✓NBCOT Questions #11: 551-610 (7/15/19)

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

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®

DK- STUDY 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? A. Senses are elevated. B. Muscles are spastic. C. Sympathetic functions are hypoactive. D. Muscles are flaccid.

The right 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.

X- 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? A. Have client use a logbook that provides a calendar with the current therapy session schedule B. Engage the client in a daily self-care routine of showering, dressing, and groomingC. Allow the client to guide intervention sessions by providing minimal structure to the sessions D. Organize an orientation group in which the client can share perceptions of orientation

The right 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.

DK- 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? A. An activity that is challenging and likely to cause tension among members B. An activity that is highly structured so participants know exactly what is expected of them C. A parallel group activity that enables participants to work alongside one another D. An activity that facilitates participants' success and thus improves their self-esteem

The right 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.

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. The OTR® realizes that the client requires a specialized driving evaluation. The therapist has had only minimal experience (one 2-hour lecture) in driving and community mobility. Which option BEST reflects appropriate professional and ethical standards for the OTR® in working with this client? A. The OTR® discusses his or her lack of experience with the supervisor and refers the client to a certified driver rehabilitation specialist. B. The OTR® reports the client to the Department of Motor Vehicles. C. The OTR® discharges the client back to the independent living facility. D. The OTR® assumes that the performance deficits found in the general assessment and managed in the intervention plan will carry over to improve the client's driving fitness.

The right answer is A Assessing skills underlying the task of driving is within the scope of practice for the general OTR®. A comprehensive driving evaluation, however, should be conducted by an OTR® driver rehabilitation specialist. B: Reporting the client to the Department of Motor Vehicles is premature. C: Discharging the client without focusing on the client's driving and community mobility needs is unethical. D: No evidence has shown that the performance deficits found in a general assessment and managed in a general intervention plan will carry over to improve driving fitness.

Retired NBCOT® Question 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? A. Assess the student's perceptual-motor processing using standardized testing. B. Determine the most appropriate desk set-up for the student to complete class assignments. C. Instruct the teacher on ways to cue the student using kinesthetic learning techniques. D. Provide worksheets for the student to practice letter formation during study group.

The right 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. Perceptual-motor 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.

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? A. Dress the affected arm by placing the sleeve over the affected arm B. Put the head through the neck opening by bending the neck forward C. Place the unaffected arm into the sleeve by placing the sleeve over the unaffected arm D. Rub the affected arm on the leg to straighten the sleeve

The right 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.

X- 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? A. Aggressive outbursts of behaviors when frustrated with a project B. Overassertive, controlling behaviors during group activities C. Difficulty engaging in problem solving D. Panic over task choices

The right answer is A During task performance, clients with symptoms of schizophrenia can show elevated levels of frustration and aggression 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.

X- 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? A. Complete employee participation B. Projection of new injuries C. Anticipated reoccurring injuries D. Long-term beneficial outcomes

The right 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.

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

The right answer is B Burns to the dorsum of the hand require the metacarpophalangeal joints to be splinted in 70°-90° 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.

XXXXXA 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? A. Eye-tracking input B. Mouth stick control C. Light touch activation system D. Switch-encoding input

The right answer is A Given the client's lack of volitional head control and upper-extremity movement, eye-tracking input will allow the client to input through the use of a virtual keyboard. The headband can help to steady the client's head for the eye-tracking movement on the 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 use hand controls on a keyboard, even with light touch activation. 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.

X- 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? A. Ideational praxis B. Motor organizational praxis C. Symbolic play D. Exploratory play

The right 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.

An OTR® is facilitating an activity for a group that includes an adolescent with major depression. Partway into the session, the adolescent complains of an inability to concentrate on the activity because the bright lights in the room have caused sore eyes. How should the OTR® respond? A. Offer the client a choice to discontinue the session and ask the nurse about medication changes and effects B. Immediately report the situation to the nurse and ask the client to rest for the day C. Ignore the client's response because it might be an effort to avoid work D. Speak to the client privately and inquire whether the client is telling the truth

The right answer is A OTR®s should be cognizant of the possible functional performance effects of medication. Offering a choice is an effective way of handling an adolescent. B: Reporting to the nurse may be unnecessary because photosensitivity is a common side effect of psychotropic medication. C, D: These responses show distrust of the client's report and will not address the client's needs.

X- 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? A. Principle 1: Beneficence B. Principle 3: Autonomy and confidentiality C. Principle 4: Social justice D. Principle 6: Veracity

The right 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.

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

The right answer is A Severe head injuries include GCS scores of 8 or less. B: Moderate head injuries include GCS scores of 9-12. C: Mild head injuries include GCS scores of 13-15. D: The GCS does not classify an "extreme" head injury.

Retired NBCOT® Question 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? A. Activities to improve handwriting should be included as part of the intervention. B. Ninety-eight percent of the student's peers would score better on the fine motor test. C. Fine and gross motor skills are within an acceptable range from the norm. D. Fine motor and gross motor skills are moderately delayed compared to the norm.

The right 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: Gross motor skills are within an acceptable range from the norm, but fine motor skills suggest a delay. D: Gross motor skills are within an acceptable range from the norm, but fine motor skills suggest a delay.

Retired NBCOT® Question 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? A. Organized play group in a community playground B. Backyard of the child's home with siblings C. Group session in the occupational therapy clinic with other children D. Tumbling group for preschoolers in a community gymnasi

The right 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.

X- Retired NBCOT® Question 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? A. Advise the child to wear an absorbent incontinence pad or a youth-size disposable diaper. B. Suggest restricting the child's fluid intake during the day to limit urine production. C. Recommend the child apply manual pressure on the abdomen while emptying the bladder. D. Educate the parent and child about alternative means of collecting the child's urine.

The right 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.

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

The right 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.

DK- 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? A. Cumulative trauma B. Orthopedic impairment C. Autoimmune symptoms D. Neurological complications

The right 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.

An OTR® consulting with a transitional living program housing adults with chronic mental illness is working with a resident to support the resident's new role as a part-time employee of the town library, which is located a few blocks from the residence. The client does not drive because of medication side effects. Which intervention BEST addresses community mobility skills relevant to this client's situation? A. Teach the client how to safely lift and move heavy loads of books B. Educate the client about pedestrian safety and practice the walk to work C. Educate the client about automobile safety in the event the client is able to find a ride to work D. Work with the client to obtain a driver's license

The right answer is B AOTA's (2010) "Statement on Driving and Community Mobility" includes in the OTR®'s role addressing walking to promote independence and prevent injury. A: Teaching the client to lift and move books, although related to the client's work, is not relevant to the client's community mobility goal. C: Education about automobile safety is not relevant to the client's contextual factors. D:Working to obtain a driver's license is not an appropriate goal; the client does not drive because of medication side effects.

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

The right answer is B All hip replacement clients should wipe between their legs in a sitting position. A, C, D: These methods may violate hip precautions as well as increase fall risk.

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? A. Advise the client to wear a facial pressure garment in public and practice putting it on, eating, and taking it off in the clinic B. Have the client participate in activities that can restore confidence and self-esteem, such as applying theater-type full-coverage makeup C. 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 D. Have the client participate in stretching activities to improve movement of the facial muscles

The right 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 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? A. Position the monitor a minimum of two arm lengths away from the client. B. Position the monitor at eye level and one arm length away from the client. C. Tilt the monitor up so that the client is looking at the lower half of the screen. D. Recommend that the client use a large type size of no less than 16 points.

The right 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 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? A. Postural hypotension B. Tardive dyskinesia C. Increased hypoglycemia D. Tyramine reaction

The right 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.

X- An OTR® has just begun working on the cardiology unit of an acute care hospital and will be responsible for supervising the COTA® who has been on this unit for 5 years. What is the BEST type of supervision for this COTA®? A. Continuous B. Minimal C. Routine D. Close

The right answer is B The COTA® has been working on the unit for 5 years and likely sees very similar types of patients. Therefore, the COTA®'s knowledge and professionalism likely do not require frequent supervision. A, C, D: It would be inappropriate to provide this in-depth or frequent supervision to an experienced COTA® working with a specific population.

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? A. Call for assistance, and put the client in the wheelchair. B. Lower the client onto the OTR's flexed leg, then down to the floor. C. Hold the client up with a gait belt until another practitioner can get a chair. D. Using the gait belt, pull the client into the closest chair.

The right answer is B 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.

X- 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? A. Job rotation through different workstations B. Raising the table height of the assembly line by 3 inches C. Implementing factorywide stretching exercises during breaks D. Introducing high-speed, high-vibration power tools for speedy assembly

The right 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.

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? A. Rules-of-the-road recognition; Motor-Free Visual Perception Test, Third Edition; finger-to-nose test B. Trail Making Test, Part B; Useful Field of View; and Mini-Mental State Examination C. ROM, manual muscle strength, and family interview D. Color discrimination, contrast sensitivity, and depth perception

The right 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.

X- 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? A. "I'm unable to ambulate safely with a cane or walker." B. "We don't have enough room to move the wheelchair between rooms in our home." C. "I'm unable to push myself up a ramp in a wheelchair." D. I'm unable to remove the armrest to transfer."

The right 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.

An OTR® is asked by her organization to provide services to a famous actor with the expectation that the client will receive preferential treatment for therapy times and frequencies. What is the OTR's best next step? A. Pair the client with similar clients to maximize the client's therapy time. B. Treat all clients according to clinical need and guidelines for prioritization. C. Ask that the client be transferred to an OTR who has more time available. D. Agree to provide longer treatment sessions for the client, thereby upholding the ethical principle of Fidelity.

The right answer is B This option best upholds the principles of Beneficence and Justice; it meets the needs of all clients regardless of payor status. A, D: These options demonstrate a treatment bias. Prioritizing one client's needs over another or providing differential treatment is not equitable and therefore violates the ethical principle of Justice. Treatment should be provided according to the clinical needs of the client (Beneficence). C: This option does not reconcile the ethical conflict; it merely transfers the conflict to another provider.

DK- X STUDY 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? A. Use open-ended questions to allow the client to give rich detail about the client's needs. B. Use close-ended questions to prevent frustration caused by difficulty in word retrieval. C. Use observation as a primary source of information from the client. D. Use the caregivers to provide the majority of the client's history.

The right answer is B With a client with early-stage HD, it is important to use close-ended questions that require yes-no 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.

DK-X An OTR® works as a member of a Commission on the Accreditation of Rehabilitation Facilities (CARF)-accredited comprehensive team of occupational rehabilitation professionals. Which type of return-to-work program BEST reflects the program of which the OTR® is a member? A. Work simulation B. Work hardening C. Work conditioning D. Work therapy

The right 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 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? A. Poor Plus (2+/5) B. Good (4/5) C. Fair Minus (3/5) D. Normal (5/5)

The right 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 and 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 and the client would not have difficulty washing the opposite side of the body.

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? A. Providing accessibility recommendations B. Educating on preventative health measures C. Developing pressure relief methods D. Recommending durable medical equipment

The right 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.

DK- 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? A. Watching sports B. Reading a book C. Driving a car D. Watching a play

The right 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.

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? A. Individualized assertiveness training B. Reality-orientation group C. Relaxation-focused group D. Daily routine group

The right 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® 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? A. Ask the caregiver to detail his or her schedule and ability to supervise the client upon release. B. Ask the caregiver to take notes on the session and provide brief feedback when complete. C. Ask the caregiver to practice adaptive activities alongside the client. D. Ask the caregiver to read a manual regarding hip replacement surgery.

The right 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.

X- 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? A. Meeting a new friend B. Initiating a routine C. Listening to instructions or conversations D. Forming a bond with more than one teacher

The right 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.

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? A. An occupational performance skill B. An occupation aid C. An occupation enabler D. An occupational profile

The right 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.

DK-X 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? A. Kneading bread dough B. Upper-extremity PROM exercises C. Stress-loading tasks D. Progressive resistive exercises

The right 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.

X- When dealing with clients who have dementia, what would be the primary role of the OTR® in addressing caregiver burden? A. Provide recommendations about community resources. B. Provide recommendations about medication management. C. Provide recommendations related to home modifications. D. Provide recommendations related to safe transfers.

The right 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® 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? A. Provide task lighting to promote the client's vision B. Complete acuity testing to determine whether the client needs glasses C. Refer the client to an optometrist or ophthalmologist for automated perimetry testing D. Provide client education materials in large print

The right 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.

To facilitate participation in familiar daily living tasks by clients with dementia, what would be an appropriate INITIAL stage of intervention? A. Recommend home modifications. B. Provide caregiver education. C. Develop strategies to simplify familiar tasks. D. Establish appropriate daily routines.

The right 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.

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

The right 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.

X- Retired NBCOT® Question 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? A. To increase overall endurance for daily tasks B. To promote normal venous and lymphatic return C. To improve mobility for preferred activities D. To facilitate passive ROM through a full arc of motion

The right 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.

X- 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? A. Instruction in PROM and application of joint mobilization techniques B. Use of cold packs followed by application of ultrasound C. Instruction in a stress loading program and incorporation of use of the upper extremity in functional activities D. Serial casting

The right 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. Astifidis, R. P. (2007). Pain-related syndromes: Complex regional pain syndrome and fibromyalgia. In C. Cooper (Ed.), Fundamentals of hand therapy: Clinical reasoning and treatment guidelines for common diagnoses of the upper extremity (pp. 376-387). St. Louis, MO: Mosby/Elsevier; p. 380. Explanations of Incorrect Answers 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.

A manager instructs an OTR® to keep a client for a week more than originally planned. The OTR, who has a decade of experience in this particular clinical setting, believes that all the goals have been met and that the client can no longer benefit from occupational therapy services at this level of care. What is the OTR's most appropriate next step? A. Agree to provide services for the extra week of services. B. Preauthorize payment for the services from the payor. C. Discuss the OTR's concerns with the manager. D. Report the manager immediately to an employee hotline.

The right answer is C This response is the best option, given that it reflects the right to benefit from services (Principle 1, Beneficence). The right to benefit is meant to determine the best decisions for provision of services to a client. Talking with the manager is a sufficient first response for this situation. A: Provision of an extra week of services without need is unnecessary. B: This option assumes that there is a likelihood of further services to be provided. D: This response is not the best next step, but it may be indicated as a potential option after other possibilities are pursued.

An OTR® is working with a client who has major depression and works for a service-based business that opens at 9:00 a.m. and closes at 5:00 p.m. The client finds work meaningful but is unable to keep up with a full-time schedule because of the depression. The OTR would like to advocate for workplace accommodations. According to the Americans With Disabilities Act of 1990 (ADA), what is a reasonable accommodation for this client? A. The client should be allowed to work 3 hours per day. B. The client should be given a flexible start time. C. The client could job share with a coworker. D. The client can break for 3 hours in the middle of the day.

The right answer is C To satisfy the client's needs while respecting the business's normal operations, this option is best for the client, according to ADA guidelines. The ADA suggests that the employer should not have to provide accommodations that would disrupt the flow of normal operations. A: This accommodation is not reasonable because it would not meet the employer's needs for 8 hours of labor per day. B: This accommodation is not reasonable because the work hours are not conducive to this particular business, which is service based and must be open for at a predictable time for its customers. D: This accommodation is not reasonable because it disrupts the normal working hours necessary for the type of business for which the client works.

X- 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? A. Mini-Mental State Examination B. Assessment of Motor and Process Skills C. Modified Fatigue Impact Scale D. Canadian Occupational Performance Measure

The right 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 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 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 does not assess a client's self-perception of ADL abilities.

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? A. Install bed rails to keep the client from climbing out of bed. B. Place the client in a nursing home C. Conceal the doorknobs so that the client cannot open the doors. D. Move the client's bed into one of the caregiver's rooms.

The right 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.

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? A. The student may be supervised by the entry-level COTA as long as the COTA consults with the OTR. B. The student may be supervised by an OTR who works at another facility. C. The student may be supervised by an entry-level COTA who works at another facility. D. The student cannot complete fieldwork at the facility because adequate supervision is not available.

The right 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.

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? A. 5% B. 25% C. 50% D. 75%

The right 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.

STUDY- 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. A Incomplete fibrous ankylosis B. Jaundice and vomiting C. Breech presentation D. Limited reactions to play

The right 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.

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? A. Disorders of sequencing and adapting prioritization and problem solving B. Disorders of social skills and concentration C. Disorders of sensory integration and perception D. Disorders of thinking and memory

The right 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.

A COTA® working on an inpatient rehabilitation unit has had two patients fall in the past month. The supervising OTR® has concerns about the COTA®'s safety awareness during certain interventions. Which approach is the BEST for the OTR® to take to address these concerns? A. Speak with the rehabilitation manager about possible disciplinary action. B. Review the documentation of the two patients who fell and discuss their cases thoroughly with the COTA® to determine the causes of the falls. C. Ask the COTA® whether more thorough supervision is needed and then proceed to provide close supervision. D. Collaborate with the COTA® to determine potential causes of the falls and provide direct supervision with more deliberate feedback.

The right answer is D Supervision that is more frequent may be necessary when the OTR®, COTA®, or both determine that additional supervision is needed to ensure safe and effective delivery of occupational therapy services. In this case, safety is a major concern, and therefore additional supervision may be necessary. A: This unnecessary step would put the COTA®'s job at risk; more appropriate solutions exist before going to this type of extreme measure. B, C: These approaches offer more indirect supervision; moreover, C is not appropriate because whether the COTA® says yes or no, more supervision is warranted because of the OTR®'s safety concerns.

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

The right 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.

An OTR® lived in a state in which the occupational therapy practice act required 10 hours of continuing education to provide a particular intervention (physical agent modalities [PAMs]) and was deemed competent by the OTR's previous employer. The OTR now works in a state where 20 hours of continuing education are required. The employer tells the OTR to provide PAMs to the OTR's clients because competency was demonstrated with the previous employer. What is the OTR's best next step, considering the ethical principle of Justice? A. Provide the services that are clinically appropriate and in accordance with the current employer's standards. B. Contact the previous employer to confirm that service competency was met. C. Provide the intervention now so as not to delay client services and sign up for the additional 10 hours of continuing education. D. Acquire the 10 additional hours of continuing education before providing PAMs to clients.

The right answer is D The ethical principle of Justice requires the clinician to adhere to state credentialing requirements, which supersede organizational policies or practices. A: This option is illegal and therefore violates the ethical principle of Justice. B: Service competency is defined according to state law, so the previous employer's opinion is not relevant. C: This option aligns with the ethical principle of Beneficence, but it is in direct violation of the principle of Justice and is illegal; it does not meet the minimum standard of conduct.

X- 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? A. Veracity B. Fidelity C. Beneficence D. Justice

The right 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.

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

The right 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.