Final: NBCOT
Hold a regular fork in the terminal device and hold a regular knife in the L hand: This is the safest and most appropriate option
A154: A client with a traumatic below the elbow amputation of the dominant R arm has participated in OT for prosthetic training. The therapist prepares a discharge plan that incorporates recommendations to facilitate independence in meal preparation and feeding. Which method is best for the therapist to recommend the client use to cut meat?
Extension: This is to avoid the contracture tendency of the neck which is Flexion
A15: An occupational therapist constructs a splint for a person who incurred full thickness facial and anterior neck burns. In which position should the therapist splint the neck?
The apartments water temperature: The disease results in diminished temperature sense, paresthesia, pain, and cold extremities
A166: An individual with an incomplete C6 spinal cord injury has secondary diagnosis of thromboangiitis obliterates (Buerger's disease). The OT conducts a pre-discharge home evaluation of the client's rented apartment. Which is the most important area for the therapist to assess.
On at all times, except for dressing changes: immobilization typically lasts 5-10 days
A169: A person recovering from skin grafting due to full thickness burns is prescribed splints to immobilize the grafted areas in anti-deformity positions. Which splint wearing schedule is best to include in the splinting protocol for the first 72 hours post-op?
Supine with elevation of the head and shoulders: With GERD stomach contents come up. The head needs to be elevated above the stomach. Everything else is a contraindication for a THR
A34: An individual recovering from hip replacement surgery prepares for d/c home. The client has a secondary diagnosis of gastric esophageal reflux disease (GERD). which is the best position for the OT to recommend?
90deg to the joint: allows for the most effective application of force
A35: An occupational therapist designs a dynamic splint for an individual recovering from tendon repair. At which angle should the therapist position the outrigger?
Use mobile arm supports for feeding: C5 = head & neck control, elbow flexion, palmar supination
A54: A patient with a complete injury of the spinal cord at the C5 level completed inpatient rehab which concentrated on increasing independence in activities of daily living. In the discharge documentation, which is most likely for the occupational therapist to state the client is able to do?
An elbow lock splint: injury to 5th and 6th brachial plexus roots = arm hangs limp with shoulder rotated inward. This splint stabilizes the elbow and allows for more functional use of the arm
A69: A therapist receives a referral to construct a splint for an individual with Erb's palsy. Which orthosis would be most effective for this condition?
flexed 90 degrees with neutral degrees of pronation/supination: this is the easiest position for the activities as well and the most functional and natural
A80: A client with a right below elbow amputation begins prosthetic training with a body- powered myoelectric prosthesis. The OT collaborates with the client to begin training in the use of the terminal device to grasp and release objects. Which elbow position is best for the OT to place the client's elbow in during grasp and release activities?
Invite the client to expand upon the nature of these concerns: you want them to know that their concerns are worth mentioning and may be able to adjust your interventions. Documenting concerns is not justification for an extended length of stay
A83: An occupational therapist works with an individual with chest and UE burns. During the intervention session, the client expresses vague fears about personal safety at home and asks the therapist to advocate for an extension in the discharge date. According to the medical record, the client has incurred the burns during a cooking accident. Which is the therapists initial response to the clients stated concerns?
Pillow to support mom's arm during breast feeding: Breast feeding is physically easier than bottle feeding and the mom has enough UE function to support the Childs head, especially with the pillow support
A87: A woman with a complete SCI at the C5 has given birth to her first child. The client seeks suggestions on methods to facilitate independent and safe parenting. Which of the following is most beneficial for the OT to recommend the mother use to help her independently feed her child?
Ask open-ended questions to explore the concerns further: This is within an OTs domain and does not need to be referred to a physician. providing reassurance doesn't deal with the concerns at the moment. discussing positioning alternatives can be discussed after the client's concerns have been identified.
A94: During an OT session, a veteran recovering from bilateral traumatic LE amputations expresses several concerns about having a changed body and questions its sexual appeal. Which response is best for the OT to take in response to the client's concerns?
Empty the client's filled catheter bag and maintain the client's upright position: symptoms are indicative of autonomic dysreflexia. this is a medical emergency that needs to be treated immediately. The upright position helps manage the rise in BP
A98: An individual incurred a SCI at the C5 level. During an OT session focused on developing the ability to feed independently using adaptive equipment, the OT notes that the client is flushed and sweating excessively. The client requests that the session end early due to a pounding headache. Which action is best for the OT to take first in response to this situation?
Recommend a prosthesis with a myoelectrically controlled hand: While there are prosthetics that can be used for purely cosmetic reasons, it would be best if he could increase functional performance when doing activities
B104: An older teen with a congenital R below- elbow amputation had never wanted a prosthesis before. Now he wants to 'look good at prom' and ' more normal when doing things with my friends.' Which action would be most beneficial for the OT to take to best meet the client's needs?
Proprioception: this is maintained with a condition of anterior spinal cord syndrome
B112: An adult incurred an injury to the anterior spinal artery at the T12 level. The OT completes a sensory eval with this client. Which sensation is most likely for this therapist to document that the individual has retained?
Positions of comfort: These are postures of adduction and flexion of the UEs, flexion of the hips and knees, and plantar flexion of the ankles. They provide comfort but are likely to lead to contractors. Positions of pain and discomfort are unavoidable for people recovering from deep partial thickness burns
B117: An individual is recovering from deep partial thickness burns on the upper extremities, chest, and lower neck. The OT provides equipment to prevent positions that can result in contractures. Which are the most important positions to prevent?
Contact the physician and describe the observations: The physician can decide whether to recast, dress the open area, refer to the wound care team, fabricate a new splint, or employ other action
B125: A person with arthrogryposis undergoes serial casting with weekly cast changes of the right wrist. Upon cast removal during the 4th week, the therapist notices a small open area and a red rash over the ulnar styloid. Which is the OT's best response?
Return the person to the w/c and immediately recline it: These are symptoms of orthostatic hypotension which is common of people with SCIs. Reclining the individual bring the blood pressure back to a normal range
B129: An individual with a SCI at T1 is practicing a stand pivot transfer. The patient complains of dizziness and nausea. Which action is most important for the OT to take first?
Active flexion/passive extension: Kleinert protocol for early phase (0-4 weeks)
B150: An individual is recovering from a FTR and is 2 days post-op. The OT plans the client's early mobilization program. Which is the most appropriate exercise routine for the OT to use within the limits of a dorsal block splint?
The client's understanding of the purpose and procedure of the splint protocol
B151: The OT meets with the client to ensure compliance with the prescribed splinting protocol. Which is the most important outcome of this session?
Light ADLs such as grooming: Kleinert protocol this is introduced 6-8 weeks post-op
B152: The client is now 7 weeks post-op from a FTR. Which is the most appropriate interventions for the OT to use with the client?
Integrating weight shifting into daily activities: C7 can perform depression transfers so they are able to weight shift and this needs to happen daily to relive pressure
B163: An individual with a SCI at C7 reports noticeable redness on the ischial tuberosity during self-examination with a mirror. Which action is best for the OT to recommend?
Dressing the lower body: C7 has difficulty dressing LE
B26: A 7 yo with spina bifida at the C7 receives home-based services. Which ability is most relevant for the OT to focus on during intervention?
An ultra-light rigid frame with a low back: T9-10 has partial innervation of abs and full innervation of UEs so does not need high back support.
B63: A young adult with T9-10 SCI wishes to engage in sports activities. Which wheelchair features are best for the OT to recommend to this client?
Consult stable owner to discuss alternate ways to mount horse: best option INITIALLY then the therapist can plan the intervention which may be a home based transfer training program
B89: In an outpatient rehab clinic, an OT is treating a high school student with spina bifida resulting in full motor paralysis and sensory deficits below L1. The client is a competitive swimmer and is able to transfer independently from the w/c to the pool w/o an assistive device. The client's goal is to learn how to mount and ride a horse. Which is best for the therapist to do initially to help the client attain this goal?
Eval trunk and LE ROM: This determines if the patient can use LEs to dress which many of these patients do
C106: A teen with congenital bilateral above-elbow amputations is referred to OT to increase I in ADLs. The teen wants to be I in donning and doffing shirts. Which action is best for the OT to take first?
A dynamic extension splint: This injury is classified as a low-level radial nerve injury. Signs include incomplete extension of the fingers and thumb MP joints
C114: A patient presents with a radial nerve injury below the supinator. The OT constructs a splint to facilitate and promote function. Which is the most effective splint for the therapist to fabricate for this individual?
The use of modified techniques to perform transfers and BADLs
C146: A patient is recovering from a posterolateral THR . The client has aphasia from a CVA which incurred 4 yrs ago. The client states that private payment for any health care services or equipment is not possible at this time. What should the OT focus on during post-op therapy interventions
Use of abductor pillow between LE: This prevents adduction of the hip
C147: A patient is recovering from a posterolateral THR . The client has aphasia from a CVA which incurred 4 yrs ago. The client states that private payment for any health care services or equipment is not possible at this time. Following surgery, which is the most appropriate bed positioning intervention for the OT to recommend?
3-in-one commode: reimbursable by medicaid
C148: A patient is recovering from a posterolateral THR . The client has aphasia from a CVA which incurred 4 yrs ago. The client states that private payment for any health care services or equipment is not possible at this time. The client is being d/c home. Which equipment should the OT recommend to ensure safety and independence toileting?
Have the patient demonstrate the techniques that have been taught: Expressive aphasia interferes with the persons ability to verbally express themselves so demonstration is the best method
C149: A patient is recovering from a posterolateral THR . The client has aphasia from a CVA which incurred 4 yrs ago. The client states that private payment for any health care services or equipment is not possible at this time. How can the OT most reliably determine that hip precautions will be effectively implied post d/c?
Maintain AROM: this is a primary anti-deformity technique
C162: An older adult with RA is provided with a functional hand splint to help prevent deformity. The OT also advises the individual about actions that can be taken to help prevent deformity. Which of the following is most important for the OT to advise the patient to do?
Compression garments: provide equal compression over the entire area to prevent scarring
C166: An OT works with a person who incurred full thickness burns to both arms.Which intervention approach would be most effective to provide to control hypertrophic scar formation?
fixed elbow socket and a heavy duty serrated grip terminal device: An individual with a short below-elbow amputation will require a fixed elbow socket to provide stability. A carpenter will need the heavy duty serrated grip terminal device hold tools and nails
C19: A carpenter incurred a short below-elbow amputation. The client plans to return to work.Which components would be most important for the OT to recommend for the prosthesis?
CMC palmar abduction: it is the major movement of the thumb to pick up a can
C2: An OT works with a survivor from a house fire. The client has burns on both hands that limit thumb mobility. The client identifies a personal goal of being able to pick up and hold cans to enable independent shopping and meal prep activities. Which movement of the thumb should the goal statement include?
stand pivot transfer to the non-surgical side: Excessive hip flexion, internal rotation, and adduction past neutral are contraindicated and this is minimized by transferring to the non-surgical side
C32: A patient is recovering from a THR (posterolateral incision, cementless fixation). Which is the best type of bed to w/c transfer for the OT to teach the patient to use?
UE strengthening with emphasis on the triceps: This will facilitate I in transfers
C37: An individual recently had a L transferal amputation as a result of the complications of diabetes. The client is 2 yrs status-post a R transtibial amputation as a result of the same precipitant. The client has a R prosthesis. The client is referred to OT for prosthetic interventions for the L residual limb. The referral notes that the complications of neuromas and phantom limb pain are present in this limb. Which intervention is best for the OT to implement during the first session?
Donning pants while in bed: Someone with a C6 can independently don underwear and pants while in bed but may need min A for socks and shoes
C46: An intervention plan for a person with a complete lesion of the spinal cord at C6 has been developed by the OT. Which activity should be included in this plan as a goal for the client to develop?
C7-8: Other levels do not have the fine motor skills to perform these skills independently
C58: An OT working in a SCI unit evaluates a client for bowel and bladder training. The client and OT set goals for independence in all aspects of bowel and bladder care, including skin inspection. Which is the highest or most severe level of complete SCI the client can have and be able to achieve this goal?
A wrist splint in functional position with a slot to hold a typing stick: the functional position the support needed due to absence of wrist extensors/flexors
C88: An individual with a complete C5 prepares for discharge. The individual plans to return as the editor of children's books. Which adaptive equipment is best for the Ot to recommend the client use to access desktop publishing programs?
Flex the fingers with wrist extension and extend the fingers with wrist flexion: We want to enhance the development of a tenodesis grasp. This pattern will shorten the flexor tendons without compromising joint ROM. This will enhance the tenodesis grasp.
C89: An adolescent incurred a SCI at C5. During family education, the OT instructs the caregivers in the provision of PROM to the patient's wrists and fingers.Which method should the therapist teach the family?
A long-handled reacher: precautions are no hip flexion beyond 90 which makes it difficult to reach things. The reacher can facilitate safety and independence
C94: A client is being dischargeD after recovery from hip replacement surgery to live at home alone. Which is the most important equipment for the therapist to review with the client prior to d/c?
Lock the elbow in 90 deg of flexion and teach only TD control: This is the functional position for the completion of activities. Control of the elbow joint would occur independent of TD control training
C99: An individual with a traumatic above-elbow (transhumeral) amputation has received a body-powered prosthesis. To train the person in the operation of the terminal device (TD), which of the following should the OT do initially?
Contact the child's physician: probable symptoms of heterotrophic ossification
A131: Two months ago a child received full thickness circumferential burns of both upper extremities. The child shows progressively decreasing ROM of the R elbow with a 25deg loss to date with a stiff endpoint. The child complains of increased pain in the elbow. Which action should the occupational therapist take first in response to this change in status?
Wrapping: figure eight pattern will reduce the volume of the residual limb and shape it
A134: A patient incurred a traumatic UE amputation. During pre-prosthetic treatment. the OT molds the contours of the residual limb to shape it in preparation for the prosthesis. Which method is most effective for the occupational therapist to use?
Establish the OTAs service competency in splinting: This is required before the OTA can take on any new tasks
A151: An OTA recently attended a 2-day splinting workshop. The OTA asks the supervising OT for a caseload that includes more clients that require splinting interventions. Which action is best for the OT to take in response to this request?
A board game using a tenodesis grasp to move game pieces: C7 = Elbow extension, wrist flexion, finger extension
A117: An OT provides recommendations for play activities that a parent with a complete SCI at the C7 level can do with children, aged 8 & 10. Which is the best adapted activity for the therapist to recommend?
Work on meal prep activities with the client sitting: Safety first. Many meal prep activities can be completed while sitting and there is no need to delay
A121: A person recovering from a THR wants to begin meal prep. The client refuses to use the walker that was ordered by the physician. The physician is unavailable for consultation. Which is the best initial action for the OT to take in response to the situation?
