Mental Health- Adult

What are OT interventions for mood disorders (depression and mania)?

1. Cognitive-behavioral therapy to uncover distorted beliefs and faulty thinking patterns 2. Interpersonal psychotherapy to improve interpersonal and psychosocial functioning

What are OT interventions for anxiety disorders?

1. Cognitve-behavioral training to: a. Enable clients to approach situations that cause anxiety b. Understand the fear cycle c. Challenge distorted cognitions related to fear 2. Relaxation therapy including: a. Breathing b. Meditation c. Visualization d. Progressive muscle relaxation 3. Expressive writing to help the client understand and accept the occurrence of stressors

What are OT interventions for personality disorders?

1. Development and maintenance of collaborative relationships. 2. Consistency during treatment 3. Validation of the client's feelings. 4. Development and maintenance of motivation for change. 5. Mood stabilization and expression of appropriate emotions. 6. Promotion of increased self-concept, self-esteem, insight, and judgement. 7. Development of interpersonal relationships.

What are OT interventions for DEMENTIA?

1. Environmental adaptations for safety 2. Caregiver education 3. Behavioral interventions to manage fatigue and sleep-wake cycles

What is the main focus of the various treatment settings for mental health?

1. Focus on improving engagement in occupation by increasing psychological and behavioral awareness. 2. Encourage collaboration with a social support network and the mental health system. 3. Increasing self-confidence.

Tuckman: Developmental stages of Groups 1. _____: Participants become acquainted with one another and familiarize themselves with the task 2. _______: Participants challenge one another and the leader 3.________: Participants develop trust in one another and the leader and avoid conflict as they focus on the task at hand 4._______: Participants work together as a cohesive unit. conflict may be present, but it's effectively resolved 5._______: The major task is to review group history and make changes as needed. Participants reflect on their history, evaluate what went well and what caused problems, and adjust themselves as a group in response to this review. For example, participants may choose to change the way decisions are made if their current method has proven too stressful to the group

1. Forming 2. Storming 3. Norming 4. Performing 5. Reforming

What are OT interventions for Schizophrenia and other psychotic disorders ?

1. Illness management and recovery, including group and individual programs 2. Assertive Community Treatment to provide support and skills training in natural environment 3. Family psychoeducation 4. Supported employment 5. Integrated dual diagnosis treatment for co-occuring mental illness and substance abuse

OT interventions for substance abuse

1. Psychosocial therapies including: a. Coping b. Stress management c. Social skills training 2. Cognitive-based interventions geared toward increasing clinet's motivation and control of life.

What are pharmalogical treatment for Schizophrenia and other psychotic disorders ?

1. Typical antipsychotics: a. Chlorpromazine b. Haloperidol c. Fluphenazine 2. Atypical antipsychotics: a. Clozapine b. Olanzapine c. Quetiapine d. Ziprasidone e. Risperidone f. Aripiprazole

The OTR® is working on a task-oriented gardening activity with a small group of adolescents in an inpatient mental health setting. One of the participants becomes self-absorbed and distractible and has bursts of energy that are affecting the other members of the group. What is the OTR®'s MOST appropriate response? A. "How are we doing with our pot transfer? We need to get this done today." B. "Can I speak to you privately about your behavior during the group work?" C. "You seem to be distracting the other members of the group." D. "Please stop whatever it is you are doing."

A. "How are we doing with our pot transfer? We need to get this done today." why? When a client starts shows symptoms of a manic episode, particularly emotional and cognitive symptoms, it is best to help the client engage in goal-directed action. B, C, D: These responses serve to make the client aware of his or her behaviors but do not necessarily help the client return to meaningful task performance.

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? A. Cognitive-behavioral B. Psychodynamic C. Model of Human Occupation D. Dynamic Interactional Model

A. Cognitive-behavioral why? A cognitive-behavioral 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.

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

A. Infants and toddlers with established risk because of a diagnosis automatically qualify for Part C services.

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

A. Occupational therapy is one of 16 primary services provided for children in need of early intervention services why? As part of IDEA Part C, occupational therapy is listed as a primary service, as are speech and physical therapy and special instruction.

An OTR® is collaborating with a team of early intervention specialists to develop an individualized family service plan (IFSP). Which of the following components is required? A. Steps to support the child's transition to preschool B. Projected dates of each individual service to be provided C. A detailed report and documentation of all sources of income for the family D. A statement of all expenses to be incurred from occupational therapy services

A. Steps to support the child's transition to preschool why? A description of the steps to support the child's transition to preschool is one of the required components of an IFSP under the Individuals With Disabilities Education Act.

If the therapy group is MATURE (i.e., able to work together effectively in resolving conflicts) and has high verbal abilities, the practitioner's leadership style is ______

ADVISORY -The OT works alongside the group participants in a coaching capacity. Advisory leadership enables group members to perform at their highest capacity

________ Involves changing the requirements of the occupation to be more congruent with the client's abilities

Adaptation

Name this essential feature of Dementia: 1. Loss of comprehension of visual, auditory, or other sensations

Agnosia

What disorder is responsible for the imapct on occupational performance described below? 1. Physical impairments, including: a. Difficulty physically responding to stress in PTSD b. Cardiac problems in panic disorder 2. Cognitive impairments, including a. Difficulty following directions and concentrating because of hyperaroused states b. Lowered memory capacity because of trauma 3. Psychosocial impairments including disruptions in relationships and career development

Anxiety disorders

What is this pharmacoloigcal treatment used for? 1. Benzodiazepines: a. Alprazolam b. Lorazepam 2. Selective serotonin reuptake inhibitors: a. Fluxetine b. Paroxetine c. Fluvoxamine d. Sertaline e. Citalopram 3. Tricyclic antidepressants

Anxiety disorders

Name this essential feature of Dementia: 1. Absence or impairment of ability to communicate through writing, speech, or signs

Aphasia

Name this essential feature of Dementia: 1. Inability to perform purposive movements without sensory or motor impairment

Apraxia

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? A. Discussing task performance B. Exercising to music C. Using a sensory room D. Baking cookies

B. Exercising to music why? 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.

Which element of the occupational therapy assessment is essential for a middle school student with oppositional defiant disorder? A. Cooking evaluation B. Interview with a parent or caretaker C. Handwriting assessment D. Eye-hand coordination screening

B. Interview with a parent or caretaker why? Intervention with adolescents with oppositional defiant disorder must include the family.

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? A. Culture-emergent model B. Kawa model C. Counseling psychology model D. Person-Environment-Occupation model

B. Kawa model why? 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 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? A. Effects of combining alcohol with psychotropic medications B. Need to protect oneself from direct sun when taking psychotropic medications C. Increased likelihood of ataxia after consuming typical picnic foods for people using monoamine oxidase (MAO) inhibitors D. Need to take medications before leaving for the picnic to avoid losing them

B. Need to protect oneself from direct sun when taking psychotropic medications why? Photosensitivity is a side effect of many psychotropic medications. Avoiding direct exposure to sun is essential.

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? A. Cognitive-behavioral B. Psychodynamic C. Cognitive disability D. Behavioral

B. Psychodynamic why? 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.

A child with a sensory processing disorder and Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome) is attending a regular classroom. Which reasonable accommodation would be BEST for this child under the Individuals With Disabilities Education Improvement Act? A. Place the student's desk at the back of the classroom B. Reduce the number of math problems to one per page C. Increase the number and variety of spontaneous activities in the school day D. Increase the number of other students at the student's lunch table

B. Reduce the number of math problems to one per page Why? B. Reduce the number of math problems to one per page

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? A. Assign the client to a role that does not involve touching food. B. Remind the client of triggers for compulsive behavior and recommend use of latex gloves for the activity. C. Encourage the client to use utensils to avoid touching the food. D. Assign the client the role of teaching and managing hygienic cooking behaviors.

B. Remind the client of triggers for compulsive behavior and recommend use of latex gloves for the activity. why? Cognitive-behavioral 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 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? A. Prevocational training sufficiently prepares clients with mental illness for work. B. Supported employment programs with a "place-and-train" perspective are more effective than other vocational approaches. C. Transitional employment placement through a clubhouse model is a time-honored method for increasing job placement. D. Sheltered workshops are useful programs for advancing work participation.

B. Supported employment programs with a "place-and-train" perspective are more effective than other vocational approaches. why? Current rehabilitation focus is on the place-and-train supportive employment approach, and evidence supports its use.

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

B. Tardive dyskinesia why? 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.

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? A. Set academic, functional, and measurable goals achievable within a 6-month time frame B. To the maximum extent possible, the student must be educated with nondisabled peers C. Transition planning must begin with an emphasis on future vocational goals and independent life skills D. To be succinct, the IEP reports only the needs and challenges of the student

B. To the maximum extent possible, the student must be educated with nondisabled peers why? 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.

A 6-year-old child with moderate autism has poor interoceptive sensory skills. Which occupation may be MOST significantly affected? A. Handwriting B. Toileting C. Reading a book D. Playing a video game

B. Toileting why? 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.

What is this pharmacological intervention used for? 1. Mood stabilizers: a. Lithium carbonate 2. Anticonvulsants: a. Carbamazepine b. Divalproex sodium c. Gabapentin

Bipolar disorders

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? A. "I think that participating in occupational therapy will make you feel a lot better." B. "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." C. "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." D. "I can see that you aren't feeling well, and I'm sorry for this. Can we try again tomorrow?

C. "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."

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? A. The task includes mostly familiar steps but also one step requiring new learning. B. The project and tasks involved are relatively unstructured. The client is given opportunities to find and revise errors. C. A model of the completed project is provided for the client to imitate. Simple instructions are provided. D. The project is designed to encourage relatively independent planning and organizing to complete tasks.

C. A model of the completed project is provided for the client to imitate. Simple instructions are provided. why? 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.

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? A. Depression B. Conduct disorder C. Attention deficit hyperactivity disorder D. Schizophrenia

C. Attention deficit hyperactivity disorder why? 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. -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.

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? A. Social Skills Rating Scale B. Occupational Therapy Psychosocial Assessment of Learning C. Canadian Occupational Performance Measure D. Test of Playfulness

C. Canadian Occupational Performance Measure Why? The Canadian Occupational Performance Measure is a structured interview used to develop a client's occupational profile.

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? A. Cognitive-behavioral B. Psychodynamic C. Cognitive disability D. Behavioral

C. Cognitive disability why? 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.

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? A. Psychoanalytic B. Developmental C. Cognitive-behavioral D. Occupational

C. Cognitive-behavioral why? Cognitive-behavioral 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 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? A. Validation B. Limit setting C. Confrontation D. Reframing

C. Confrontation why? 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 OTR® 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? A. Paint by number B. Crossword puzzles C. Free-form clay building D. Decorating gingerbread cookies

C. Free-form clay building why? 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.

The mother of a 7-year-old boy with autism asks the OTR® to teach her child to urinate inside the toilet bowl. Which method is BEST to teach this skill? A. Use a water gun to squirt water inside the toilet bowl to teach the concept of in and out B. Ask the child to sit, keep deflecting the urine stream inside the bowl, and slowly stand C. Place a piece of cereal inside the bowl to serve as a target D. Use a piece of cardboard to elevate the rim of the bowl for a visual cue

C. Place a piece of cereal inside the bowl to serve as a target why? Using a target such as a piece of cereal can help increase a child's attention to accuracy when learning to urinate while standing.

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? A. Develop a social skills program for children with behavioral concerns B. Provide direct services to children in special education C. Provide a presentation to teachers on multisensory handwriting strategies D. Integrate technology for children with autism

C. Provide a presentation to teachers on multisensory handwriting strategies why? 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.

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? A. Recommend individual sessions to catch up on missed goals during the client's absence. B. Allow the client to rest, then resume therapy. C. Resume group therapy sessions as soon as possible and apply cognitive-behavioral methods. D. Discuss with psychiatrist the possible need for the client to receive medication to improve behaviors.

C. Resume group therapy sessions as soon as possible and apply cognitive-behavioral methods. Why? Resumption in group-based community programming with a cognitive-behavioral 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.

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. A projective test such as House-Tree-Person B. Worker Role Interview C. Role Checklist D. Canadian Occupational Performance Measure

C. Role Checklist why? 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.

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.

C. The client could job share with a coworker. why? 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.

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? A. Altruism B. Catharsis C. Universality D. Cohesion

C. Universality why? 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 4-year-old child with autism always flushes the toilet before using it and leaves the toilet unflushed after using it. What should the OTR® do to ensure correct toileting habits? A. Give a reward every time the child flushes the toilet after using it B. Suggest a sensor-activated toilet to ensure it is flushed after each use C. Use a visual schedule depicting the correct flow of actions during toileting D. Facilitate memory by prompting the child to flush the toilet after each use

C. Use a visual schedule depicting the correct flow of actions during toileting why? A visual schedule tends to work better than auditory and operant conditioning for children with autism when teaching them the correct steps in using the toilet.

_________: Distored thinking leads to the behavioral and emotional problems related to mental illness. The focus of this therapy is to increase awareness of and eventually change cognitive distortions to ultimately alter behavior and the emotional impact on function

Cognitive-behavioral therapy

What community outpatient setting is being described? 1. Clients transitioning from, for example, a long-term hospitalization or a period of residence in a skilled nursing facility may move to a halfway house or adult foster care setting. 2. Some halfway houses are more permanent than temporary. 3. However, the concept of halfway houses is to provide temporary supervision under group living conditions to encourage healthy occupational engagement and independent living. 4. Adult foster care does much the same thing but with smaller group or with one person at a time.

Community residential settings such as a halfway house and adult foster care

What community outpatient setting is being described? 1. These settings are designed for clients to meet with mental health professionals for: a. Ongoing medication management b. Lifestyle management c. Self-care activities d. Group therapies 2. General monitoring of health conditions and referral to other health professionals is often a component of these clinics.

Community-based mental health clinics

What type of clinical reasoning is being described? 1. Blending of all forms of reasoning to flexibly respond to changing conditions and predicting client futures.

Conditional reasoning

What community outpatient setting is being described? 1. These lifestyle management programs are designed to assist clients over an extended period and provide meaningful occupational engagement as tolerated for clients with more chronic mental health conditions.

Consumer-based, nonprofit, or health system-based DAY treatment programs

What mood disorder is this? 1. Chronic (at least 2 years) mood disturbance with fluctuating hypomanic and depressive symptoms

Cyclothymic Disorder

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? A. "Discontinue use of the medication until you see your doctor." B. "Remember the dietary restrictions related to MAOIs." C. "Side effects are present in all medications. You just have to get used to them." D. "Let's get your psychiatrist or a nurse on the phone now so you can discuss your concerns."

D. "Let's get your psychiatrist or a nurse on the phone now so you can discuss your concerns." why? 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.

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? A. Directive B. Facilitative C. Cooperative D. Advisory

D. Advisory why ? 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.

During an occupational therapy evaluation, which approach would pose the biggest barrier to engaging in a client-centered process with an adult client who is able to converse? A. Paying attention to the meaning of nonverbal cues B. Being directive C. Being too empathetic with the client D. Asking too many closed-ended questions

D. Asking too many closed-ended questions why? Questions that have a simple yes-no or single-word answer do not capture the essence of an individual client as an occupational being. Although closed-ended questions might be helpful in filling out an assessment tool with single-word answers, they prevent the client from conveying his or her perspective, which is the core of client-centered practice.

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®? A. Test the client's sense of reality. B. Identify the problem. C. Identify the good and bad points of a behavior. D. Avoid argument and opposition to the client's resistance.

D. Avoid argument and opposition to the client's resistance. why? Avoiding getting into arguments or opposing the client's resistance refers to the "roll with resistance" principle of motivational interviewing.

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

D. Directive task and activities group why? 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 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? A. Contact the nursing staff to escort the client back to the client's room. B. Remind the client of the need for 24 hours of bed rest after ECT. C. Invite the client to participate in a different group that focuses on reminiscence. D. Encourage the client to choose one of the available tasks to work on during the group.

D. Encourage the client to choose one of the available tasks to work on during the group. why? 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.

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? A. Volunteer activities in the community B. Long-term budgeting for house repairs C. Vocational retraining and job seeking D. Role playing social interactions

D. Role playing social interactions why? 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.

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®? A. Employment retraining B. Job searching C. Housing procurement D. Room and self-care management

D. Room and self-care management why? 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.

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? A. This client could be discharged home alone with weekly checks for novel safety issues and health maintenance needs and reminders. B. This client could be discharged home with family for support in all areas of IADLs and personal care including bathing, dressing, and hygiene. C. This client should remain in the psychiatric facility under close 24-hour supervision for safety and personal care needs. D. This client could be discharged to a supported living arrangement with the expectation that the client can independently complete the morning self-care routine.

D. This client could be discharged to a supported living arrangement with the expectation that the client can independently complete the morning self-care routine. why? 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).

If participants in a therapy group have LOW cognitive abilities, the OT's leadership style should be more _____

DIRECTIVE -they should provide more directions and structure and be more prescriptive in directing the way group activities unfold

What is this pharmacological intervention used for? 1. Selcetive serotonin reuptake inhibitors: a. Citalopram (Celexa) b. Escitalopram (Lexapro) c. Fluoxetine d. Paroxetine 2. Seratonin- norepinephrine reuptake inhibitors: a. Duloxetine b. Venlafaxine 3. Antidepressants: a. Bupropion b. Mirtazapine

Depressive disorders

What type of clinical reasoning is being described? 1. Investigative reasoning and analysis of cause and nature of conditions

Diagnostic reasoning

What mood disorder is this? 1. Characterized by major depressive symptoms that are less severe and present chronically for a period of at LEAST 2 years

Dysthymic Disorder

OT's assist with medication management through ____ interventions

EDUCATIONAL interventions

These OT interventions are used for what disorder? 1. General principles: a. Physical harm reduction b. Cognitive reconstruction c. Psychosocial functional enablement 2. Specific interventions: a. Menu planning and meal preparation b. Lifestyle redesign and independent living skills training c. Communication and assertiveness training d. Stress management e. Projective artwork and use of crafts f. Relapse prevention g. Body image improvement

Eating disorders

What disorder is responsible for the impact on occupational performance described below? 1. Maladaptive eating habits and impaired meal preparation skills 2. Maladaptive lifestyle habits and impaired independent living skills 3. Impaired communication and assertion skills 4. Impaired stress management skills 5. Resistance to change

Eating disorders

What type of clinical reasoning is being described? 1. Directed toward analyzing ethical dilemma

Ethical reasoning

If the group shows FAIR to GOOD insight and motivation, the OT's leadership style should be more ___

FACILITATIVE -The OT should allow participants to take responsibility for some group activities while maintaining control over goals and decision making

_______ is a gradual withdrawal of support as the client gains improved skills

Fading

A 3-year old with autism is working on developing functional play skills. Which play activity is BEST for achieving this goal? a. Playing in a noisy gym with peers b. Doing an isolated puzzle activity c. Feeding dolls

Feeding dolls -B/c functional play uses real objects to re-create real life situations

What traditional setting is being described? 1. Clients are admitted to the psychiatric unit of an acute care hospital, usually as a result of active and uncontrolled symptoms related to mental illness. 2. These hospitalizations are belief and designed to manage behavior, stabilize clients on medication, and refocus clients on engagement in occupation.

Inpatient

What type of clinical reasoning is being described? 1. Directed toward building positive interpersonal relationships

Interactive reasoning

What traditional setting is being described? 1. In cases of severe, distressing, and uncontrollable symptoms (i.e., psychosis) or serious threat to self or others. 2. Clients may be hospitalized for extended periods of time (2 weeks to 2 months). 3. Interprofessional teams work closely with the client to stabilize symptoms, ensure adherence to medication protocols, and habitualize patterns of daily activity and self-care.

Long-term hospitalization

Name this essential feature of Dementia: 1. Impairment in ability to think abstractly, plan, initiate, sequence, monitor, and stop complex behaviors

Loss of executive function

_______ Reduction of the demands of an occupation For example, use of contrasting colored material to help a client who has visual impairments complete a weaving activity

Modification

What disorder has this impact on occupational performance? 1. Low self-esteem and motivation levels, compromising successful completion of daily tasks 2. Family and work roles affected by mood 3. Daily routines disrupted during manic episodes 4. High work loss rates

Mood disorders (Depression and mania)

What type of clinical reasoning is being described? 1. Used to make sense of people's particular circumstances

Narrative reasoning

What type of clinical reasoning is being described? 1. Practical reasoning used to fit therapy possibilities into realities of service delivery

Pragmatic reasoning

What type of clinical reasoning is being described? 1. Consideration and use of intervention routines for identified conditions

Procedural reasoning

An Autistic 25 year old unemployed man is isolated and lives alone. Using the Model of Human Occupation (MOHO), which assessment is most appropriate to use when first evaluating the client

Role checklist

_______ The practitioner helps the client by doing parts of the task that are too hard, but they have the client do the rest, so that the task may be completed

Scaffolding

The impact on occupational performance described below is a result of having what disorder? 1. Cognitive impairments, including problems with attention, memory, executive functions, and screening of relevant vs irrelevant information 2. Compromised health and wellness 3. Recovery and reintegration hindered by community barriers and social stigma

Schizophrenia and other psychotic disorders

What type of clinical reasoning is being described? 1. Use of applied logical and scientific methods

Scientific reasoning

The foundation for an effective therapeutic relationship is practitioner _____. This allows practitioners to understand the values they acquired growing up and the role that the dysfunction plays in their ability to form meaningful therapeutic relations. This is critical to moral development and moral reasoning as a clinician and to the development of good clinical reasoning skills

Self-awareness

What community outpatient setting is being described? 1. Clients with chronic mental illness may reside in these facilities to receive ongoing care when conditions are not suitable for living with friends or family independently. 2. In some cases, home health care is required for clients with chronic mental health conditions to continue aging in place or residing in their homes.

Skilled nursing residential care and home health care

Name the disorder described below. 1. People with these disorders experience physical symptoms that have a psychiatric source. 2. These clients are frequently encounters in settings outside mental health practice settings because of the association of the disorders with physical illness. 3. OT's may be the first health practitioner to recognize symptoms related to these disorders. 4. The pain and discomfort related to these disorders are real and should not be mistaken as malingering or symptom magnification for secondary gain.

Somatoform Disorders

What community outpatient setting is being described? 1. A variety of clubhouse programs have been used to engage people with mental health conditions, typically of a chronic nature, in EMPLOYMENT. 2. On-the-job assistance and theraputic intervention are provided and strong collaboration occurs among the client, therapist, and employer-seems to work best. 3. The clubhouse model offers a physical space in which people with mental illness can receive support for community living and explore work potential.

Supported employment, transitional employment, and vocational rehabilitation

True or False Children with Oppositional Defient Disorder (ODD) need clear rules about what behaviors are acceptable and not and expectations for the group need to be made explicit

TRUE

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? A. The client will demonstrate appropriate coping skills in identified stressful situations with 100% success. B. The client will independently apply relaxation techniques and report relief from stress at 0/10 after using the technique. C. The client will apply grounding techniques with 100% accuracy as a preventative measure to reduce over-stimulation. D. 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.

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. why? 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

School-based intervention uses a Response to Intervention (RtI) approach ___________:Interventions include assisting in school-wide prevention efforts, collaboration with personnel to create positive environments, and observing all chindrens behavior ________: Interventions include developing and running programs for at-risk students and consulting with teachers to modify learning demands for at-risk students _____: Interventions include providing individual or group intervention for students with mental health concerns and collaborating with school-based mental health providers

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