occupational history interviews are comprehensive." "You should practice doing occupational history interviews."

Solution: The correct answer is C. Effective feedback is descriptive and specific rather than evaluative and general. This feedback provides specific information about the problem (a lack of comprehensiveness) and also offers a description of how to solve the problem in future attempts (by using a checklist). A, B: This feedback is evaluative and indicates the presence of a problem without describing what the problem is. D: This feedback is too general and does not specify that a problem exists or what the problem is.

During a therapy evaluation of a client who sustained a radial head fracture, the OTR® notes that elbow range of motion (ROM) is 60° of extension and 80° degrees of flexion; wrist ROM is 30° of extension and 25° of flexion. Which statement about this client is TRUE? This client will need additional education in pain management because pain is the most common complication after elbow injury. This client will regain elbow ROM before wrist ROM, because wrist stiffness is the most common complication after elbow injury. This client will regain wrist ROM before elbow ROM, because elbow stiffness is the most common complication after elbow injury. This client will require only one visit for home exercise program (HEP) instructions, and the OTR can then discharge the client from therapy.

Solution: The correct answer is C. Elbow stiffness is the most common complication of elbow trauma. A: Although pain is a primary consideration for all clients, it should subside as healing progresses. B: It is important to include wrist ROM and strengthening when addressing elbow injuries, but wrist ROM should return to normal before elbow ROM. D: Even if the OTR is recommending a HEP for a client, the OTR should suggest return visits to measure carryover of HEP training and adjust the HEP, as needed, until the client has returned to independence.

An OTR® is 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? Have the prosthetist make the client a prosthesis and implement a wearing schedule. Recommend that the client wait another month and then return for prosthetic fitting and training. Have the client talk with other clients who have similar amputations. Refer the client for psychiatric evaluation and treatment.

Solution: The correct answer is C. Encouraging the client to talk with others who have experienced similar amputations can help facilitate acceptance. A: The client will likely reject the prosthesis and refuse to participate in activities that incorporate it. B: Waiting an additional month is unlikely to increase acceptance. Providing active interventions is likely to speed up the process. D: Although the client may require additional support, the fear and rejection of the residual limb represents the changes in body image the client is undergoing.

An OTR® is working with an adult client with sensory processing difficulties who finds it uncomfortable to commute to a job via train because of the noise of the train and of other passengers talking. Which environmental modification would allow the client to continue to commute and maintain employment? Encourage the client to obtain a driver's license and avoid train travel Petition the train system to allow the client to occupy a compartment alone and ask others to sit elsewhere Recommend the use of noise-cancelling headphones with a device that plays music or books the client enjoys Assist the client in seeking employment closer to home to avoid train travel

Solution: The correct answer is C. Environmental modification in the form of assistive technology would allow the client to continue to commute and maintain employment. Benson (2009) specifically suggested the use of headphones to manage noisy environments for people who have sensory processing impairments. A: Encouraging the client to avoid train travel does not directly address the stated problem in occupational performance. B: A compartment for one person is impractical from the standpoint of the transportation system and would isolate the client. D: Seeking other employment is not an environmental modification that would allow the client to continue in the current role and routine.

An OTR® is establishing reasonable accommodations for a client with a history of chronic fatigue syndrome. The client is employed as a receptionist for a small extermination company. The client exhibits decreased short-term memory, periodic joint pain and stiffness, and frequent headaches. The essential job functions include answering phone calls, taking messages, sending out statements for services rendered, and setting up appointments. Which accommodation is MOST appropriate for the OTR® to recommend FIRST? Change the client's work schedule to provide additional time for the client to complete the morning routine Provide a motorized scooter to minimize walking, conserving the client's energy and preventing pain Implement a day planner and list of prioritized job tasks to serve as memory aids Provide a flexible work schedule by permitting the client to work from home at least 3 days per week

Solution: The correct answer is C. Essential job functions are job duties fundamental to the position the individual holds or desires to hold. Reasonable accommodations may include altered work schedule and duties, facility modifications, purchase of adaptive equipment or assistive technology, or modifying or designing a new product. Implementing use of a day planner is the most appropriate initial accommodation under these circumstances because it allows the client to continue to perform essential job functions while accommodating the short-term memory issue. A: Altering the work schedule may be a consideration if the client identifies difficulty completing the morning routine. It would not be considered the most appropriate initial accommodation. B: A motorized scooter may be a prohibitive accommodation for a small company. Joint pain and stiffness are periodic, and the essential job functions are primarily sedentary; therefore, provision of a scooter would not be an initial modification. D: A flexible work schedule with ability to work from home may not be a reasonable accommodation for a small business.

An OTR® in home health care is seeing a client who has Stage III Alzheimer's disease. The client lives with an adult daughter and likes to wander around the house and has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no step at the front entrance. The client's daughter is determined to have the client remain at home with her as long as possible. The daughter has expressed fear that the client might fall down the stairs at the back door while wandering. To prevent the client from using the back door, what would the OTR® MOST likely recommend? Painting a big "STOP" sign on the back door Painting the door yellow to contrast with the environment Using a poster to camouflage the back door and the door knob Installing a motion-detecting light at the stairs to the garage

Solution: The correct answer is C. Evidence has shown that camouflaging a door and its doorknob can decrease way-finding behavior when an client with Alzheimer's disease wanders. A: A big "STOP" sign requires that the client be able to recognize and understand it. This ability will not be preserved in a client with Stage III Alzheimer's disease; therefore, this option will not be useful in deterring the client from using the back door. B: Making the door contrast with the environment enhances visualperceptual acuity and might actually increase the possibility of the client's opening and using the back door. D: A motion-detector light can light up the stairs at the garage but cannot prevent the client from wandering out and using them.

An OTR® is reviewing the medical chart of a client who has Parkinson's disease. The neurologist has indicated that the client has a festinating gait. What does the client's gait look like? The client's steps are stiff and slow. The client's steps are halting and unsteady. The client's steps are small and rapid. The client's steps are marked by pauses.

Solution: The correct answer is C. Festinating gait is marked by small, rapid steps resulting from a forward-tilted posture of the head and trunk. A, B, D: These do not indicate a festinating gait.

A COTA® in a short-term acute care psychiatric hospital is leading a psychodynamic group. Which of the following activities would be the MOST appropriate for this group? Paint by number Crossword puzzles Free-form clay building Decorating gingerbread cookies

Solution: The correct answer is C. Free-form clay building allows for the least amount of structure. Clients are free to form the clay however they want, so the piece takes on a symbolic meaning important to the client. A: Painting by number is highly structured, with minimal opportunity for a participant to express subconscious thoughts and feelings. B: Crossword puzzles provide minimal opportunity for self-expression or for conflicts in the psyche to emerge. D: Decorating gingerbread cookies involves some choice in expression and the potential to evoke body-related thoughts and feelings, but free-form clay building has less structure and is a more effective activity for this group.

A client was referred to occupational therapy because of persistent pain in the neck and shoulder and the recent onset of paresthesia in the right index and middle fingers. The OTR® decides that the symptoms may be work related and proceeds with an onsite ergonomic assessment. During the ergonomic assessment, the OTR® observes that the client uses the mouse 80% of the time. What will the OTR® MOST likely recommend? Using a vertical mouse and placing it at desktop level Changing to a laptop so that the client can use the touchpad instead of a mouse Performing full upper body stretches after every 20 minutes of mouse use Assigning the client other tasks that require less frequent use of the mouse

Solution: The correct answer is C. Frequent stretches and movements away from the static posture and prolonged use of a mouse is another strategy to prevent repetitions and muscle strain. A: Putting the mouse at regular desktop height is usually too high for most workers and can lead to shoulder tension. B: From an ergonomic standpoint, using a laptop without modifying the level of the monitor screen or the keyboard may lead to other musculoskeletal symptoms. D: Job changes are usually not part of the recommendations after an ergonomic assessment.

An OTR® is working with a 3-year-old with a developmental delay in preschool. The child is having a tantrum because it is time to stop playing and go to circle time. Which strategy might have prevented a tantrum? Praising the child when the child is engaging in positive behaviors and making good choices Teaching the child how to self-calm Giving a warning before the preferred activity came to a close Telling the child the rules and expectations and following them

Solution: The correct answer is C. Giving the child a warning when a preferred activity is coming to a close will help the child transition to the next activity and may reduce the likelihood of a tantrum. A, B, D: Although these strategies may be appropriate to teach a child with a developmental delay in preschool, they are not related to transitioning.

An OTR® is working with a child who is overresponsive to vestibular input, extremely scared of movement, and fearful of jumping. What type of sensory dysfunction might this child have? Somatodyspraxia Tactile defensiveness Gravitational insecurity Hyporesponsivity

Solution: The correct answer is C. Gravitational insecurity is characterized by hypersensitivity to vestibular input. Children with this type of sensory integrative dysfunction are often extremely fearful of movement and having their feet off of the ground. A: Somatodyspraxia is characterized by difficulties with motor planning. B: Tactile defensiveness is characterized by difficulty making sense of or interpreting tactile input. D: Hyporesponsivity is characterized by an underresponsivity or high threshold for certain stimuli.

What is an effective strategy to facilitate maximal independence in self-feeding with a client who has middle- to late-stage dementia? Change the client's diet to foods that are palatable and easy to chew. Change the consistency of foods to allow for easier chewing and swallowing. Provide hand-over-hand guidance for food retrieval and utensil-to-mouth motions. Provide constant verbal cues throughout feeding to improve attention to the self-feeding task.

Solution: The correct answer is C. Hand-over-hand guidance is an effective strategy to encourage maximal independence through participation in daily living tasks, including self-feeding. A, B: Changing the diet and changing the consistency of foods might encourage the client to eat more but will not specifically address maximal independence in self-feeding. D: Although structured prompting is effective in assisting clients with dementia, continual verbal cues might be overwhelming.

A client has difficulty with ankle flexion that is causing an issue with tripping over items. In particular, the client is especially concerned with tripping in the bathroom. Which is the MOST appropriate environmental adaptation that could be recommended for this issue? Removal of water spillage Installation of grab bars Removal of loose bath mat Installation of a shower chair

Solution: The correct answer is C. If a client is unable to lift the toes properly and is trying to manuver in a bathroom, a loose bathmat could catch the toe or foot and create a tripping hazard. A: Water spilled on the floor might cause a client to slip, but not to trip. B: Grab bars are an important safety item and may be used by a client to keep from falling, but they will not prevent a client from tripping. D: A shower chair is important for clients who cannot bear weight or who have decreased endurance, but it cannot prevent a client from tripping

A 76-year-old client will be using a wheelchair after discharge from an acute rehabilitation facility. The client has achieved independence in wheelchair mobility on level surfaces but still requires minimal assistance for transfer. The client is planning to move into a daughter's home, which was not the client's previous residence. The OTR® conducts an onsite home evaluation with the client and the client's daughter. The client's goal is to be able to prepare lunch daily while the client's daughter is at work. What is the MOST important mobility performance to be observed during the home evaluation? The client's ability to stand and reach the cabinets The client's ability to stand at the stove while cooking The client's ability to maneuver the wheelchair in and out of the kitchen The client's ability to reach the faucet while seated in the wheelchair

Solution: The correct answer is C. If the client cannot maneuver the wheelchair in and out of the kitchen, then an alternative cooking station will need to be set up so that the client can prepare lunch in another room. A, B: Standing while performing any part of the meal preparation task would not be recommended without the presence of others. D: If the client cannot reach the faucet while seated in the wheelchair, modification to the activity demand such as an alternative hand-cleaning method can be used.

What skills might a client with middle-stage dementia have difficulty performing on the basis of typical psychosocial or cognitive abilities present during this stage of dementia? Speaking Swallowing and chewing Managing finances Posture and balance

Solution: The correct answer is C. In middle-stage dementia, a person will begin having moderate impairment in IADLs, such as finances, shopping, medication management, and complex meal preparation. A: Although comprehension of written and spoken language is affected in the middle stage of dementia, speaking itself is not affected until the late stage. B, D: Problems with swallowing and chewing, as well as and posture and balance difficulties, are most likely encountered by clients with late-stage dementia.

While an OTR® is working with a client on vocational training in a community-based setting, the client becomes frustrated with a computer task and states, "I am too slow at the computer; I can't do this." The OTR responds, "I notice that you take your time to be very careful not to make mistakes while you are working. I am sure that employers would think that is a positive quality in a job candidate." Which interpersonal strategy does the OTR's statement exemplify? Interpretation Metaphor Reframing Encouragement

Solution: The correct answer is C. In this example, the OTR turns a quality that the client perceives as negative (typing slowly) into a positive quality (being careful not to make mistakes). By reframing this quality, the OTR aims to change the client's thinking about a quality that the client possesses. A: Interpretation conveys the OTR's understanding of the client's motive for his or her behavior. An example of interpretation in this example could be "I see that typing is not your favorite work task." B: Metaphor is a way to convey a concept to a client without a lengthy explanation. In this example, saying, "I would rather be a tortoise than a hare" would imply that being slow is better than being fast. D: Encouragement, which is sometimes confused with reframing, primarily involves positive regard by the therapist for what the client is doing and is capable of doing. An example of an encouraging response is, "It's OK that you type slowly. Just because you type slowly does not mean that you cannot complete the task. Come on, let's keep working."

An older adult client with low vision has a goal of becoming more independent in meal preparation. Which home modification would be MOST beneficial? Remove throw rugs in kitchen Use visual scanning techniques Increase lighting in kitchen Use optical devices correctly

Solution: The correct answer is C. Increasing the intensity and amount of available light enables objects and environmental features to be seen more readily and reduces the need for high contrast between objects. A: Throw rugs would reduce fall risk in the kitchen; however, removing them does not promote meal preparation tasks for clients with low vision. B, D: Visual scanning techniques and optical devices are not home modifications; they are interventions to promote use of residual vision.

An OTR® is working on functional mobility with an infant in early child intervention. The infant is able to stand while holding onto a surface or piece of furniture. What is the next "just-right" developmental challenge? Transitioning from sitting to kneeling Bearing weight through both lower extremities Walking with hand-held assistance Standing on one foot

Solution: The correct answer is C. Infants are typically able to take steps with hand-held assistance around age 10 months, after they are able to stand up while holding on to a surface or a piece of furniture. A, B: Transitioning from sitting to kneeling and bearing weight through both lower extremities would usually occur before standing while holding on to furniture. D: Standing on one foot would usually occur after the child learned to walk.

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? <6 months 9 months 12 months 15 months

Solution: The correct answer is C. Infants typically begin to crawl by age 9 months. Given this child's delay, crawling may emerge around 12 months. A, B, D: By age 3 months, most infants have mastered head control. Around age 6 months, an infant begins to roll. Around age 12 months, many children are able to walk.

An OTR® is working with a child with retinopathy of prematurity and wants to provide the child's parent with activities to work on between sessions. Which activity would be appropriate for an OTR® to recommend? Encourage the parent to attend to the infant's social smile by smiling back. Encourage the parent to attach a nonbreakable mirror to the infant's crib. Encourage the parent to introduce toys to the infant that can be touched, listened to, and tasted. Encourage the parent to reduce auditory stimuli and refrain from talking or singing when playing with the infant.

Solution: The correct answer is C. Infants with visual impairments need to be supported to promote development in play and should learn to incorporate their other senses. A: It is likely that a child with a significant visual impairment would not be able to see the parent's smile. B: It is likely that a child with a significant visual impairment would not be able to see his or her reflection in the mirror. D: It is likely that the OTR® would recommend that the parent of a child with visual impairment increase vocalizations around the child to support the development of the child's auditory sense.

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? Provide the child with a pencil grip. Encourage the teacher to provide a copy of the teacher's notes. Instruct the child in keyboarding. Allow the child to use print instead of cursive writing.

Solution: The correct answer is C. Instructing the child in keyboarding would provide the child with a compensatory way to produce written language instead of handwriting. A: The pencil grip would adapt the writing instrument but is not a compensatory approach. B: This option suggests a modification to task demands but does not include a compensatory approach. D: Allowing the child to print still requires the child to use handwriting, and printing may be as difficult as cursive.

An OTR® is evaluating a client with multiple sclerosis (MS). What main evaluation finding related to neuromusculoskeletal function can the OTR anticipate? Slowed movement of the extremities Uniform resistance to passive movement Tremor when moving the extremities to reach Inability to initiate movement in the extremities

Solution: The correct answer is C. Intention tremor is commonly seen in people with MS. A: Slowness of movement is not typically seen in people with MS. They may, however, have unsteady or incoordinated movements. B: Uniform resistance to passive movement indicates that rigidity is occurring, a symptom not typically present in people with MS. D: Ability to initiate movement is not typically impaired in people with MS.

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

Solution: The correct answer is C. MCP joint extension helps isolate proximal and distal IP joint flexion and allows maximum FDP excursion. A: This splint holds the MCP joints in extension, not flexion. B: FDP excursion occurs with distal IP joint flexion, not extension. D: Proximal IP joint extension is facilitated when the MCP joints are blocked in flexion, not extension.

A client with middle-stage dementia has maintained the ability to complete repetitive tasks common in middle adulthood. For example, if given a basket of socks, the client will reflexively fold them until the task is complete. Given this information, what recommendation would be appropriate for the OTR® to give caregivers? Provide challenge to the client by placing the laundry basket at various heights to improve trunk stability and balance. Provide challenge to the client by putting various types of clothing into the laundry basket, which will aid in maintaining this skill. Provide the client with a basket of socks at a set time each day, determined by the client's arousal level, to give structure to the client's day. Provide the caregivers with information about how they can use a basket of socks to decrease agitation in the client.

Solution: The correct answer is C. Interventions to control the daily structure of a person with dementia have been documented to provide balance between the times the person is in high arousal versus low arousal. A, B: Providing too much challenge to a client with dementia might increase agitation; providing structure to the client's day is the best option to decrease agitation and promote better balance. D: Engaging a client in a task once the client is agitated might be difficult; providing structure to the client's day is the best option to decrease overall agitation and promote better balance.

Which assessment tool would an OTR® administer to gain an understanding of how a child's sensory processing abilities are affecting the child's participation in daily life activities at home? Sensory Integration and Praxis Test (SIPT) Sensory integration clinical observations Sensory Profile BruininksOseretsky Test of Motor Performance (BOT2)

Solution: The correct answer is C. Interviews and caregiver questionnaires such as the Sensory Profile can be used to gain an understanding of how sensory problems influence a child's participation in daily activities. A, B: The SIPT and sensory integration clinical observations would provide the therapist with information related to the underlying neurological functions that affect sensory integration. However, these two assessment tools would not provide information about how the child's ability to integrate sensory information that affects daily life activities. D: The BOT2 would provide the OTR® with information about the child's motor planning, but not about daily life activities.

Which statement BEST describes a task-oriented group in the "storming" phase of group development? Because two participants were able to work out their differences early on, the group is now running smoothly and handles problems efficiently. The group is meeting for the first time, and participants are asking the group leader for help because they don't understand the task at hand. A participant who has recently joined the group sets up a roadblock to everything another participant says. A third participant does not think that the task is reasonable and questions whether accomplishing it is even possible. The group leader is exhausted by all the questions about the details of the finished product. No one seems to want to work together, and the participants seem to expect the leader to solve this problem.

Solution: The correct answer is C. It is common for disagreements to occur during the storming phase. Setting up roadblocks and questioning the task at hand are normal during this stage. A: This group is in the performing stage: Participants are able to problem solve through challenges. The disagreements that are the hallmark of the storming stage have been resolved. B: A group meeting for the first time is in the forming stage. D: Reliance on the group leader is common during the forming stage, in which the group has not yet taken ownership of the task and instead expects the leader to solve all issues.

A client is able to say only "yes," "no," or "hello." This client is also incontinent of bladder and bowel and is unable to walk. In which stage of Alzheimer's disease (AD) is this client? Early Middle Late Mild cognitive impairment

Solution: The correct answer is C. Late-stage AD is characterized by limited speech, decreased ambulation, and incontinence. A: People in early-stage dementia are likely to begin having difficulty within the community and with IADLs but have intact ADL performance. They typically have no problems with bladder or bowel related to AD. B: People with middle-stage dementia will also continue to have skills in habitual ADLs and routines. They can also maintain conversation. They typically have no problems with bladder or bowel related to AD. D: People with mild cognitive impairment will have less consistent patterns of loss than what is found in AD. They will be able to carry on conversation and will not have difficulty with bladder or bowel function related to the impairment.

Using the Allen Cognitive Level Screen-5 for screening, followed by use of the Allen Diagnostic Module and the Routine Task Inventory for confirmation of screening results, an OTR® identifies Level 4 as the current level of functioning of a client in an adult day treatment center. What is the MOST appropriate scenario for activity completion for this client? The task includes mostly familiar steps but also one step requiring new learning. The project and tasks involved are relatively unstructured. The client is given opportunities to find and revise errors. A model of the completed project is provided for the client to imitate. Simple instructions are provided. The project is designed to encourage relatively independent planning and organizing to complete tasks.

Solution: The correct answer is C. Level 4 activities typically require a model as a guide to task completion, simple directions, and unshared tools. Unstructured tasks, problem solving, planning, and even independent completion of unfamiliar steps without guidance are likely too challenging for a person at Level 4. A: This choice is appropriate for Level 5 of the Allen Cognitive Level Screen. A client at Level 5 has new learning occurring, and inductive reasoning enables new ways of performing activities. B: This choice is appropriate for Level 3 of the Allen Cognitive Level Screen. A client at Level 3 can engage in repetitive, unstructured actions. D: This choice is appropriate for Level 6 of the Allen Cognitive Level Screen. A client at Level 6 can think of hypothetical situations and do mental trial and error.

An OTR® recommends task lighting for a client with age-related macular degeneration. Where should the task light be positioned to promote the client's vision? On top of a shiny surface that reflects light On a patterned surface or cloth to decrease glare Opposite the writing hand or nearest to the best seeing eye On top of dull, low-contrast fabric to reduce reflected light

Solution: The correct answer is C. Lighting should be positioned opposite the writing hand or nearest to the best seeing eye to promote the client's vision. A: Shiny surfaces should be avoided or covered to reduce reflection and improve visibility. B, D: Patterns should be reduced and high contrast used so task lighting more effectively promotes the visibility of objects in the environment.

Since getting new workstations, clerical workers at a law office are noticing increased neck stiffness and fatigue, and an OTR® is preparing a 1-week educational program for them. Which strategy would be MOST likely to reduce neck stiffness and fatigue? Require workers to stand and march in place for 5 min once every hour during the day Provide neck stretching and strengthening exercises to improve flexibility Move computer monitors into alignment with keyboards so workers face the monitor straight on Position workers with forearms resting on the edge of the desk while typing for support

Solution: The correct answer is C. Maintaining head and neck alignment reduces the risk of strain to the neck. A: Standing during prolonged sitting tasks allows for a change in position but is not the most direct strategy to prevent neck injury. B: The evidence neither supports nor refutes the effectiveness of routine exercise programs in preventing injuries. D: Positioning arms in this way contributes to contact stress injury.

An OTR® in an outpatient psychosocial program sets goals with a client to improve motivation for completing basic ADLs every day, resume daily community activity, and medication management of sertraline (Zoloft). The therapist is MOST likely working with a client with what diagnosis? Obsessivecompulsive personality disorder (OCD) Schizophrenia Major depression Substance abuse disorder

Solution: The correct answer is C. Major depression is characterized by loss of interest in self-care and socialization. Sertraline is a typical pharmacological treatment for depression. A: The question does not describe typical symptoms of OCD, such as preoccupation with details and organization. B: Although symptoms of schizophrenia can include reduced motivation, limitations in self-care, and socialization, sertraline is not typically a primary, first-choice medication for schizophrenia. D: More information indicating substance abuse would be needed to warrant choosing this item over major depression.

An OTR® needs to categorize the driving behaviors of a client with Parkinson's disease. Using Michon's (1985) Hierarchy of Driving, in which three categories will the OTR® review the client's driving behaviors? Motor skills, cognitive skills, and visual skills Concentration, attention, executive function Strategy, tactic, and operation Person, vehicle, environment

Solution: The correct answer is C. Michon's (1985) Hierarchy of Driving categorizes drivers' behaviors into the strategic, tactical, and operational categories. A: Motor skills, cognition, and vision are the general performance domains underlying the task of driving. B: Concentration, attention, and executive function are the cognitive functions underlying driving performance. D: Person, vehicle, and environment are categories featured in Haddon's Matrix (Gielen, Sleet, & DiClemente, 2003), a framework for crash and injury prevention.

An OTR®; is providing dressing skills training for a client with traumatic brain injury (TBI). The client has a sequencing deficit and continually places underwear over pants and socks over shoes. What strategy is appropriate for the OTR to use with this client? Use picture cards of dressing and have the client put the steps of dressing in order Have the client write out the steps in dressing using paper and pencil Hand the client each item of clothing and provide assistance in donning the item Ask the client which clothing item should be selected next

Solution: The correct answer is C. Minimizing environmental distractions and decreasing the complexity of the task will allow the client to experience success in completing one step of the task at a time. A, B: Tabletop activities will not generalize or transfer to the client's ability to dress successfully. D: Asking the client questions about which step of the task comes next may present too great a challenge and increase the client's frustration.

An OTR® is conducting a handwriting evaluation with an 8-year-old client. During the evaluation, the OTR® notices that the child's eyes are not in alignment when copying from far point to near point. What type of problems might the child experience as a result of eye misalignment? Being able to manipulate a pencil from writing point to eraser Being able to answer a question posed by the teacher when the child had not volunteered Being able to copy assignments from the chalkboard into an assignment notebook Being able to organize papers into a folder

Solution: The correct answer is C. Misalignment of the eyes, along with shaking eyes, excessively large or small pupils, and pupils that are not black but appear to have an opaque film over them are all red flags related to visual problems. Misalignment of the eyes may complicate the child's ability to copy assignments from the chalkboard into an assignment notebook. A: The child would rely on motor skills to complete the task. B: The child would have to rely on attention skills and other cognitive skills to complete this task. D: The child would primarily rely on motor skills and organizational skills to complete this task.

A COTA® who spent 2 years working on the orthopedics unit of an acute care hospital is now working on the neurological floor. How is appropriate supervision BEST described? The OTR® and COTA decide to set up supervisory visits on an as-needed basis. The COTA requires minimal supervision owing to his or her 2 years of experience The OTR and COTA agree that close supervision is best at this time. The OTR and COTA decide that continuous supervision is needed.

Solution: The correct answer is C. More frequent supervision may be necessary when the OTR, COTA, or both determine that additional supervision is needed as a result of changes in work demands, such as in caseloads or populations served. In this case, a COTA who has experience working with patients with orthopedic conditions may require more close supervision when working with clients with myriad health conditions. A, B: These approaches could potentially jeopardize the effectiveness and safety of occupational therapy services rendered. The OTR needs to provide closer supervision to the COTA because the population served has totally changed. D: It is likely difficult for the COTA to be in the supervising OTR's line of sight at all times in an acute care hospital

An OTR® receives orders to evaluate and treat a client with an incomplete S2 spinal cord injury. What is the BEST conclusion the OTR® can make regarding the client's recovery process? Recovery for incomplete spinal cord injuries is predictable and dependent on severity. Complete injuries are associated with better outcomes than incomplete injuries. Each day that goes by without return of function decreases the likelihood of recovery. A client's dedication or "hard work" in rehabilitation can cause nerve function to return.

Solution: The correct answer is C. Most recovery starts within the initial treatment period, generally several weeks postinjury. Each day that goes by without a change in function decreases the likelihood of recovery. A: Recovery for spinal cord injuries is unpredictable, partly because no measure exists to determine true severity of the injury. B: Incomplete injuries are associated with better outcomes than complete injuries. D: Rehabilitation does not affect the degree of recovery, only the prevention of further deformity.

An OTR®; who passed the initial NBCOT exam has decided not to be recertified through NBCOT. Which consequence will result from the OTR's decision? The OTR will not be allowed to practice occupational therapy in the United States. The OTR's practice opportunities and credentials will remain unchanged. The OTR may practice occupational therapy in a state that does not require certification, but the OTR's credentials will change to OT. The OTR may practice occupational therapy in a state that does not require certification, and the OTR's credentials will remain unchanged.

Solution: The correct answer is C. NBCOT recertification is not required for occupational therapists, and some states allow occupational therapists to practice without being recertified by NBCOT; however, choosing not to renew NBCOT certification means a change in credentials from OTR to OT. A: Some states do not require NBCOT recertification to practice occupational therapy. B: The OTR's practice opportunities will not change, but the OTR's credentials will change from OTR to OT without recertification. D: The OTR's credentials will change from OTR to OT without recertification even if the occupational therapist is allowed to practice in a certain state.

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? Ultrasound Fluidotherapy Neuromuscular electrical stimulation (NMES) Conventional transcutaneous nerve stimulation (TENS)

Solution: The correct answer is C. NMES can be used during an activity to decrease shoulder subluxation post CVA. A, B: Ultrasound and fluidotherapy cannot be used during an activity and do not increase functional control of muscles. D: TENS can be used during an activity but is typically used for pain and edema control.

Which phrase BEST depicts a client factor, according to the Occupational Therapy Practice Framework: Domain and Process? Communication and interaction skills Home management abilities Neuromusculoskeletal functions Personal habits and routines

Solution: The correct answer is C. Neuromusculoskeletal functions falls under the broad category of client factors in the Framework. A: Communication and interaction skills are performance skills rather than client factors. B: Home management abilities fall under the areas of occupation. D: Personal habits and routines fall under the category of performance patterns.

A client with an acute mild brachial plexus stretch injury affecting the left side reports limited forward shoulder flexion because of pain; limited cervical mobility; forward head and rounded shoulder posture; and decreased sensation in the thumb, index, and radial side of the long finger. The client has full range of motion in internal and external rotation of the shoulder. The occupational profile reveals that the client is an accountant who enjoys surfing and tennis on the weekends. What instruction should the OTR® provide on the first visit? Rotator cuff strengthening exercises for humeral head stability to reduce impingement pain noted with forward flexion Forward flexion active-assisted exercises to reduce capsular tightness Postural correction exercises, modification of the workstation to promote appropriate posture, and reduction of overhead activities Recommendation to maintain normal work activities but avoid tennis and surfing until further notice

Solution: The correct answer is C. Nonoperative treatment of a brachial plexus stretch injury includes education on how to minimize further irritation to the brachial plexus, including postural education and education regarding avoidance of provocative positions (e.g., overhead activities). A, B: Normal pain-free range of motion in internal and external shoulder rotation indicates no involvement of the rotator cuff. D: Posture is a crucial component of treatment. Forward head posture indicates limited scapular mobility. When scapular mobility is limited, motion at the glenohumeral joint is adversely affected because of an imbalance in scapulohumeral rhythm.

A client has a 3½-year-old child and a 2-year-old child. Because of postpartum depression, she has been unable to return to work since the birth of the younger child. What home- and community-based occupational therapy services would BEST help the client improve her worker role? Job simulation and work retraining in the home Facilitation of employer-client meetings to negotiate bringing the children to work Weekly goal setting, time management activities, and use of a positive-events diary to build self-confidence Facilitation of employer-client meetings to negotiate work-at-home options

Solution: The correct answer is C. Nonpharmacological approaches to treating depression, including postpartum depression, focus on assistance with gradual lifestyle reexamination and positive support to build self-confidence, assist with task demands through time management, and problem solving. A, B, D: These choices are helpful compensatory strategies, but they do not directly address reducing the impact of depression on the client's worker role.

A client with spinal cord injury has been on bedrest for several days. The OTR® is preparing to begin mobility activities with the client. Which device is BEST to use for mobilizing the client? Stander or standing table Standard wheelchair Tilt-in-space wheelchair Mat table for sitting

Solution: The correct answer is C. Orthostatic hypotension often occurs with deconditioning from bed rest, and a tilt-in-space wheelchair allows the client to be reclined quickly if the client's blood pressure drops too low in sitting. A: When first getting a client upright after a traumatic injury, a standing table may present too great a challenge. B: A standard wheelchair does not allow the client to be reclined quickly if he or she experiences a change in blood pressure. D: Sitting upright on a mat table may present too great a challenge immediately after a prolonged period of bed rest.

An OTR® who is not a certified driving specialist has a client who needs an assessment to determine whether safe driving is possible. When is it necessary to refer this client to a specialist in driving? As soon as the request is made to determine whether the client can safely drive a car When the request involves testing the client's visual perception abilities When a formal driving evaluation has been determined to be necessary After other testing has determined that the client should not drive

Solution: The correct answer is C. OTRs are considered experts who have knowledge and skill in the driving arena without extra certification. General evaluations that assess the skills necessary to drive (i.e., strength, attention, visual perception) are within a general practitioner's area of service. However, if a formal driving evaluation is necessary, then the client should be referred to a specialist in driving and community mobility. A: OTRs are considered experts who have knowledge and skill in the driving arena without extra certification. General evaluations that assess the skills necessary to drive (i.e., strength, attention, visual perception) are within a general practioner's area of service. B: OTRs are able to complete visual perception testing. D: If the client is found to have performance impairments that correlate with driving risk, an OTR must recommend cessation of driving and can focus on interventions to improve the client factors that prohibit driving, but the client does not necessarily have to be referred to a driving specialist.

Which recommendation should an OTR® make to the caregiver of a client with dementia who is suffering from caregiver stress? Recommend that the caregiver inquire about medication to reduce the caregiver's stress. Recommend that the caregiver inquire about additional sleep medication for the client. Recommend that the caregiver contact a local adult day care to inquire about its services. Recommend that the caregiver find a teenager in the neighborhood who can watch the client.

Solution: The correct answer is C. OTR®s have a responsibility to provide caregivers with information related to local resources to reduce caregiver burden. A, B: It is not appropriate for an OTR® to recommend medication for the caregiver or adjust a medication dosage for a client. D: A teenager would not be an appropriate choice as a sitter for a client with dementia.

When dealing with clients who have dementia, what would be the primary role of the OTR® in addressing caregiver burden? Provide recommendations about community resources. Provide recommendations about medication management. Provide recommendations related to home modifications. Provide recommendations related to safe transfers.

Solution: The correct answer is C. OTR®s have specific skill in providing recommendations about home modifications. Home modifications can benefit clients with dementia and their caregivers by providing a safe environment that prevents unsafe wandering and provides optimal occupational engagement for reduced caregiver burden. A, D: OTR®s can provide information about community resources and safe transfers at various stages of the process, but home modifications, which is a skill unique to OTR®s, will have the most benefit to caregivers of clients with dementia. B: OTR®s should avoid providing recommendations about medication management but should refer caregivers to other health care providers who would be able to provide this information to them.

An OTR® is working with a 9-year-old child with autism who has been on a new extended-release stimulant medication for 3 days. When the child comes to the clinic after school, the child is manic, zoned out, and crying for no apparent reason. What is the MOST immediate course of action for the OTR®? Provide sensory activities to help the child become calmer and more organized Change the therapy time so the medication is still in effect during occupational therapy sessions Ask the parents about possible side effects of the medication affecting behaviors and performance Recommend taking a break from medication and observe whether behaviors improve

Solution: The correct answer is C. OTR®s need to monitor and report possible effects of medications on performance and behaviors. A, B, D: These options will not directly address issues about side effects of medication.

An OTR® 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 OTR® be MOST likely to write? Client's pain-free AROM of right elbow is now 15 to 110. Client can perform 30 repetitions of elbow flexionextension using a 1-lb weight. Client can brush teeth using the involved upper extremity without pain. No progress was noted this week.

Solution: The correct answer is C. Occupation-based practice requires documentation of improvement in occupations such as ADLs. A, B: Statements about AROM and exercise document progress from a biomechanical frame of reference. D: This statement does not document improvement as a result of therapy.

An OTR® who supervised an occupational therapy assistant student in the student's final Level II fieldwork in an acute psychiatric hospital hires the student for a COTA® position. The student plans to sit for the NBCOT® exam in 2 weeks. How should the OTR® supervise this new employee? Supervise the new employee as a COTA®/L because the employee has completed all courses and fieldwork Always provide direct, face-to-face supervision for the new employee Supervise the employee consistent with national and state guidelines on uncertified employees Ask the new employee to initiate an occupational therapy assessment

Solution: The correct answer is C. Only after passing the NBCOT® examination can an occupational therapy assistant use the COTA® designation. A: The employee cannot be supervised as a COTA®/L until after successful completion of the NBCOT® exam. B: Although some state guidelines would require direct, face-to-face supervision in this case, not all states have this requirement for employees who are not certified. D: Even a certified and licensed COTA® cannot initiate an occupational therapy assessment; only an OTR® can do so.

An OTR® works with elderly clients with low vision. A client with macular degeneration is referred after substantial symptom progression and loss of vision. The client's spouse states that for the past 3 months, the client has uncharacteristically refused to participate in social activities, is frequently irritable and uncommunicative, and is unwilling to perform personal care or routine tasks. What should the OTR® advise the spouse to do? Consider exploring assisted living alternatives. Insist that the client resume accompanying the spouse to bridge club and prepare a snack to share with the club. Encourage the client to consult a mental health provider. Advise the client and spouse to seek professional counseling to adjust to the inevitable changes in the marriage.

Solution: The correct answer is C. People with low vision are at high risk for mood disorders and depression. A, B, D: Because the reported symptoms have been going on for 3 months, these choices may not provide the appropriate intervention for the cause of the client's behavioral symptoms.

An OTR® is conducting a job demand analysis in a food production company. The OTR observes the workers in the shipping and handling department loading and unloading a delivery truck. According to the Occupational Therapy Practice Framework, Domain and Process (4th ed.), which aspect of the occupational therapy domain is being assessed? Contexts Performance patterns Performance skills Client factors

Solution: The correct answer is C. Performance skills are observable, goal-directed actions and consist of motor skills, process skills, and social interaction skills. A job task analysis is a nonclient's specific observation of the job's activity demands, including the performance skills needed to complete the task. A: Contexts are the environmental and personal factors specific to each client that influence engagement and participation in occupations. B: Performance patterns are the acquired habits, routines, roles, and rituals used in the process of engaging consistently in occupations and can support or hinder occupational performance. D: Client factors are specific capacities, characteristics, or beliefs that reside within the person, group, or population and influence performance in occupations.

An OTR® has had many observations of the adjustment that clients go through following spinal cord injury. The OTR® would like to put together focus groups to explore the experiences of individuals who are adjusting to spinal cord injury. What study design methodology would be best for this type of research project? Randomized controlled trial Single-case design Phenomenology Participant observation

Solution: The correct answer is C. Phenomenological study design would allow for the collection of participant's experiences through focus groups that contain open-ended interview questions. A: Randomized controlled trial (RCT) study design is appropriate for studying the effects of different treatment by assigning participants to different intervention groups. RCT involves quantitative data collection based on outcome measures, whereas the scenario described suggests gathering of client experiences through qualitative data. B: Single-case designs include only one participant and would not be useful in gathering the experiences of multiple individuals with spinal cord injury through focus groups. D: Participant observation study design involves the researcher becoming part of the participant's experience and gathering qualitative data in the process through experiencing the same contexts the participant does. The researcher would not be able to join as a participant with individuals with a spinal cord injury to share a like experience.

Several OTR®s working in a county public school system are planning interventions for middle school students that address goals for personal independence with community mobility and academic goals in reading and mathematics. Which student activities could the OTR®s use to address both goal sets? Doing math worksheets that include a word problem about automobile speed Interviewing a truck driver about that job and telling other students what they learned in the interview Reading and following an electronic search for a bus route that passes near their home and calculating distances between stops Passing out bus schedules in the cafeteria to encourage other students to use public transportation

Solution: The correct answer is C. Precin et al. (2012) suggested using electronic searches to teach map-reading skills and trip distance calculation to address quantitative skills. Researching a bus route near the students' home adds the component of relevance to their search. A: Doing a math worksheet provides practice in mathematics but does not address personal community mobility skills. B: Interviewing a truck driver focuses more on social interaction and verbal skills than community mobility, mathematics, and reading skills. D: Passing out bus schedules in the cafeteria does not address students' community mobility and is more focused on social interaction skills than mathematics and reading.

What principle of the Occupational Therapy Code of Ethics (2015) guides occupational therapy practitioners to accurately represent their credentials, qualifications, education, experience, and training to all service recipients, students, employees, research participants, and colleagues? Principle 1, Beneficence Principle 4, Justice Principle 5, Veracity Principle 6, Fidelity

Solution: The correct answer is C. Principle 5, Veracity, requires accurate representation of credentials, qualifications, education, experience, and training in all forms of communication. A, B, D: Although all principles in the Code of Ethics are essential to ethical behavior, they do not directly address accurate representation, as does Principle 5, Veracity. Truthful representation of one's background is explicitly addressed as part of the principle of Veracity.

An OTR® ergonomic consultant in a hospital is notified of a significant increase in work-related musculoskeletal disorders among nurses since the implementation of electronic health records. The OTR® is asked to present a report on the issues to the upper-level management team. What should the OTR® include in the report to identify the problem and generate possible solutions? A list of the injured nurses with their corresponding musculoskeletal disorder conditions and total lost days away from work A report on the average time spent on the computer per shift per department and a recommendation for a hospital-wide computer training class for all nurses A summary of the fixed heights of the various workstations and tables at the nurses' stations and a list of recommended adjustable-height workstations A slide show documenting improper positioning and posture of nurses at the current workstations and recommendations for hospital-wide body mechanics training

Solution: The correct answer is C. Proper positioning of the monitor and keyboard are the main factors to be considered in ergonomics. Because nurses are of different heights and can be documenting in different environments (e.g., in patients' rooms, at the nurses' stations, or sitting vs. standing), it is important that the workstations be versatile and accommodate each nurse and each situation. A: Providing a list of injured nurses and conditions does not help to identify problems and generate solutions. B: If the majority of the nurses have been identified as lacking computer skills that therefore leads to prolonged documentation time on the computer, then a hospital-wide computer training class is one possible solution. However, if the ergonomic set-up is not addressed with adjustable-height workstations, training will not solve the problem of having a high incidence of musculoskeletal disorders. D: Providing a slide show of improper posture during documentation may help to illustrate some of the problems but will not help to generate any solutions.

An OTR® is providing intervention in the home of a client who is recovering from Guillain-Barré syndrome. The client ambulates independently using a walker, but becomes unsteady when tired. What should the OTR® include as part of the intervention for supporting the client's safety at home? Talk with family members about providing contact-guard assistance whenever the client is engaged in daily tasks. Advise the client to complete self-care tasks while seated in a wheelchair in the home bathroom. Problem-solve with the client to identify and eliminate existing fall risks within the home. Teach the client diaphragmatic breathing techniques to use during functional ambulation at home.

Solution: The correct answer is C. Providing safety strategies for proper use of a walker within the home is the most effective intervention strategy because it allows the client to identify situations that could be modified for better safety. A: The client is independent using a walker and contact-guard assistance is not indicated and may lead to loss of occupational function for the client. B: The client should be allowed to perform as many tasks with the use of the walker as possible to maintain the client's independence. D: Respiratory control is not typically a cause of fatigue for a client with Guillain-Barré syndrome, and breathing techniques would not improve steadiness with ambulation.

A law firm is redesigning its workspace. The clerical staff, many of whom work long hours, have frequently complained about back stiffness and fatigue. An OTR® has been consulted about how the new office space might be designed to prevent or alleviate these problems. Which strategy would be MOST likely to reduce back stiffness and fatigue? Provide desks that can be adjusted for standing or sitting, so that workers can change position. Provide stretching and strengthening exercises to improve flexibility, decrease stiffness, and strengthen muscles. Provide chairs that are more fully adjustable for lumbar and other back support. Position workers so that forearms can rest on the edge of the desk while typing for support.

Solution: The correct answer is C. Providing seating that is individually adjustable for back support would be the first step in addressing back issues in a group of workers who are seated for long hours. Intervention for back pain in individual workers would be handled in a individualized, client-centered approach. A: Standing during prolonged sitting tasks allows for a change in position but is not the most direct strategy to prevent back injury. B: The evidence neither supports nor refutes the effectiveness of routine exercise programs in preventing injuries. D: Positioning arms in this way contributes to contact stress injury.

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? Encourage the patient to select items needed for each task. Provide multisensory cues for locating self-care items. Provide task setup and simple instructions. Use hand-over-hand assistance during dressing.

Solution: The correct answer is C. Providing task setup and simple instructions allows for the appropriate tools to be used for the desired activity, and the simple instructions allow for guided support in task completion. A: The patient is demonstrating ideational apraxia and will be unable to select items needed for tasks. B: Use of multisensory cues is not appropriate for a patient at the Level VI Confused-Appropriate functional ability, because too much sensory information may overwhelm the patient. D: Providing hand-over-hand assistance does not provide appropriate support for apraxic motor perception disorder, which benefits more from repetitive active basic motor sequences.

A client with stroke is demonstrating a 1-finger-width separation of the acromion and the head of the humerus. In the intervention session, what should be the FIRST step of the OTR®;? Fit the upper extremity with a sling to minimize its movement Recommend that the client not use the upper extremity Train the client and caregiver in safe handling of the upper extremity during transfers Provide passive range of motion (PROM) exercises to minimize contractures of the upper extremity

Solution: The correct answer is C. Providing training in safe handling techniques to properly position and move the affected upper extremity is the most important approach to addressing shoulder subluxation. A: Further assessment is needed to determine whether the client requires a sling. The client's pain level, functional level during transfers, and awareness of the affected upper extremity, as well as the presence of edema, should be assessed before providing a sling. B: Avoiding use of the upper extremity will lead to further limitations in functional use and contribute to learned nonuse of the extremity. D: PROM is important to minimize the effects of loss of soft-tissue length but does not address the client's subluxation.

An OTR® is 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? Cut the wear time back to 30 minutes and gradually increase it, using 10-minute increments. Add additional socks to better pad the prosthetic device. Contact the prosthetist to adjust the device to improve the fit. Educate the client on proper residual limb care to prevent skin breakdown.

Solution: The correct answer is C. Reddened areas that last more than 20 minutes are indicative of pressure in the prosthetic device that will eventually cause skin breakdown. The prosthesis must be adjusted by the prosthetist to ensure proper fit. A: Reddened areas that last more than 20 minutes are indicative of pressure in the prosthetic device that will eventually cause skin breakdown. A slower increase in wear time is unlikely to improve prosthesis fit. B: Reddened areas that last more than 20 minutes are indicative of pressure in the prosthetic device that will eventually cause skin breakdown. Although adding prosthetic socks can be used to account for changes in residual limb size during the day, they should not be used to pad a poorly fitting prosthesis. D: Reddened areas that last more than 20 minutes are indicative of pressure in the prosthetic device that will eventually cause skin breakdown. All clients should be educated in proper residual limb care; however, it will not prevent skin breakdown if the prosthesis does not fit correctly.

A client with early-stage Huntington's disease is displaying excessive voluntary movements. The client prefers to bathe in the shower. What recommendation would be appropriate to improve the client's ability to bathe as independently as possible? The client should sponge bathe. The client should receive an assist from the home health aide. The client should use safety bars and a tub bench. The client should use soap on a rope.

Solution: The correct answer is C. Safety bars and a tub bench will allow increased safety and independence in the shower. A, B: Suggesting that the client sponge bathe or receive an assist from the home health aide does not address the client's independence in the client's preferred method of bathing. D: Soap on a rope could be helpful, but it would not be the OTR®'s primary recommendation; grab bars and a tub bench would be more important for safety. In addition, once a tub bench is installed, the client might find that symptoms are minimized, because good posture and a supportive seating surface are recommended to reduce symptoms of HD.

An OTR® 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? Radial side of the hand Thumb and index fingers Ulnar side of the hand Index and middle fingers

Solution: The correct answer is C. Sensory distribution of the low ulnar nerve involves the ulnar side of the hand, primarily the ulnar side of the fourth finger and the entire fifth finger. A, B, D: Burns in these areas correlate with the sensory distribution of the median nerve.

A newly certified OTR® wants to provide occupational therapy coverage on an "as-needed basis" at a medical center burn unit. What should the OTR® expect the facility to provide in order to promote continuity of care for these services based on best practice standards? Funds to attend professional development classes to learn about evidence-based burn care Availability of burn-care protocols currently used for patients with thermal injuries Options for establishing service competence for completing clinically based processes and procedures on the unit Written communication from the primary therapist in advance of the coverage date outlining patient care routines

Solution: The correct answer is C. Service competency will support that the newly certified OTR® and existing practitioners in the burn unit are performing functions similarly and achieving the same outcome. A: Continuity of care is not ensured with practitioners attending professional development classes because practitioners will implement practice in their own way. Services competency ensures teaching, training, and evaluation of practitioner on the basis of skills delivery. B: Providing burn-care protocols does not ensure continuity of care because practitioners may interpret the protocols in their own way. Service competency ensures teaching, training, and evaluation of a practitioner. D: Written routines or protocols may provide guidance for the new OTR® in typical practice approaches in the unit, but they will not ensure continuity of care.

Which type of pressure do occupational therapy practitioners most commonly identify as leading to moral distress and organizational ethics violations? Deciding whether an intervention is within the scope of occupational therapy practice Describing progress by recipients of service when little change has occurred Providing interventions based on the likelihood of best reimbursement Extending work hours to treat more clients

Solution: The correct answer is C. Slater and Brandt (2011) described a study conducted in 2008 that identified reimbursement constraints as one of the top ethical concerns leading to moral distress in occupational therapy practitioners. Practitioners reported that being pressured to provide therapeutic service primarily for financial benefit rather than for the health and well-being of clients was highly distressing. A, B, D: Deciding whether an intervention is within the scope of occupational therapy practice, describing progress by recipients of service when little change has occurred, and extending work hours to treat more clients, although potentially distressing, were not commonly identified by occupational therapy practitioners.

A client who has Trace (1/5) lower-extremity muscle strength and Good (4/5) upper-extremity muscle strength is learning safe transfer techniques. Which transfer device would be MOST BENEFICIAL for the client to use when transferring from a standard wheelchair to a variety of surfaces? Hydraulic lift Lift seat Sliding board Transfer disc

Solution: The correct answer is C. Sliding board transfers are useful for a person who has trace muscle strength in the lower extremities and good upper-extremity muscle strength. A, B: The client is able to participate more fully in the transfer by positioning the lower extremities; a power lift is not needed, and using a power lift may decrease the client's independence over time. D: With trace lower-extremity muscle strength, the client would not be able to use a transfer disc because this device supports the client for getting into position for the transfer only.

An OTR® is performing a home evaluation for a client with Stage IV amyotrophic lateral sclerosis (ALS). On what will the OTR®'s recommendations MOST LIKELY focus? Modifications to keep the client's lifestyle as close as possible to occupations preferred before diagnosis Environmental adaptations such as moving frequently used items to easy-to-reach and nearby areas Creation of a first-floor setup and increased accessibility to a wheelchair or durable medical equipment Technology changes such as a motorized stair lift

Solution: The correct answer is C. Someone with Stage IV ALS is likely to have severe weakness in the lower extremities, causing an inability to ambulate. Working with a client and his or her family to create a safe, accessible first-floor setup is the best option; the patient and family will need recommendations for moving furniture, creating spaces that a wheelchair or power chair can navigate, and the most appropriate durable medical equipment such as a hospital bed and specialized mattresses to prevent pressure sores. A: ALS is progressive, and the client will need to change his or her lifestyle to adapt to increasing disability. B: Environmental adaptations may be appropriate for the earlier stages of ALS, when a client is more mobile. D: A stair lift would not be the best option for a client at this advanced stage because a family member would be required to carry the wheelchair to the opposite end of the stairs.

An OTR® is preparing to discharge a client to home after hip replacement. The client reports having a high-step tub with a shower door and no money to buy additional equipment. Which recommendation is MOST appropriate for bathing? Recommend the client substitute a plastic lawn chair for a shower chair. Recommend the client place nonskid strips on the floor of the stall. Recommend the client sponge-bathe at the sink until equipment can be purchased. Recommend the client stay at the facility until equipment can be purchased.

Solution: The correct answer is C. Sponge-bathing at the sink is an alternative activity if hip precautions cannot otherwise be met. A: Using unproven or inspected materials as substitutions may endanger the client. B: Although nonskid strips may make the tub safer, the client may still be endangered without a shower chair or transfer mechanism. D: Because the client has met discharge criteria, keeping the client in the facility when otherwise able to return home is not ethical.

An OTR® evaluates a client and determines that the client is "standby assist or contact guard assist for dressing tasks but minimal assist for bathing tasks." What do these levels of assistance mean? The client can dress with someone within eyesight but needs someone within arm's reach for bathing. The client can dress with adaptive equipment but needs someone within arm's reach for bathing. The client can dress with someone within arm's reach but needs physical assistance for bathing. The client can dress with adaptive equipment but needs physical assistance for bathing.

Solution: The correct answer is C. Standby assist or contact guard assist means that someone needs the caregiver within arm's length. Minimal assist assumes that the client cannot complete the task and needs someone to complete part of it (as much as 25%). A: Having a caregiver within view of the client while the client performs the task would be considered supervision. B, D: Use of adaptive equipment would be considered modified independent.

A therapy group of clients with rheumatoid arthritis is meeting once a week. These clients may benefit from a group education approach to teach which technique? Exercises to increase stability of the hands and digits Medication management to ensure proper use of prescribed medications Joint protection strategies to help prevent further joint stress or injury Night splinting in a position of antideformity

Solution: The correct answer is C. Studies have shown a decrease in reported pain and disability after participation in a group program in which joint protection strategies have been taught. A, B, D: Exercises, medication management, and night splinting are more appropriate as individual rather than group interventions.

An OTR® is conducting an evaluation with a child on the pediatric intensive care unit. While observing the child's heart monitor, the OTR® notes that the child may be experiencing tachydysrhythmia and alerts the nurse immediately. What are the implications of tachydysrhythmia? The child's heartbeat is less than 60 beats per minute. The child has an atrioventricular block. The child's heart beat is between 200 and 300 beats per minute. The child has a pacemaker.

Solution: The correct answer is C. Tachydysrhythmia is fairly common in children with cardiac conditions. In extreme cases and when complications are present, it can lead to congestive heart failure. It is characterized by fast heart rate of 200300 beats per minute. A, B, D: These options are related to bradydysrhythmia.

S, an occupational therapy student, experiences major personal stress during a challenging time in school. Feeling behind schedule and overwhelmed by an assignment, S calls L, a classmate and friend, and asks for a copy of L's paper to get a sense of the format and content expectations of the assignment. To best adhere to the Occupational Therapy Code of Ethics (2015), what should L do? Be empathetic and avoid harm to S by providing a copy of the paper, under the agreement that S's paper will be worded differently from L's Claim not to understand the format and content guidelines and refer S to another classmate who knows more about them Express discomfort about sharing the paper because doing so may violate the Code, and encourage S to seek help from the professor of the course Share the paper but report S to the AOTA Ethics Commission for possible violation of the principles of Nonmaleficence and Justice

Solution: The correct answer is C. Taking action to avoid being exploited and to encourage ethical behavior is recommended for all occupational therapy professionals, including students. A: It is possible to remain empathetic with and supportive of a colleague without agreeing to do something that may cause professional harm to oneself or another. B: Avoiding taking action, although not in violation of the Code, is less desirable than educating others about the importance of adhering to the Code. D: Agreeing to share the paper may put L in violation of the Code. Taking action to avoid a violation by consulting with the AOTA Ethics Commission or a more experienced professional, such as a professor, clinical supervisor, or university ombudsperson, would be more appropriate.

To facilitate participation in familiar daily living tasks by clients with dementia, what would be an appropriate INITIAL stage of intervention? Recommend home modifications. Provide caregiver education. Develop strategies to simplify familiar tasks. Establish appropriate daily routines.

Solution: The correct answer is C. Task simplification is a primary intervention used with clients with dementia to maintain independence in daily living tasks. A, B, D: These answers are interventions that would be appropriate with dementia; however, developing strategies to simplify familiar tasks must come before the others.

An OTR®; is conducting a cooking group for people with schizophrenia. The OTR writes the following information in a progress note after a treatment session: "Paranoia and delusions continue to limit the client's independent living skills. Client remains unable to move through a task from beginning to end without being distracted by delusional thoughts." Where in a SOAP note would the OTR document this information? In the S section In the O section In the A section In the P section

Solution: The correct answer is C. The A, or assessment, section contains an interpretation of subjective and objective information from a treatment session. A: The S, or subjective, section of a SOAP note gives the client's perspective on his or her condition, treatment, or experience. B: The O, or objective, section records measurable data obtained during the treatment session. D: The P, or plan, section outlines the frequency and duration of continued treatment for the client.

An OTR® receives orders to evaluate and treat a client with an S1 spinal cord injury. Which instrument is MOST appropriate for assessing the client's current level of independence? Canadian Occupational Performance Measure (COPM) Nine Hole Peg Test FIM Adult Sensory Profile

Solution: The correct answer is C. The FIM is the most widely used disability measure in rehabilitation medicine and captures many basic disability areas. A: The COPM is used to detect changes in a client's self-perception of occupational performance over time. C: The Nine-Hole Peg Test measures finger dexterity and would not give a thorough picture of the client's level of independence. D: The Adult Sensory Profile identifies sensory process patterns and effects on functional performance.

An OTR® evaluates a client who has sustained a traumatic brain injury and uses the Glasgow Coma Scale (GCS) to record the client's conscious state using the combined score. Which of the following three responses is recorded with the GCS? Verbal, threat, autonomic Appropriate, motor, autonomic Eye opening, motor, verbal Eye opening, verbal, autonomic

Solution: The correct answer is C. The GCS is an evaluative and reassessment tool that uses eye opening, verbal, and motor responses to track the level of consciousness of clients with head injuries. A, B, D: Autonomic and threat responses are more closely linked to the central nervous system. Appropriate responses would describe a broader scale, and the term is not associated with the Glasgow Coma Scale.

When working with a client with chronic pain, the OTR® needs to set a tone that will facilitate a therapeutic relationship with the client. Which statement sets an open and appropriate tone when working with a client who has chronic pain? "Your pain is all in your head. All you have to do is ignore it." "I have pain when I wake up in the morning. I have arthritis. It usually takes a while before it gets any better. Maybe you should try to exercise in the morning to get things moving, like I do." "I realize that you are in pain. Let's try this activity and see what happens. If you need to stop, let me know, but I would like to see you push yourself." "I think we should slowly increase the time you are spending at work-related tasks so that you can get back to work as soon as possible."

Solution: The correct answer is C. The OTR needs to acknowledge that the client with chronic pain has pain; the OTR also needs to communicate the importance of the client's participating to the best of his or her ability. A: It is never appropriate to suggest that a client with chronic pain does not have pain. B: By focusing the conversation on him- or herself, the OTR is minimizing the impact of pain on the client's functioning. D: Although it might be appropriate to address work tasks with this client, the OTR's response does not acknowledge the client's pain or other psychosocial concerns.

An OTR® is assisting a client with an incomplete T2 spinal cord injury (SCI). The client is anxious and concerned about being able to live independently. Which response is the MOST accurate for the OTR® to give the client, based on the OTR®'s knowledge of the typical recovery pattern of a client with a T2 SCI? Suggest the client make arrangements for a long-term residential facility with support. Advise the client not to be concerned with the future and to concentrate on rehabilitation. Advise the client that recovery from SCI is often unpredictable, and people with SCI can live fulfilling, active lives. Suggest the client move to a supportive apartment when available to increase independence.

Solution: The correct answer is C. The OTR® can provide information regarding traditional prognosis and facilitate optimal independence and functioning. A, D: These responses are premature in the evaluation stage and may not be accurate. B: This response is not client centered and does not serve to facilitate a cooperative therapeutic relationship.

During an initial interview with a young adult who has Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome), the OTR® notices that the client lives alone and is isolated, does not go out much, does not value family relationships, and does not seem to have any friends. Additionally, the client is not gainfully employed and does not take care of the apartment. The client spends most of the day surfing the Web and watching TV. Using the Model of Human Occupation, which of the following assessments would be the MOST appropriate? A projective test such as HouseTreePerson Worker Role Interview Role Checklist Canadian Occupational Performance Measure

Solution: The correct answer is C. The Role Checklist gathers information on the client's former and current roles and the value the client places on these roles, consistent with the Model of Human Occupation. A: A projective test such as the HouseTreePerson is not designed to evaluate roles or role behavior but rather to reveal a client's personality. B: The Worker Role Inventory is associated with the Model of Human Occupation and would yield valuable information but is too narrowly focused on the worker role. D: The Canadian Occupational Performance Measure helps clients identify their perceptions of their own occupational performance.

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? Helps to reduce the incidence of learned helplessness and low self-esteem among students who have communication deficits Meets specific standardized assessment requirements as outlined in the Individuals With Disabilities Education Improvement Act of 2004 Promotes educational team collaboration regarding students' AT needs throughout the school day Provides a method for prioritizing students' occupational therapy intervention activities based on hierarchy of scores

Solution: The correct answer is C. The SETT allows for collaboration and communication among educational team members to support good decision making to determine the AT needs of a student. A: The SETT is used to determine AT needs of a student, not just communication needs, and does not address learned helplessness or self-esteem of a student. B: The SETT is a framework and does not meet standardized assessment criteria. D: The SETT is a framework that results in qualitative information about a student's needs and does not provide a score.

What should the OTR®; do for the affected upper extremity when positioning a client with hemiparesis in side lying on the affected side? Place in adduction Place on the humeral head Protract the arm forward Support in internal rotation

Solution: The correct answer is C. The affected upper extremity should be placed in protraction to allow optimal soft-tissue lengthening. A, D: The upper extremity in clients with hemiparesis naturally tends to assume a position of adduction and internal rotation, so positioning should emphasize slight abduction and external rotation to neutral. B: Positioning a client's affected upper extremity directly on the humeral head may result in increased pain and impingement of the shoulder.

An OTR® is using groups in a residential rehabilitation facility for people with substance abuse. The OTR has identified a group of clients who have difficulty with assertiveness during encounters with significant others. The OTR decides to use role playing with the group members to help them improve their response in such events. What frame of reference does this intervention choice suggest? Psychodynamic Sensorimotor Behavioral Developmental

Solution: The correct answer is C. The behavioral frame of reference uses repetition to shape a client's behaviors in a safe environment in order to reduce negative thoughts and emotions associated with the stressful event. In this example, the OTR wants the clients to practice assertiveness in their interactions so that they can feel prepared and confident in future interactions outside the therapy setting. A: A psychodynamic frame of reference is mostly discussion based and individualized. B: A sensorimotor frame of reference uses sensory experiences to assist in regulation of responses. D: A developmental frame of reference examines the client's age and expectations of the environment and uses activities that facilitate successful completion in this context.

An OTR® and a client with multiple sclerosis (MS) collaborate to set client-centered goals; the client expresses interest in developing an exercise program but states that weakness and fatigue are barriers. What program should the OTR® FIRST recommend? A home program including bike riding, walking, and free weights with careful monitoring of fatigue A strengthening program to reduce weakness associated with the disease's deconditioning process Aquatic therapy to reduce the effects of weakness while promoting gentle exercise Progressive resistive exercises under the supervision of the OTR® to avoid overexertion

Solution: The correct answer is C. The buoyancy of water helps reduce the effects of weakness; aquatic exercise programs for clients with MS should be in room-temperature or cooler waters because of heat sensitivity. A: A home exercise program may be intimidating to someone new to exercise, although it is important to educate people with MS in how to monitor their fatigue and prevent overexertion. B, D: Strengthening would likely not be a first approach to introducing an exercise program. Evidence shows that fatigue can be reduced by participating in a structured aerobic program. Further, strengthening will not reverse the neurological weakness from MS, but it can reduce the weakness from being deconditioned.

A client diagnosed with amyotrophic lateral sclerosis (ALS) 2 years ago is admitted to the hospital because of worsening mobility at home. Before the hospitalization, the client was independent with ADLs but required assistance for IADLs, including cooking, shopping, and home management. Which approach is MOST likely to be the priority for this client in the acute care setting? Maximize the client's participation in IADLs Identify appropriate positioning for the client in bed Guide the caregiver in assisting the client with ADLs Facilitate increased strength to maximize abilities

Solution: The correct answer is C. The caregiver should be trained in skills for assisting the client with ADLs, because the client will require greater assistance for tasks as symptoms progress. A: Focusing on maintaining the client's participation in ADLs would be more appropriate than promoting independence in IADLs, given the progressive nature of ALS. B: Instruction on positioning in bed is not indicated at this time, given the client's ability to be mobile and participate in ADLs. D: The client's strength should be optimized to maintain abilities as long as possible, but increasing strength should not be a focus of intervention because of the progressive nature of ALS

An OTR® is observing a client in the home environment. The client is able to ambulate safely within the house. The OTR decides to assess kitchen management and safety during light meal preparation. During the assessment, the client has difficulty reaching into cabinets above shoulder level. What might the OTR want to assess further during this functional motion assessment? Grip strength Plantar flexion and extension Shoulder flexion Hip extension

Solution: The correct answer is C. The client has difficulty reaching above shoulder level for functional tasks, indicating that the client likely has some deficits in shoulder flexion. A, B: There is no indication that the client has distal deficits in motion or strength. D: The client was independently and safely ambulating within the home; no hip motion or strength deficits were noted.

An OTR® has received a referral to evaluate a client with dementia who lives alone in the community. When the OTR® arrives at the client's home, the OTR® notices that the client is well groomed but appears to have forgotten that the OTR® had called earlier in the day to set up the appointment. Which area of occupation would be a priority to assess during the initial occupational therapy assessment? Bathing and showering Sleep Emergency system access Personal device care

Solution: The correct answer is C. The client has early-stage dementia as evidenced by short-term memory deficits but maintains the ability to complete routine ADLs. Other ADLs are likely intact, but IADLs, in particular those that require higher level executive function, would be affected at this stage. In addition, the client lives alone so understanding the client's safety in the community would be important. A, B, D: Bathing or showering and personal device care are both ADLs and not likely to be impaired at this stage. Sleep, although an IADL and possibly affected, would not be priority at this time.

An OTR® is assessing a client with bulimia. The client has become preoccupied with hiding purging behaviors from friends and family. While developing an occupational profile with the client, the OTR notices that as the client's bulimia has evolved, the client has replaced many valued activities with the bulimia. The client has severe occupational imbalance, with no participation in anything but binging and purging behaviors. Which strategy would be MOST successful with this client? Teach the client relaxation strategies to provide relief from the stress caused by the bulimia. Recommend social activities to encourage the client to interact with friends and family in a more positive way. Provide the client with leisure activities that will create more balance and offer the client more control over the client's life. Assign the client small-group activities with other clients to provide the client with information about the health impact of bulimia.

Solution: The correct answer is C. The client is demonstrating occupational imbalance, so exploring new leisure activities would be important to help the client create a more balanced life. Learning a new skill would also allow the client to feel more control over his or her life. A: Although relaxation strategies might be an acceptable intervention, there is no indication that the bulimia is causing the client distress. B: Social activities would be important because social relationships and social participation are most likely strained because of the client's preoccupation with hiding the purging. However, the primary concern is the client's occupational imbalance. D: Education is a good intervention idea, but it does not address the immediate concern, which is the client's occupational imbalance.

During the initial evaluation for a client with Parkinson's disease, the OTR® asks the client to "pretend you are brushing your teeth," that is, show the movement of brushing teeth without using the supplies needed for brushing teeth. The client is unable to initiate movement of the dominant arm toward the mouth to demonstrate oral hygiene. Which step should the OTR take NEXT in the evaluation of this client? Try a wrist weight to stabilize the arm during teeth brushing Ask whether the caregiver can provide arm support to bring the hand to the mouth Observe as the client brushes teeth with toothbrush and toothpaste at the bathroom sink Provide a mobile arm support to compensate for arm movement when brushing teeth

Solution: The correct answer is C. The client may not have understood the verbal instructions, and performing the task in the actual context may allow for more accurate demonstration of the client's abilities. A: If the client is unable to initiate movement of the dominant arm during simulated teeth brushing, it is unlikely that adding weight would facilitate movement. B: Suggesting the assistance of a caregiver for brushing teeth may entail a greater level of assistance than the client actually requires. The client should be provided opportunity to complete ADLs at the highest level of independence desired. D: Clients with Parkinson's disease may have difficulty initiating or limitations in movement because of rigidity. Use of a mobile arm support would not be appropriate without further evaluation of the client's needs.

An OTR® is providing intervention to a client with an anxiety disorder who hyperventilates when faced with difficult work tasks. The OTR (with the client's permission) works with the employer to identify work tasks in which the client can be successful. What frame of reference does this intervention suggest? Cognitive-behavioral Psychodynamic Cognitive disability Behavioral

Solution: The correct answer is C. The cognitive disability frame of reference uses the client's strengths to allow for function. An example of a cognitive disability intervention is training caregivers to provide appropriate environmental supports for the client. A: The cognitive-behavioral frame of reference works on the thoughts and reactions related to environmental triggers. Through journaling and reflection, the client can identify triggers that cause the anxiety to escalate. B: The psychodynamic frame of reference suggests that unresolved childhood events are the reason for dysfunction. A psychodynamic intervention is usually discussion based. D: The behavioral frame of reference relies on the idea that behavior is learned and that it can be unlearned. Using breathing and relaxation techniques during a stressful event can facilitate a change in response.

As an occupational therapy practitioner, you have accepted an assignment to go overseas to work with victims of a disaster in a culture that is new to you. In preparation for your trip and in consideration of the Occupational Therapy Practice Framework: Domain and Process, which of the following elements is part of the context in which activity occurs that you will need to consider when planning occupational therapy intervention? The process used to carry out the activity The tools used to complete the activity The cultural beliefs held by the person engaging in the activity The praxis skills required to complete the activity

Solution: The correct answer is C. The context of an activity comprises the interrelated cultural, personal, temporal, virtual, physical, and social conditions in which the activity takes place. A, B, D: According to the Occupational Therapy Practice Framework: Domain and Process, the context in which an activity occurs does not include the process, tools, or praxis skills used to complete the activity.

A participant in a research study who has provided informed consent tells the OTR® that she wants to withdraw. Which ethical principles require the OTR to bring the conversation to the attention of the primary investigator? Fidelity and Veracity Veracity and Justice Autonomy and Fidelity Autonomy and Justice

Solution: The correct answer is C. The ethical principle of Autonomy relates to the participant's right to end any participation in a research study for any reason. Informed consent in research allows a person to stop participating in a research study. Because the OTR is not the PI, the principle of Fidelity would require her to communicate respectfully regarding the request with the PI. Fidelity acknowledges that "professional relationships are greatly influenced by the complexity of the environment in which occupational therapy personnel work. Practitioners, educators, and researchers alike must consistently balance their duties to service recipients, students, research participants, and other professionals as well as to organizations that may influence decision making and professional practice." The OTR must involve the PI to effectively balance these obligations. A, B, D: These options do not refer to ethical standards that reflect a participant's right to stop participating in a research study. The principle of Veracity refers to representation of the profession and utilizing objectivity when doing so. The principle of Justice refers to provision of services in a fair manner. Although these principles relate in some aspects to the ethical issue in the scenario, the principles of Autonomy and Fidelity are more directly relevant.

The OTR®'s next client has macular degeneration in both eyes. To prepare the treatment environment for this client, which course of action should the OTR® take? Close the blinds and the curtains. Sit directly in front of the client. Increase lighting and avoid glare. Place dark objects on a black table.

Solution: The correct answer is C. This client will see more clearly if the room lighting is adequate. However, glare should be avoided because the eye condition may make the person more sensitive to glare. A: This action would make it more difficult for the client to see the environment. B: Because macular degeneration tends to affect the central visual field, this action would hinder the client from seeing the therapist. D: This action would reduce contrast and make it more difficult for the client to distinguish objects.

An OTR®; wants to find an evidence-based rationale for using a sensory integration intervention with at-risk youths. What must the OTR do FIRST to construct an evidence base for practice? Access available databases to search the literature for evidence regarding sensory integration and at-risk youths. Evaluate whether peer-reviewed articles from five journals support using a sensory integration intervention with at-risk youths. Develop a question to guide a literature search for information regarding a sensory integration intervention with at-risk youths. Apply existing evidence about sensory integration to practice with at-risk youths.

Solution: The correct answer is C. The first step in systematically integrating research evidence into practice is writing an "answerable" question that can guide a literature review. A: An "answerable" question must be written before searching the literature. B: The existing literature cannot be gathered or evaluated until an "answerable" question has been written to guide the literature review. D: An "answerable" question must be developed and answered to guide the literature review before evidence can be applied to practice.

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. What is the PRIMARY purpose of initiating an exercise program for this patient? To increase overall endurance for daily tasks To promote normal venous and lymphatic return To improve mobility for preferred activities To facilitate passive ROM through a full arc of motion

Solution: The correct answer is C. The goal of therapy is to restore a patient's participation in meaningful goal-directed activities that are preferred by the patient, and engaging in an exercise program that will improve mobility may facilitate improved engagement. A: Cancer rehabilitation focuses on engaging the patient at whatever level is possible for the patient; the focus is not on increasing endurance at Stage III level of progressive cancer when endurance is likely to not increase. B: Promoting venous and lymphatic return is a primary purpose of lymphedema therapy and would not be the primary purpose of an exercise program. D: Facilitating PROM through a full arc of motion is not a functional outcome of therapy and will not result in improved engagement in activity by the patient.

An OTR® is designing a work hardening program for a client 3 months post-knee replacement. The client is employed as florist delivery person. In designing a circuit program, the OTR® applies best practice through application of the principles of hierarchy of functional return. Which circuit program BEST reflects the principles of hierarchy of functional return? Application of cold pack, instruction in proper body mechanics, modification of seating surface, and use of weighted wheeled cart Instruction in ROM exercises, performance of progressive-resistance lower-extremity exercises, and performance of tasks in standing with increasing duration Instruction in progressive-resistance lower-body strengthening exercises, performance of work simulation tasks, and lifting objects floor to waist Manipulation of small objects, performance of reaching tasks, lifting objects with increasing speed and resistance from floor to waist

Solution: The correct answer is C. The hierarchy of functional return involves gradual gradation of tasks from gross to fine motor movements, increased resistance, and repetition from simple to complex tasks with postural changes to promote neuromuscular reeducation. A, B, D: These responses do not apply the principles of hierarchy of functional return, which consists of gradual gradation of activity based on movements, resistive levels, and repetitions that were either difficult to perform or contraindicated during earlier stages of healing.

An OTR®; is looking for evidence to support a new mental health intervention. In searching the literature, the OTR finds several pieces of Level IV evidence but no evidence at Levels I, II, or III about the intervention. What can the OTR conclude about the evidence regarding the efficacy of the new mental health intervention? The literature contains enough evidence to justify the efficacy of the intervention. The literature does not contain enough evidence to justify the efficacy of the intervention. The literature does not contain the level of evidence necessary to justify the efficacy of the intervention. The literature contains the level of evidence necessary to justify the efficacy of the intervention.

Solution: The correct answer is C. The levels of evidence are as follows: Level I, systematic reviews, meta-analyses, and randomized controlled trials; Level II, two-group, nonrandomized studies (cohort, case controls); Level III, one-group, nonrandomized studies (pretest-posttest designs); Level IV, descriptive studies that analyze outcomes (single-subject and case designs); and Level V, case reports and narrative literature reviews. Only evidence at Level I and Level II can make claims about efficacy. Because the literature review found only Level IV evidence, the OTR cannot draw conclusions about the efficacy of the new mental health intervention under consideration. A, B: Whether enough evidence exists to support the efficacy of the intervention is irrelevant. The literature review did not yield any Level I or II evidence, which are the only levels of evidence that address efficacy. Thus, the OTR's conclusion should relate to the type (level) of evidence found through the literature review. D: The literature review did not yield the correct type (level) of evidence needed to make claims about the intervention's efficacy.

A client with Alzheimer's disease (AD) perseverates on having to pick up children from daycare. At which stage of the disease process is this client likely at? Mild cognitive impairment Early Middle Late

Solution: The correct answer is C. The middle stage of AD is characterized by clients' thinking that they are back in an earlier stage of life. A: People with mild cognitive impairment will have less consistent patterns of loss than what is found in AD. They will be able to carry on conversation and will not have difficulty with bladder or bowel function related to the impairment. B: People in early-stage dementia are likely to begin having difficulty within the community and with IADLs but have intact ADL performance. Their short-term memory loss becomes an issue that affects their safety in the community. D. People in late-stage dementia need assistance for all areas of function, both ADLs and IADLs. They would not have the conversational skills to perseverate on a topic

An OTR® is working with a child who has a diagnosis of myclomeningocele spina bifida. Which ADLs might be difficult for a child with this condition? Grooming at the sink Feeding oneself lunch Upper-body bathing Toileting at school

Solution: The correct answer is D. Children with myelomeningocele spina bifida have sensorimotor problems at or below the level of their lesion. Lower-extremity paralysis and loss of sensation is common. Bowel and bladder programs may need to be implemented to help children with toileting across environments. A, B, C: Children with myelomeningocele spina bifida should be able to complete grooming, feeding, and upper-body bathing without difficulty.

A client has advanced rheumatoid arthritis in both hands. Evaluation results indicate severe MCP joint subluxation and ulnar drift of the index through small fingers, as well as tenosynovitis of the extensor tendons bilaterally. The OTR® expects that when using assistive devices, the client will be able to perform all routine dressing and grooming activities. Which term accurately reflects this client's projected level of function for dressing and grooming? Independent Minimal assistance Modified independent Supervised

Solution: The correct answer is C. The modified independent functional level involves a client performing activities independently with the use of assistive devices. A: The independent functional level involves a client performing activities independently without the use of assistive devices. B: The minimal assistance functional level involves a client requiring 25% physical assistance or verbal support to complete a task. D: The supervised functional level involves a client requiring supervision or a verbal cue for safety to complete a task.

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. What information about the patient MUST the OTR® obtain prior to initiating intervention? Neuromuscular diagnostic evaluation results Cultural concepts of death and spiritual beliefs Postsurgical precautions and mobility limitations Availability of family support and community resources

Solution: The correct answer is C. The patient's postsurgical precautions and mobility limitations will affect which interventions are possible. Aggressive exercise and some edema control techniques may be contraindicated because of the patient's recent surgery and compromised immune system. A: The patient's condition as described in the Statement does not suggest issues related to neuromuscular diagnosis. B: Although it would be helpful to know a client's cultural concepts of death and spiritual belief, the OTR® does not have to know this information to provide intervention. D: Information about family support and community resources will be important for preparing to move to hospice, but the information is not essential prior to intervention.

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? Within three sessions, the client will independently don the prosthesis and obtain good electrical contacts with the electrode sites 100% of the time. Within three sessions, the client will be able to open and close the myoelectric terminal device 100% of the time. 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. 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.

Solution: The correct answer is C. The pre-positioning phase focuses on teaching the client with an amputation to position the terminal device for optimal grasp. A: Learning to correctly don the prosthesis occurs during the donning and doffing phase of training. B: Learning to open and close the prosthesis occurs during control training. D: Functional training is the last step in prosthesis training and occurs after pre-positioning skills are obtained.

What is a primary goal in treating clients with dementia? Restore function. Improve cognitive deficits. Maintain functional capacity. Maintain caregiver safety.

Solution: The correct answer is C. The primary goal in working with clients with dementia is to maintain functional capacity A, B: Attempting to restore function or improve deficits in clients with dementia is not recommended because the dementia process is progressive. Trying to intervene in this way with some clients might lead to increased agitation and confusion. The best approach for dementia care is to intervene at the client's current cognitive and physical capacities. D: Safety of the caregiver, although important, is not the primary concern when developing an intervention plan for clients with AD. Clients with dementia are not typically a safety concern to their caregivers if the client's functional capacity and dignity are maintained.

A client has lost considerable weight since his admission to a long-term care facility, and his family is concerned because he constantly complains about how sore he gets from sitting in his wheelchair now that he is "nothing but bones." Why would the OTR® recommend a wheelchair cushion for this client? It will provide a cushioned surface on which to sit. It will raise the seat height for better mobility. It will redistribute pressure on his sitting surface. It will prop up the client so he is sitting upright.

Solution: The correct answer is C. The purpose of a wheelchair cushion is to redistribute pressure on the sitting surface away from the ischial tuberosities and the coccyx. A, D: Not all wheelchair cushions are cushioned. Cushions are important because they fill in the sling seat bottom to make the seat more stable. B: Although a seat cushion raises the seat height, it may make mobility more difficult for the client because the client has to reach further for the pushrims.

An OTR® is approached by a client with Alzheimer's dementia who asks, "Do I finish high school next year, or am I already finished? I don't want to go back." What is the BEST response for the OTR® to make? "Try to remember that you completed high school 60 years ago." "I'll have to find out if you finished high school. Try not to ask me again." "It sounds like you're a little worried about that. You're already finished with high school. You don't have to go back." "Didn't you go to college?"

Solution: The correct answer is C. The recommended method of communicating with a client with Alzheimer's is to provide as brief and accurate a response as possible without overchallenging the client. Addressing the emotional rather than the factual components of the request, when appropriate, is also recommended. A, B, D: These choices do not provide the client with the reassurance or a response that will allow the client to let go of the question and continue any tasks.

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? The client should obtain proper footwear (e.g., orthotic shoes) and wear them while at tradeshows. The client should bring antifatigue matting to stand on when talking to customers at tradeshows. The client should bring a tall, adjustable sitstand stool and sit on it throughout tradeshows. The client should request that this task be shared with another worker so the client attends fewer tradeshows.

Solution: The correct answer is C. The sitstand stool will allow the client to rest and efficiently unload the joints during the show, and it will allow the client to be at eye level when talking to customers. It will eliminate the client's having to repeatedly stand and sit and reduce fatigue by promoting rest. A, B: These options will reduce forces on the feet but not as efficiently as sitting, and they will not address the client's fatigue issues. C: This option will reduce the client's overall exposure to the forces on the feet but will not eliminate the problem on the days that the client must attend tradeshows.

An OTR®; is developing a professional development plan. The OTR has identified personal needs for growth after completing a self-assessment. What step should the OTR take NEXT in developing the professional development plan? Review progress toward current professional development goals and objectives. Determine available resources for meeting goals and objectives. Determine what learning needs to occur. Set new goals for professional development.

Solution: The correct answer is C. The steps in developing a professional development plan are to (1) reflect on current performance to date and determine learning needs on the basis of the self-assessment results; (2) review progress toward previous professional development goals; (3) ascertain what resources exist to meet identified professional development goals; (4) modify previous professional development goals and set new ones; (5) take action to meet professional development goals; and (6) document completed professional development activities. Thus, after identifying personal needs for growth by means of a self-assessment, the next step an OTR would take would be to determine what learning needs to occur.

Which compensatory approach can the OTR® BEST use to optimize driving comfort for a client with a small body size? Devices to assist with transfers Automatic transmission, power brakes, and cruise control An adjustable seat, seat belt, and other controls. Adaptation of the parking brake

Solution: The correct answer is C. These adaptations will mitigate the effects of having a small body size and increase the client's driving comfort. A: Transfer devices are not suitable because the client does not have limitations with mobility. B: These recommendations are usually made for a client who requires less stress on the joints, for example, a client with arthritis in the upper or lower extremities D: This recommendation is usually made for a client who requires less stress on the joints, for example, a person with arthritis in the upper or lower extremities.

A client 6 months post-stroke has made almost a complete recovery except for weakness in the left leg and slight restriction with left ankle dorsiflexion. The client completed an on-road driving assessment and did fine. However, the client is complaining of difficulty with entering and egressing because of an inability to swing the left leg into the vehicle. What is the OTR®'s BEST consideration for this client? Prescribing a Handybar® (Avin, Victoria, British Columbia, Canada) for support during transfers Referring the client to physical therapy for lower-extremity strengthening and ROM exercises Prescribing a leg-lift device and a foot-drop splint Recommending a new vehicle with a turning seat for easy transfers, entry, and egress.

Solution: The correct answer is C. These devices will enable the client to be independent in vehicle entry and egress. A: A Handybar is not needed because the client has not had difficulty with balance during transfers. B: The client has already completed physical therapy and has residual impairments. D: This choice involves unnecessary expense

A physician has referred a client to an outpatient setting for an occupational therapy evaluation and intervention. The client has late effects from a stroke that occurred approximately 10 years ago. The OTR® conducts the evaluation and begins to formulate the client's goals. Which short-term objective would be MOST appropriate for improving independence in homemaking? Client will demonstrate one-handed homemaking techniques to the therapist in 5 days. Therapist will teach client five one-handed homemaking techniques for meal preparation. By 2 weeks, client will be independent in cutting vegetables using adaptive equipment. Using an adaptive cutting board, client will peel and cut up five vegetables.

Solution: The correct answer is C. This answer includes all the components necessary for a measurable goal (client, measurement, what client will achieve, condition required to achieve the goal, and how long it will take the client to achieve the goal). A: This goal is missing the measurement aspect of the objective. B: This item would be part of the intervention plan rather than a goal. D: This goal is missing the assistance level and the estimated time it will take for client to achieve the goal.

An OTR® is competent in the type of services being requested for a client but has been asked to administer an unfamiliar standardized assessment. What is the most ethical response in this instance? Delay treatment and collaborate with the supervisor or colleagues to acquire competency for administering the assessment. Refuse to administer the assessment. Transfer the client to an OTR who is familiar with the assessment, and work to gain competency in delivery of the assessment. Administer the assessment before obtaining additional training, but schedule time to demonstrate competency at a later date.

Solution: The correct answer is C. This option is consistent with best practice and ensuring competence, and it adheres to the ethical principle of Beneficence. Additionally, this option reflects the essence of the ethical standard of Justice. A: If there is an option to transfer services to a competent provider, it should be offered as to not delay services. B: Refusal of services without consideration for increased understanding is not the most ethical response or the next step to take in this scenario. D: Administering an assessment without determining competence is in violation of the principle of Beneficence.

An OTR® working in a school system has been asked to help the education team planning for Tier 1 of a Response to Intervention (RtI) model. Which role is appropriate for an OTR at Tier 1 of RtI? Develop a social skills program for children with behavioral concerns Provide direct services to children in special education Provide a presentation to teachers on multisensory handwriting strategies Integrate technology for children with autism

Solution: The correct answer is C. Tier 1 includes general education schoolwide services geared toward prevention of educational difficulties. A: Providing a social skills program is a Tier 2 service. B, D: Direct client services and technology integration for specific clients are Tier 3 services.

An OTR® is also a part-time salesperson for an adaptive equipment vendor. The OTR accepts a position in a rehabilitation hospital as a direct service practitioner and intends to keep the sales job, too. What should the practitioner do, consistent with the AOTA Ethics Commission's advice about engaging in business transactions with clients and ensuring ethical responsibility in a sales position? Avoid recommending the purchase of adaptive equipment sold by the vendor the OTR works for Sell the equipment to clients but reduce the cost by the amount of the OTR's sales commission Disclose the relationship with the outside business to clients and the employer Quit the job as an adaptive equipment salesperson

Solution: The correct answer is C. To avoid either conflict of interest or the perception of conflict of interest, disclosure to clients and employers of an outside business relationship is advised by the AOTA Ethics Commission. A, B, D: The primary emphasis of the AOTA Ethics Commission opinion is disclosure. Under full disclosure, guidelines can be arranged to address circumstances surrounding vending, permission can be obtained or denied by the employer, and the decision to keep or relinquish the sales job can be negotiated.

An OTR® 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? Application of ice at the end of the treatment session Instruction in gentle AROM during functional activities Instruction in progressive resistive exercise Education to avoid movements that trigger pain

Solution: The correct answer is C. To prevent future flare-ups, progressive resistive exercise should be initiated at the end of therapy visits when the lateral epicondylitis has subsided. A, B, D: Application of ice, gentle AROM during functional activities, and avoidance of movements that trigger pain are all appropriate treatment interventions in the acute phase of tendinitis.

An OTR®; in an acute care setting is working on a dressing program with a client with spinal cord injury. What statement by the OTR is appropriate to facilitate positive coping for the client? "I have selected these clothes for you today." "Would you like to wear the blue or the red shirt?" "What clothes do you want to wear today?" "You should wear these clothes today."

Solution: The correct answer is C. To promote positive psychosocial adaptation, clients with spinal cord injury should be allowed opportunities to participate in decision making and to guide care tasks that require assistance. A, D: Selecting clothes for the client does not allow the client a choice in the dressing process and therefore does not support the client's psychosocial adaptation or positive coping. B: Clients with spinal cord injury do not typically have cognitive deficits; therefore, limiting the choice the client needs to make is unnecessary.

An OTR® is establishing an intervention plan for a client who sustained a work-related musculoskeletal injury to the low back. The client has been out of work for 6 months and presents with generalized deconditioning. What would be the MOST appropriate duration for this client's treatment program? A minimum of 8 hours of treatment per day for 1 month. A minimum of 8 hours of treatment per day for 1.5 months. A minimum of 5 hours of treatment per day for as long as 3 months. A minimum of 5 hours of treatment per day for as long as 1 month.

Solution: The correct answer is C. Total body deconditioning may require from 1 month to as long as 3 months of reconditioning the worker to preinjury status. A, B, D: The focus of the question is on duration of treatment, not frequency of treatment, and the focus of return-to-work programs is to predict outcome. The Commission on the Accreditation of Rehabilitation Facilities standards do not prescribe a frequency specific to the duration of treatment needed to predict outcomes. Some programs may release clients from the program once they are able to tolerate 5 hours of activity; however, this duration may not be appropriate for all clients

An OTR® will be presenting information on transitional work programs at an inservice meeting. Which statement BEST describes such programs? Transitional work programs focus on restoring musculoskeletal and cardiovascular systems as well as safely performing work tasks. Transitional work programs focus on increasing ROM, strength, and coordination. Transitional work programs use actual work tasks and environments as a form of rehabilitation. Transitional work programs are used to make a disability rating for insurance purposes.

Solution: The correct answer is C. Transitional work programs use the actual work tasks and environments as a form of rehabilitation. After becoming familiar with the client's job requirements and measuring the client's functional abilities, the occupational therapist determines tasks that the client can safely and dependably perform at work. A, B: Restoration of musculoskeletal and cardiovascular systems, ROM, strength, and coordination is not the main focus of transitional work programs, although the work may have some benefits for these areas. D: Functional capacity evaluations may be used by the physician to make a disability rating for insurance purposes.

A COTA® in an acute rehabilitation facility has been working with a client for four consecutive sessions. The COTA® learns that the client has two cats at home for which the client is the sole caregiver. Which option BEST describes the COTA®'s role in making pet care a goal? The COTA® can write this IADL goal into the next progress note and alert the OTR® to the change in the plan of care. The COTA® cannot add a goal once the evaluation has been completed. The COTA® can discuss this possible IADL goal with the OTR® to determine its appropriateness and how to address it as an intervention. The COTA® can write this IADL goal into the daily treatment note and update the OTR® on the addition.

Solution: The correct answer is C. Ultimately, the OTR® is responsible for creating the intervention plan, but the OTR® and COTA® partner with the client to develop this plan. After the evaluation is completed, new information may arise, such as learning that a client is responsible for pet care at home. The COTA® has valuable client-centered information that can help to adjust the intervention plan in a meaningful way. A, D: The COTA® must first collaborate with the OTR®; moreover, goals must be added to progress notes or recertification notes, not to daily treatment notes. B: The notion that a COTA® cannot add a goal once the evaluation has been completed is not accurate because new information about clients often emerges once rapport is developed.

During a journal reading activity led by the OTR®, a client becomes very emotional when disclosing sensitive personal feelings on how the client's family perceives the client's admission to the mental health facility. Several other clients recognize that they share the same feelings and perceptions, which makes the client feel better. According to Yalom's therapeutic factors in groups, what curative factor is this? Altruism Catharsis Universality Cohesion

Solution: The correct answer is C. Universality is the curative factor gained from other members' sharing of similar feelings, thoughts, and problems. A: Altruism is when members feel a boost in self-concept from extending help to others. B: Catharsis is the release of strong feelings about previous or present experiences. D: Cohesion is the feeling of trust and togetherness in a group.

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? Instruct the client to use a knife with a built-up handle. Instruct the client to raise the kitchen counters to place the food to be chopped closer to the shoulder. Instruct the client to use a knife with a bent handle. Instruct the client to have the spouse do all the food chopping.

Solution: The correct answer is C. Using a knife facilitates a position of deformity (increased ulnar deviation). One important principle of joint protection is to prevent positions of joint deformity. An ergonomic knife with a bent handle will place the wrist and hand in neutral, reducing stress, but still allow the client to perform the occupational task. A: Although a built-up handle will improve grasp, it will not address the joint deformity. B: Raising the counter will increase the stress on the client's hand. D: Eliminating the task will remove the stressors, but eliminating a task that a client enjoys should be avoided.

An OTR® is consulting with a general education teacher regarding a student with a significant visual impairment who is being included in kindergarten. The teacher has questions about the best way to teach the child where materials are in the classroom so that he can access them independently. Which strategy would be appropriate? Encourage the child to use depth perception and spatial awareness skills to understand where he or she is in relation to the materials. Encourage the child to use social skills and ask peers to retrieve materials for him. Encourage the child to use tactile and proprioceptive senses to understand where he or she is in relation to the materials. Encourage the child to use imitation skills and to follow peers to understand where he or she is in relation to the materials.

Solution: The correct answer is C. Using these senses will help the child to establish a mental map of the classroom. A: Depth perception and spatial awareness are reliant on the visual sense. The child has a visual impairment, so this option is not appropriate. B: The teacher wants to teach the child where the materials are so that he can access them independently. D: The child has a significant visual impairment and may not have enough vision to see where his peers are going or what they are doing.

A client with middle-stage dementia has been wandering outside the house in the middle of the night. The client's caregivers have been using monitoring devices and recently added door alarms, but by the time someone can attend to the client's wandering, the client is usually at the neighbor's driveway. The weather has become colder, and the family is concerned that the client will get frostbite if the client wanders outside again. What would be the OTR®'s next appropriate recommendation? Install bed rails to keep the client from climbing out of bed. Place the client in a nursing home Conceal the doorknobs so that the client cannot open the doors. Move the client's bed into one of the caregiver's rooms.

Solution: The correct answer is C. Visual barriers, such as concealing the doorknobs, have been found to be effective with people with dementia. The client might not attend to the doorknob because it is unseen or the client will find it difficult to open the doors and get out of the house. The concealed doorknobs might also give the family time to wake up and redirect the client. A: Installing bedrails could be considered a restraint. B: Nursing home placement does not appear to be viable because the family, through their efforts, appears to be invested in keeping the client with dementia in the home. D: Moving the client's bed into the caregiver's bedroom might be an option, if other environmental modifications do not work. Moving the bed into the caregiver's bedroom could also add to caregiver burden, which should be avoided.

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? Demonstrate and ask the client to imitate the OTR®'s movements. Guide the client through the physical movements of the task. Lay out the items needed for the task prior to the start of the session. Use verbal praise during each task to encourage on-task behavior.

Solution: The correct answer is C. Visual cues are significant at Level 4. Keeping items in plain view and minimizing clutter in the environment will facilitate this client's performance of self-care tasks. A: Imitation of the practioner's actions occurs at Level 3; this client is functioning at a higher level than that. B: Guiding the client through the physical actions of an activity is required at Level 2; this client is functioning at a higher level than that. D: At Level 5, clients are more aware of the social and physical consequences of their action, and verbal praise may be a more useful strategy. A client functioning at Level 4 will not be receptive to verbal praise.

An OTR® is working with a client who has visual processing speed and divided attention deficits. In assessing the client's fitness to drive skills, what task is likely to be MOST DIFFICULT for the client? Identifying a gray vehicle on a rainy day Accurately reading traffic signs or identifying colors on a traffic light Reacting quickly when a car pulls out in front of the driver's vehicle Accurately judging the space when pulling into a parking space

Solution: The correct answer is C. Visual processing speed and divided attention are the critical client factors necessary for dividing attention between multiple stimuli on the road and reacting quickly to prevent a potential adverse event. A: This ability pertains to contrast sensitivity. B: These skills pertain to color discrimination. D: This skill pertains to depth perception.

A client who suffered a stroke would like to return to work as a computer specialist. The OTR® is asked to explain vocational evaluation to the client. What explanation should the OTR® provide? Vocational evaluation determines the essential functions of a job area to conduct work tolerance screenings. Vocational evaluation identifies safety risks that may impede a worker's ability to complete job tasks. Vocational evaluation assesses a client's readiness and ability to engage in a particular occupation. Vocational evaluation determines an organization's compliance with the Americans With Disabilities Act.

Solution: The correct answer is C. Vocational evaluation may be conducted for a person who has not worked previously, who has been injured and is preparing to return to work, or is unable to return to a previous job. Vocational evaluation may be general or specific addressing a person's potential for work or readiness to return to a specific occupation. A: Essential functions of a job area are determined through a job demands analysis. B: Safety risks are more effectively evaluated through on-site job demands analysis. D: Compliance with the Americans With Disabilities Act is better identified through direct consultation with the organization.

Which outpatient treatment intervention is contraindicated for decreasing the arm edema and stiffness associated with complex regional pain syndrome of the upper extremity? Instruction in the use of contrast baths several times a day Instruction in performing gentle, pain-free AROM movements several times a day Provision of an arm sling to wear during the day Provision of a compression garment to wear during the day

Solution: The correct answer is C. Wearing an arm sling will increase stiffness and edema because it places the extremity in a dependent and static position for long periods of time. A, D: Taking contrast baths and using a compression garment are beneficial for edema control of the arm in a client with complex regional pain syndrome. B: Gentle, pain-free AROM encourages circulation, decreases stiffness, and may assist in interrupting the pain cycle

The client lives in a long-term care facility and uses a wheelchair to get to the dining room. The OTR® has removed the client's wheelchair footrests. Which reason BEST explains why the OTR® removed the footrests from the wheelchair? Staff push the client, and the footrests get in the way. The client's legs are short, so the client does not need the footrests. The client propels the chair using only the feet. The client propels the chair using only the hands.

Solution: The correct answer is C. When a client propels a wheelchair using only the feet, footrests are removed because they are in the way. A, D: Even if staff push the client or the client propels the chair using only the hands, the client would still need to have the feet on the footrests so that the legs do not dangle. B: A drop seat could be used if the client's legs are short to make sure the feet are supported on the footrests and do not dangle.

An OTR® and a Level II Fieldwork student at a long-term care facility observe a new resident moving his wheelchair forward by gripping the front of the pushrim and giving it multiple tiny pushes. The OTR® asks the student, "Why do you think he is pushing his wheelchair that way?" The student observes a bit longer and responds: The seat back is too low. The wheelchair is too wide. The seat back is too high. The armrests are too low.

Solution: The correct answer is C. When the seat back height is above the lower angle of the scapula, it can prevent adequate shoulder extension, which is necessary for contacting the pushrim. A, B: If the seat back of the chair was too low, the client would able to extend his shoulders and get a proper grip on the pushrim; if the chair was too wide, the client would only reach the top of the pushrim. D: If the armrests were too low, the client would have a greater ability to reach the top of the pushrim.

An OTR® in an inpatient setting is inviting an adolescent with major depression to participate in an individual treatment session. The adolescent has refused to participate for 3 days, claiming not to feel well. How should the OTR® BEST respond? "I think that participating in occupational therapy will make you feel a lot better." "I noticed you've been feeling like this for 3 days straight now, and it might be helpful for you to participate in occupational therapy." "I can see that you aren't feeling well. Let's try doing something you like that will not take too long and see what happens." "I can see that you aren't feeling well, and I'm sorry for this. Can we try again tomorrow?"

Solution: The correct answer is C. When working with a client who is depressed, it is essential to relate with understanding and empathy. Encouraging participation in any way can be helpful. A, B: Using a "snap out of it" attitude will not be beneficial for a depressed client. D: Not participating in any activity at all will not be beneficial for a depressed client.

A worker is injured at a construction site. The worker's case manager requests a referral to an OTR® through the employer's workers' compensation carrier. The employer frequently checks in with the worker and the case manager about the status of the case. Who is the client in this situation? Insurance carrier Case manager Worker Employer

Solution: The correct answer is C. Work injury cases involve many parties; the worker with the injury remains the client. A, B, D: Work injury cases involve many parties; the worker with the injury remains the client.

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? The condition progresses slowly, and children often experience difficulty with muscles around their pelvis and shoulder girdle. The condition progresses so that the facial muscles have decreased mobility; children eventually have a masklike appearance. The condition usually has onset during adolescence, and it progresses until children cannot raise their arms above their heads. The condition progresses quickly, and children often need to use a wheelchair by age 9.

Solution: The correct answer is D. A: This answer describes limb girdle muscular dystrophy, not DMD. B, C: These answers describe facioscapulohumeral muscular dystrophy, not DMD.

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? Zone I Zone II Zone III Zones IV and V

Solution: The correct answer is D. D: Zone IV consists of the transverse carpal ligament, and the median nerve runs under this ligament; Zone V is distal to this ligament and thus contains the median nerve branch. A, B, C: Zones I, II, and III do not contain the median nerve branch.

A client arrives at the occupational therapy clinic 10 minutes late for a session crying uncontrollably. When the OTR® attempts to engage the client in conversation, the client responds, "I don't want to talk about it. Is that so bad?" Which response would be MOST effective? "Let's have our session later, after you've stopped crying." "You poor thing! How can I help you?" "Come on, now; that's enough of that." "It must be very difficult."

Solution: The correct answer is D. "It must be very difficult" acknowledges the client's feelings without being judgmental and lets the client know that the OTR sees that client is upset. A, C: Postponing the session or telling the client to stop crying do not demonstrate empathy toward the client and will hinder the establishment of trust and rapport. B: Saying "You poor thing" conveys pity, which can be destructive to the therapeutic relationship.

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

Solution: The correct answer is D. A boney block can only be removed surgically. 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 evaluating a client with Stage 4 Parkinson's disease (PD). During ROM and manual muscle testing, the client presents with cogwheel motions and is mostly quiet with an occasional moan. What would be the BEST action for the OTR® to take? Continue testing, then apply heat or ice (to the client's preference) to reduce pain associated with stiffness. Study the client's facial expressions and body language to determine which specific movements elicit a pain response. Discontinue the manual muscle testing and assess at a later time. Continue with gentle stretching, and determine pain by asking clear questions that require a one- or two-word response.

Solution: The correct answer is D. A client with advanced PD would likely experience common symptoms such as muscle rigidity, which may be exacerbated by ROM or manual muscle testing. "Cogwheeling, common in clients with Parkinson's disease, is identified by jerky movements and is considered rigidity superimposed on tremor. Rigidity often is associated with musculoskeletal pain" (Cooper, 2008, p. 477). The client may not be able to tell the OTR® that he or she is experiencing pain; it is critical that the OTR® help the client feel comfortable with hands-on techniques and assess verbally in clear, concise language, with close-ended questions. A: The OTR® must further evaluate the pain before intervening with a modality; although moist heat is a modality that may lessen the pain from rigidity, ice may worsen symptoms. B: A common symptom of PD is a masklike facial expression; the flat affect and lack of nonverbal communication makes it necessary to assess pain by other means. C: For a thorough evaluation, it would not be best to fully discontinue the ROM and manual muscle testing without further measuring the client's movements and pain.

An OTR® assesses a client using the Allen Disability Framework. The client scores an Allen Cognitive Level (ACL) of 4.0. Given this score, what discharge arrangement would the OTR likely recommend for this client? This client could be discharged home alone with weekly checks for novel safety issues and health maintenance needs and reminders. This client could be discharged home with family for support in all areas of IADLs and personal care including bathing, dressing, and hygiene. This client should remain in the psychiatric facility under close 24-hour supervision for safety and personal care needs. This client could be discharged to a supported living arrangement with the expectation that the client can independently complete the morning self-care routine

Solution: The correct answer is D. A client with an ACL of 4.0 should be in a supported living arrangement but would be expected to complete habitual routines independently (e.g., morning self-care). A: This response indicates a person functioning at an ACL of 5.2. B, C: These responses indicate a person with an ACL of less than 4.0, because a person at such a level will require close supervision and support for all needs.

Which behavioral symptom might a client with early-stage dementia have? Pacing Difficulty choosing appropriate clothing Vulgar or rude language Suspicion

Solution: The correct answer is D. A client with early-stage dementia might become suspicious; it is common for clients to think misplaced items have been stolen or that their spouse may be unfaithful. A, B, C: Pacing, difficulty choosing appropriate clothing, and vulgar or rude language are all common behavioral symptoms of middle-stage dementia related to loss of impulse control and difficulty communicating needs.

A client 6 months post-stroke has made almost a complete recovery except for weakness in the left leg and slight restriction with left ankle plantar flexion. The client has not driven since the stroke. The OTR® decides to do a behind-the-wheel assessment. Which choice is BEST for such an assessment? A fixed route incorporating driving in a residential area, city, and highway. A two-lane road with moderate speed (45 miles per hour) during peak traffic hours Only in the client's familiar environment A closed-road course in a protected environment

Solution: The correct answer is D. A closed-road course in a protected environment limits exposure to other traffic, traffic control devices, objects, and pedestrians and allows the client to execute basic vehicle maneuvering in a controlled environment. The driver rehabilitation specialist can then concentrate on closely observing the client to determine the client's ability to continue with the on-road evaluation. A: A fixed route of this type is not appropriate because the client has not driven since the stroke and may not be able to meet the demands of this route. B: This approach is not appropriate because of the moderate speed requirements, which may be difficult for the client to follow as a result of residual deficits. C: The client's environment may still pose traffic challenges requiring intact fitness-to-drive skills.

An OTR® receives a referral to complete a functional capacity evaluation (FCE) on a client 2 months after a Stage 2 quadriceps strain. The client is employed as a police officer and sustained the injury during an altercation with a suspect. To identify the client's essential job functions, which sources would be BEST for the OTR to use? The U.S. Department of Labor's Dictionary of Occupational Titles, O*Net, job classifications, and client interview Employer-provided job description, client and supervisor interview, and completion of a vocational evaluation The National Institute of Occupational Safety and Health (NIOSH) guidelines, job description, and client interview The U.S. Department of Labor's Dictionary of Occupational Titles job classifications and job description

Solution: The correct answer is D. A comprehensive FCE should assess all the physical demands of work as defined by the Dictionary of Occupational Titles (DOT). The DOT serves as a source document for job demands and aptitudes for all job classifications. OTR®s should refer to DOT and the employer-provided job description to identify essential job functions. A: Client interview is subjective; therefore, review of an employer-provided job description is recommended. B: Supervisor interview is subjective. Vocational evaluation is a comprehensive assessment to evaluate a person's potential to do any type of work and to determine one's aptitudes, abilities, and interests to explore all reasonable options for work. C: NIOSH provides recommendations related to prevention of workplace illness and injuries.

An OTR® is screening an older adult who has had a stroke. The physician's referral notes that the client eats food on only half of the plate and completes grooming tasks swiftly, making many mistakes. Which scanning pattern would be MOST likely to prompt the OTR to recommend additional testing for unilateral neglect? Organized, symmetrical scanning Rescanning with an organized scanning Abbreviated or shortened scanning Disorganized, random scanning

Solution: The correct answer is D. A disorganized, random scanning pattern is characteristic of unilateral neglect, which can be further assessed using a cancellation, drawing, or reading task. A, B, C: An organized and symmetrical scanning pattern, rescanning with an organized scanning pattern, and an abbreviated or shortened scanning pattern are all characteristic of visual field deficit, not unilateral neglect.

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

Solution: The correct answer is D. A firmly based chair with armrests is recommended for clients with hip replacement; chairs with cushions or rocking functions may negatively affect hip precautions because of variability in surface. A: A chair with wheels is unstable for safe transfers, regardless of sturdiness. B: A traditional recliner does not provide adequate support to ensure hip precautions. C: A rocking chair is unstable for safe transfers.

An OTR® is working with a teenager with autism on eating in the cafeteria using good table manners. Which strategy would be appropriate to meet this outcome? Partially feeding the teenager and using a backward chaining technique Requesting that the teenager take a time out or break to work on self-calming strategies Delaying gratification by postponing lunch until the teenager can demonstrate good table manners Encouraging the teenager to model the behavior of a peer who is eating with good table manners

Solution: The correct answer is D. A modeling strategy, which would consist of having a peer complete the task and then having the child copy the peer, is the most appropriate option. A, B, C: These strategies would not provide the teenager with a clear understanding of the expectations for behavior in the cafeteria.

An OTR® is completing an initial evaluation with a client who has relapsing and remitting multiple sclerosis. Sensorimotor skills assessment indicates that the client's daily activities are limited by low endurance and decreased upper-extremity coordination. In addition, the client has been unable to remain in a job as a clerical worker. What additional information is MOST important to gather before developing an intervention plan? Medical test results, including neurological and imaging exams Availability of home care services to support the client in the home and recommend modifications Reports of other health professionals involved in the client's care Contextual and environmental factors that support the client's ability to adapt to the diagnosis

Solution: The correct answer is D. Contextual and environmental factors provide information about a client's available support systems, which can influence his or her ability to adapt to the diagnosis. A, B, C: Although these sources provide important information, this information is not critical in devising an intervention plan for the client.

An OTR® is working in a school with a high incidence of violence in a district with increasing numbers of students diagnosed with oppositional defiant disorder. The superintendent announces the formation of a task force to study the problem. Which response to this announcement would be BEST? Document the progress the OTR® has made with students with oppositional defiant disorder to justify continuing work with these students Increase the frequency of visits to the students on the OTR®'s caseload with this diagnosis because the task force will scrutinize intervention with these students Research intervention strategies to make sure that the intervention the OTR® has been providing to these students is considered best practice Contact the superintendent and request to be appointed to a seat on the task force to study violence and the incidence of oppositional defiant disorder

Solution: The correct answer is D. AOTA's societal statement on youth violence has clearly articulated the role occupational therapy should play in this area. Prevention is within the scope of occupational therapy practice, and practitioners should welcome any opportunity to participate. A: Documentation should always be kept up to date. B: Frequency of visits to clients should be determined case by case on the basis of the client's needs, not a potential threat of scrutiny. C: Researching intervention strategies to ensure that one is engaging in best practice should not be done retroactively but rather as a proactive, ongoing process.

A 76-year-old client will be using a wheelchair after discharge from an acute rehabilitation facility. The client has achieved independence in wheelchair mobility on level surfaces but still requires minimal assistance for transfer. The client is planning to move into a daughter's home, which was not the client's previous residence. The OTR® conducts an onsite home evaluation with the client and the client's daughter. During the home evaluation, it is obvious that the hallway to the bathroom is too narrow for the client to turn the wheelchair without assistance. What would be the MOST APPROPRIATE transitional recommendation to include in the report? Referral to homecare occupational therapy for wheelchair mobility training Training in a 3-point wheelchair-turning technique in a narrow hallway Wearing an adult diaper and refraining from using the bathroom Securely placing a bedside commode between the bed and the side wall

Solution: The correct answer is D. Access the bathroom using a wheelchair is often challenging. A bedside commode provides an alternative means for toileting. A: Although referral to homecare occupational therapy is appropriate for general home safety and functional mobility, it may not be appropriate for wheelchair accessibility training in a narrow hallway. B: A 3-point wheelchair-turning technique is very labor intensive and not practical for daily and frequent use. C: Encouraging a client to use an adult diaper reinforces dependent behavior and should be avoided.

A client with multiple sclerosis has recently become more dependent on a manual wheelchair for functional mobility. The client lives alone and wants to remain independent. The house has two entrances: The front entrance has four steps with a total height of 28 inches. The entrance from the backyard has a 5-inch-high threshold and another separate 5-inch-high step 10 feet away from the threshold. What would be the MOST appropriate ramp modification for this client? A 14-foot-long ramp at the front entrance A 28-foot-long ramp at the front entrance A 20-foot-long ramp at the back entrance, covering the step Two 5-foot-long ramps for the back entrance and the step

Solution: The correct answer is D. According to the Americans With Disabilities Act of 1990 (Pub. L. 101336) accessibility guideline, the maximum slope of a ramp is 1:12. Using two ramps at the back entrance has the advantage of shorter ramps, which are easier for a wheelchair user. A: A 14-foot ramp will make the slope too steep for wheelchair use. B: The front entrance, with a total height of 28 inches, will require a 28-foot-long ramp. Propelling a wheelchair safely up and down a ramp of this length is very taxing for a wheelchair user. C: Propelling a wheelchair safely up and down a continuous, 20-foot-long ramp will be very tiring for a wheelchair user, especially a client with multiple sclerosis.

An OTR® completed a functional capacity evaluation on a client previously employed as a painter before undergoing a rotator cuff repair. To ensure quality services are provided as part of this client's work conditioning program, what should the OTR® do FIRST? Refer the client to a vocational rehabilitation counselor. Instruct the client in proper body mechanics. Modify paint roller and brush handles. Design a circuit to include aerobic conditioning.

Solution: The correct answer is D. Aerobic conditioning is a component of a work conditioning program. A: Vocational counseling and assessment is a component of work hardening program, not a work conditioning program. B: Instruction in proper body mechanics can be incorporated into the work conditioning program. C: Before making modifications to tools, the client should undergo treatment to maximize functional abilities.

An OTR® working in a neurology unit was referred a client with low back pain. During the interview, the client mentions that the low back pain started after several stressful life events, but the client does not recall a specific injury. Malingering and fear of illness do not seem to be a part of this scenario, because the client is eager to resume exercise and other activities. What is the client's likely diagnosis? Low back pain Factitious disorder Histrionic personality disorder Conversion disorder

Solution: The correct answer is D. All symptoms point to conversion disorder, also known as functional neurological symptom disorder. A: Organic low back pain is caused by traumatic or repetitive musculoskeletal injuries. B, C: The case as described includes no signs of factitious disorder or histrionic personality disorder.

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? Methods for immobilizing the hand, importance of taking anti-inflammatory medications, and typical work restrictions Handouts illustrating therapy putty exercises, proper wear and care of a resting hand splint, and methods for completing contrast baths Instructions for upper-extremity strengthening using therapy bands, fine motor activities, and stress-loading exercises Techniques for managing edema, illustrations of tendon glide exercises, and methods for modifying daily activities

Solution: The correct answer is D. Controlling edema, initiating tendon glides, and making recommendations for modifying daily activities are all strategies that are indicated in the early nonoperative management of carpal tunnel syndrome. A: The hand does not require immobilization in conservative management of carpal tunnel syndrome; the wrist may be immobilized in neutral to minimize median nerve compression. B: A resting hand splint is not indicated in conservative management of carpal tunnel syndrome; the wrist may be immobilized in neutral to minimize median nerve compression. C: Stress loading is not indicated at any stage of carpal tunnel syndrome management.

A client with a learning disability is interested in exploring work opportunities after high school graduation. The client has difficulty sequencing more than three-step directions and lacks attention to detail. Which option would be considered a component of the planning process for the student's transition from high school? Completion of a transition-related evaluation by a vocational rehabilitation counselor to identify the student's strengths, weaknesses, and interests Completion of a job site analysis with physical demands to determine the feasibility of the client's performing specific tasks Provision of written directions to complete a three-step task and use of samples to promote problem solving Situational observation, interview, and activity analysis to determine a match between the client's abilities and expected performance

Solution: The correct answer is D. An effective transition-related evaluation primarily uses situational observation, interview, and activity analysis to determine a match between the client's abilities and expected occupational performance. A: A transition-related evaluation is typically completed by an OTR®, not a vocational rehabilitation counselor. B: Completion of a job site analysis is clinically indicated and is a component of a transition services evaluation. C: Provision of written directions and work samples may be components of client's program implementation; however, the OTR must determine whether the client has the cognitive ability to follow written directions.

An OTR® wants to evaluate a client's fitness to drive. Which off-road assessment would be the BEST for the OTR® to administer? A computer-based information-processing training tool An off-the-shelf driving-based computer game A brake reaction timer used to simulate braking An interactive computer-based program to simulate the activity of driving

Solution: The correct answer is D. An interactive computer-based program to simulate the activity of driving, also known as a driving simulator, is the best off-road choice because of its relative validity with on-road outcomes. A: This tool will only provide information on processing speed. B: No empirical evidence exists to suggest that an off-the-shelf driving-based computer game can assess fitness-to-drive skills. C: This test will only provide information on reaction time, not fitness to drive.

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? Ulnar claw Boutonniere deformity Swan neck deformity Ape hand deformity

Solution: The correct answer is D. Ape hand deformity is the result of median nerve injury at the elbow or proximal forearm. A: Ulnar claw is a result of an ulnar nerve injury and hyperextension of the metacarpophalangeal joint in the small and ring finger with proximal interphalangeal flexion. B, C: Boutonniere and swan neck are finger deformities and structural ligament injuries.

An OTR® is working in a preschool with a child who has a developmental delay in toileting. The child is beginning to show interest in toileting and can stay dry for more than 2 hours at a time. What is the next "just-right" challenge for this child? Moving the bowels regularly Wiping independently after having a bowel movement Managing clothing during toileting Telling someone when he or she has to go to the bathroom

Solution: The correct answer is D. At age 2, children typically begin to show interest in toileting, can stay dry for 2 or more hours, and can flush the toilet independently and urinate regularly. The next developmental challenges include telling someone that they have to use the bathroom, waking up dry after sleeping, wiping self after urinating, and washing hands independently. A: A child typically has regular bowel movements by age 18 months. B, C: Wiping independently after a bowel movement and managing clothing independently typically happens after age 3 and usually before age 5.

A client with multiple sclerosis (MS) reports decreased ability to pay attention to daily work-related tasks, including keeping track of documents and phone calls. Which strategy is the MOST appropriate for this client? Change the work environment to work at home Modify the workload to decrease fatigue levels Improve lighting in the work environment Complete one task at a time and avoid multitasking

Solution: The correct answer is D. Attention to task is a cognitive skill that benefits from a cognitive compensatory approach in clients with MS. Avoiding multitasking helps the client pay attention to one task a time, improving focus on each task. A: Changing the work environment to work at home would not address the client's ability to track documents and phone calls. B: Fatigue may affect cognition; however, modifying the workload is not the most appropriate intervention to address decreased attention to tasks. C: Lighting would not influence the client's ability to attend to tasks.

A new OTR® receives a referral to evaluate a very depressed client. The new OTR®'s supervisor recommends using motivational interviewing as the main source of information during assessment. Which statement is one of the four general principles of motivational interviewing that guides the interaction between a client and an OTR®? Test the client's sense of reality. Identify the problem. Identify the good and bad points of a behavior. Avoid argument and opposition to the client's resistance.

Solution: The correct answer is D. Avoiding getting into arguments or opposing the client's resistance refers to the "roll with resistance" principle of motivational interviewing. A, B, C: The principles of motivational interviewing are to roll with resistance, express empathy, develop discrepancy, and support self-efficacy. These answers do not support any of these principles.

An OTR®; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The OTR writes the following goal for one group member using the COAST method: "The client will cook a meal before being discharged." What conclusion can you draw about the specific conditions (or S) under which this client is supposed to complete the occupation? The client will complete the occupation in the hospital's kitchen with adaptive equipment. The client will complete the occupation at home with no adaptive equipment. The client will complete the occupation at a community transitional facility using modified techniques. The client will complete the occupation in the hospital's kitchen using no adaptive equipment or modified techniques.

Solution: The correct answer is D. Because no specifications are given for adaptive equipment or modified techniques and the client is attending a predischarge hospital cooking group, it is appropriate to assume that the client will not require special conditions for the completion of this goal and that the occupation will be completed in the hospital's kitchen. A, B, C: These statements assume conditions that were not specified in the goal.

A client with amyotrophic lateral sclerosis requires significant assistance with ADLs because of limited upper extremity function and fatigue. The client reports an increase in shoulder pain, and the OTR® observes edema in the hand. The client uses a wheelchair, and during the occupational therapy evaluation the OTR observes the client's arm hanging at the side of the wheelchair. Which intervention is BEST to address the shoulder pain and hand edema? Train the caregiver in PROM for the arm and hand Advise the client to continue normal activities, using the arm as tolerated to provide active motion Fit the client with an adaptive device for grasp, such as a universal cuff Provide appropriate arm support using a sling or wheelchair device

Solution: The correct answer is D. Because of the client's dependence on wheelchair positioning and loss of upper extremity function, external arm support may be needed to facilitate proper positioning while the client is in the wheelchair and thereby minimize shoulder pain and hand edema. A: PROM is important in maintaining upper extremity mobility, but it is not the first priority when a client is experiencing shoulder pain and hand edema. B: For the client to be able to participate in typical activities, the pain and edema need to be addressed first. C: A universal cuff is contraindicated with hand edema, and the evaluation findings do not indicate that the client is experiencing decreased grasp strength.

When considering a wheeled mobility device with a client, the OTR® proposes a scooter. Which of the following client characteristics was the primary reason for proposing a scooter versus a manual wheelchair? The client is unable to safely ambulate in the home. The client's home can easily accommodate a wheeled mobility device for moving from room to room in the home. The client claims he will consistently use any wheeled mobility device he is prescribed. The client is able to walk around his home, but cannot walk any distance in the community.

Solution: The correct answer is D. Because the client is able to walk around his home he does not qualify for a manual wheelchair. A, B, C: These statements reflect Medicare criteria that must be met for a manual wheelchair

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? How long the pain and swelling have been present What prior surgeries the client has had What activities aggravate the pain and swelling What the client's medications and medication allergies are

Solution: The correct answer is D. Before applying any medication using phonophoresis, the OTR® needs to be aware of the client's current medication and any medication allergies. A, C: Knowing the duration of and triggers for pain can influence the choice of settings and the kind of medication used for effective treatment. B: Surgeries (e.g., implantation of a cardiac pacemaker) would not affect treatment of the arm.

An OTR® 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? "Keep feet close together for stability during client transfers." "Bend at the waist when performing dressing changes." "Arms should be outstretched when lifting." "Bend at the knees, and keep shoulders and hips parallel."

Solution: The correct answer is D. Bending at the knees ensures that the caregiver will use the large muscles of the lower extremities during heavy work. In addition, keeping shoulders and hips parallel protects the lower back from unnecessary and dangerous twisting when moving heavy objects. Both techniques together will ensure the best outcome for the caregiver. A: Feet should be put one in front of the other or in a wide stance to provide a wide base of support. B: Caregivers should bend at the knees and avoid bending at the waist to protect their lower back. C: Use the largest muscles of the body; arms outstretched will add unnecessary strain to the back during heavy work.

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? Swan neck deformity Mallet finger deformity Ulnar drift deformity Boutonnière deformity

Solution: The correct answer is D. Boutonnière deformity is defined as PIP flexion combined with DIP hyperextension. A, B, C: Swan neck deformity, mallet finger deformity, and ulnar drift deformity are other common deformities of the hands in RA; however, they do not involve PIP flexion combined with DIP hyperextension.

At what stage of Alzheimer's disease (AD) does nerve cell damage cause significant motor impairments that limit the ability to complete life tasks? Mild cognitive impairment Early stage Middle stage Late stage

Solution: The correct answer is D. By the late stage of AD, nerve cell damage has become so significant that not only are cognitive processes impaired, but motor skills are also affected. A, B, C: Motor skill deficits are minimal in middle-stage dementia and imperceptible in earlier stages of AD.

A 5-year-old client has been referred for fabrication of an orthosis after a flexor tendon repair. Which protocol would be MOST appropriate for this client? Early active motion Duran protocol Kleinert protocol Immobilization orthosis for 3-4 weeks

Solution: The correct answer is D. Children who cannot understand or follow a prescribed protocol for motion are best treated initially with an immobilization orthosis to strengthen the repair before movement to reduce the chance of rupture. A, B, C: These protocols are more appropriate for adults, who are able to follow directions and adhere to instructions.

Which occupation might a child with arthrogryposis multiplex congenital likely have difficulty with? Being fed. Socializing with friends Listening to a teacher's instructions. Donning a shirt.

Solution: The correct answer is D. Children with arthrogryposis multiplex congenital have incomplete contractures or fibrous ankylosis of all or many of their joints, which would make donning a shirt, the only occupation that involves the use of the extremities, difficult without adaptive equipment or modified techniques. A, B, C: Children with arthrogryposis multiplex congenital have incomplete contractures or fibrous ankylosis of all or many of their joints. These options do not involve the child using the extremities.

A client is wearing a splint secondary to having had a flexor tendon repair of the third and fourth digits 2 weeks ago. The client is registered to compete in a motorcycle race during the upcoming weekend. The client informs the OTR® that the splint must be removed in order to properly grasp the motorcycle's hand clutch. What INITIAL action should the OTR® take in this situation? Schedule a follow-up appointment for the week following the race to reassess the client's status. Discharge the client from occupational therapy due to noncompliance with the post-surgical protocol. Fabricate a temporary splint for the patient to use during the motorcycle race. Explain the consequences of the client's decision on the overall post-surgical outcomes.

Solution: The correct answer is D. Clients have the ultimate responsibility for decisions about their daily needs, and occupational therapy services and the practitioner can help the client make an informed decision. A: The client should have a follow-up appointment, although the most important initial action is to inform the client about the impact of the decision. B: Clients have the ultimate responsibility for decisions on their care, and practitioners must respect clients' choices so discharging the client from services is not appropriate. C: Fabricating an alternative splint for the client would present a possible risk to the client if the activity is contraindicated in the recovery. The practitioner cannot put accommodating the client's choices above safe intervention.

During the initial evaluation, a client with multiple sclerosis (MS) reports feeling overwhelmed by choices for daily activities and symptom management. Which intervention is MOST appropriate for this client? Collaborate with the caregiver to plan routines for the client Refer the client to a social worker to manage daily activities and symptoms Refer the client to a psychologist to discuss feelings of being overwhelmed Collaborate with the client to develop self-management skills

Solution: The correct answer is D. Clients who develop self-management skills have higher quality of life. Using self-management skills allows clients to make sure their needs are met and their unique circumstances are addressed. A: Clients with MS should have as much control over their daily routines as possible, so having the caregiver plan routines for the client is not the most appropriate strategy. B: A social worker does not specialize in establishing daily activity routines, which are best addressed through occupational therapy intervention. C: Referral to a psychologist may be necessary to allow the client to discuss feelings of being overwhelmed; however, occupational therapy is the discipline that best addresses daily activity needs and symptom management for clients with MS.

A 76-year-old client will be using a wheelchair after discharge from an acute rehabilitation facility. The client has achieved independence in wheelchair mobility on level surfaces but still requires minimal assistance for transfer. The client is planning to move into a daughter's home, which was not the client's previous residence. The OTR® conducts an onsite home evaluation with the client and the client's daughter. In determining accessibility of the home environment during the onsite home evaluation, with what area of evaluation will the OTR® be MOST concerned? Location and height of light switches Presence of clutter in the environment Arrangement of furniture in the bedroom Width of doorways and hallways

Solution: The correct answer is D. Clients who use a wheelchair as a primary means of functional mobility require wider doorways and hallways for accessibility. Structural modifications may need to be done if the entryway to the house has any barrier. A: Light switches that cannot be reached can be easily modified with other alternative input methods. B, C: Furniture can be rearranged and clutter reduced or eliminated to allow for wheelchair accessibility.

An OTR®; is concerned with preventing shoulder pain in a client with hemiparesis in the acute stages of stroke recovery. Which intervention is appropriate to prevent shoulder pain in this client? Allow the client to dangle the hemiplegic upper extremity alongside the chair Position the client in side lying on the hemiplegic side with internal rotation and scapular retraction Use overhead pulleys with prolonged stretch at end range Emphasize activities that allow external rotation, shoulder flexion within 90°, and scapular protraction

Solution: The correct answer is D. Clients with hemiparesis should be encouraged to move the upper extremity with external rotation, shoulder flexion within 90°, and scapular protraction to allow for optimal motor recovery by promoting soft-tissue elongation. A. The upper extremity of clients with hemiparesis should be supported at all times by resting it on a surface or using the unaffected upper extremity to position the affected upper extremity. Gravity provides too much force on already weakened muscles and may further the dissociation of the humeral head from the shoulder joint. B: Positioning of the upper extremity in clients with hemiparesis should emphasize external rotation to neutral and scapular protraction. C: Overhead pulley systems should be avoided at all times because of the potential to increase pain in the upper extremity of clients with hemiparesis.

An OTR® is working with a driver who is experiencing visual neglect poststroke. What is the MOST APPROPRIATE compensatory approach the OTR® can use to help the driver improve on-road performance? Teach the person to look at a reference point in the vehicle, such as the center of the hood, to improve lane maintenance. Avoid night driving to limit exposure to the bright lights from other vehicles Avoid driving in peak traffic hours and in inclement weather. Awareness training pending the client's insight.

Solution: The correct answer is D. Clients with neglect or visual attention deficits are usually anosognostic and do not gain insight into their impairment, or the effect of the impairment, on driving performance. A, B, C: These compensatory strategies are not the best choice because of the client's visual attention deficits.

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? Partial or full absence of the capitates and hamate and muscle hypertrophy Dislocation of the humerus and signs of nerve damage Bony malformations and underdeveloped musculature Partial or full absence of the radius and bowing of the ulnar shaft

Solution: The correct answer is D. Congenital club hand is associated with partial or full absence of the radius and bowing of the ulnar shaft. In addition, the upper extremity nerve and musculature are either absent or underdeveloped. A, B, C: These options include a partial presentation of congenital club hand (e.g., nerve damage or underdeveloped musculature), but they also include information about presentations that are not aligned with this condition.

An OTR is evaluating a client for an injury to the right middle finger. On assessment, the OTR notices that the client is unable to extend the distal interphalangeal (DIP) joint but can move it into extension passively (mallet finger). What treatment plan would the OTR recommend for this injury? Electrical stimulation and ultrasound to facilitate extensor tendon gliding A hand strengthening program Resting of the joint A static orthosis holding the DIP joint in slight hyperextension

Solution: The correct answer is D. D: An orthosis holding the DIP joint in slight hyperextension places the tendon on slack for optimum healing of the extensor tendon injury. A: Electrical stimulation and ultrasound are not used on tendon injuries until 6-8 weeks postinjury. B: Gripping activities can damage the tendon further initially. C: The joint does need to rest, but the slight hyperextension position is essential to place the tendon on slack for healing.

An OTR is working with a child who has an epiphyseal fracture of the proximal interphalangeal bone with slight malalignment. Which intervention is MOST appropriate for a child with this condition? Do nothing; the child's fracture will heal and no occupational therapy is required Fabricate a serial cast for the child's finger Fabricate a dynamic splint for the child's finger Buddy tape the finger to an adjacent finger

Solution: The correct answer is D. D: The least invasive and most effective treatment for a slight malalignment is buddy taping, and this is the intervention the child would be most likely to tolerate. A: Because it is an epiphyseal fracture, it is important to realign the bone for future growth. B, C: A serial cast or dynamic splint is generally unnecessary for slight malalignment secondary to fracture and may not be well tolerated by children.

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? Progress notes that include pain reports, psychosocial complaints, modalities received, job analysis, and plans for next session Daily notes that reflect a detailed description of circuit training, including duration, number of repetitions, or both Progress notes that reflect the client's attendance, number of sessions, and response to the program Progress notes that reflect daily gradations of activities and exercises arranged in a therapeutic hierarchy

Solution: The correct answer is D. Daily gradations may not be clinically indicated for all clients. In the case of cumulative trauma disorders, clients may need to have tissue tolerance established by focusing on one specific job demand. A, B, C: These responses are reflective of documentation content that should be included in work hardening programs. A: Progress notes may also include pain behaviors, progress to date, meetings held, classes attended, cancellations of appointments, and client's attempts to problem solve and descriptions of any modifications. B: Daily circuit and schedule sheets are recommended for all clients to foster client responsibility for and independence with the program. C: Progress notes should complement initial and discharge summaries and keep the treatment team abreast of progress or problems.

A child with attention deficit hyperactivity disorder (ADHD) is seeing an OTR® to work on developing on-task behaviors in the classroom. Which intervention strategy would be appropriate to support the child in developing on-task behaviors? Modifying the classroom environment so that the child is not sitting near close friends and will have a tendency to talk less to the surrounding students. Introducing the child to other students with ADHD so that they can discuss what it feels like to have this condition. Requesting that the teacher not penalize the student for off-task behavior until the student's medication has been adjusted. Developing a behavior modification program in which the child is rewarded for being on task at different intervals throughout the day.

Solution: The correct answer is D. Developing a behavior modification program in which the child is rewarded for being on task at different intervals throughout the day would be an appropriate occupational therapy intervention to support the child in developing consistently on-task behaviors. A: A child with ADHD may still become off task, even if he or she is not sitting near friends. B: Although it might be helpful for the child to meet other people with ADHD, he or she may not learn any strategies that will help with staying on task. C: A child with ADHD may continue to demonstrate off-task behaviors, even if he or she is on medication.

An OTR® works in an interdisciplinary adult day program for clients with chronic mental illness. Other professionals working in the program include a recreational specialist, an art therapist, and a social worker. For what area is the OTR® MOST likely to assume leadership? Creative expression Crisis management Sports activities Community integration

Solution: The correct answer is D. Each of the four choices would include opportunities for the OTR® to provide service. However, OTR®s focus more directly on activities needed for participation in the community. A: This approach would be taken by an art therapist. B: This approach would be used by a social worker. C: This approach would be used by a recreational specialist.

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? Functions that an employer determines are to be completed by each employee The physical functions of a job task, such as hand manipulation skills for writing The speed with which each task must be performed on the job to meet productivity standards Functions that an employee must be able to complete, with or without a reasonable accommodation

Solution: The correct answer is D. Essential job functions, as defined by the ADA, are those that the employee must be able to complete, with or without accommodation. The ADA distinguishes between job functions that are essential—that is, those that must be completed by the employee—and functions that can be carried out by other employees in the same environment when an employer is making decisions about hiring and accommodating someone with a disability in the workplace. A: An employer provides judgment as to what each employee's essential job functions are, but the employer's judgment in determining essential job functions is not all encompassing. B: The physical functions of a job are not considered, only the outcome of the work task. The ADA distinguishes between what needs to be done and how it should be done. C: Speed is a determinant of essential job functions, along with other factors, but it does not define them.

During an occupational therapy session, the spouse of a patient asks the OTR® to use a treatment technique described on an Internet website. The OTR® is not familiar with the technique, but the spouse insists, "There's nothing to lose by trying it." What is the BEST action for the OTR® to take in response to this request? Ask the spouse to provide the Web address of the Internet site in order to complete more research. Complete the facility's human subject protocols prior to beginning the treatment technique. Obtain the patient's written consent prior to beginning the requested treatment technique. Perform a literature search about the treatment technique prior to discussing it further with the spouse.

Solution: The correct answer is D. Evidence-based practice is a priority within occupational therapy, and using evidence-based interventions is associated with better outcomes for clients. The practitioner is obligated to establish the credibility of an intervention before implementing it with a client. A: Exploring the Web address from the spouse may be necessary once the practitioner determines the literature available for the intervention; however, credible sources of peer-reviewed literature should be sought first. B: The practitioner is not initiating an applied research project even if the intervention is tried with the client, so human subject protocols are not needed. C: The practitioner is not initiating an applied research project even if the intervention is tried with the client, so informed consent is not required, though the client should have consented to occupational therapy services at the start of services. The practitioner is also obligated to inform the client of risks associated with experimental interventions.

An OTR® is treating a client with decreased digital range of motion and minimal subacute edema of the same hand. After ascertaining that there are no contraindications to modality use, which preparatory method is the BEST choice for before therapeutic activities? Pneumatic pump application to the hand and digits Contrast bath application to the hand and digits Mild cold pack application to the hand and digits Mild, superficial heating application to the hand and digits

Solution: The correct answer is D. Heating between 71.6°F and 105.8°F increases lymph flow and helps soften tissues to promote increased range of motion. Heating does not exacerbate minimal edema. A: Pneumatic pumps are rarely used in hand therapy. B: No evidence indicates that contrast baths reduce edema. C: Cold application is usually used to control acute inflammation. Acute edema occurs within the first 24 to 72 hours after injury.

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? 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 Volar-based ulnar gutter with MCP and IP joints of the ring and fifth fingers in 0° extension and the wrist in neutral Dorsal-based wrist cockup splint with MCP and IP joints free and the wrist in approximately 20° extension 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

Solution: The correct answer is D. Holding the MCP joints in flexion helps prevent contracture of the collateral ligaments. A: A dorsal hood splint does not offer adequate protection for the fractured metacarpal. B: Maintaining the MCP joint in extension may lead to collateral ligament shortening and decreased ability to flex the MCP joint after the fracture is healed. C: Maintaining the MCP joints in extension may lead to shortening of the lateral bands and joint contractures.

What is the first course of action an occupational therapy practitioner should take to begin to resolve an ethical dilemma? Formulate possible resolutions to remediate the dilemma. Identify the resources available to resolve the dilemma. Report the ethical dilemma to the state regulatory board. Determine whether an ethical violation has occurred.

Solution: The correct answer is D. Identifying whether an ethical violation occurred should take place before determining the best solutions, identifying the resources available, and reporting the violation to regulatory boards. A, B: These courses of action might possibly be taken later; the situation first needs to be identified as an ethical dilemma. C: This course of action would occur later, if at all, once the situation was identified as an ethical violation and remediation at the facility level was tried.

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? Begin using desensitization with the texture that is the most irritating to the client Begin using desensitization at the most sensitive area to be treated Instruct the client to use the desensitization techniques one or two times a day for 30 minutes each as part of a home program Instruct the client in use of a transcutaneous electrical nerve stimulation (TENS) unit during desensitization activities

Solution: The correct answer is D. If desensitization is poorly tolerated, the activity can be combined with use of a TENS unit initially to decrease the client's perception of pain. A, B: Desensitization begins with the least irritating texture in the least sensitive area to be treated. C: Desensitization is best used for short periods (3 to 5 minutes five or six times per day).

A student in kindergarten has dyspraxia and frequently falls when playing at recess and during gym class. When completing at-desk art and writing activities, the student often reverses numbers and letters and holds the pencil with an immature grasp. What should be the INITIAL focus of intervention sessions with this student? Identifying assistive devices for improving handwriting legibility Using parquetry activities for improving visualspatial and visualmotor skills Engaging in fine motor games to increase pinch and grip strength Providing a just-right challenge during gross motor play activities

Solution: The correct answer is D. Improving the child's safety during recess and gym class should be the first priority of the intervention plan, so addressing gross motor play skills is most appropriate. Providing the just-right challenge will allow the child to participate in tasks that do not overwhelm yet are also not so simple that the task is routine or uninteresting. This challenge will allow the child to develop praxis with gross motor play. A: Identifying assistive devices for handwriting may be a component of the intervention but should not be the initial focus of the intervention plan; improving the child's safety with play is most important. B: The scenario does not suggest that visualspatial or visualmotor skills are interfering with the child's ability to engage in gross motor play or with the child's ability to complete handwriting activities. C: Implementing hand strengthening for improving handwriting may be a component of the intervention but should not be the initial focus of the intervention plan; improving the child's safety with play is most important.

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? Environmental aids should be used to assist the residents with completing dressing tasks. One-step commands are needed to start dressing and every few minutes thereafter until the task is complete. Total assistance is required for the residents to complete all dressing activities. Verbal cuing and physical assistance are needed throughout the dressing task.

Solution: The correct answer is D. In Stage III of Alzheimer's disease, an individual requires frequent physical and verbal assistance throughout ADLs as memory and physical status continue to decline. A: Environmental aids at Stage III are used to compensate for deficits in perception related to safety with mobility. An individual with Stage III Alzheimer's disease would require the physical and verbal assistance of another person to complete ADLs. B: One-step commands are not needed until Stage IV of Alzheimer's disease. C: Total assistance is not needed generally until the end of Stage IV of Alzheimer's disease.

An occupational therapy student asks the professor for additional time on a final exam because of an attention deficit disorder and claims to have been too busy to get the required accommodations letter from the university's office for students with special needs. The professor waives the requirement and grants the additional time. On the basis of the principles of the Occupational Therapy Code of Ethics (2015), how can the professor's behavior BEST be characterized? The professor behaved benevolently while protecting Principle 6, Fidelity. The professor supported the student's right to privacy while ensuring that no harm was imposed on other students. The professor behaved both empathically and prudently. The professor behaved altruistically but violated Principle 4, Justice.

Solution: The correct answer is D. In behaving benevolently toward the student, the professor may not have weighed the fairness of the waiver to other students by giving the student an unfair advantage. Additionally, NBCOT® does not recognize a disability unless the student's university recognizes it. The professor should prepare the student to take the NBCOT and future course exams by denying any accommodations until they are properly designated by the university. A: The professor may have violated Principle 6, Fidelity, by not adhering to the school's guidelines for accommodating students with disabilities. Subprinciple 6K state that practitioners shall "abide by policies, procedures, and protocols when serving or acting on behalf of a professional organization or employer to fully and accurately represent the organization's official and authorized positions." B: Obtaining accommodations for a disability does not threaten one's right to privacy. Other students may have been indirectly harmed by the preferential treatment provided to this student. C: Although the professor may have behaved empathically toward the student, more careful scrutiny of the situation might have identified the threat to justice and fairness for other students. Prudence likely was not a main focus of the decision.

A client with Huntington's disease presents with decreased motor planning. What is the most effective intervention for an OTR® to implement with this cognitive impairment? Provide alternative suggestions for safe mobility, including use of a wheelchair for community mobility. Provide the client with strategies to self-assess performance on tasks. Suggest that the client reduce participation in tasks that are difficult. Have the client imagine performing the task in a smooth, coordinated manner.

Solution: The correct answer is D. Mental imagery is an effective strategy to improve motor abilities for clients with decreased motor planning. A, C: These options limit the client's participation in daily life tasks as opposed to improving coordinated movements. B: Self-assessment may be helpful, but it would not be suggested as the most effective intervention. More evidence supports use of mental imagery as an intervention with Huntington's disease.

A client's family asks the OTR® to withhold information about the client's lack of progress in occupational therapy. Without information to support limitation of information exchange, the OTR decides to accurately discuss progress and related concerns with the client. Which ethical principle underlies the OTR's justification for disclosure? Autonomy Justice Nonmaleficence Veracity

Solution: The correct answer is D. In the Occupational Therapy Code of Ethics (2015), Principle 5, Veracity, states, "Occupational therapy personnel shall provide comprehensive, accurate, and objective information when representing the profession." Veracity refers to comprehensive, accurate, and objective transmission of information, including documentation of clinical status. A: In the Occupational Therapy Code of Ethics (2015), Principle 3, Autonomy, states, "Occupational therapy personnel shall respect the right of the individual to self-determination, privacy, confidentiality, and consent." B: In the Occupational Therapy Code of Ethics (2015), Principle 4, Justice, states, "Occupational therapy personnel shall promote fairness and objectivity in the provision of occupational therapy services." C: Occupational Therapy Code of Ethics (2015), Principle 2, Nonmaleficence, states, "Occupational therapy personnel shall refrain from actions that cause harm."

While reviewing work hardening program documentation, an OTR® realizes there is no entry in the client's medical record of a meeting conducted with the insurance case manager, client, and client's employer regarding light-duty options. According to best practice guidelines, how should the OTR® amend the client's medical record to include a summary of the meeting? Back-date the entry to correspond to the actual date of the meeting, and insert a summary of the meeting into the client's medical record. Insert a summary of the meeting into the margins of the client's medical record. Use correction tape or fluid to correct the client's medical record and insert details of the meeting in the proper sequence. Enter the information as a late entry into the client's medical record.

Solution: The correct answer is D. Information that must be entered out of sequence should be entered into the medical record as a late entry and must be identified as such per AOTA guidelines. A, B, C: Backdating, use of corrective tape or fluid, or inserting information into the margins is not best practice and may constitute fraud or be interpreted as such if content is ever called into question. Meetings with work hardening clients, insurance case managers, and employers should be documented in a timely manner in the medical record.

An OTR® is contacted by a small grocery store chain to develop an injury prevention program for its employees. As a guiding framework, which element should the OTR consultant NOT include in the corporate plan? A process for worker involvement in the program Strategies to identify risky work conditions Protocols for data collection to identify outcomes Plans to reduce the number of injuries sustained by employees

Solution: The correct answer is D. Injury prevention consultants do not reduce injuries per se. Their role is to help companies reduce their losses by instituting various activities. A, B, C: The options are all elements of an injury prevention program as recommended by the Occupational Safety and Health Administration and the National Institute for Occupational Safety and Health.

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? Hand based, including only the middle finger Forearm based, including only the middle finger Hand based, including the middle, ring, and index fingers Forearm based, including the middle, ring, and index fingers

Solution: The correct answer is D. 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. 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.

The occupational profile of a client recently diagnosed with bilateral osteoarthritis of the first carpometacarpal joints of the thumbs reveals that the client is retired and enjoys reading, playing cards with friends, and painting. The client has insurance coverage for only three occupational therapy sessions. What client education topics should the OTR® focus on FIRST? Hand strengthening exercises the client can perform independently Orthoses that may be fabricated to support and protect affected joints Thermal modalities to reduce pain and stiffness Joint protection principles

Solution: The correct answer is D. Joint protection principles are ideally taught early in the disease process to decrease joint stress and damage. A: Exercise programs that use active range of motion have been found to be more effective than strengthening; thus, hand strengthening exercises would not be the first focus for this client. B, C: Although orthotics and thermal modalities may be effective interventions, practitioners must work within time constraints. Joint protection principles would be addressed first because they cover the scope of the client's valued occupations.

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? Keep feet together to maintain a high center of gravity for transfer When lifting, do as much as possible in the transverse plane Use a stoop lift, when possible, to assist clients in transfer Maintain the clients body as close as possible while transferring

Solution: The correct answer is D. Keeping the client close while lifting is associated with decreased lumbar stress and is easily addressed in prevention A: A high center of gravity decreases stability and increases susceptibility of lower back B: Proper lifting is to be performed in the sagittal plane; the transverse plane would encourage "twisting" while lifting, increasing lower back susceptibility. C: A stoop lift is indicated for lifting very light loads (20 pounds and below)

Which occupation-based intervention activity is MOST appropriate to develop the bilateral hand skills of a 3-year-old child with autism? Holding a cup while pouring water from a large pitcher Donning a dress and buttoning the several half-inch buttons on the dress Writing the child's own name while stabilizing the paper Holding the handle of a small bucket while filling it with water from a faucet

Solution: The correct answer is D. Of the options, holding the handle of a small bucket while filling it with water from a faucet is the most appropriate play-based activity for the child's age. A: Holding a cup while pouring water is a bilateral skill activity, but holding a large pitcher and cup at the same time will be a difficult task for a 3-year-old. B: Buttoning a dress is a bilateral hand activity, but buttoning small buttons is not a developmental expectation for a 3-year-old. C: Writing one's own name is not expected of a 3-year-old child.

An OTR® is working with a client on functional transfers from the bed to the wheelchair. The client has a tendency to do unexpected things when transferring, requiring the OTR to be extremely aware of proper body mechanics to complete the transfer in a safe manner for both the OTR and the client. Which principle should the OTR follow to avoid injury? Combine movements such as bending and rotating so that the transfer is more fluid. Keep a small base of support to avoid entangling the OTR's and the client's feet. Keep a slightly arched back to be prepared if the client begins to fall. Stay close to the client to keep the weight of the transfer next to the OTR.

Solution: The correct answer is D. Keeping the weight of the client close while assisting with a transfer allows the OTR to lift with the strongest parts of the body. If the client is farther away, the OTR's arms will do the majority of the work. A: The principles of basic body mechanics include not combining movements. For example, rotating the back while bending backward or forward could lead to injury. B: According to the principles of basic body mechanics, when assisting with a transfer, the OTR should have a wide base of support to maintain balance and therefore avoid harming the client. C: According to the principles of basic body mechanics, the spine should always be kept in neutral, not arched, to prevent injury when assisting with a transfer.

An OTR® is working with a toddler in early intervention who has a diagnosis of a developmental delay. The OTR® suspects that the child may have an intellectual disability. Which item in the child's history is an early indicator of an intellectual disability? A Incomplete fibrous ankylosis Jaundice and vomiting Breech presentation Limited reactions to play

Solution: The correct answer is D. Limited reactions to play, delays in meeting typical milestones, unresponsiveness to physical contact or handling, feeding difficulty, and neurological soft signs are all early indicators of intellectual disabilities. A: The presence of incomplete fibrous ankylosis is associated with arthrogryposis multiplex congenita. B: A history of jaundice and vomiting may be related to galactosemia, which if controlled properly does not lead to intellectual disabilities. C: A history of breech presentation is associated with congenital hip dysplasia.

A delivery worker in a large metropolitan city has an acute onset of low back pain. The low back pain is prohibiting the client from performing at a productive level because of the high pain level. What is the MOST IMPORTANT physical risk factor that should be closely examined in an ergonomic assessment? Excessive stop-and-go because of the high-productivity delivery expectations Prolonged static sitting posture from driving longer than 60 minutes without a break Contact stress from pressing the body against the packages when carrying them Awkward posture and overreaching when pulling packages out of the truck

Solution: The correct answer is D. Low back pain is a common work-related musculoskeletal disorder arising from poor body mechanics. Regardless of the weight of the packages, the client needs to be able to maintain proper body mechanics and back alignment when reaching to retrieve packages at different levels. The OTR® will need to determine the client's body build type and the space and the package locations in the truck, and make recommendations to maintain proper body mechanics or use of adaptive equipment to prevent further strain to the low back. A: Frequent stop-and-go breaks up the routine of the job tasks and avoids prolonged static posture. However, productivity expectations often play a role in hurrying behavior and should be considered after assessing body mechanics and back alignment. B: Even though a prolonged static sitting posture could be a contributor to low back pain, it is more often a factor considered for long-distance truck drivers. It is safe to assume a delivery worker in a big metropolitan city will not be driving for a prolonged period. C: Carrying packages close to the body is the proper and recommended body mechanics for carrying any load and will not increase strain to the client's low back.

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

Solution: The correct answer is D. Low-impact weight-bearing exercises and education can help older adults to reduce osteoporosis. A: Although a pamphlet will provide education, it has a low probability of changing behaviors related to osteoporosis. B: Providing supplements is outside the scope of practice for occupational therapy. C: Completing dual-energy X-ray absorptiometry scans, which would be part of evaluation for osteoporosis, is outside the scope of occupational therapy practice.

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. What intervention would be MOST BENEFICIAL for preparing the patient to transition to hospice care? Reviewing the potential impact of chemotherapy on occupational performance Providing activities to engage the patient in reminiscence strategies for life review Encouraging the patient to set goals for effectively using remaining time and energy Identifying ways to enable participation in prioritized desired tasks once at home

Solution: The correct answer is D. Many people at the end of life due to cancer want to remain engaged in occupation. Engaging the patient with purpose may keep the patient from feeling helpless. A: Patients respond to treatment differently, and functional loss will occur at varying rates, so it is best to address the patient's current abilities rather than project into the future. B: Although life review may help a patient plan for death, preparing to transition to hospice care should encourage participation so the patient continues to life live to the fullest each day, and many patients at the end stage of life want to continue to engage in occupation. C: A person's energy during inpatient hospitalization may be depleted, but it is expected to recover some as blood counts recover from treatment. Patients' energy levels will be variable given their individual situation and will vary day to day, so planning use of remaining time and energy will be difficult.

A client with middle-stage Parkinson's disease demonstrates tremor and rigidity bilaterally in upper extremities, mild difficulties with executive functioning, and increased fatigue during ADL and IADL performance. Which is the BEST occupational therapy intervention for a client in the middle stages of Parkinson's disease? Splinting to minimize tremor during fine motor coordination tasks Progressive resistive exercises to improve fine motor control function Training in the use of power mobility to maximize functional mobility independence Modification of clothing with minimal fasteners or hook-and-loop closures to reduce fine motor control demands

Solution: The correct answer is D. Modifying or eliminating clothing fasteners decreases the demand on fine motor coordination for a client experiencing tremors. A: Splinting is not an intervention for tremors. B: Resistive exercises do not improve fine motor control. C: A client with Parkinson's disease is likely not appropriate for a motorized wheelchair because of decreased fine motor control.

An OTR® supervises a COTA® who works with a group of adults who are continuing their recovery from alcohol and drug addiction by living in a halfway house. The OTR® suggests that the COTA® become familiar with a particular group intervention in working with these clients. What type of intervention would the OTR® MOST likely suggest? An occupational deprivation group ProjectMAINSTREAM A heavy work activity group A 12-step self-help group

Solution: The correct answer is D. Most substance abuse programs include one or more self-help groups that use a classic 12-step process. Most substance abusers seek help through self-help groups. Occupational therapists working with this population are likely to become involved in facilitating or supporting these groups. A, C: These group activities are not necessarily specific to substance abuse disorders. B: ProjectMAINSTREAM is intended for education of professionals providing services for substance abuse clients.

What is the FIRST step in the process of designing a group protocol for clients with mental illness? Find appropriate dates and times for conducting the group. Identify the appropriate outcomes of the group and methods for tracking and recording them. Develop group goals and determine the size of the group. Identify a problem and the factors that will motivate the people in the group to change.

Solution: The correct answer is D. Motivation to change is regarded as an initial step in developing a group protocol. It requires identification of a problem and interaction with potential group members to determine what will promote change. A, B, C: The other item choices are part of developing a group protocol and are considerations made after the group's problems have been identified.

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? Arousal and orientation Sequencing and categorization Initiation of movement and language Attention span and short-term memory

Solution: The correct answer is D. Nonrestorative sleep, fatigue, and pain interfere with the client's ability to pay attention and remember day-to-day events. A, B, C: Arousal and orientation, sequencing and categorization, and initiation of movement and language are cognitive deficits and are most likely to be the result of traumatic brain injury or cerebrovascular accident, not fibromyalgia.

An OTR® receives a referral to evaluate a client with Alzheimer's disease. The client is difficult to redirect while performing the assessment. What would be the BEST approach for the OTR® to use to gather appropriate information to complete the assessment and guide intervention planning? Decide that it is not the appropriate time to complete the assessment; plan to return later in the day. Talk to the physician about the client's inability to maintain attention to the assessment. Explain to the family members that they should contact the OTR® when the client is able to participate more fully in the assessment. Observe the client's behavior and reactions to environmental stimuli to gather information for the assessment.

Solution: The correct answer is D. Observation can yield rich information about a person with dementia. It is one of the primary modes of assessment recommended for people with dementia. A, C: Delaying the assessment as a result of behaviors is not appropriate because they are a hallmark feature of AD. B: Contacting the physician to discuss behaviors that have been observed during contact with the client might be acceptable, but doing only this does not address the referral.

A client was referred to occupational therapy because of persistent pain in the neck and shoulder and the recent onset of paresthesia in the right index and middle fingers. The OTR® decides that the symptoms may be work related and proceeds with an onsite ergonomic assessment. Before the onsite ergonomic assessment, what is the MOST important information for the OTR® to gather? Company's and supervisor's names Client's loyalty to the company Times of the day when the client takes breaks Client's daily routine work pattern

Solution: The correct answer is D. Obtaining information on the client's daily routine work pattern will help to identify job and productivity expectations, how the client prioritizes work tasks, the number of nonstop hours the client spends on the computer, and the client's work habits. A: This information can usually be found in the referral and is not essential prior to the ergonomic assessment. B: This information is not needed for an ergonomic assessment. C: This information can be obtained as part of gathering information on the client's daily work routine.

A student with a developmental delay is participating in a prewriting group with other kindergarten students. The student has achieved the goals of successfully copying a cross, an oblique line, and a square. Which copying task should be included during the NEXT phase of the student's prewriting program? Series of vertical lines on wide-ruled paper Monosyllabic words posted on a whiteboard Person figure consisting of various shapes Letters of the student's first name

Solution: The correct answer is D. Once a child is successful in copying a cross, an oblique line, and a square, the next progression of handwriting skill includes the child printing his or her own name. A: A child is already able to draw vertical lines if the child is able to copy a cross, an oblique line, and a square, so this skill would not be necessary. B: A child would not be ready for far-point copying at this stage of handwriting development, although the child could begin working on copying most lowercase and uppercase letters. C: The child is ready to progress to copying uppercase and lowercase letters; working on shape drawing by copying a person would not sufficiently challenge the child.

An OTR® is evaluating a client with a diagnosis of blindness. The OTR observes the client bumping into objects, people, and the door frame and is worried about the client's potential for injury. What referral should the OTR make FIRST? To physical therapy, to address balance, gait, and mobility aids To a physician, to determine whether the client's medical condition has changed For guide dog services, to promote safety in the community To orientation and mobility services, to assess for use of a white cane

Solution: The correct answer is D. Orientation and mobility specialists teach travel (mobility) skills, including use of a white cane, to clients with a vision impairment to promote safe and independent travel. At this time, this client may not be safe for independent mobility; these specialists can provide the techniques and skills to promote safety. A: The client's difficulty navigating results from an inability to see and negotiate the environment, not from difficulty with balance or gait, for which a referral to physical therapy would be appropriate. B: A referral to the physician would be unnecessary because the client has been diagnosed with blindness. C: Orientation and mobility specialists also may provide guide dog services, but such services require more lengthy evaluation and training than use of a white cane.

An OTR® in a private clinic is discussing with other practitioners potential peers who can be paired or grouped with a 3-year-old client. The client has autism, and the goals include improving play and social skills. Which potential peer has appropriate characteristics to consider when choosing peers to partner with this client? A child of a different gender, to promote gender diversity and exposure to children of that gender A child with the same diagnosis who has not been paired with another child during therapy sessions A child with the same diagnosis and developmental level as the client A slightly older child with a slightly higher developmental level than the client

Solution: The correct answer is D. Peers of different ages and different developmental statuses can promote different types of play and leisure behaviors and can advocate a multitude of play skills. A: For younger children, same-gender peers might be extremely important and can highly influence play skills. B, C: Peers with a high level of positive peer interaction and experience working with others can help facilitate play skills, but a child with similar issues may not be able to help improve play skills.

An OTR® has recommended that a student with a learning disability use an assignment notebook to write down homework assignments for each class. Which factor related to learning disabilities does this compensatory strategy address? Disorders of sequencing and adapting prioritization and problem solving Disorders of social skills and concentration Disorders of sensory integration and perception Disorders of thinking and memory

Solution: The correct answer is D. People with learning disabilities often have difficulty with short- and long-term memory. Using an assignment notebook would mean that the student would not have to recall the assignments after leaving the class. A, B, C: These options are not specifically related to the underlying reason why the student would need to bring an assignment notebook to class.

An OTR® wants to develop a group activity for clients with personality disorder in an inpatient psychiatric facility. The group has Allen Cognitive Level (ACL) scores ranging from 5.0 to 5.4. What activity would be MOST appropriate to use with these clients in the initial stages of the group? Volunteer activities in the community Long-term budgeting for house repairs Vocational retraining and job seeking Role playing social interactions

Solution: The correct answer is D. People with personality disorders and people with an ACL in the low 5s have difficulty with social interactions because they are egocentric. Role playing social interactions would be best option when initiating a group with these clients. Improving social interaction will form the basis for the rest of the interventions appropriate for this group. A: Volunteer activities would be more appropriate for clients at ACL 5.6 and above. The tasks involved would be too complex for lower levels. B: Long-term budgeting and house maintenance would be more appropriate for clients at ACL 5.6 and above. The tasks involved would be too complex for lower levels. C: Vocational retraining and job seeking would be appropriate for clients at ACL 5.2 and above, but job seeking would be more appropriate for clients at ACL 5.4 and above, and levels for vocational training could vary. Clients at ACLs from 5.2 to 5.4 would need more repetition in training to solve problems and create solutions so that they would not have to problem-solve independently.

A client is 2 days poststroke in acute care with right hemiparesis. On admission to occupational therapy, the client's FIM™ scores were 2 for dressing, 1 for bathing, and 3 for feeding. Which intervention is MOST appropriate to try first? Refer the client for a driving evaluation in preparation for community reentry Educate the client and caregiver about a home program addressing right-side awareness Supervise the client in completing hygiene tasks standing at the sink while emphasizing use of the right arm Train the client in postural activity at the edge of the bed to increase supported sitting

Solution: The correct answer is D. Postural stability is essential to performing many ADLs, and hemiparesis influences the client's ability to maintain postural stability at the edge of the bed. A: Driving evaluations are not appropriate for clients in acute care stroke rehabilitation. B: Home program training will be important as the client prepares to transition from the acute care and inpatient rehabilitation environments. However, this intervention should not be the first approach. C: The client's FIM levels indicate that standing at the sink for hygiene tasks is too difficult for the client at this time.

An OTR® is setting up a booth to promote occupational therapy services at a community-sponsored health fair. A vendor has donated various therapy equipment and product brochures for the OTR® to display. When reading one of the brochures, the OTR® identifies a product promotion that claims to eliminate pain for any condition. What is the BEST course of action for the OTR® to take regarding this printed information? Display only those products that are supported in occupational therapy literature by evidence-based research. Post a product disclaimer about the equipment at the booth that is visible to the health fair attendees. Advise the company representative that the product information and equipment cannot be displayed at the health fair. Recognize that the claim is invalid and eliminate the printed product endorsement from the booth.

Solution: The correct answer is D. Practitioners are ethically obligated to report any acts that make false claims and must not use such products or services in practice to refrain from any actions that may inflict harm. A: Products do not have to be supported in occupational therapy literature to be incorporated in practice, though considering the evidence base is important. B: Product disclaimer is not sufficient to avoid the use of products or services that make false claims or may potentially inflict harm. The product or service may not be used in practice at all. C: The product should be reported to appropriate authorities who can take action with the company representative.

An OTR® attended a continuing education workshop on the topic of proprioceptive neuromuscular facilitation. The OTR® plans to use this approach with an outpatient orthopedic population. What INITIAL action should the OTR® take prior to implementing this approach with clients? Ask the workshop instructor for permission to use copyrighted protocols. Develop a department budget for the required equipment and supplies. Discuss the use of the intervention with referring physicians. Review the evidence in peer-reviewed literature related to the approach.

Solution: The correct answer is D. Practitioners must be aware of the need to stay up to date in practice, and peer-reviewed literature is an acceptable source of scholarly information to examine the evidence. A: Obtaining copyright permission is important when using material from another person; however, the practitioner should first seek scholarly based peer-reviewed literature to assess the quality of the evidence. B: The quality of the evidence as an effective intervention must be assessed before the method is implemented with equipment and supplies. C: Communicating opportunities of evidence-based practice is an important step in implementing evidence into everyday practice; however, the quality of the evidence should be assessed first so the team can make informed decisions.

An OTR® is presenting an inservice to case managers about the benefits of occupational therapy for patients who have respiratory disorders. What should be the PRIMARY focus of this presentation? Differences between occupational therapy and respiratory therapy Specific occupational therapy protocols for patients who have respiratory disorders Revenue-generating potential of occupational therapy services Impact of occupational therapy services on patients' abilities to function at home

Solution: The correct answer is D. Presenting intervention outcomes is important in establishing program justification such as expanding occupational therapy services to include patients who have respiratory disorders. A: Differences between the disciplines may be included in the inservice; however, this area should not be the primary focus of the presentation because case managers will find information on effectiveness of services more beneficial. B: Although specific occupational therapy protocols may be beneficial in establishing the outcomes of occupational therapy services for patients with respiratory disorders, the case managers will find information on effectiveness of services more beneficial. C: Revenue generated from expanding services is an important consideration in justifying programs; however, case managers will find information on the effectiveness of services related to improving patient outcomes more beneficial.

An OTR® is working in an inpatient psychiatric setting where the average length of stay is 5 days. Which group activity would be MOST appropriate for patients with depression? A parallel group in which participants work on a free-form clay project of their choice A cooperative group in which participants plant a garden A project group in which participants paint a watercolor on a blank canvas A parallel group in which each participant completes his or her own solid-color ceramic tile trivet

Solution: The correct answer is D. Simple and concrete activities are most appropriate for clients hospitalized with depression. For the trivet activity, the solid color removes the need to make decisions about color and pattern, the trivet provides clear physical boundaries, and gluing the tile onto the backing is simple and concrete. Participation in a parallel group minimizes the need for social interaction but allows physical proximity to others. A: Working on a free-form clay project of their choice would be too overwhelming for most patients hospitalized with depression, who have difficulty making decisions and initiating activity. B: A cooperative group is not a good choice for most people hospitalized for depression because it requires the individuals to interact and problem solve with each other, which can be difficult. Planting a garden would be a poor choice for a 5-day hospitalization because the results would not be visible before patients are discharged. C: Painting a watercolor would not provide enough structure and might overwhelm patients with severe depression.

Why does the Occupational Therapy Code of Ethics (2015) encourage occupational therapy practitioners to use evidence-based evaluations, interventions, and therapeutic equipment whenever possible? Evidence-based practice ensures compliance with institutional rules. All clients have a right to self-determination. Failure to use evidence-based practice is malpractice. Evidence-based practice provides the greatest likelihood of benefiting others.

Solution: The correct answer is D. Principle 1F (Beneficence) states that practitioners shall "take steps (e.g., continuing education, research, supervision, training) to ensure proficiency, use careful judgment, and weigh potential for harm when generally recognized standards do not exist in emerging technology or areas of practice." Principle 2A (Nonmaleficence) states that practitioners shall "avoid inflicting harm or injury to recipients of occupational therapy services, students, research participants, or employees." Use of evidence from empirical research and clinical expertise to inform occupational therapy practice provides the greatest likelihood that practitioners will provide best possible care and reduce the threat of doing harm. A: Although institutions may encourage evidence-based practice, the Code encourages it because evidence-based practice increases the likelihood that clients will receive the best possible care. B: Self-determination, part of Principle 3, Autonomy, is an important issue but is not related to use of evidence-based practice. C: Although malpractice may occur when occupational therapy practitioners do not use evidence to support practice, the Code encourages evidence-based practice not because it considers use of practice that is not evidence based to be malpractice but because evidence-based practice increases the likelihood that clients will receive the best possible care.

An OTR® has discontinued occupational therapy services with a client. A month after the completion of services, the client and the OTR see each other unexpectedly at the local grocery store. They express interest in each other. They start dating within a month of this meeting at the grocery store. This action is illegal and should be reported to the authorities immediately. This action is within the occupational therapy ethical guidelines for the principle of Nonmaleficence. This action is within the occupational therapy ethical guidelines for the principle of Beneficence. This action may or may not be ethically appropriate and needs to be investigated further.

Solution: The correct answer is D. Principle 2, Nonmaleficence, states that occupational therapy personnel shall intentionally refrain from actions that cause harm. Principle 2C states that practitioners shall avoid engaging in any sexual relationship or activity with recipients of services. Although the client and OTR are no longer in a professional relationship, Principle 2I requires the OTR to "avoid exploiting any relationship established as an occupational therapy clinician, educator, or researcher to further one's own physical, emotional, financial, political, or business interests at the expense of recipients of services, students, research participants, employees, or colleagues." Further investigation is warranted to ensure that the OTR is not using his or her role in an exploitative manner. A: Even if it were inappropriate for the OTR and the former client to begin dating, it would not be illegal as long as it was consensual. More information is needed, however, because State law may prohibit this interaction. B: If the OTR and the client were still in a professional relationship, this action would not be appropriate under the principle of Nonmaleficence. The OTR and the client are no longer in a professional relationship, but further investigation is warranted to ensure that the OTR is not using his or her role in an exploitative manner. C: Beneficence is the principle that occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services. It does not apply in this scenario because the OTR and the client are no longer in a professional relationship.

When the AOTA Ethics Commission determines that unethical conduct has occurred, it typically issues a disciplinary action. Which disciplinary action does NOT require public report of conclusions and sanctions? Suspension of AOTA membership Censure Revocation of AOTA membership Reprimand

Solution: The correct answer is D. Reprimand is a formal expression of disapproval of conduct communicated privately by letter from the AOTA Ethics Commission. A, B, C: Censure and suspension and revocation of membership all require a report of conclusions and sanctions in an official AOTA publication.

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? They provide for more postural control with seating. They require a smaller turning radius to maneuver. They involve an easier steering system. They are easier to load into the trunk of a car.

Solution: The correct answer is D. Scooters are modular and can be disassembled and loaded into and taken out of the trunk of a car more easily than a power wheelchair. The primary disadvantage of power wheelchairs is that they are so large and heavy that they cannot be placed in the trunk of a car and require a special transport system. A: Power wheelchairs provide more postural control with various seating options. Special seating is difficult to attach to a scooter, and it is therefore not recommended for someone with significant postural control challenges. B: In most instances, scooters require a larger turning radius than power wheelchairs and may have limited ability to manuver indoors. C: Steering and control of a scooter can be difficult, so a person with marginal control may be better served by using a power wheelchair that has a variety of control options.

The OTR® wants the client's caregiver to complete a proxy assessment of the client's driving skills. What assessment would be BEST for the caregiver to complete? AARP Driver Safety Course Driving Habits Questionnaire SAFER Driving: The Enhanced Driving Decisions Workbook Fitness-to-Drive Screening Measure (previously known as the Safe Driving Behavior Measure)

Solution: The correct answer is D. The Fitness-to-Drive Screening Measure was developed for caregivers to rate the driving ability of the person for whom they care. A: The AARP Driver Safety Course is an educational course for mature drivers. B: The Driving Habits Questionnaire only assesses driving history and driving habits. C: SAFER Driving: The Enhanced Driving Decisions Workbook is a self-assessment tool completed by the driver.

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 rigid, prefabricated metacarpophalangeal (MCP) joint ulnar deviation splint A prefabricated thermoplastic resting hand splint A custom-fabricated wrist cock-up splint A soft, prefabricated wrist, thumb, and MCP joint support

Solution: The correct answer is D. Splinting all the joints of the hand reduces the chances of increased stress on unsupported joints. Studies have suggested that compliance increases with soft splints Because the client does not have significant deformities, a prefabricated splint should fit. A, B, C: These types of splint either support only one joint (A, the MCP; C, the wrist) or are made of hard materials (B). Splinting all the joints of the hand reduces the chances of increased stress on unsupported joints. Compliance at night tends to be greater with soft splints.

An OTR® is describing a client with a hand injury to an occupational therapy student. The OTR® states that the client presents with burning and stabbing pain in the hand, shiny skin, very stiff joints, and abnormal sweating and hair growth. What medical condition does this client MOST likely have? Fibromyalgia Carpal tunnel syndrome Neuroma secondary to index proximal interphalangeal amputation Complex regional pain syndrome

Solution: The correct answer is D. Symptoms of complex regional pain syndrome often include pain, swelling, stiffness, and sudomotor and trophic changes. A: Fibromyalgia presents with pain, fatigue, and tender trigger points. B: Carpal tunnel syndrome presents with numbness and tingling in the thumb and index and middle fingers. C: Neuroma is hypersensitive and painful to touch.

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? Above the client's head Within arm's reach On a moveable surface Beyond arm's reach

Solution: The correct answer is D. Tasks that are beyond arm's reach will facilitate a weight shift and challenge the client's postural abilities. A. Placing an object overhead facilitates a shift in the client's center of mass; however, this placement encourages the client to move up rather than forward or backward, left or right, or through rotation. B: Placing objects within arm's reach will not elicit a postural change. C: A moveable surface may elicit a client's postural shift but may be too challenging for the client as a first approach.

Over whom does the AOTA Ethics Commission have jurisdiction? All AOTA members All graduates of accredited OT and OTA programs Licensed OTs and OTAs but not occupational therapy educators OTAs and OTs with AOTA membership at the time of an alleged incident

Solution: The correct answer is D. The AOTA Ethics Commission does not have jurisdiction over occupational therapy practitioners who were never AOTA members or who were not members when the incident in question occurred. A, B: Not all OTs, OTAs, and graduates of occupational therapy programs are AOTA members, and the AOTA Ethics Commission does not have jurisdiction over nonmembers. C: Not all licensed OTAs and OTs or occupational therapy educators are AOTA members; only AOTA members are subject to the AOTA Ethics Committee's jurisdiction.

An OTR® conducting an analysis of occupational performance of a client with multiple sclerosis needs to choose an assessment that allows consideration of the client's self-perception of abilities. Which assessment would BEST be able to capture this information? Mini-Mental State Examination Assessment of Motor and Process Skills Modified Fatigue Impact Scale Canadian Occupational Performance Measure

Solution: The correct answer is D. The Canadian Occupational Performance Measure is a client-centered measure that allows clients to report their own perceptions of their self-care, leisure, and work or play abilities. A: The Mini-Mental State Examination provides a summative measure of cognitive skills, but it does not assess a client's self-perception of ADL abilities. B: The Assessment of Motor and Process Skills allows for observation and measurement of a client's motor and process skills related to occupational performance of selected ADL or IADL areas, but it does not assess a client's self-perception of ADL abilities. C: The Modified Fatigue Impact Scale measures the impact of fatigue on daily activities, but it does not assess a client's self-perception of ADL abilities.

An OTR® is working with a client in an inpatient psychiatric facility and decides to use the Allen Cognitive Level Screen to assess cognitive functioning. Which goals would be appropriate on the basis of the Cognitive Disabilities Model? The client will demonstrate appropriate coping skills in identified stressful situations with 100% success. The client will independently apply relaxation techniques and report relief from stress at 0/10 after using the technique. The client will apply grounding techniques with 100% accuracy as a preventative measure to reduce over-stimulation. The client will be discharged home from the inpatient psychiatric unit with daily checks from caregiver to address novel safety needs in the home environment.

Solution: The correct answer is D. The Cognitive Disabilities Model assesses the client's current cognitive functioning to maximize supports in the environment that will facilitate maximal occupational performance. This goal suggests that after discharge, the client will be placed in an environment that will successfully manage the client's current cognitive ability through appropriate environmental supports. A: This goal is based on a cognitive-behavioral approach, not the Cognitive Disabilities Model. B: This goal is based on the behavioral approach, not the Cognitive Disabilities Model. C: This goal is based on a sensorimotor approach, not the Cognitive Disabilities Model.

An OTR® receives an order to evaluate and treat a client with a traumatic brain injury. What test is MOST APPROPRIATE to determine the client's level of consciousness? Canadian Occupational Performance Measure (COPM) Mini-Mental State Examination (MMSE) Minnesota Multiphasic Personality Inventory (MMPI) Glasgow Coma Scale (GCS)

Solution: The correct answer is D. The GCS is the traditional method used by health care professionals to assess levels of consciousness after traumatic brain injury. A: The COPM is used to detect changes in a client's self-perception of occupational performance over time. B: The MMSE is a screening tool used to detect cognitive impairment. C: The MMPI assesses personality traits and psychopathology.

An OTR®; is reviewing hard-copy client charts before a group treatment session. While reviewing the charts, the OTR receives an urgent phone call and must leave the chart room. How can the OTR ensure that the charts remain protected during the OTR's absence from the room? Close the charts and stack them on a table. Lock the door to the chart room. Cover the charts with other documents to obscure them from view. Close the charts and return them to their original secure location.

Solution: The correct answer is D. The Health Insurance Portability and Accountability Act requires that documentation be kept confidential and accessible only to individuals who are involved in a client's treatment. Even during a brief absence, charts should be returned to their original secure location if there is any possibility that another person may come into contact with them. A, B, C: None of these safeguards prevents others who have access to the chart room from coming into contact with the information in the charts.

The topic of the February 7, 2013, newsletter MLN Matters, published by the Medicare Learning Network under the Centers for Medicare and Medicaid Services, was changes in the criteria for mobility assistive equipment and MRADLs, which OTR®s working with positioning, seating, and wheelchairs need to know for reimbursement. What does the Medicare acronym MRADLs stand for? Movement-related ADLs Motion-related ADLs Motor-related ADLs Mobility-related ADLs

Solution: The correct answer is D. The Medicare beneficiary must have significant limitations in one or more MRADLs that prevent task accomplishment, increase risk during task accomplishment, or prevent task accomplishment in a reasonable amount of time to qualify for coverage of mobility assistive equipment. A, B, C: These responses do not address mobility.

An OTR® is asked to bill for occupational therapy services in a group setting to maximize billable hours. The principle of Justice requires that occupational therapy personnel comply with institutional rules, state laws, and relevant AOTA official documents. What is the BEST next step for the OTR to take? Report this request to the company hotline immediately. Comply with the request and make no other actions. Report this request to the state regulatory board. Work with the employer to identify the best options for efficient and clinically appropriate provision of services.

Solution: The correct answer is D. The OTR cannot bill in a different way without violating the principle of Justice, and the OTR cannot comply with the request without violating the principle of Beneficence, because provision of occupational therapy services on the basis of reimbursement rather than clinical need is ethically problematic. The principle of Fidelity precludes the OTR from reporting the practice as a first step. Therefore, the best next step is to try to work it out with the employer. A: This option as a first step violates the principle of Fidelity. B: Compliance with this billing request potentially violates the principle of Beneficence if clinical decision making is based on reimbursement rather than on clinical need. C: Reporting the request to the state regulatory board overrides chain of command to address this particular ethical dilemma and is not an appropriate next step in this scenario.

An OTR® develops an intervention plan for a client with bipolar disorder. The OTR focuses, with the client's permission, on the client's work environment because the employer appears to be resistant to providing accommodations. Consequently, the OTR provides educational information to the client's boss about bipolar disorder. What approach does this intervention strategy take? Delay deterioration in performance skills Maintain performance component skills Prevent secondary disability and anticipatory action Reduce behaviors and environmental barriers

Solution: The correct answer is D. The OTR's approach can reduce environmental barriers at work by explaining bipolar disorder, answering questions about the condition, and providing education about accommodations, thus facilitating the employer's ability to provide necessary accommodations for this client. A: By providing practice in occupation and specific performance skills, the OTR could assist in delaying any decline in performance skills; however, this approach might not involve the client's immediate work environment. B: The OTR could provide targeted interventions to assist the client in maintaining performance skills through occupation and activity that are designed around preserved skills, but this approach might not involve the client's immediate work environment. C: The OTR could provide activities to restore occupational balance while assisting the client with improving self-esteem and self-concept; the goal would be to prevent secondary disability, such as anxiety resulting from decreased feelings of control. However, this option does not relate directly to the work environment.

An OTR®; is conducting a cooking group for people with schizophrenia. The OTR writes the following information in a progress note after a treatment session: "Client will continue to attend the cooking group 2 times per week for 4 weeks to address attention, sequencing, and task completion." Where in a SOAP note would the OTR document this information? In the S section In the O section In the A section In the P section

Solution: The correct answer is D. The P, or plan, section outlines the frequency and duration of continued treatment for the client. A: The S, or subjective, section of a SOAP note gives the client's perspective on his or her condition, treatment, or experience. B: The O, or objective, section records measurable data obtained during the treatment session. C: The A, or assessment, section contains an interpretation of subjective and objective information from a treatment session.

A client with amyotrophic lateral sclerosis reports functional limitations when completing his daily routine. The OTR® has completed ADL and IADL assessments as part of the evaluation and is considering how the client's upper-extremity motor control is affecting his functional ability. Which assessment would be MOST effective for assessing this client's upper-extremity ability? Modified Ashworth Scale Trigger point evaluation FIM Purdue Pegboard test

Solution: The correct answer is D. The Purdue Pegboard test is a timed test of upper-extremity function and is useful in determining a client's functional limitations. A, B, C: These do not assess functional ability of the upper extremities. The Modified Ashworth Scale is a measure of spasticity. Trigger point evaluation is a measure of localized soft-tissue pain. The FIM is a measure of ADL independence.

An entry-level OTR® working in an outpatient rehabilitation clinic is evaluating a client who was recently hospitalized for dehydration and subsequently diagnosed with mild cognitive impairment. The client lives alone in an independent living facility. Before admission, the client was independent in ADLs and light homemaking and active in community and social activities, including driving independently. The client reports no crash record and no violations or citations but avoids night driving, highway driving, and driving in rush-hour traffic or heavy rain. What are the MOST APPROPRIATE areas of intervention for addressing remediation of the client's driving skills? Neck and upper-extremity ROM limitations Eyehand coordination skills and visual acuity fields Reaction time and speed of client's moving between gas and brake Processing speed, visual scanning, and divided attention skills

Solution: The correct answer is D. The areas are consistent with the deficits suggested by the client's diagnosis of mild cognitive impairment. A: These areas pertain to improving the client's physical condition but neglect the mild cognitive impairment. B: These areas pertain to physical endurance, which may be compromised as a result of the dehydration, but they are not the best intervention for the client. C: These areas pertain to motor performance, specifically to speed and coordination of the right leg. They do not address the obvious and more severe cognitive impairment of the client.

A client with best corrected visual acuity of 20/200 bilateral has had several near collisions and is working with an OTR® to improve driving performance. What are the BEST compensatory strategies the OTR can recommend to decrease the impact of the driver's impaired visual acuity on road performance? The client should use bifocal lenses. The client should drive on roadways with reduced speed limits and should not drive at night. The client should drive with a "co-pilot" who can read road signs out loud. Train the client in the use of alternative transportation and start the driving retirement process.

Solution: The correct answer is D. The client's visual acuity is such that driving is not a safe activity. It is appropriate to begin the driving retirement process. A: Lenses should be corrective lenses. B: With this client's visual acuity, even these driving modifications are not safe. C: Using a "co-pilot" is not an acceptable strategy for driving in the United States.

An OTR® is working in a clubhouse with a group of clients who have mental health issues. Which leadership style would be MOST effective? Director Authority figure Facilitator Advisor

Solution: The correct answer is D. The clubhouse model puts the locus of control on the members. When designing groups, the members formulate the goals, and the OTR® acts as an advisor. A, B: Leading a group as a director or authority figure is not congruent with the clubhouse model, in which the clients direct the program. Although at times the OTR® may need to provide the group with some direction, control of the goals and decision making remain in the hands of group participants. C: A group leader as facilitator maintains control over goals and decision making, so this leadership style would not be best for this group.

An OTR® reads a scientific study that compares treatment effectiveness after an activity-based intervention versus rote exercise to increase upper extremity function in two groups. The mean score on the activity-based group increased by 14 points, and the mean score of the rote control group increased by 12 points. Results from the t test that compared the group outcomes were statistically significant (p < .05). Which type of evidence BEST describes the results of this scientific study? Case-control Correlational Descriptive Experimental

Solution: The correct answer is D. The experimental study design addresses intervention effectiveness because participants are assigned to different groups to determine the effects of the intervention. A, B: Case-control and correlational designs are used to identify relationships between variables to identify risk factors or causes of a situation. The use of two groups with different interventions requires effectiveness measures over time. C: Descriptive study design is used to describe and analyze a phenomenon, not determine the effectiveness of an intervention.

A client who has an enduring mental illness arrives late for an initial occupational therapy evaluation at a community mental health facility. The client's appearance is unkempt and dirty. The client lives with family members, spends the majority of leisure time drinking with friends, and has been terminated from multiple jobs. One of the client's goals is to "get a job." What should be the PRIMARY focus of this client's intervention when using the Model of Human Occupation? Helping the client gain mastery over living conditions and work environment based on the client's preferences Exploring the client's thoughts and underlying conflicts related to engagement in occupation Teaching the client self-care and vocational exploration skills in areas of occupational interest Supporting the client's participation in daily routines and work tasks based on current skills and abilities

Solution: The correct answer is D. The focus on Model of Human Occupation in intervention is for the client to engage in occupational performance through doing, thinking, and feeling within the therapeutic environment. A: Mastery of a task is not essential within the Model of Human Occupation in intervention, because the emphasis is on occupational engagement. B: The Model of Human Occupation considers a client's thoughts and feelings about the abilities for doing everyday activities, but not the client's thoughts and underlying conflicts related to engagement in occupation. C: Therapeutic strategies within the Model of Human Occupation include giving feedback, coaching, structuring, and encouraging client to encourage occupational participation; these strategies do not include teaching the client to do something. Rather, the environment is set up so that the client is able to engage and learn about the occupation through the guiding of the practitioner.

A client provides a gift to every person in the department including the OTR® who worked with the client. This gift is consistent with cultural practices of the client and is valued at less than $5.00. Which ethical principle BEST helps determine whether it is appropriate for the OTR to accept the gift? Veracity Fidelity Beneficence Justice

Solution: The correct answer is D. The guiding ethical principle is Principle 4, Justice. The amount of the gift is minimal, and the gift was given to everybody. It is appropriate to accept the gift. This scenario did not create a situation in which objectivity or boundaries were compromised and the nominal amount of the gift does not "unduly influence the therapeutic relationship or have the potential to blur professional boundaries, and adhere to employer policies when offered gifts." A: Veracity addresses truthfulness in representation of credentials. B: Fidelity relates to keeping promises. C: Beneficence addresses safety for recipients of services.

An OTR® is developing a return-to-work program as part of a hospital-based outpatient clinic because of an increase in the number of referrals for hand and musculoskeletal injuries. The hospital is located in a suburban area. The OTR® has several clients who are employed as hair stylists. Which workstation design is MOST appropriate? Barber chair, simulated hair-washing sink with mannequin, scissors, wigs, razors, hair rollers, hair dryer, mirror, combs and brushes, and shelving with hair products and weights Computerized resistive equipment, commercially generated work samples to increase eyehand coordination, upper-extremity and hand ROM, manual and fine motor dexterity, standing tolerance and balance Computerized resistive equipment to increase upper-extremity and hand strength, customized work samples to increase upper-extremity and hand ROM, weighted sled, weighted boxes, and shelves Weighted boxes and sled, shelves, therapeutic crafts projects to improve fine motor dexterity, hair-washing sink with mannequin, wigs, hair care supplies, scissors, hair dryer, and therapy putty

Solution: The correct answer is D. The key to equipment selection is the therapist's creativity and understanding of the basic apparatus requirements. Workstations should simulate physical demand characteristics and aptitudes of a variety of work at graded levels and incorporate jobs that may be unique to a specific geography. Custom-designed samples and therapeutic projects offer significant therapeutic benefit to clients. A: The workstation design is too specific to the current caseload and not able to be readily generalized to a variety of work. B, C: Computerized resistive and commercially generated work samples are often valuable tools; however, they are not necessarily key components of workstation design.

A client with an acquired brain injury does not have private funds to pay for skilled occupational therapy services. The client does not have access to Medicaid. As a result, the client chooses to discontinue therapy. Which ethical principle requires the practitioner to respect the client's decision? Justice Beneficence Veracity Autonomy

Solution: The correct answer is D. The practitioner should help the client locate other forms of funding, but if the client is unable to secure reimbursement, the client has the right to refuse treatment secondary to the burden of cost. A: The principle of Justice promotes fairness and objectivity in the provision of occupational therapy services, but the client's right to refuse is not related to justice, even if refusal is based on unjust circumstances. B: The principle of Beneficence states that occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services. Beneficence holds personnel accountable to integrity for goals related to treatment. C: The principle of Veracity requires personnel to be honest with claims of ability and professional skills. This principle relates to the clinician, not to the client's choice to discontinue therapy.

In preparation for an upcoming orchestral performance, an adolescent student has been practicing playing a string musical instrument 5 to 6 hours per day. The student reports hand pain that is causing illegible handwriting and an inability to complete written classwork in a timely manner. What INITIAL action should the OTR® take in this situation? Advise the student to take a break from music practice until the pain subsides. Arrange for the student to use a computer for written assignments for school. Collaborate with the music teacher to determine an appropriate rest/practice schedule. Schedule a time to observe the student during a rehearsal set-up and practice.

Solution: The correct answer is D. The primary goal of intervention for upper-extremity overuse with musicians is to identify and reduce muscle tensions when playing the instrument. Observing the student during a rehearsal and practice would allow the practitioner to gather this information. A: It may be necessary for the student to decrease practice time or discontinue playing altogether, although this does not have to be the initial action until the practitioner observes the student playing the instrument. B: The increase in practice time is what has caused the hand pain to occur, and changing from writing to computer use will not address the source of the problem. C: Collaborating on accommodations to the practice schedule may be a necessary intervention approach once the practitioner has observed the student playing the instrument.

Principle 2, Nonmaleficence, of the Occupational Therapy Code of Ethics (2015) imparts an obligation to do no harm to others. Which of the following ethical violations is MOST likely a violation of the principle of Nonmaleficence? The director of an occupational therapy program receives a gift from a vendor in appreciation for the purchase of several items for the program. Because the gift is worth less than $75, the director decides not to report it to the employer. A clinical supervisor offers a reduced fee for hand management services to a physician who regularly refers clients to the occupational therapy program. To convince a research participant to continue in a low-risk study, an occupational therapy researcher offers an additional $50 incentive to the participant. An OTR® meets the sibling of a service recipient and has an intimate relationship with the sibling while continuing to provide occupational therapy for the family member.

Solution: The correct answer is D. The principle of Nonmaleficence, specifically Subprinciples 2C, 2F, and 2G, are violated when occupational therapy practitioners engage in personal relationships with service recipients and their family members. A: Failure to report a gift is primarily a violation of Principle 4, Justice. B: Although reducing a fee in exchange for referrals may be in violation of Principle 4, Justice, it is unlikely that any direct harm to others would result from the action. C: An additional incentive for a research participant is more likely to violate Principle 3, Autonomy, because it does not adhere to standard informed consent procedures. Because the study is low risk, however, there is limited potential for direct harm.

An OTR® has gone out on a date with a client that the OTR is still treating. A colleague of the OTR finds out about the date and wants to report the incident as a breach of ethics. What ethical principle will the OTR be reported as violating? Beneficence Autonomy Justice Nonmaleficence

Solution: The correct answer is D. The principle of nonmaleficence requires that occupational therapy professionals refrain from behavior that could cause harm. The well-being of the client could be jeopardized by a personal relationship with the OTR, which by its nature cannot be therapeutic. The example in the question is about professional boundaries and the objective recommendations or actions by the OTR that could be influenced by a dual relationship. Dual relationships with clients are inappropriate and unethical, whether they are romantic in nature or simply involve taking on a family member as a client. A: Beneficence refers to the demonstration of concern for others' safety and well-being. B: Autonomy is the concept that practitioners have a duty to treat the client according to the client's desires, within the bounds of accepted standards of care, and to protect the client's confidential information. C: Justice refers to the fair, equitable, and appropriate treatment of persons and access to occupational engagement.

A physician has referred a client to an outpatient setting for an occupational therapy evaluation and intervention. The client has late effects from a stroke that occurred approximately 10 years ago. The OTR® is performing a screening before initiating the evaluation. Which is the MOST likely reason for completing the screening? To complete the occupational profile and become acquainted with the client To meet the client and conduct a standardized interview before the evaluation To complete the assessments to save time during the evaluation process To identify whether the client may benefit from occupational therapy services

Solution: The correct answer is D. The purpose of a screening is to determine whether a client would benefit from an occupational therapy evaluation or services. The other three options would be completed during the evaluation process.

A high-level ulnar nerve injury may result in which characteristic deformity? Flexion of the ring and small finger metacarpophalangeal (MCP) joints because of loss of the extension-controlling forces of the third and fourth lumbricals Hyperextension of the index and middle finger MCP joints because of loss of the extension-controlling forces of the first and second lumbricals Unchecked abduction of the ring and small finger MCP joints because of lack of motor innervation of the third and fourth lumbricals Hyperextension of the ring and small finger MCP joints because of loss of the extension-controlling forces of the third and fourth lumbricals

Solution: The correct answer is D. The third and fourth lumbricals are innervated by the ulnar nerve. Loss of motor function in these muscles allows the extensor digitorum communis to extend the MCP joints without any opposing controlling forces, also known as "claw hand" deformity. A, C: The third and fourth lumbricals are prime flexors of the MCP joints. A high ulnar nerve injury would result in the inability to use the lumbricals for flexion. B: The first and second lumbricals are innervated by the median nerve and therefore are not affected in ulnar nerve injuries.

An OTR® is working with an elderly client in the early stages of Alzheimer's disease who qualifies financially for participation in an adult day program but cannot participate because of lack of transportation to the site. The local paratransit service feels the client needs one-on-one supervision when traveling, and providing such supervision is beyond the scope of their service. Transit system volunteers are willing to travel with older adults who need physical assistance, but they feel unprepared to travel with people with cognitive deficits because of dementia. What role might the OTR® play in helping the transportation system address this issue in a sustainable way? Volunteer to ride with the client on the paratransit van to the day care program three times a week Advocate for the day care program to fund and operate a separate transportation system for people who attend the program Drive the woman to the day care program and bill her family privately for mileage Design and carry out a training program for transit volunteers with an emphasis on facilitating the travel of people with dementia

Solution: The correct answer is D. The transit system would benefit from a program that allows it to serve adults with dementia. Providing training for transit system volunteers that can be replicated ensures sustainability. A, C: Volunteering to ride with or transport the client is not sustainable because the solution cannot be replicated for all clients in this position. B: A separate transportation system for the day care center does not offer a solution for the public transit system

A client who has hemiplegia currently transfers to a variety of surfaces using a stand-pivot technique with moderate assistance from a caregiver. The main bathroom in the client's home has a standard tub/shower combination. Which type of durable medical equipment would be MOST BENEFICIAL for supporting the client's participation in bathing at home? Hydraulic bath lift Shower chair with armrests Three-in-one shower commode Tub transfer bench

Solution: The correct answer is D. The tub transfer bench fits a standard tubshower combination by having two legs of the bench inside the tub and two legs of the bench outside the tub. The client could complete a stand-pivot transfer from the wheelchair to the tub transfer bench. A: The client is able to complete a stand-pivot transfer, so the use of a mechanical lift would exceed the client's assistance needs. B: A shower chair with armrests would not allow the client to transfer from the wheelchair to the shower chair because of the armrest interfering with the transfer surface. C: A three-in-one shower commode would require the caregiver to move the commode from the shower for commode use at other times. A separate commode for the toilet would be more beneficial in this situation.

A client with multiple sclerosis (MS) is experiencing memory deficits that are hindering the client's ability to take medications accurately. Which intervention is the MOST appropriate to support performance in medication management for this client? Simplify the task steps in managing medications Change the time when the client takes medications Have the client use a timer to take medication at designated times Provide the client with written directions for medication management

Solution: The correct answer is D. The use of memory aids, such as written directions, has been shown to improve cognitive function for clients with MS. Providing written directions can promote independence and accuracy in managing medications. A: Simplifying task steps addresses the cognitive deficit of sequencing and is an energy conservation strategy to manage fatigue; however, this intervention does not provide support for memory. B: Changing the time when the client takes medications would require the involvement of the physician, and there may be little flexibility in the medication schedule. C: If the client is experiencing memory deficts that interfere with taking medications, the client will likely not remember to use a timer.

An OTR® is evaluating a client with Parkinson's disease who lives at home but has begun to have mobility challenges. Which intervention is BEST to facilitate lifestyle changes to improve safety? Issue a long-handled reacher and teach the client how to use it Advise the client to continue to carry items during functional mobility Issue a rolling walker and educate the client how to use it Introduce use of a rhythmic beat to facilitate mobility

Solution: The correct answer is D. The use of rhythm has been shown to support mobility in people with Parkinson's disease. This approach can minimize the impact of the immobilization that may occur from this disease. A: A long-handled reacher may be difficult for a client with Parkinson's disease to use because of tremors and rigidity. B: Carrying items during mobility may decrease postural stability responses. C: A rolling walker may not be effective because the motoric freezing and festinating gait characteristic of this condition cause people to take smaller steps to adjust for postural instability.

An entry-level OTR® working in an outpatient rehabilitation clinic is evaluating a client who was recently hospitalized for dehydration and subsequently diagnosed with mild cognitive impairment. The client lives alone in an independent living facility. Before admission, the client was independent in ADLs and light homemaking and active in community and social activities, including driving independently. The client reports no crash record and no violations or citations but avoids night driving, highway driving, and driving in rush-hour traffic or heavy rain. What occupations or activities will yield the BEST results for the client's continued independence in fitness to drive? Shoulder arch and pulleys to increase the client's ROM Light woodworking activities to increase the client's general endurance as a prerequisite for fitness to drive Planning routes and trips via Google maps using the computer in the clinic Passenger activities for visual scanning, processing, and divided attention skills

Solution: The correct answer is D. These tasks are consistent with the deficits posed by the client's diagnosis of mild cognitive impairment. A, B, C: These tasks are not the best interventions because they address range of motion, endurance, and use of technology that may not improve the client's cognitive functions for driving

An OTR® decides to use the Cognitive Orientation to daily Occupational Performance (CO-OP) approach to encourage use of effective and appropriate social behaviors for a 9-year-old with attention deficit hyperactivity disorder. Which example illustrates an application of the CO-OP approach? The OTR, with some input from the child, establishes goals for the child regarding essential skills that the parent thinks need to be developed. The OTR directly teaches important strategies to help the child remember how to respond in stressful social situations. The OTR targets multiple skills in social situations to optimize the learning environment. The OTR asks questions to allow the child to process what behaviors were appropriate and inappropriate in a situation.

Solution: The correct answer is D. This approach is an example of the "ask, don't tell" principle of guided discovery using CO-OP. The OTR asks rather than tells the child the sources of breakdown during performance in occupations. A: This approach goes against the CO-OP principle of client centeredness and allowing the child to be as actively involved in goal planning as possible. B: This approach goes against the enabling principles of CO-OP. CO-OP supports facilitation rather than direct teaching of strategies to help a child perform occupations. C: This approach goes against the CO-OP guided discovery principle of "one thing at a time." To facilitate learning of skills, targeting only one skill at a time is recommended.

When performing a manual muscle test (MMT) on a client, the OTR® should use standard principles to guide the evaluation of muscle strength. Which statement accurately reflects those principles? The OTR can safely perform MMT on a client in acute pain. The OTR should apply the same amount of resistance for all muscles tested. The OTR should stabilize distally from the joint and apply resistance proximally to the joint. The OTR should apply resistance applied gradually and increase it as the client responds.

Solution: The correct answer is D. To appropriately measure muscle strength, the OTR should apply pressure in a gradual manner, giving the client time to respond to the resistance. A: The OTR should not perform MMT when the client is in acute pain. B: Larger muscles (e.g., those in the buttocks) can receive more resistance than smaller muscles (e.g., those in the forearm). C: Stabilization should occur proximally with resistance applied distally.

An inpatient had a traumatic brain injury several days ago. The OTR® is completing an initial mobility screening with the patient. When assisting the patient to move from supine to sit, the patient's body moves into an extensor thrust pattern. This interferes with the patient's ability to move independently to upright sitting. Which primitive motor response is inhibiting this bed mobility skill? Associated reaction Asymmetrical tonic neck reflex Optical righting reflex Tonic labyrinthine reflex

Solution: The correct answer is D. Tonic labyrinthine reflex is a response that results in extensor tone while in supine. A: Associated reactions occur when a motion in one extremity is copied in the opposite extremity. B: Asymmetrical tonic neck reflex occurs when the head is turned to one side and the arm on the skull side flexes while the arm on the face side extends. C: Optical righting reflex occurs when the head is unable to align with a horizontal object from a starting position of lateral head flexion.

An OTR® is working with an older adult client with low vision. The OTR has provided large-print reading materials and talking devices. Which interventions should the OTR also include for this client? Remediation eye treatments Range of motion (ROM) eye exercises Occlusion through eye patching Change in room lighting or task lighting

Solution: The correct answer is D. Treatment of low vision generally involves adaptations such as large-print reading materials, magnifiers; talking devices; increased contrast to highlight edges, borders, or backgrounds; and changes in lighting. A, B, C: Remediation eye treatments, which include ROM eye exercises and occlusion through patching, are interventions provided by an optometrist or ophthalmologist.

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? Gradient compression garments Superficial slow-speed vibration Manual decongestive therapy Transcutaneous electrical nerve stimulation

Solution: The correct answer is D. Use of modalities may exacerbate edema conditions and are generally contraindicated in situations of cancer. A: Gradient compression garments such as stockings and sleeves may be useful in providing limb support, which promotes edema reduction and is not contraindicated for reducing edema with cancer. B: Superficial slow-speed vibration would not be contraindicated as an intervention to reduce edema with cancer. C: Manual decongestive therapy will target the pathways of the lymph, promote edema reduction, and is not contraindicated in reducing edema with cancer.

A client with T5 spinal cord injury (SCI) is having difficulty with lateral trunk flexion, which is limiting independent transfers. The client is returning to work as a banker and will be spending 4 to 6 hours continuously in a wheelchair. Which intervention activity should the OTR®; consider FIRST? Have the client move in diagonal patterns of movement over a therapy ball Provide verbal cues for the client to realign the trunk during tasks Place objects on the floor that the client has to reach for Have the client practice weight shifting in the wheelchair for pressure relief

Solution: The correct answer is D. Weight shifting for pressure relief is an essential skill for clients with SCI to minimize the risk of skin breakdown while completing tasks during the workday. A: Dynamic seated postural tasks on a therapy ball will provide too great a challenge for a client with T5 SCI and will not provide specific weight-shifting skills. B: Trunk alignment will not be the greatest challenge for the client in maintaining seated posture during work activities. C: A client who is having difficulty with lateral trunk flexion, especially a client with T5 SCI, will not be able to immediately reach to the floor to pick up items.

An OTR® is performing a physical examination as part of a positioning and seating assessment. For which conditions would the OTR® apply manual pressure to the pelvis to determine whether a deformity is flexible or inflexible? Scoliosis, lordosis, sarcoidosis Lordosis, exocytosis, windswept deformity Kurtosis, kyphosis, lordosis Scoliosis, windswept deformity, kyphosis

Solution: The correct answer is D. With scoliosis, windswept deformity, and kyphosis, as well as with lordosis, the pelvis can be flexible or fixed (i.e., inflexible). For a client with any of these conditions, it is important to determine pelvic mobility in assessing seating and positioning. A, B, C: Sarcoidosis is a disease, exocytosis refers to inflammatory cells in the epidermis, and kurtosis refers to a frequency curve; hence, none of these words applies to spinal deformity.

An OTR® is providing a back injury prevention program for workers at a food manufacturing plant. The OTR® has provided education in proper body mechanics and on proper equipment use to decrease effort with tasks. Which component should the OTR® also include in the program? Support group Functional capacity evaluation Instruction in the use of physical agents Training in symptom identification

Solution: The correct answer is D. Workers should be educated to identify and report symptoms early; evidence indicates that early identification of musculoskeletal disorders in the workplace reduces the severity of the injury and associated costs. A: No evidence is available of the benefit of a support group in back injury prevention. B: Functional capacity evaluation should be performed by a qualified and trained individual to maintain fidelity of the evaluation. C: Physical agent modalities are provided on the basis of clients' specific needs.

An OTR® is working with a second grader with autism who is fully included in a general education classroom. The teacher has indicated that the child is "on yellow." On the basis of this information, what sort of support should the OTR® provide the child in terms of behavior? The child may benefit from physical restraint. The child may benefit from a time out. The child may benefit from being removed from the classroom on a regular basis. The child may benefit from environmental adjustments, cues, or facilitation.

Solution: The correct answer is D. Yellow-zone behavior is usually considered mildly problematic and does not pose a safety risk to the child or other people. This type of behavior can usually be addressed by making environmental adjustments or providing cues or facilitation A: In extreme cases, physical management may be necessary; however, yellow-zone behaviors do not warrant such management. B: Red-zone behaviors, or those that require immediate attention because someone is at risk, may warrant the use of time out. C: This approach would remove the child from academic time and would not be beneficial to the child's learning.

Even though some paratransit systems offer customized assistance, most require that the rider is functionally able to meet the vehicle at the street. What term is used to describe this type of service? Arm-through-arm service Curb-to-curb service Door-to-door service Demand-responsive service

Solution: The correct answer is B. A transportation service that requires riders to meet the vehicle at the street is referred to as curb-to-curb service, reflecting the expectation that the traveler can enter and exit the home and the vehicle without assistance. A: Arm-through-arm service refers to supplemental transportation services in which the rider is offered personal physical assistance to and from the doorway of the home to the door of the vehicle. C: Door-to-door service refers to services in which the rider is met at the door and assisted to the door of their destination. D: Demand-responsive service refers to a transit system categorization of services that are by request as opposed to fixed route.

An OTR® in an outpatient center is working with a client who has rheumatoid arthritis. The client, who is the parent of two children, has worked with a driver rehabilitation specialist on vehicle modifications that allow safer and more comfortable operation of the client's car. Which other aspect of community mobility might a generalist OTR® address? Securing the client's children safely in their car seats, including handling the car seats and positioning the children Training the client in adapted techniques for dressing and bathing the children with hand deformities Adjusting the foot pedals of the car to allow the client to minimize stress to the foot and ankle joints Recommending enhanced vehicle mirrors and techniques to accommodate for the client's reduced neck range of motion

Solution: The correct answer is A. AOTA's (2010) "Statement on Driving and Community Mobility" addresses the issue of assisting parents with disabilities in managing passenger safety for their children. B: Training in techniques for bathing and dressing children is not in the domain of community mobility interventions. C, D: Alterations to the client's vehicle require the skills of a specialist trained in driver rehabilitation or vehicle modifications as opposed to a generalist OTR® addressing an IADL.

A generalist OTR® is working with a teenager with developmental disabilities who hopes to acquire a driver's license. Which intervention MOST appropriately addresses this client's community mobility needs? Training to improve the client's comprehension of travel rules tested in the licensing process Practice in driving skills in the OTR's vehicle in the school parking lot Practice in handwriting skills to improve the client's communication about driving skills Use of cognitive-behavioral therapy to address the client's beliefs about the ability to drive

Solution: The correct answer is A. AOTA's (2016) statement "Driving and Community Mobility" states that occupational therapy intervention for people with developmental disabilities may include evaluation, education, and training in preparation for obtaining a driver's license. B: On-road driving practice would require specialist training as a driver rehabilitation specialist. C: Practice in handwriting skills is unrelated to community mobility skills. D: No indication is provided that the client's beliefs about ability to drive need to be addressed.

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? Silicone gel sheet Neoprene sheet Silastic elastomer Dynamic splint

Solution: The correct answer is D. 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. A, B, C: Silicone gel sheet, neoprene sheet, and silastic elastomer can be used under pressure garments to increase pressure garment conformity to the skin.

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? Take circumferential measurements of the forearms, wrists, palms, and digits. Use a volumeter to measure water displacement of the forearms and hands. Ask the patient to elevate the right hand above the level of the heart. Compare differences in time in completing the Nine-Hole Peg Test.

Solution: The correct answer is A. 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. B: It is not appropriate to wet the open wounds at this stage. C: Elevation of the edematous hand above the level of the heart is a method of intervention to decrease edema; it is not an approach for measuring edema. D: The Nine-Hole Peg Test is a test of coordination and does not directly measure the amount of edema.

An OTR® is evaluating an electrician who sustained an electrical burn in the right palmar area 2 days ago. The client has a subdermal burn in the middle of the palm with a full-thickness burn extended into the middle and index fingers. After completing the initial goniometric measurements of the right wrist and fingers, what other assessment is MOST IMPORTANT for the OTR® to perform before developing an intervention plan? Gross sensory screening Edema measurement Grip and pinch strength Manual muscle testing

Solution: The correct answer is A. For a client with an electrical burn, it is especially important to complete gross sensory screening of the involved limb to identify the extent of peripheral sensory nerve involvement. Similarly, for full-thickness and subdermal burns, it is likely that the peripheral sensory nerves are involved. B, C: Although edema measurement and grip and pinch strength are important as baseline measurements, they might not be feasible in the early stage of subdermal and full-thickness burns because of bulky dressing. D: Full manual muscle testing is not indicated unless the burns also involve the proximal arm area.

An OTR® is working with a student with autism spectrum disorder (ASD) to address impairments in social interaction skills, including turn taking, eye contact, and verbal and nonverbal communication. Which intervention embeds practice of these skills in the IADL of community mobility? Practicing interaction with the driver of a public transportation vehicle Practicing turn taking at an ice cream shop Asking the client to make eye contact five times during a therapy session Setting a goal for the client to sit without talking to anyone on the school bus

Solution: The correct answer is A. Interaction with a public transportation driver must take place within the realm of community mobility. Case-Smith and Arbesman (2008) observed that naturally occurring opportunities for social interaction are potential occupational therapy interventions for people with ASD. B, C: Turn taking at an ice cream shop and eye contact during therapy sessions do not take place within the context of community mobility. D: Sitting on the school bus without talking to anyone does not address skill development in the realm of social interactions, although it does take place within the realm of community mobility.

Every generalist occupational therapy practitioner should be prepared to address community mobility within his or her practice setting. What is one way to do so? Maintain a resource library or database about transportation options in the area Conduct on-road driving evaluations to determine fitness to drive Provide direct assistance to clients in boarding and riding public transportation vehicles Assist clients by providing rides to and from therapy sessions

Solution: The correct answer is A. Making transportation resources or information available to clients is pertinent to every practice setting and does not require specialized training or certification. B: Conducting on-road driving evaluations requires specialized training. C: Direct assistance to transportation users is not within the scope of practice of many practice settings. D: Providing rides to and from therapy sessions is not acceptable within most practice settings.

An OTR® is working with a person who has disabilities that prevent safe driving. Which statement BEST explains why the OTR® cannot assume that the use of public transportation is an option? The same functional impairments that prevent safe driving may also present barriers to the use of public transportation. People with disabilities who are used to getting in and out of relatively low automobiles cannot board buses because of buses' greater height. Adequate visual acuity is the determining factor in whether a person can use public transportation. Public transportation is not a socially acceptable form of transportation for most people with disabilities.

Solution: The correct answer is A. Many of the same medical and functional factors that interfere with driving may also interfere with the demands of using public transportationfor example, impaired mobility, impaired vision, slowed processing speed, and cognitive deficits. Task unfamiliarity introduces an additional complication. B: Difficulty boarding buses because of greater height is too specific an issue for the question posed. C: Visual acuity is only one functional factor and is not addressed in the literature. D: That public transportation is socially unacceptable to people with disabilities is too general a statement.

An 85-year-old client cannot access fixed-route transit and has chosen to use a supplemental transportation program operated by volunteer drivers. What characteristics of such a program might make it more appealing to this client? The "Five As": Availability, accessibility, acceptability, affordability, and adaptability The convenience and privacy of traveling in the client's own automobile The use of large vehicles that transport multiple people between fixed stops Curb-to-curb services at low or no cost to the traveler because the transportation is paid for through grant funding

Solution: The correct answer is A. The Five As represent characteristics of best practice in the provision of senior-friendly supplemental transportation, as outlined by the Beverly Foundation. B: Travel in one's own automobile is not necessarily a characteristic of supplemental transportation. C: The use of large vehicles and fixed stops is not characteristic of supplemental transportation systems. D: Supplemental transportation systems have varied sources of funding but typically are not fully grant funded; they also are more commonly door-to-door than curb-to-curb.

The client, a nondriver, lives in a fourth-generation family homestead in a remote area and was referred to occupational therapy services after sustaining an above-knee amputation. The client is extremely concerned about community independence and being able to go shopping, attend church services, and make social visits to friends. The client has a strong emotional attachment to the homestead. Which intervention option is the best option to satisfy the client's community mobility needs? Develop a community mobility plan with acceptable, affordable, and reliable transportation options for the client to access multiple goods and services in the community. Adjust the physical environment for inclusiveness and accessibility specific to the client's needs. Ensure that the client is independent with the use of mobility devices including a wheelchair, scooter and transfer board. Suggest that the client interview volunteer drivers who can provide services as well as taxi vouchers.

Solution: The correct answer is A. The client is socially and culturally connected to the area and the family homestead, and the OTR® needs to formulate goals to optimize the client's independence in community needs. B: Adjusting the physical environment alone will not allow for independence in community mobility. C: Independence with mobility devices will not satisfy the need of the client to be independent in the use of community mobility. D: These options alone, although an important aspects of independence in community mobility, will not meet the client's community mobility needs.

Older women who are members of an ethnic minority and live on lower incomes have been identified as using public transportation more than most people in their age cohort. How might their reliance on public transportation influence the engagement in community occupations of this population? Participation in community occupations will be limited by the hours of transportation service and the cost to use it. Access to taxi services will expand this population's access to community occupations. Public transportation offers access to more geographic areas than does a private automobile, so this population will have unlimited occupational opportunities. Participation in community occupations will be severely restricted for this population because they use public transportation.

Solution: The correct answer is A. The relationship between transportation access and community engagement is determined by the cost and scope of transportation relative to the resources and desires of the person. B, C, D: These assumptions may be incorrect, depending on the scope and cost of services relative to the user.

An OTR® is developing an intervention plan for a client with postacute myocardial infarction on the cardiac care unit. What metabolic equivalent of task (MET) should the client's early activity intervention not exceed? 1-2 METs 3-4 METs 5-6 METs 7-8 METs

Solution: The correct answer is A. When a client is on the cardiac care unit, activities should not exceed 1 to 2 METs. Any higher MET level requires too much exertion, which results in increased oxygen consumption and a higher heart rate than may be tolerated. B, C, D: When a client is transferred off the cardiac care unit to a hospital floor, activities can exceed 2 METs in progresssion of the cardiac rehabilitation program. Clients can walk, shower seated, and perform upper-body exercises (3 to 4 METS) as tolerated.

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 taken from the thigh was placed on the mid-forearm 3 days postinjury. When all the wounds are closed and the graft is stable, what is the BEST intervention to prevent hypertrophic scar development? Jobst pressure sleeve with inserts Elastic bandage wrapping from distal to proximal Scar massage 3-5 times per day Frequent PROM and AROM

Solution: The correct answer is A. When most of the wounds are closed, a Jobst pressure garment is the best choice to prevent hypertrophic scarring. Adding inserts increases the effectiveness of compression therapy. B: Elastic bandaging provides light compression and can initially be used when the wounds are not closed. C, D: Scar massage and ROM activities are an important part of burn rehabilitation but are not interventions for preventing hypertrophic scars.

When evaluating a client in a skilled nursing facility, the OTR® notes that the client's skin has a yellowish cast, the fingernail beds are bluish in color, and the client has noticeable edema in both lower extremities. What condition would MOST likely cause these symptoms? Right-sided congestive heart failure Left-sided congestive heart failure Aortic stenosis Aortic insufficiency

Solution: The correct answer is A. When the right side of the heart fails, blood flows back into the venous system. Symptoms of right-sided heart failure include cyanotic nail beds, jaundice, and lower-extremity edema. B: When the left side of the heart fails, blood flows back into the lungs, causing difficulty breathing, anxiety, and cerebral hypoxia. C, D: Aortic stenosis and aortic insufficiency have symptoms similar to those of left-sided heart failure.

An OTR® is evaluating a new client and notes that the client has a bluish tinge to the skin and lips. The client also presents with significant edema. Which medical condition is this client MOST likely to have? Emphysema Chronic bronchitis Cystic fibrosis Cirrhosis of the liver

Solution: The correct answer is B. A client with chronic bronchitis has poor oxygenation, resulting in a bluish tinge to skin and lips, along with edema. A: A client with emphysema is most likely to have pinkish skin. C: A client with cystic fibrosis may have yellowing of the skin. D: A client with cirrhosis of the liver will tend to have an orange tint to the skin.

An OTR® is working with a client who is planning to take fixed-route transportation from home to school. The client sustained a closed-head injury 2 years ago and has difficulty with problem solving, especially related to changes in routine. What is the MOST important step for the OTR® to practice with the client? Walking from home to the train station Learning how to read the train schedule Obtaining exact change for the fare Getting on and off the train safely

Solution: The correct answer is B. A client with problem-solving difficulty should be provided with a strategy to address future changes in routine. Because both train and school schedules may change from time to time, it is important for the client to learn how to read the train schedule. A, D: Changes in the walking route from the home to the train station or in the client's ability to get on and off the train are less likely than changes in the train schedule. C: Obtaining a monthly train pass can avoid the necessity of having exact change for each ride. Also, a ticket vending machine or purchase station may be able to return change.

An OTR® is working with a client with quadriplegia who has reentered a rehabilitation center to work on improving community mobility skills 1 year post injury. Which intervention would BEST address the client's treatment priorities? Maximizing the recruitment of motor units in partially innervated musculature through the use of functional electrical stimulation Practicing advanced wheelchair skills on community outings, including navigating doorways and uneven terrain Cotreating with the physical therapist to address therapeutic standing in long-leg braces Practicing the use of a power wheelchair in anticipation of a future need

Solution: The correct answer is B. AOTA's (2010) "Statement on Driving and Community Mobility" addresses community navigation by wheelchair users as a skill of the generalist OTR®. A, C: Functional electrical stimulation and physical therapy are interventions focused at the person level as opposed to the community level. D: Practice in using a power wheelchair is not indicated as a need.

According to AOTA's (2010) "Statement on Driving and Community Mobility," what training must an occupational therapy practitioner have to address the IADL of community mobility? Advanced training as a driver rehabilitation specialist Successful completion of training as an OTR® or COTA® Specialized training with transportation systems and departments A specific number of courses that address driving and community mobility

Solution: The correct answer is B. AOTA's (2010) "Statement on Driving and Community Mobility" states that all OTR®s and COTA®s possess the training and education necessary to address driving and community mobility as an IADL. A: Although advanced training is necessary to become a specialist in driving and community mobility, every occupational therapy practitioner can address driving and community mobility from a general IADL perspective. C: Specialized training with transportation systems and departments is not necessary to address a client's community mobility. D: Occupational therapy educational standards do not mandate specific hours or credit in coursework addressing driving and community mobility.

Recipients of Medicaid may be eligible for subsidized transportation for health care and life maintenance trips. Why is it important for occupational therapy practitioners to be aware of this possibility? Most occupational therapy clients are funded by Medicaid. People with disabilities are disproportionately represented among Medicaid beneficiaries. Public transportation providers do not accept Medicaid vouchers for transportation. Medicaid covers transportation only to physician visits and not to therapy appointments

Solution: The correct answer is B. According to Vanderbur and Silverstein (2006), people with disabilities are disproportionately represented among Medicaid beneficiaries and therefore may be eligible for transportation subsidies. Occupational therapy practitioners should be aware of the availability of this option so they can appropriately refer clients for transportation services. A: Evidence does not support the statement that most occupational therapy clients are funded by Medicaid. C, D: Medicaid transportation policy differs from state to state, and these statements are not correct in all circumstances.

Which psychiatric condition is MOST frequently seen as interfering with the occupational engagement of a client with cardiac disease? Panic attack Major depression Personality disorder Hypochondriasis

Solution: The correct answer is B. Among clients with cardiac disease, 15%-20% meet the criteria for major depression. Clients with depression have poorer outcomes and increased morbidity and mortality. A: Clients with cardiac disease may exhibit increased stress and anxiety, but not panic attacks specifically. C, D: Clients with cardiac disease do not show a significant increase in either personality disorder or hypochondriasis.

A client sustained facial burns that required several grafting surgeries. An OTR® is seeing the client in an outpatient setting 6 months post surgery. The client wishes to go out to lunch with a friend but is fearful of participating in this social activity. What treatment intervention would be MOST beneficial for this client? Advise the client to wear a facial pressure garment in public and practice putting it on, eating, and taking it off in the clinic Have the client participate in activities that can restore confidence and self-esteem, such as applying theater-type full-coverage makeup Advise the client to wear a clear facial mask in public and carry a letter from the physician indicating that the client has facial burns Have the client participate in stretching activities to improve movement of the facial muscles

Solution: The correct answer is B. Applying makeup to well-healed burns can improve a client's ability to cope with a change in body image and to function psychosocially. A, C: Wearing a facial pressure garment or clear facial mask does not address the client's body image issues or fear of social situations. D: Stretching activities will improve the movement but not the appearance of the client's face.

A 4-year-old client sustained full-thickness burns on the volar surfaces of both wrists and forearms 4 months ago. In spite of using pressure garments and splinting for position, the child has developed thick scars across the wrists. Active and passive wrist flexion and extension are, respectively, as follows: right, 70/25 and 80/40; left, 70/30 and 85/50. Which activity would be MOST EFFECTIVE in improving wrist mobility? Finger painting on a vertical surface Crawling though a tunnel maze Playing an X-Box bowling game Throwing bean bags through vertical targets

Solution: The correct answer is B. Because the burns are on the volar surface, the client has the most limitation in both active and passive wrist extension movement. Crawling is a developmental activity that can develop both flexibility and strength at the wrists through weight bearing. A, C, D: Although these play activities may involve active wrist flexion and extension, crawling is the only activity that incorporates passive stretching through the occupation of play.

An OTR® is working on the organ transplant unit of a major hospital. What psychiatric condition is a client with a long-term transplantation MOST likely to experience? Depression Anxiety Dementia Personality disorder

Solution: The correct answer is B. Clients may experience anxiety because of the guilt they feel over benefiting from someone else's death or while waiting for a matching donor. Organ recipients may also be affected by a type of posttraumatic stress disorder. A: Clients may experience depression, but it is not the most common psychiatric condition for transplant recipients. C, D: Dementia and personality disorder are not considered complications or psychological disorders common to clients with organ transplants.

An OTR® is working with a client in acute care who is complaining of leg cramps and pain when walking. These problems are a common symptom of what condition or surgical procedure? Cardiac arrhythmia Peripheral artery disease Lung transplantation Coronary artery bypass graft

Solution: The correct answer is B. Cramping and pain when walking—also known as intermittent claudication—are caused by decreased blood flow when exercising and are common symptoms of peripheral artery disease. A: Cardiac arrhythmia does not generally cause leg cramps or leg pain. C: Problems after lung transplantation usually include infections, fatigue, and breathing difficulties, not leg cramps or pain. D: A client may have stitches in the leg from removal of the saphenous vein for grafting in the heart, but stitches do not result in leg cramps or pain.

Which symptom of autism spectrum disorder (ASD) may have an impact on the use of public transportation? Motor impairments may make it difficult for people with ASD to board public buses. Impaired executive functioning may result in a person with ASD misjudging when to get on or off a bus. Visual impairments may result in a person with ASD not being able to read bus schedules or bus identifiers. Impairments in regulating autonomic functions may make it difficult for people with ASD to wait outside for a bus in extreme temperature conditions.

Solution: The correct answer is B. Executive function deficits are a common symptom of ASD and may result in impaired judgment. A, C, D: Motor, visual, and autonomic impairments are not primary symptoms associated with ASD and therefore would not typically pose a challenge related to community mobility for people with ASD.

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? Compression glove worn 24 hours per day with 20 minutes of deep scar massage every 2 hours during waking hours 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 Coban self-adherent wrap on each individual finger during the day, deep scar massage 3 times per day, and antideformity hand splint at night Coban self-adherent wrapping of each individual finger and elasticated tubular bandage 24 hours per day, regular PROM of left fingers and wrist

Solution: The correct answer is B. It is important that the mother accept the child after the accident, and having therapeutic playtime can help with motherchild bonding. To not further overwhelm the mother, the initial scar management program should be simple and yet efficient. The use of silicone gel pad inserts at the web spaces can soften the scar and maintain the web spaces. A, C, D: 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.

An OTR® working in a community hospital has been asked to serve on a team assessing the livability of surrounding communities. Which definition BEST describes the concept of livability? Provision of sidewalks, crossing signals, and curb cuts to ensure that all citizens of the community can move around the community without an automobile Community design that promotes maximum participation of all citizens, regardless of age or ability Mix of housing that allows families with and without children and people of all ages and incomes to live in inclusive neighborhoods Design of the physical aspects of a community to allow equal access to goods and services for wheelchair users

Solution: The correct answer is B. Livability is a concept that extends beyond specific types of physical access or design to encompass all aspects of community life that may invite participation by all community dwellers, regardless of age or ability. A: Walkability refers only to the built environment. C: Housing policy is not a component of livability. D: Physical accessibility is only one component of livability.

The private automobile is the dominant form of transportation for most adults in the United States and is closely tied to occupational routines. Older adults who can no longer drive need viable options for other types of transportation to remain engaged in valued occupations. How do the majority of older adult nondrivers in the United States travel in the community? As riders on public transportation vehicles As passengers in private automobiles driven by someone else As operators of nonmotorized or small-scale vehicles such as bicycles and golf carts As pedestrians during daylight hours and not at all at night

Solution: The correct answer is B. Multiple sources confirm that an overwhelming majority of older adults nondrivers travel in cars driven by someone else once they can no longer drive. A, C, D: Older nondrivers do not use these forms of community mobility in great numbers.

Older adults who are familiar with using public transportation and enjoy it as an affordable and accessible alternative to driving may have concerns about their personal safety while traveling, particularly if their functional abilities are changing. How might an OTR® collaborate with well elders to address personal safety concerns at the level of community? Refer the older adults for individual therapy sessions to improve their functional abilities Partner with older adults to advocate for strategies to improve the safety of waiting areas and vehicles Write a letter on behalf of the older adults to the transportation authority stating the concerns the older adults reported Encourage the older adults not to use the public transportation system and instead to ask for rides from friends and family

Solution: The correct answer is B. Partnering to advocate for strategies to improve safety is both collaborative and at the level of community rather than individual intervention. A: Referral for therapy is an individual-level action as opposed to a community-level action. C: Writing a letter to the transportation authority is not collaborative. D: Encouraging older adults not to use public transportation does not respect the current occupational routines of the older adults as stated.

In reading a client's medical chart, the OTR® notes that the client has a history of postprandial orthostatic hypotension. What activity precautions should the OTR give the client? Limit standing to 30 minutes while completing an occupation, such as cooking. Avoid a positional change from lying down to standing within 30 minutes of eating a meal. Take several minutes in the morning to move from lying down to sitting and then standing after being in bed all night. Avoid leaning the head too far forward, for example, bending over to tie shoes while sitting.

Solution: The correct answer is B. Postprandial orthostatic hypotension occurs when a person goes from supine to standing shortly after eating a meal. It generally affects older adults, people with hypertension, and people with Parkinson's disease. A: This precaution applies to neurally mediated hypotension, which occurs in children and young adults after standing for extended periods of time. C: This precaution applies to orthostatic or postural hypotension, which occurs in people on prolonged bedrest who sit or stand too quickly. D: This precaution would be unnecessary because inverting the head would increase blood flow to the head, not decrease it.

In a pulmonary rehabilitation setting, what would an OTR® instruct a client to do to ensure that the client is not holding his or her breath during the strenuous part of an activity? Hold the neck in midline Count out loud or talk Prop elbows on the countertop Lift both arms to 90° of flexion

Solution: The correct answer is B. Pulmonary rehabilitation clients may be instructed to count out loud, sing, or talk to ensure that they are exhaling during the strenuous part of an activity. A: Holding the neck in midline improves swallowing more than breathing. C: Propping elbows on a countertop assists in stabilizing the upper extremities when incoordination interferes with upper-extremity tasks. D: Lifting both arms to 90° of flexion would make breathing more difficult.

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? Passively range all digits and joints at once Passively range each digit and joint one at a time Instruct the client to actively make a fist, then straighten the fingers completely Instruct the client to wear a resting hand splint at all times

Solution: The correct answer is B. Ranging each joint separately decreases the chance of rupturing finger extensor tendons with dorsal hand burns. A, C: 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. D: Wearing a splint inhibits the ability to perform PROM of the hand.

An OTR® is working with a client who has been placed on bedrest because of a deep vein thrombosis. After anticoagulation therapy has been initiated, what is the accepted waiting period to resume occupational therapy interventions involving ambulation? 12 hours 2-3 days 5-7 days 8-10 days

Solution: The correct answer is B. Recent literature has indicated that ambulation may be permitted on the 2nd or 3rd day after anticoagulation therapy has been initiated. A: It takes longer than 12 hours for the partial thromboplastin time to be within therapeutic range. C, D: Recent research has indicated that bedrest should not be continued for more than 3 to 4 days.

An OTR® 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 OTR would be MOST appropriate? Ask the client to lean backward and rest the arms on the chair arms, then practice pursed-lip breathing Ask the client to lean forward and place the forearms on the thighs, then practice pursed-lip breathing Ask the client to sit upright and allow the arms to dangle, then guide the client to use visual imagery 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

Solution: The correct answer is B. Resting the arms on the thighs releases the diaphragm, making breathing easier and lessening fear. Pursed-lip breathing can slow breathing and reduce anxiety. A, C, D: Leaning backward or sitting upright does not release the diaphragm.

An OTR® is working with a community organization to address child passenger safety and injury prevention, including car seat safety and pedestrian and bicycle safety. Which organization would be MOST appropriate for the OTR® contact? National Center for Senior Transportation SafeKids USA AARP National Mobility Equipment Dealers Association

Solution: The correct answer is B. SafeKids USA is a national nonprofit organization that provides resources and advocates for policy related to community mobility for children. A: The National Center for Senior Transportation provides training and resources pertaining to transportation for older adults. C: AARP addresses issues related to people age 50 and older. D: The National Mobility Equipment Dealers Association is an industry group that provides adapted driving and mobility equipment for travelers with disabilities.

Which community-level action can an OTR® undertake to address the walkability of the area in the practice's neighborhood? Teach a specific client skills related to pedestrian safety Volunteer to serve on a city planning advisory board Read pedestrian safety materials available from the U.S. Federal Highway Administration Assist older clients in writing letters to AARP describing the lack of walkability features of their area

Solution: The correct answer is B. Serving on a city planning advisory board is the only option that is a community-level action. A: Teaching a client pedestrian safety skills is an individual-level intervention. C: Reading pedestrian safety materials, although advisable for practitioners working in community mobility, represents personal knowledge development as opposed to a community-level action. D: Letter writing is not a community-level action and does not represent effective advocacy relative to walkability. Although AARP is involved in walkability efforts and advocacy, it does not serve as a repository for community-level complaints.

A client in the burn unit sustained deep partial-thickness burns to the bilateral dorsal hands 1 week ago. What is the BEST position for splinting to prevent deformity? Volar hand splint with wrist in neutral, metacarpals (MPs) in slight hyperextension, and interphalangeals (IPs) in full extension Volar hand splint with wrist in 30º extension, MPs in 70º flexion, and IPs in full extension Dorsal hand splint with wrist in neutral, MPs in 90º flexion, and IPs in 50-70 flexion Dorsal hand splint with wrist in 30º flexion and MPs and IPs in full extension

Solution: The correct answer is B. When a burn occurs on the dorsal surface of the hand, it has potential to form a claw-hand deformity. The intrinsic-plus position is thus the best splinting position to prevent contracture. A: It is not anatomically appropriate to immobilize a hand with MP hyperextension C, D: When the dorsal surface of the hand is burned, a dorsal splint should be avoided to decrease shear and friction on the skin's surface.

A client in the acute burn unit sustained full-thickness chemical burns to the bilateral anterior and inner thighs. The client underwent grafting operations 2 weeks ago, and the surgeon has confirmed graft adherence. What would be the OTR®'s BEST choice to initiate compression therapy? Custom-made Jobst garment Spandex bicycle pants Coban self-adherent wrap Thigh-high thromboembolism-deterrent (TED) stocking

Solution: The correct answer is B. Spandex bicycle pants are sufficient to apply gentle pressure on the anterior and inner-thigh areas without causing excessive shear or pressure on the newly adhered graft. A: Although a tailor-made Jobst garment is a good choice for compression therapy in the later stage, it is important to initiate compression therapy with lighter pressure for desensitization in the early stage when the wound is still fresh. C: Coban self-adherent wrap will be difficult to manage in a large area such as the thighs. It is more commonly used in small areas such as the fingers. D: Thigh-high TED stockings would be contraindicated because the top end of the TED hose will likely create shear on the anterior and inner thighs, where new skin grafts are still at risk of breaking open.

In 2005, Congress passed a federal transportation bill, SAFETEA-LU, which included funding for a program that encouraged children (including those with disabilities) to bike and walk to school, acted to reduce air-polluting traffic near schools, and encouraged healthy lifestyles from a young age. What was the name of this initiative? WalkFit to School Safe Routes to Schools Children With Disabilities Act Healthy American Students

Solution: The correct answer is B. The Safe Routes to School program was funded from 2005 to 2012 as part of the SAFETEALU legislation (Pub. L. 10959) and provided 100% federal funding to facilitate states' initiatives to create safe environments surrounding schools and encourage children to bike and walk to school as part of developing a healthy lifestyle. In 2012 these initiatives were combined with others as part of the federal Transportation Alternatives Program. A, C: D: These are not names of federal legislative efforts to encourage children to walk and bike to school.

An 88-year-old client has given up driving as a result of decreased vision. The client has a history of carpal tunnel, diabetes mellitus (poorly controlled), congestive heart failure, and osteoarthritis in both knees and thumbs. The client has frequent medical appointments within a 20-mile radius of home. The client lives alone and is 10 blocks away from the closest bus station. What is the BEST choice for community mobility for this client? Fixed-route transportation Paratransit transportation Neighbors providing rides Volunteer driver program

Solution: The correct answer is B. The most reliable transportation service for this client is paratransit. The client can call ahead of time to reserve rides for the frequent medical appointments. A: With the client's complicated medical conditions, fixed-route transportation may be too taxing because the client would need to walk 10 blocks to the bus station, wait for the bus, and get on and off the bus. C, D: Both rides provided by a neighbor and a volunteer driver program might not be reliable and available for the client's frequent medical appointments.

Research indicates that older adults with stroke who previously used public transportation decrease their use of public trains and buses more because of changes in physical capacities than because of changes in cognitive capacities. Which statement BEST describes the relationship between stroke and public transportation use? The demands for mapping and following a travel route require attention and intact spatial relationships. The use of mass transit requires balance, the ability to safely move from sit to stand, and the ability to grasp and hold. The interpersonal demands of using public transportation require executive function skills. The use of mass transit requires visual and auditory skills to navigate the transportation environment.

Solution: The correct answer is B. The use of trains and buses challenges balance, general mobility, and hand skills. A, C, D: These cognitive and sensory capacities do not influence public transportation use as much as physical capacities.

Which example offers the BEST way to incorporate community mobility exposure into psychosocial rehabilitation? Refer the client to a certified driver rehabilitation specialist. Provide opportunities for practice and role play before the client uses a mode of transportation. Provide the client with information on personal safety during travel. Educate the client on the availability of city or county pedestrian walkways or bike paths.

Solution: The correct answer is B. This choice allows for skill training in choosing a mode of transportation. A: This choice is expensive and may require out-of-pocket payment from the client; it can be addressed by the generalist, and therefore the specialist does not need to intervene. C: Providing safety tips will not allow for community mobility exposure. D: Providing education on walking or bike paths will not best facilitate the client's community mobility exposure.

An OTR® 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? Use a shower chair, bathe with hot water from a handheld shower, use relaxation breathing, and inhale on exertion Use a shower chair, bathe with warm water from a handheld shower, use pursed lip breathing, and exhale on exertion 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 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

Solution: The correct answer is B. Using a shower chair, bathing with warm water from a handheld shower, using pursed lip breathing, and exhaling on exertion all contribute to independent showering for a client with COPD. A: Hot water adds to humidity and makes breathing more difficult. The client should use pursed lip rather than relaxation breathing techniques and should exhale rather than inhale on exertion. C: Using a shower chair takes less energy than getting into and out of a tub. Hot water adds to humidity and makes breathing more difficult. Leaning forward in the tub releases the diaphragm and makes breathing easier. D: Using a shower chair takes less energy than getting into and out of a tub. Cool water may chill the client and require more energy for tasks. Resting the arms on the thighs, not on the sides of tub, releases the diaphragm and makes breathing easier.

An OTR® is treating a client who burned the bilateral lower extremities 10 days ago. The client refuses to participate in ADLs because of pain. The client rates the level of pain as 4 of 10 when resting in bed and 7 of 10 when standing. What is the BEST action for the OTR® to take? Report the client's pain levels to the medical doctor and request stronger pain medication. Apply an elastic bandage wrap for vascular support before getting the client out of bed. Allow the client to perform ADLs while lying in bed, and focus on bed mobility skill. Explain to the client that nonparticipation may lead to an early discharge from therapy.

Solution: The correct answer is B. With lower-extremity burns, providing vascular support before standing decreases blood pooling in the lower extremity and therefore decreases pain in standing and ambulation. The client should learn an alternative strategy to manage pain early on in the intervention. A: A nonpharmacological pain intervention should be attempted before requesting stronger pain medication. C: Allowing the client to stay in bed does not allow for active participation in an upright posture and may lead to muscle wasting in the client. D: Threatening the client with the consequence of nonparticipation usually does not address the main pain factor or motivate the client to participate.

An OTR® is working with transplant recipients who have recently been discharged from a major hospital. Which type of client would be MOST likely to develop an infection posttranplantation and require greater infection control measures? A client with a kidney transplant A client with a heart transplant A client with a lung transplant A client with a liver transplant

Solution: The correct answer is C. A client with a lung transplant is the most susceptible to infection because the transplanted organ is exposed to bacteria and germs on inhalation. A, B, D: Clients with kidney, heart, and liver transplants are not as likely to experience infection as lung transplant recipients, because these internal organs are more protected from direct infections.

An OTR® consulting with a municipal transit provider seeks to address transportation provision at a systems level as opposed to providing service to individual clients. Which role would be MOST appropriate for this OTR®? Assisting older travelers in embarking and disembarking from a bus Reading and understanding policy related to the effects of arthritis on a client's ability to drive Designing and conducting a paratransit eligibility determination process Educating volunteer drivers in a faith-based community who wish to serve nondrivers with disabilities

Solution: The correct answer is C. AOTA's (2010) "Statement on Driving and Community Mobility" lists the role of involvement in paratransit eligibility determination for OTR®s addressing community mobility at the transportation system level. A, B: Assistance in entering and exiting a bus and for clients with a specific diagnosis is specific to individual clients. D: Volunteer drivers in a faith-based community are part of a supplemental transportation program, not a municipal transit system.

A young adult client with complete C4 quadriplegia from a spinal cord injury is being discharged from inpatient rehabilitation to the family home in a rural area. Which community mobility intervention would be MOST relevant to this client? Teaching the client to drive an automobile using hand controls Educating the client on use of the wheelchair to access a subway system Providing training for the client and family on how to safely transfer and secure the client and wheelchair in the family vehicle Working collaboratively with the client to read and understand a bus schedule

Solution: The correct answer is C. AOTA's (2010) "Statement on Driving and Community Mobility" states that occupational therapy's role in addressing community mobility includes addressing passenger safety such as securing passengers and wheelchairs. A: Teaching the client to drive using hand controls is not relevant to the client's functional abilities. B, D: These public transitrelated interventions are incongruent with the client's rural context.

An OTR® is working on the intensive care unit of a hospital. The client has hypertension and has an arterial line catheter inserted in the radial artery. What change in the client is the OTR MOST likely to record during treatment? A decrease in blood pressure when the head of the bed is elevated A decrease in heart rate when client is positioned from supine to short sitting at the edge of the bed An inaccurate blood pressure reading when the wrist is moved An increase in respiration rate when the client is positioned side lying

Solution: The correct answer is C. An arterial line catheter is inserted in the radial artery at the wrist to continuously monitor arterial pressure. When the wrist is moved, it can disrupt the catheter and affect the blood pressure reading. A: A client with hypotension, not hypertension, would generally have a decrease in blood pressure when the head of the bed is elevated. B: A client would generally have an increase in heart rate when going from supine to sitting. D: Depending on the client, side lying may increase or decrease the respiration rate.

An OTR® is working in a cardiac rehabilitation program. Of the four clients on the OTR's caseload, which client would require a longer warm-up and cool-down period during exercise and activity sessions? The client with congenital heart disease The client with a coronary artery bypass graft The client with a heart transplant The client with an automatic defibrillator

Solution: The correct answer is C. Because a donor heart is denervated, the autonomic nervous system does not control the client's heart rate. The heart relies on circulating hormones, which take longer to increase and decrease the heart rate. A, B, D: In congenital heart disease and after cardiac surgery, the heart remains innervated, so the client's autonomic nervous system regulates the heart rate.

Community mobility has been described in the occupational therapy literature as a conduit for participation in valued occupations. In addition to being a means to move from one place to another, what is the relationship of community mobility to participation? An occupational performance skill An occupation aid An occupation enabler An occupational profile

Solution: The correct answer is C. Community mobility is a set of activities that allow access to and support participation in occupation. This characterization encourages practitioners to recognize community mobility as more than a discrete set of services that allow clients to move between two points, but rather an essential form of support for occupational engagement. A: According to the Occupational Therapy Practice Framework: Domain and Process, community mobility is an instrumental activity of daily living, not an occupational performance skill. B: Occupation aid is not relevant terminology. D: The occupational profile consists of client information obtained during an initial evaluation rather than the content or outcomes of that process, which may include community mobility.

An OTR® is working with a client who is experiencing congestive heart failure that has developed gradually over a long period. The client is displaying limited tolerance for light to moderate homemaking activities. Which compensatory strategy would be BEST for the OTR® to demonstrate to the client to improve tolerance to these activities? Pursed lip breathing Sternal precautions Work simplification techniques Use of adaptive devices

Solution: The correct answer is C. For clients who show limited endurance for or tolerance of activities, work simplification techniques can improve their ability to complete tasks independently. A: Pursed lip breathing is more appropriate for clients with respiratory conditions. B: Sternal precautions are not needed with clients with congestive heart failure unless they have recently undergone open-heart surgery. D: Adaptive devices generally compensate for decreased ROM or muscle strength, not low tolerance for activity.

Transportation researchers advocate for the development of services that can foster coordination and collaboration among transportation providers both public and private and acknowledge that specially trained OTR®s can fulfill this role. What is this concept called? Mobility advocacy Mobility discovery Mobility management Mobility independence

Solution: The correct answer is C. Mobility management is the term suggested by Eby, Molnar, and Pellerito (2006) and is based on developing projects across the United States. A, B, D: These terms do not represent the concept presented in this question and are generic terms that do not indicate a specified role in public transportation.

An OTR® is working with a team in a neonatal intensive care unit to prepare a family for their infant's discharge home the next day. Which action addresses the MOST important occupational therapy-related consideration for these clients' community mobility needs? Ensuring that the parents have valid driver's licenses and a safe vehicle in which to transport the child Instructing the parents to consider the possible need for adaptive mobility equipment in their future vehicle choices Determining how the child will be transported in the immediate future and making recommendations regarding child passenger safety Educating the parents about future adaptive mobility options such as adapted strollers and tricycles

Solution: The correct answer is C. Occupational therapy practitioners address community mobility as an IADL (AOTA, 2008), and the immediate needs of this family are for safe transportation as they leave the hospital. A: Ensuring that the parents have valid driver's licenses and a safe vehicle is outside the scope of occupational therapy practice. B, D: Future mobility options are not the immediate intervention priority.

An OTR® is working with a client who had a pacemaker implanted 10 days ago. Which activity would be contraindicated because of pacemaker precautions? Heating tea in a microwave at waist level Lifting a light jacket from one surface to another Placing hair in a ponytail using both upper extremities simultaneously Brushing hair using the upper extremity opposite the pacemaker placement

Solution: The correct answer is C. Pacemaker precautions include no shoulder flexion or abduction greater than 90° on the side on which the pacemaker was implanted for the first 4 weeks. A: Electrical devices that affect pacemaker function, such as magnets, MRI machines, metal detectors, and portable media players, should be avoided. Newer pacemakers are not affected by the use of microwaves. B: Lifting a light jacket is within the guidelines of lifting no more than 10 pounds. D: Shoulder abduction or flexion greater than 90° on the side opposite pacemaker placement is acceptable movement. Clients' shoulder movement is restricted only on the operated side.

An OTR® is working with a client in an outpatient center who has been diagnosed with Raynaud disease affecting the fingers. What home program instruction is MOST appropriate for a client with Raynaud disease? Wear a flexion glove at night. Use a cold pack to increase finger circulation. Wear gloves when exposing the fingers to a cold environment. Visually inspect the fingers daily for tumor growth.

Solution: The correct answer is C. Raynaud disease disrupts blood flow to the digits in vasospastic attacks. The client needs to be educated to wear gloves when exposing hands to the cold, such as reaching into a freezer. A: A flexion glove is worn when passive range of motion in flexion is limited in the digits, which does not occur with Raynaud disease. B: A cold pack will trigger a Raynaud's episode. D: Fingers need to be inspected frequently for ulcers, scars, and discoloration. Tumor growth is not a part of Raynaud disease.

A school-based OTR® is serving several children who use wheelchairs as their primary means of mobility. All of the children ride the public school buses between school and home. The director of special education services has noted that the school's responsibility for the well-being of the children includes their use of school-sponsored transportation. What might the OTR® do to help ensure the safety of these children on the school bus? Offer to ride with the children on the school bus to ensure they are safely seated and are not exposed to danger along the school bus route Suggest to the children's parents that they seek transportation other than the school buses Develop knowledge of safe seating strategies and wheelchair restraint use and help train bus personnel in safe body mechanics while assisting wheelchair users Educate the children in how their wheelchairs should be restrained during travel and ask them to sign a waiver stating that they, rather than the school, are responsible for seating themselves safely

Solution: The correct answer is C. School-based OTR®s have skills in body mechanics, seating, and positioning and are part of the team addressing child school bus safety. A: An OTR® riding the bus would not benefit the children or the school in terms of overall school bus safety; in addition, not all students with disabilities may ride the same bus. B: Advising parents to use other transportation is not legal; schools that provide transportation must have it available for all children. D: The school is responsible for the child's safety, not the child.

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 taken from the thigh was placed on the mid-forearm 3 days postinjury. To minimize the risk of graft rejection in the initial phase (7 days postinjury), in what should the client be instructed? Daily active pronation and supination exercises at least 5 times per day Desensitization using ice to gently rub the burned areas from distal to proximal Retrograde massage followed by elastic bandage wrapping from distal to proximal Immobilization using the elbow extension splint and avoiding forearm movement

Solution: The correct answer is D. During the initial phase after skin graft operation, it is important to maintain immobilization for 2-7 days or per the physician's specific instruction. A, B, C: Risk of graft rejection as a result of shear friction, movement, and excessive pressure should be avoided.

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 taken from the thigh was placed on the mid-forearm 3 days postinjury. The client would like to return to softball practice as soon as possible. What would be the BEST activity during the initial phase of rehabilitation? Elbow extension splint 2 hours on, 2 hours off Upper arm rehab bike for 30 minutes, twice daily Scar massage followed by interactive, virtual-reality computer sports games Wall pulley and wall ladder followed by skin care regimen

Solution: The correct answer is C. Taking into consideration the client's previous occupation as a softball player, virtual-reality computer sports games can involve similar sports movements and be motivating. However, because newly healed skin might split open as a result of overstretching or shearing force during movement, it is important to perform scar massage with a lubricant before activity. A, B, D: These activities are preparatory activities that do not take into consideration the client's areas of occupation.

The provision of paratransit services is a legal mandate for public transportation providers, who must provide complementary and equivalent transportation services to those who cannot access fixed-route transportation because of a disability. Which law provides this mandate? Olmstead Act SAFETEALU Act Americans With Disabilities Act Rehabilitation Act of 1973

Solution: The correct answer is C. The Americans With Disabilities Act of 1990 established the mandate to provide complementary paratransit services under Title II, Part B. A: The Supreme Court's decision in Olmstead v. L. C., 527 U.S. 581 (1999), eliminated unnecessary segregation of people with disabilities and was not specific to transportation. B: The Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEALU; Pub. L. 10959) authorized federal surface transportation programs and did not address transportation rights. D: The Rehabilitation Act expanded civil rights for people with disabilities but did not mandate access to paratransit services.

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 taken from the thigh was placed on the mid-forearm 3 days postinjury. What is the OPTIMAL intervention to prevent formation of elbow contracture? A dorsal elbow flexion splint to position the elbow at 90 degrees flexion and the forearm in supination. A volar elbow flexion splint to position the elbow at 90 degrees flexion and the forearm in neutral. A dorsal elbow extension splint to position the elbow at extension and the forearm in neutral. A dorsal elbow extension splint to position the elbow at extension and forearm in supination.

Solution: The correct answer is C. The antideformity position for the elbow is elbow extension and forearm in neutral position. Also, because the client has a partial-thickness skin graft at the anterior aspect of the forearm and to maintain maximum surface area of the grafted area, it is better to position the forearm in a neutral position. A, B: Positioning the elbow in 90 degrees flexion will encourage contracture that will prevent elbow extension. Only a dorsal arm splint should be used because the burn area is in the anterior aspect of the arm. D: The forearm should be positioned in neutral to maintain maximum surface area of the grafted area.

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? Provide the client with low-load prolonged stretch using an elbow flexion splint. Instruct the client in daily aggressive PROM at the elbow. Instruct the client in a daily AROM program within the pain-free range. Recommend the client use a long-handled swivel spoon for self-feeding.

Solution: The correct answer is C. The client is developing heterotopic ossification at the right elbow. The best intervention is to preserve AROM. A, B: The client is developing heterotopic ossification at the right elbow. Use of a splint for sustained stretches and aggressive PROM are contraindicated for this condition. D: The client is developing heterotopic ossification at the right elbow. The client may need adaptive equipment for self-feeding, but maintaining AROM should be the highest priority in the initial intervention.

An OTR® is treating a client who had a split-thickness skin graft 2 days ago on the left posterior axillary area. What postoperative occupational therapy intervention would be the BEST choice? Perform gentle passive left shoulder ROM to pain tolerance twice daily. Perform active left shoulder ROM as tolerated, incorporated into daily activities. Fabricate an axilla splint with left shoulder in 120 degrees abduction and slight external rotation. Occupational therapy is not indicated in the postoperative phase of care.

Solution: The correct answer is C. The postoperative phase of care is 5-10 days post-skin graft operation. During this phase, it is important not to disturb the grafted area so that graft adherence will occur. However, to prevent deformity from scar tightness and shrinkage, it is important to position the arm in antideformity position—that is, 120 degrees abduction and slight external rotation. A, B: Even though ROM exercise and activity are important in postburn rehabilitation, a period of immobilization is enforced immediately after grafting to allow for graft adherence; therefore, no PROM or AROM is allowed during the postoperative phase. D: Occupational therapy is an essential intervention in order to prevent postoperative contracture.

An OTR® has determined that a visually impaired client can no longer drive. What should the therapist include in the occupational therapy intervention to help this client be independent in the use of community mobility? Familiarize the client with the procedures for using paratransit. Obtain a bus schedule and start training the client to use the bus for fixed-route travel. Select, test, adopt, and train the client and the client's family or support system in the use of the most appropriate transportation options. Educate the client on the need for driving cessation and the importance of maintaining independence in the community mobility.

Solution: The correct answer is C. This is a comprehensive approach to follow after determining a client cannot drive. The client's family or other support system should understand the client's options for community mobility in order to support the client's independence. A, B: The client may not want to use these methods of transportation. D: This option may be part of the intervention process, but it is not adequate for independence in community mobility.

The Safe, Accountable, Flexible, Efficient Transportation Equity Act (Pub. L. 109-59) was signed into law in 2005. What is the basic premise of this law? This law includes providing transportation benefits to optimize access to the workplace and assumes that lack of transportation is a major barrier and challenge in sustainable employment. That people who can access fixed-route public transportation may travel more successfully compared with those who do not have such access. That state and local transportation decision makers play a role in bringing attention to safety concerns related to individual users of different transportation modes That people who can access public transportation in a sustainable fashion, are more likely to be successful in welfare-to-work initiatives.

Solution: The correct answer is C. This option describes the premise of the Safe, Accountable, Flexible, Efficient Transportation Equity Act. A: This option describes the Personal Responsibility and Work Opportunity Reconciliation Act (Pub. L. 10493). B: This option explains the implications of fixed- and flexible-route trips. D: This option is an implication of the 1998 Transportation Equity Act for the 21st Century (Pub. L. 105178).

Parents of children with disabilities often report socioeconomic as well as personal challenges to involving their children in community-based physical activity programs. Which example represents a socioeconomic issue that needs to be considered when planning a community-based physical activity program? Some children have disabilities that don't allow them to be physically active. Parents of children with disabilities may prefer home-based activities to protect their children from harm. Transportation costs or availability can prevent access to community-based programs. Some facilities that sponsor physical activity programs may not be accessible to children with disabilities.

Solution: The correct answer is C. Transportation costs, whether related to operating an automobile or using public transportation, can be a barrier to access for families with children with disabilities. A, B: Type of disability or desire to protect the child are personal and familial issues as opposed to socioeconomic issues. D: Access issues related to the facility are physical accessibility as opposed to socioeconomic issues

An OTR® 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 wear of an anterior elbow extension splint. What alternative would be BEST for effective treatment of the soft-tissue elbow contracture? Ace wrap the splint on instead of using straps Discharge the client from occupational therapy secondary to treatment noncompliance Refer back to the plastic surgeon for surgery Use serial casting to slowly stretch the tissue

Solution: The correct answer is D. A cast is more difficult to remove and may promote better circumferential pressure to reduce hypertrophic scarring in addition to reducing the elbow contracture. A: Ace wrapping a splint reduces edema, not contracture. B: Discharging the client will not reduce the contracture. C: Surgery is appropriate for a boney block contracture, but alternative treatment methods should be implemented for soft-tissue contractures before surgery.

An OTR® is assessing a client for safety in community mobility. The client is using a front-wheeled walker (FWW) and had a left total knee replacement 10 days ago. What client ability is the MOST important area to address in the assessment? Carrying a grocery bag safely while using the FWW Checking for traffic before crossing any intersection Handling the FWW while going up and down the curb in front of the building Crossing the crosswalk in a timely manner before the light changes

Solution: The correct answer is D. A client with a new total knee replacement and new to using a FWW walks at a slower pace than the average pedestrian. Crossing the crosswalk safely and before the light changes is a time-restricted task and should be checked out in the community mobility assessment. A: For safety, a client using a FWW should not carry a grocery bag unless a walker bag is used. B: Checking for traffic before crossing at an intersection is a general cognitive safety skill and is usually not a concern after knee replacement surgery unless the client has preexisting cognitive impairment. C: Safety in handling the walker while going up and down the curb is important, but there is no time-restriction requirement to complete the task safely.

An occupational therapy group for adults who are working on regaining occupational engagement 1 year post stroke is designed to include sessions on community mobility and to address participants' stated concerns regarding use of assistive devices in public places. Which activity would BEST address these goals? A session with a physical therapist in the clinic to practice ascending and descending stairs like those on public buses An interactive conversation about places in the community to which one can travel by public transportation An educational session about the advantages of different walkers, canes, and wheeled mobility options A field trip to the local mall using public transportation and practice in the use of walkers, canes, and scooters in the mall

Solution: The correct answer is D. A field trip to the mall involving public transportation and practice using assistive devices best combines the goals for community mobility and use of assistive devices in public places. A: Practice using stairs does not embed community mobility in a community context. B, C: Conversation and education about public transportation or assistive devices only partially address the stated goals.

As part of the therapy process, an OTR® working with a client to access community transportation evaluates the community context to determine available travel options. Which component is MOST appropriate in this community assessment process? Lobbying state representatives to provide more funding for public transportation Teaching the client how to read public transportation schedules Educating the client in personal safety practices to follow when walking in the community Analyzing community transportation options in terms of availability, affordability, and accessibility to the client

Solution: The correct answer is D. AOTA's (2010) "Statement on Driving and Community Mobility" addresses assessment of community contexts and specifically includes analysis of availability, affordability, and accessibility of transportation options as components of this process. A: Lobbying state representatives is advocacy as opposed to assessment of community context. B, C: Teaching schedule-reading skills and personal safety practices addresses client knowledge and skills as opposed to evaluation of the community context.

An OTR® is working with a community organization whose mission includes promoting universal access to transportation for people with disabilities. Which organization might the OTR® contact for training and technical assistance? Alzheimer's Association Association for Driver Rehabilitation Specialists Assistive Technology Industry Association Easter Seals Project ACTION

Solution: The correct answer is D. Easter Seals Project ACTION is a cooperative project with the U.S. Department of Transportation's Federal Transit Administration that promotes universal access to transportation for people with disabilities under federal law and beyond. Project ACTION partners with transportation providers, the disability community, and others to provide training, technical assistance, applied research, and outreach and communication. A, B, C: These organizations' missions are not focused primarily on universal access to transportation.

An OTR® is working with a client with myocardial infarction during the early rehabilitation phase in an outpatient facility. In reviewing the home program with the client, the OTR® discusses activity and exercise limitations according to metabolic equivalent (MET) levels. Which activity would be contraindicated within the first 4 weeks after a myocardial infarction because of the activity's MET level? Light housekeeping Knitting and crocheting Dressing and undressing Carrying groceries upstairs

Solution: The correct answer is D. Healing of the heart muscle takes 4 to 8 weeks. During this time, activities are limited to the 2 to 4 MET range. Carrying groceries upstairs requires 6 to 10 METs. A, B, C: Light housekeeping, knitting and crocheting, and dressing and undressing require 1.0 to 2.5 METs, well within the 2.0 to 4.0 MET range.

SafeKids USA is a nonprofit organization dedicated to eliminating preventable childhood injuries, including those related to childhood community mobility, such as pedestrian, bicycle, and car seat accidents. Which SafeKids resource would be MOST useful for an OTR® working in an early intervention program? Statistics on safety while walking to school Educational brochures on cycling safety for adolescents Information about effective driver training for teens Videos addressing car seat safety for young children with special needs

Solution: The correct answer is D. OTR®s working in early intervention are consulted about car seat fit and safety for children with developmental disabilities. SafeKids USA resources addressing this topic would be most useful relative to the age and needs of children in early intervention. A, B, C: These resources are available through SafeKids USA but are less relevant to the context of early intervention.

Public transportation systems might benefit in the long term from investing in greater accessibility and user training opportunities for young people with disabilities. Which statement BEST supports this argument? Public transportation providers will avoid financial penalties if they provide high-quality travel training for young people with disabilities. Better relationships between public schools and public transportation providers will result from more attention to the needs of young people with disabilities. Public transportation systems will have a larger pool of potential employees if they respond to the access and travel training needs of young people with disabilities. People who are taught early to use transportation systems that are accessible to their needs often become lifelong users of the system.

Solution: The correct answer is D. Precin et al. (2012) noted that people with autism spectrum disorder who are provided with travel training at a relatively young age often become lifelong users of public transportation if it is accessible to them. A: Although transit systems may incur financial penalties if they do not follow legal mandates for accessibility, no evidence indicates that the quality of travel training programs is linked to these penalties. B: Most public schools operate their own transportation systems. C: That public transportation use increases the pool of potential employees has no basis in the research literature about public transportation.

An OTR® working with older adults facing driving cessation was concerned about ensuring their continued community mobility for psychosocial as well as functional reasons. What evidence does the literature provide that supports a psychosocial focus with this population? Older adults have been found to be more content once they no longer face the pressure to drive. Driving cessation has been linked to episodes of psychosis. Research indicates that families of older adults are relieved when older adults can no longer drive. Driving cessation has been linked to social isolation, depression, and early nursing home admission.

Solution: The correct answer is D. Several studies have indicated a link between driving cessation and social isolation, depression, and early nursing home admission (Classen, 2010). A: No evidence indicates that older adults are more content once they cease driving. B: The literature on the psychosocial implications of driving cessation does not mention an increase in psychosis after driving cessation. C: Family members' feelings about the inability of older adults to continue driving are complex; relief is but one of the feelings they may experience.

An OTR® is seeking to understand how a client perceives an impending change from driving to use of other forms of transportation. Which assessment would BEST assist the OTR® in understanding the client's perception of this change? Canadian Occupational Performance Measure Motor-Free Visual Perception Test Rivermead Behavioral Memory Test Assessment of Readiness for Mobility Transitions

Solution: The correct answer is D. The Assessment of Readiness for Mobility Transitions is a tool specifically designed to assess the willingness of older adults to accept changes in their use of transportation options. A, B, C: The Canadian Occupational Performance Measure, the Motor-Free Visual Perception Test, and the Rivermead Behavioral Memory Test do not assess readiness for mobility transitions. The Motor-Free Visual Perception Test and the Rivermead Behavioral Memory Test are sometimes used in clinically based driving evaluations but are not assessments of readiness to change means of transportation.

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? The tensile strength of the burned skin will not allow for composite flexion of the fingers. A bulky dressing on the hand will limit the ability to form composite flexion of the fingers. Immobilization is critical for the initial wound healing to avoid wound widening from movement. Composite flexion of the fingers increases the risk of extensor dorsal hood disruption.

Solution: The correct answer is D. The extensor dorsal hood lies superficially at the proximal interphalangeal joint and will likely be damaged in a full-thickness burn to the dorsum hand. Until the integrity of the extensor dorsal hood is verified, Boutonniére precaution should be applied during evaluation and intervention. 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 postskin graft period, total immobilization is not needed in a postburn management program.

An OTR® is working with a client who is experiencing dyspnea while performing a daily occupation in sitting. What sitting position would BEST minimize the client's dyspnea while performing the occupational task? Sitting with trunk erect and rigidly in midline Sitting with trunk extended and slightly to one side in a more relaxed posture Slouching to one side and leaning on one arm for improved trunk support Slouching forward while avoiding maximum forward trunk bending

Solution: The correct answer is D. To ease breathing, lean partially forward, propping the forearms on the upper thighs. A, B, C: Other supine and standing positions can improve dyspnea, but these three alternative sitting positions would not ease respiration more adequately than slouching partially forward.