Missed NBCOT Q's
An OTR® is working with a client with C5 spinal cord injury. In which position is it BEST to splint to prevent deformity in the acute stage of injury?
The right answer is A When splinting in acute spinal cord injury, the wrist should be extended with thumb opposition to preserve web space and prevent deformity
An OTR® is working with a client who has difficulties with visual skills as a result of damage to the central nervous system (CNS). Which visual skill is related to CNS damage?
The right answer is B Stereopsis, or binocular depth perception, is a visual skill that would be affected by CNS damage.
An OTR® is evaluating a client with multiple sclerosis (MS). What main evaluation finding related to neuromusculoskeletal function can the OTR anticipate
The right answer is C Intention tremor is commonly seen in people with MS.
An OTR® is using the Ayres Sensory Integration Intervention program for a 6-year-old child with attention deficit hyperactivity disorder and sensory-seeking behaviors. Which principle should the OTR®keep in mind when selecting activities for this intervention program?
The right answer is D The Ayres Sensory Integration Intervention program is applied individually rather than in groups.
A participant in a research study who has provided informed consent tells the OTR® that she wants to withdraw. Which ethical principles require the OTR to bring the conversation to the attention of the primary investigator?
Veracity and Justice
A client with a nondisplaced shaft fracture of the right fifth metacarpal has a physician's order for full-time splinting. Which orthosis would the OTR® be MOST likely to fabricate?
Volar-based ulnar gutter with MCP joints of the ring and fifth fingers in 70°-90° flexion, fourth and fifth IP joints in 0° extension, and the wrist in approximately 20° extension
An OTR® completes an intervention session with a client and documents it using the SOAP note format. In which section would the OTR® write "Client is making excellent progress toward goals and has met short-term goal 1"?
A stands for the assessment part of the SOAP note. The data were interpreted by the OTR®, who used professional judgment to determine the progress the client made toward the goals.
An OTR® is providing intervention to a client with an anxiety disorder who hyperventilates when faced with difficult work tasks. The OTR suggests that the client use breathing techniques and relaxation breaks during the work day to minimize the client's response to stressful events at work. What frame of reference does this intervention suggest?
Behavioral: this frame of reference states that behavior is learned and that it can be unlearned
A client served 18 months in a maximum security prison and was released to a halfway house; the client is now participating in a community reentry program. Which of the following areas of occupation would be the best focus for an occupational therapy program?
Budgeting and shopping skills
An OTR® is writing treatment goals for a client receiving occupational therapy services in a work conditioning program after a right shoulder sprain. The client is employed as a surgical technician in an outpatient surgery center. Which option is the BEST example of a long-term goal?
Client will return to full duty as a surgical technician in a full-time capacity within 4 weeks
An OTR® is engaged in a casual discussion with a colleague about a client. The OTR conveys that the client is rude and obnoxious but deserves to be treated equally. What is the ethical basis for the OTR's comment?
Justice "Occupational therapy personnel shall promote fairness and objectivity in the provision of occupational therapy services."
A client with advanced amyotrophic lateral sclerosis (ALS) is new to a computerized communication device. On what would the OTR® treating this patient focus?
Positioning, to ensure proximal support on a lap tray ***The simplest and first approach would be to ensure positioning so that the client can see the device and having the neck and shoulder (proximal muscles) stabilized to allow the most distal control. The placement of the device is also important, with a lap tray to secure the device in bed or on the wheelchair.
An OTR® receives a referral for a child who has difficulty with handwriting. The OTR® wants to determine whether the child has difficulty with the integrated process of handwriting rather than specific components that support the production of handwriting. Which of assessment methods would be appropriate to use for this purpose?
Print Tool: a commercially available and standardized way of measuring a child's ability to produce handwriting.
An order came in for a hand splint for a new client. A newly graduated OTR® evaluated the client for the splint. The new OTR® had not made a splint on a client before and requested an experienced OTR® hand therapist's assistance. In doing so, the OTR® abided by the ethical principle that involves taking "responsibility for maintaining high standards and continuing competence?" Which principle is that?
Procedural justice
An OTR® in home health care is seeing a client who has Stage III Alzheimer's disease. The client lives with an adult daughter and likes to wander around the house and has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no step at the front entrance. The client's daughter is determined to have the client remain at home with her as long as possible. The client requires close supervision on the stairs and seems to be very fearful when putting the foot down on each step. To further ensure the client's safety in getting up and down the stairs at the back door, what would the OTR®MOST likely recommend?
The right answer is A A client with Stage III Alzheimer's disease often begins to experience changes in vision and perception. Having yellow tape on the edge of each step helps to differentiate each step and prevent the client from missing one.
An OTR® has completed an evaluation of an inpatient who has acute Guillain-Barré syndrome. The patient scored a "3" on all subtests of the Functional Independence Measure. Based on this information, which outcome would be realistic for this patient to achieve prior to transitioning to a skilled nursing facility?
The right answer is A According to the FIM score, the patient requires moderate assistance for performing activities. In the acute phase of Guillain-Barré syndrome, the patient may be experiencing muscle belly tenderness and overall fatigue; energy conservation techniques will allow the patient to engage more productively in daily self-care tasks.
An OTR® is working on an inpatient unit with a child who has a congenital heart defect. Before admission, the child was able to complete a basic self-care routine. Currently, despite wanting to complete the activities independently, the child requires assistance because of compromised endurance. What compensatory strategy or technique should the OTR® use to minimize the impact of the condition on the child's occupational performance?
The right answer is A Children with congenital heart defects may want to be independent in play and self-care tasks. Pacing activities and selecting appropriate activities are two ways to promote their independence.
An OTR® is developing a job-finding program to assist clients who have an enduring mental illness. How will research findings about supported employment assist the OTR® in the program development process?
The right answer is A Evidence-based practice is a priority within occupational therapy, and using evidence-based interventions is associated with better outcomes for clients.
A 12-year-old client with cerebral palsy and spastic quadriplegia wants to access the Internet and e-mail on the computer. The client has poor head control and is using a headband to maintain the head in midline. The client is able to turn the head to the right to operate the suction machine using head control input. The client's left upper extremity has no active movement, and the left elbow has 90° flexion contracture. The client is able to flex the right shoulder to 60° against gravity, and the right elbow has trace active movement. The client has no active wrist or finger movement except minimal right thumb adduction. What is the BEST input control for this client?
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.
After stroke, a client has difficulty orienting to relevant visual stimuli on the left side, including food on the plate and grooming items on the counter. The client completes feeding and grooming tasks swiftly and with reduced effort. What symptom would the OTR® report in the client's evaluation results?
The right answer is A Hemispatial visual neglect is the inability to orient to relevant contralateral visual stimuli. It occurs when the left brain is damaged or when there is a lesion in the right hemisphere. This client demonstrates a scanning pattern that is carried out with reduced effort and little or no rescanning.
A client reports diplopia, or side-by-side double images, and demonstrates asymmetrical pupil sizes and a droopy eyelid. What would be MOST appropriate for the OTR® to evaluate?
The right answer is A Oculomotor function is responsible for the symptoms the client is reporting. When images double side by side for near-vision tasks, pupils are asymmetrical, and ptosis (droopiness) of the eyelid occur, cranial nerves may be injured.
A COTA® is treating a client in an upper extremity outpatient clinic. During the first treatment session after the OTR® performed the initial evaluation, the client describes an area extending from the radial head to the proximal aspect of the supinator muscle as having a dull ache and burning sensation. Which syndrome is the client describing?
The right answer is A Radial tunnel syndrome is compression of the radial nerve in the proximal forearm resulting in a dull ache and burning sensation along the lateral forearm.
An OTR® plans to use ecological assessments to evaluate the strengths and weaknesses of a 4-year-old child with autism. Which assessment is a good example of an occupational therapy ecological assessment?
The right answer is A The Knox Preschool Play Scale is an assessment of play skills that can be used in various performance contexts.
Which assessment would an OTR® administer to assess a client's ability to visually scan information using central and peripheral vision and to process that information in a timely fashion?
The right answer is A The Useful Field of View assesses the ability to visually scan information using central and peripheral vision and to process that information in a timely fashion.
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?
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.
An OTR® is using suspended equipment in working with a child who has vestibular issues. The OTR® is worried that the child might be receiving too much input. What physical indicator suggests that the child might be receiving too much vestibular input?
The right answer is A When providing vestibular input, the therapist looks for warning signs that too much input is being provided. Warning signs include the child's report of nausea or dizziness, blanching, hyperactivity, and lethargy.
An OTR® recently completed a functional capacity evaluation (FCE) on a client who is a piano teacher at a school for the performing arts. The client recently sustained an avulsion injury of the index finger on the client's dominant hand at the level of the distal interphalangeal joint, which resulted in the amputation of the distal phalanx on that finger. What would the results for the FCE completed by the OTR® MOST APPROPRIATELY be used to determine?
The right answer is B A disability rating considers the worker's impairment and the impact of the impairment on the client's ability to perform preinjury for any job and considers the unique characteristics of the job. (Impairment rating does not take into account the unique factors relating to worker vocation.) In this case, the client's missing joint affects the ability to play the piano, which is one of the primary demands of the client's position. Amputation of the distal phalanx would render the piano teacher disabled from his or her career.
An OTR® is working in an inpatient setting with veterans who have upper-extremity amputations. Each morning the rehabilitation team, consisting of physician, nurse, psychologist, social worker, OTR, physical therapist, and orthotist, come together to discuss their patients' clients' progress toward the goals set within their individual disciplines. What type of team is this?
The right answer is B A multidisciplinary team is an interprofessional team composed of individuals representing the professional disciplines that serve the client. A: Transdisciplinary teams function without discipline-centered boundaries. C: Interdisciplinary teams set goals and engage in intervention collaboratively across the disciplines. D: Allied health teams are not a recognized, definable type of team collaboration.
Which occupational therapy group would benefit MOST from a highly directive and authoritative leadership style?
The right answer is B Adolescents, particularly those diagnosed with oppositional defiant disorder, need boundaries, and an authoritative leadership style is critical to successfully managing this group
An OTR® is hired as a consultant to design a productive modified-duty program for a small manufacturing plant. Which element should the OTR® NOT incorporate into the program design?
The right answer is B Although opportunities to interact with coworkers provide the injured worker the benefit of socialization and exposure to the work environment during recovery, they are not the primary focus of modified duty programs
Which psychiatric condition is MOST frequently seen as interfering with the occupational engagement of a client with cardiac disease?
The right answer is B Among clients with cardiac disease, 15%-20% meet the criteria for major depression. Clients with depression have poorer outcomes and increased morbidity and mortality.
What has the AOTA Ethics Commission recommended that occupational therapy authors do to avoid plagiarism in the electronic age?
The right answer is B Because it is challenging to ensure that authors have appropriately cited all sources, use of electronic tools is recommended to ensure that papers and presentations are not plagiarized.
A client with recent hip replacement surgery is concerned about how to shampoo hair while not able to use the shower at home. What recommendation from the OTR® will most appropriately address the client's concern?
The right answer is B Bending forward at the kitchen sink does not require as much hip flexion as bending forward at a typical bathroom sink; many clients are able to wash hair at the kitchen sink without compromising hip precautions.
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?
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.
An OTR® is working with a client in acute care who is complaining of leg cramps and pain when walking. These problems are a common symptom of what condition or surgical procedure?
The right answer is B Cramping and pain when walking—also known as intermittent claudication—are caused by decreased blood flow when exercising and are common symptoms of peripheral artery disease.
An OTR® is working with a client in the active phase of C8 spinal cord injury. What is the BEST method of preventing heterotopic ossification in the client?
The right answer is B Heterotopic ossification refers to the growth of bone in abnormal anatomic locations and is best prevented with joint ROM and medication routine.
A client has been diagnosed with lateral epicondylitis (tennis elbow). The client works in the maintenance department of a large factory and has been unable to complete some work tasks because of pain. The client fears losing this job if the pain does not improve quickly. What is the BEST strategy to assist the client with work tasks while providing relief from pain?
The right answer is B Lateral epicondylitis is a repetitive strain injury. The client is likely experiencing these symptoms as a result of job tasks that require repetitive gripping and supination. The best approach is to discuss environmental modifications with the client and implement strategies during the work day to decrease symptom aggravation caused by job tasks.
An OTR® working with families of children with autism wants to ensure a family-centered intervention program. Which strategy BEST reflects use of this approach?
The right answer is B Of the options, only involving families in selecting activities reflects a family-centered approach to intervention.
An OTR® in a home health setting is working with a client in the kitchen and hears a heated argument between the client's spouse and one of the client's children in the next room. The client begins to cry, indicating that the arguing is causing stress. What action would be MOST reasonable for the OTR® to take?
The right answer is B Referral to an expert in dealing with these matters, such as a medical social worker, is the best course of action; direct intervention is outside the OTR®'s scope of practice
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®?
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.
An OTR® is working with an 8-year-old child with mild autism to improve the child's diet repertoire and toleration of food from restaurants. The child has begun to like meat slices and white bread in the clinic. Which activity BEST uses an Ecology of Human Performance approach to intervention?
The right answer is B The Ecology of Human Performance Model states that a child's true performance occurs in natural environments. Bringing the child to a sandwich shop is a way to test transfer of a learned skill.
An OTR® is working with a client with hemiplegia on laundry tasks. Folding the laundry proves too difficult because of the weaker extremity, and the client becomes increasingly frustrated. How should the OTR® BEST modify the activity?
The right answer is B The activity analysis skill here is grading; the OTR® recognizes the difficulty of performing this bilateral upper-extremity activity and appropriately downgrades the task to reduce the need for both hands.
An entry-level OTR® working in an outpatient rehabilitation clinic is evaluating a client who was recently hospitalized for dehydration and subsequently diagnosed with mild cognitive impairment. The client lives alone in an independent living facility. Before admission, the client was independent in ADLs and light homemaking and active in community and social activities, including driving independently. The client reports no crash record and no violations or citations but avoids night driving, highway driving, and driving in rush-hour traffic or heavy rain. To address the client's community mobility needs and safety, which option is the MOST APPROPRIATE next step for the OTR®?
The right answer is B The comprehensive driving evaluation is optimal to ensure the client's fitness to drive and to reduce the client's risk of being involved in an adverse event after discharge.
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?
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.
client sustained a cerebral infarct 3 months ago with hemiparesis in the right lower extremity. The client has been discharged from physical and occupational therapy, walks with a quad cane, and is fully functional in the other extremities. The client who completed an on-road driving evaluation required adaptive equipment. The certified driver rehabilitation specialist followed a comprehensive approach. What tasks would such an approach include?
The right answer is B This method will ensure training and compensation for the client's right leg hemiparesis in a safe environment.
An OTR® is working on sitting balance at the edge of the bed with a client who has had a CVA with residual left-sided hemiplegia. The client requires minimal assistance to maintain static sitting because of lateral leaning. How can the OTR® BEST adapt or modify this activity to improve sitting balance?
The right answer is B Weight bearing on the affected side will provide lateral support and can help reduce tone. This positioning technique changes the physical demands of static sitting to improve participation in the task.
residual left-sided hemiplegia. The client requires minimal assistance to maintain static sitting because of lateral leaning. How can the OTR® BEST adapt or modify this activity to improve sitting balance?
The right answer is B Weight bearing on the affected side will provide lateral support and can help reduce tone. This positioning technique changes the physical demands of static sitting to improve participation in the task.
A client with dementia quits bathing routines before completing them and has difficulty measuring shampoo and lotion. The areas of the body that are usually washed are more distal (hands, arms). The client might attempt to wash the back, but not consistently. At what stage is this client, according to the Allen Cognitive Level Screen?
The right answer is C At Level 3.6, the client will be able to wash most distal portions of the body and those that are easily seen but will not always follow the sequence thoroughly. The client may quit before completion and may have difficulty with measuring soaps, lotions, and deodorant.
An OTR® wants to design interventions aimed at improving the executive function of clients with schizophrenia. Which of the following statements is an important consideration in designing such interventions?
The right answer is C Both occupational goal intervention strategies, which provide learning methods, and an activity training approach to habitualization of specific routines increase some aspects of executive functioning. Although more research is needed, both strategies show promise.
An OTR® has just instructed a hip replacement client on a proper sit-to-stand technique from the chair. What is the BEST method to record the client's adherence to hip precautions?
The right answer is C By observing the client, a true level of occupational performance can be recorded.
What does best practice dictate for a newly graduated OTR® who wants to administer a functional capacity evaluation (FCE)?
The right answer is C Completion of an FCE is not recommended for entry-level or novice clinicians. New graduates should attend conferences, access resources, and network with colleagues to become familiar with terminology and regulations and enhance skills and knowledge.
An OTR® reviews the cancellation test form in a client's chart. The form indicates that the client crossed out all letter Ms. What does this test assess?
The right answer is C Cross-out assessments are used in visual scanning and can be beneficial in detecting spatial neglect or visual field impairments.
An OTR® is working with a child with retinopathy of prematurity and wants to provide the child's parent with activities to work on between sessions. Which activity would be appropriate for an OTR® to recommend?
The right answer is C Infants with visual impairments need to be supported to promote development in play and should learn to incorporate their other senses.
When dealing with clients who have dementia, what would be the primary role of the OTR® in addressing caregiver burden?
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.
An OTR® ergonomic consultant in a hospital is notified of a significant increase in work-related musculoskeletal disorders among nurses since the implementation of electronic health records. The OTR® is asked to present a report on the issues to the upper-level management team. What should the OTR® include in the report to identify the problem and generate possible solutions?
The right answer is C Proper positioning of the monitor and keyboard are the main factors to be considered in ergonomics. Because nurses are of different heights and can be documenting in different environments (e.g., in patients' rooms, at the nurses' stations, or sitting vs. standing), it is important that the workstations be versatile and accommodate each nurse and each situation.
Which type of pressure do occupational therapy practitioners most commonly identify as leading to moral distress and organizational ethics violations?
The right answer is C Slater and Brandt (2011) described a study conducted in 2008 that identified reimbursement constraints as one of the top ethical concerns leading to moral distress in occupational therapy practitioners. Practitioners reported that being pressured to provide therapeutic service primarily for financial benefit rather than for the health and well-being of clients was highly distressing.
A softball player sustained a deep partial-thickness burn to the anterior aspect of the right arm from the wrist, proximal to the ulnar styloid process, to the mid-upper arm. A split-thickness skin graft from thigh to mid-forearm was performed 3 days postinjury. What is the OPTIMAL intervention to prevent formation of elbow contracture?
The right answer is C The antideformity position for the elbow is elbow extension and forearm in neutral position. Also, because the client has a partial-thickness skin graft at the anterior aspect of the forearm and to maintain maximum surface area of the grafted area, it is better to position the forearm in a neutral position.
A client with rheumatoid arthritis (RA) is a salesman for a computer company. Part of the client's job is to work in a trade exhibition booth at conferences (10-15 times a month). This task requires the client to stand continuously for 2-4 hours talking with potential buyers. The client reports that at the end of this time, the client's feet, knees, hips, and back are in severe pain, and the client is so fatigued that the client has to go straight home to bed. What is the BEST reasonable accommodation for this job task?
The right answer is C The sit-stand stool will allow the client to rest and efficiently unload the joints during the show, and it will allow the client to be at eye level when talking to customers. It will eliminate the client's having to repeatedly stand and sit and reduce fatigue by promoting rest.
An occupational therapy group for adults who are working on regaining occupational engagement 1 year post stroke is designed to include sessions on community mobility and to address participants' stated concerns regarding use of assistive devices in public places. Which activity would BEST address these goals?
The right answer is D A field trip to the mall involving public transportation and practice using assistive devices best combines the goals for community mobility and use of assistive devices in public places.
An OTR® is working in a school with a high incidence of violence in a district with increasing numbers of students diagnosed with oppositional defiant disorder. The superintendent announces the formation of a task force to study the problem. Which response to this announcement would be BEST?
The right answer is D AOTA's societal statement on youth violence has clearly articulated the role occupational therapy should play in this area. Prevention is within the scope of occupational therapy practice, and practitioners should welcome any opportunity to participate.
An OTR®; is concerned with preventing shoulder pain in a client with hemiparesis in the acute stages of stroke recovery. Which intervention is appropriate to prevent shoulder pain in this client?
The right answer is D Clients with hemiparesis should be encouraged to move the upper extremity with external rotation, shoulder flexion within 90°, and scapular protraction to allow for optimal motor recovery by promoting soft-tissue elongation.
An OTR® is working with a driver who is experiencing visual neglect poststroke. What is the MOST APPROPRIATE compensatory approach the OTR® can use to help the driver improve on-road performance?
The right answer is D Clients with neglect or visual attention deficits are usually anosognostic and do not gain insight into their impairment, or the effect of the impairment, on driving performance.
Which tool should the OTR® use to assess peripheral visual fields?
The right answer is D Confrontation testing provides a gross assessment of how much peripheral vision the client has.
An OTR® is completing a wheelchair evaluation. Because the client maintains a posterior pelvic tilt and a kyphotic thoracic spine when sitting unsupported, the therapist is particularly concerned with the client's spinal alignment in the wheelchair. What effect can poor alignment have on compression of the client's diaphragm?
The right answer is D Correct alignment in a wheelchair will have an effect on all of these items, but only vital capacity is related to compression of the diaphragm. Proper alignment decreases compression of the diaphragm, which increases vital capacity.
An OTR® is working with a 56-year-old client who has recently undergone a bilateral hip replacement. What musculature is the MOST IMPORTANT to focus on in the client's strength training?
The right answer is D Emphasis in rehabilitation should be on maintaining motion and increasing strength of surrounding musculature. Gluteal muscles are inclusive of this group.
An inpatient who has Stage III lung cancer undergoes surgery for removal of axillary lymph nodes of the dominant upper extremity, followed by palliative chemotherapy. The patient is referred to occupational therapy for ROM, edema management, and preparation for hospice care at home. What intervention would be MOST BENEFICIAL for preparing the patient to transition to hospice care?
The right answer is D Many people at the end of life due to cancer want to remain engaged in occupation. Engaging the patient with purpose may keep the patient from feeling helpless.
An OTR® is working with an infant on learning how to transition from sitting to kneeling. Which activity would be the most appropriate to achieve this outcome?
The right answer is D Placing the toy on a surface that can only be reached in kneeling or standing (not sitting) would create the next "just-right" challenge.
An OTR® is setting up a booth to promote occupational therapy services at a community-sponsored health fair. A vendor has donated various therapy equipment and product brochures for the OTR® to display. When reading one of the brochures, the OTR® identifies a product promotion that claims to eliminate pain for any condition. What is the BEST course of action for the OTR® to take regarding this printed information?
The right answer is D Practitioners are ethically obligated to report any acts that make false claims and must not use such products or services in practice to refrain from any actions that may inflict harm.
A client who has an enduring mental illness arrives late for an initial occupational therapy evaluation at a community mental health facility. The client's appearance is unkempt and dirty. The client lives with family members, spends the majority of leisure time drinking with friends, and has been terminated from multiple jobs. One of the client's goals is to "get a job." What should be the PRIMARY focus of this client's intervention when using the Model of Human Occupation?
The right answer is D The focus on Model of Human Occupation in intervention is for the client to engage in occupational performance through doing, thinking, and feeling within the therapeutic environment.
An OTR® is creating an intervention plan for a client who was recently in a car accident and has multiple fractures. The client is currently not driving but has verbalized the desire to drive again in the future. What is the appropriate hierarchy of skill building to restore competence in mobility for this client?
The right answer is D The intervention plan must be developed in sequence with the hierarchy of skills of each mobility task and their increasing complexity. Functional ambulation for ADLs is the least complex, followed by car transfers, functional ambulation for community mobility, and finally driving.
An OTR® is developing a return-to-work program as part of a hospital-based outpatient clinic because of an increase in the number of referrals for hand and musculoskeletal injuries. The hospital is located in a suburban area. The OTR® has several clients who are employed as hair stylists. Which workstation design is MOST appropriate?
The right answer is D The key to equipment selection is the therapist's creativity and understanding of the basic apparatus requirements. Workstations should simulate physical demand characteristics and aptitudes of a variety of work at graded levels and incorporate jobs that may be unique to a specific geography. Custom-designed samples and therapeutic projects offer significant therapeutic benefit to clients.
A supervising OTR® hires two newly graduated COTA®s who have different learning styles. One prefers visual learning, and the other prefers a more hands-on approach. Which approach is the BEST way for the OTR® to supervise both COTA®s?
The right answer is D This approach best addresses the different learning styles of each COTA®; the COTA® who prefers kinesthetic learning can perform the new task and the visual learner can observe.
An OTR® has a client who is no longer able to propel a manual wheelchair and is considering a power mobility device. The client asks the therapist's opinion on the advantages of a scooter over a power wheelchair. Which of the following statements about scooters is TRUE?
They are easier to load into the trunk of a car. ***Scooters are modular and can be disassembled and loaded into and taken out of the trunk of a car more easily than a power wheelchair. The primary disadvantage of power wheelchairs is that they are so large and heavy that they cannot be placed in the trunk of a car and require a special transport system
A client with stroke is demonstrating a 1-finger-width separation of the acromion and the head of the humerus. In the intervention session, what should be the FIRST step of the OTR®;?
Train the client and caregiver in safe handling of the upper extremity during transfers ***Further assessment would be required in order to determine if the pt requires a sling
A client was involved in a car accident and sustained an incomplete injury at the T12 spinal cord level. Before the injury, the client was employed as a heavy equipment operator. After some discussion, the client and OTR® determine it is no longer feasible for the client to return to this occupation. The client is interested in exploring other options for employment. What program would the OTR® use to MOST appropriately assist the client in identifying vocational options?
Work readiness program
An OTR® is setting up a booth to promote occupational therapy services at a community-sponsored health fair. A vendor has donated various therapy equipment and product brochures for the OTR® to display. When reading one of the brochures, the OTR® identifies a product promotion that claims to eliminate pain for any condition. What is the BEST course of action for the OTR® to take regarding this printed information?
Recognize that the claim is invalid and eliminate the printed product endorsement from the booth
Performing a functional transfer with a client with CVA, the OTR® blocks the client's affected knee and instructs the client to reach for the desired surface and move toward the stronger side. What transfer technique does this BEST describe?
The right answer is A An assisted stand pivot is used to move a client from one surface to another.
An OTR® in an inpatient facility is conducting a cooking activity to teach effective coping skills to a small group of adolescents. A group member becomes frustrated with a teammate and is angry and verbally threatening. What is the BEST response in this situation?
"You seem really upset right now. Would you want to take a minute to calm down or just go back to your room for now?"
An OTR is evaluating a client with a brachial plexus injury. When checking upper-extremity movement patterns, what is the GREATEST degree of abduction the OTR should allow on the affected side?
90° Any motion beyond 90° abduction may induce added stress to the brachial plexus and its roots.
In reading a client's medical chart, the OTR® notes that the client has a history of postprandial orthostatic hypotension. What activity precautions should the OTR give the client?
Avoid a positional change from lying down to standing within 30 minutes of eating a meal. ***Postprandial orthostatic hypotension occurs when a person goes from supine to standing shortly after eating a meal. It generally affects older adults, people with hypertension, and people with Parkinson's disease
An OTR® is working with a driver who is experiencing visual neglect poststroke. What is the MOST APPROPRIATE compensatory approach the OTR® can use to help the driver improve on-road performance?
Awareness training pending the client's insight ***Clients with neglect or visual attention deficits are usually anosognostic (deficit of self awareness) and do not gain insight into their impairment, or the effect of the impairment, on driving performance.
An OTR® is working with a client who has ventricular tachycardia. The client's vital signs include a heart rate greater than 100 beats per minute. What is the appropriate therapeutic response to this client's situation?
Defer the client's participation in occupational therapy until later, because the client is medically unstable
An OTR® has recommended that a student with a learning disability use an assignment notebook to write down homework assignments for each class. Which factor related to learning disabilities does this compensatory strategy address?
Disorders of thinking and memory (both long term and short term)
An OTR® is treating a client with a proximal interphalangeal (PIP) flexion contracture secondary to a sports injury. To improve extension of the PIP for functional use of the hand, what is the BEST use of limited therapy time?
Fit the client with a prefabricated dynamic PIP extension assist splint
An OTR®; is providing dressing skills training for a client with traumatic brain injury (TBI). The client has a sequencing deficit and continually places underwear over pants and socks over shoes. What strategy is appropriate for the OTR to use with this client?
Hand the client each item of clothing and provide assistance in donning the item ***Minimizing environmental distractions and decreasing the complexity of the task will allow the client to experience success in completing one step of the task at a time
A blocking splint fabricated to maintain the metacarpophalangeal (MCP) joints in extension can be useful to isolate which joint movements?
IP joint flexion and FDP excursion ***FDP excursion occurs with DIP flexion not extension
A client with multiple sclerosis (MS) states that fatigue is negatively affecting work performance. What is the BEST action for the OTR® to take next?
Instruct the client to fill out a diary card that identifies common work tasks, rate each task for how much energy it requires, and then determine appropriate interventions
Which method would be MOST effective to gather data on the needs of a homeless population in a large urban area?
Interviews with key informants who are homeless
An OTR® is working with a client who is planning to take fixed-route transportation from home to school. The client sustained a closed-head injury 2 years ago and has difficulty with problem solving, especially related to changes in routine. What is the MOST important step for the OTR® to practice with the client?
Learning how to read the train schedule ***A client with problem-solving difficulty should be provided with a strategy to address future changes in routine. Because both train and school schedules may change from time to time, it is important for the client to learn how to read the train schedule
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?
Muscles are spastic ***Muscles below the level of injury generally develop spasticity
An OTR® chooses to incorporate the use of preparatory activities to modulate muscle tone, promote proximal joint stability, and improve hand function during a handwriting intervention session. Which model of practice is guiding the OTR®'s intervention?
Neurodevelopmental ***A neurodevelopmental approach to handwriting would ideally be used for children who have tone issues, poor postural control, poor limb function, poor automatic reactions, and poor proximal stability
A client with multiple sclerosis (MS) presents with extensor tone in the bilateral lower extremities, which interferes with work tasks completed at a desk. The OTR® performs a worksite evaluation. What would the OTR® recommend to decrease spasticity?
Positioning the hips into 90° or more of flexion ***Hot temperatures are contraindicated for individuals with MS, stretching may increase fatigue
A COTA® is shifting roles within a skilled nursing facility to become the manager of the therapeutic recreation department. In which way does supervision from the OTR® change?
Supervision is no longer needed. ***OT services are not being provided, so no supervision would be necessary
Which SOAP format statement would be appropriate and objective in documenting a client's modified duty program?
The client has decreased grip strength of the right hand of 15 lb with a standard dynamometer measure
An OTR® is working with a 4-year-old who was recently diagnosed with Duchenne's muscular dystrophy (DMD). The client's parents are concerned and want to understand how this condition will progress and affect the child's participation in daily life. Which statement describes the progression of DMD?
The condition progresses quickly, and children often need to use a wheelchair by age 9.
An OTR® is working as part of the school district's response-to-intervention initiative to deliver a handwriting curriculum with the kindergarten teacher. The OTR® is working with a small group of students to remediate their pencil grips. Which grip would require remediation?
The pencil rests on the distal phalanx of the radial side of the little finger, and the pads of all five fingers control the movement; the thumb is opposed to the ring finger and the wrist is flexed.
An OTR® is providing intervention to a medically stable client who sustained upper-extremity partial-thickness burns of the dominant arm, 5% of the total body surface area, 2 days ago. Which intervention BEST represents a typical ADL intervention?
The right answer is A A 5% total body surface area burn in one of the upper extremities means that the client has approximately 50% surface area burns to the dominant upper extremity. Edema and bulky dressings in the early stage may interfere with the motion needed for ADLs, and short-term use of adaptive equipment would be indicated. Adaptation to environment and activity can facilitate the client's achieving goals for independence in ADLs.
A client with a transfemoral amputation who is being fitted for a prosthesis is reporting severe pain when placing weight on the end of the residual limb. The OTR® examines the limb but does not see any reddened or open areas. What is this pain MOST likely the result of?
The right answer is A A neuroma is a ball of nerve tissue that occurs when axons attempt to grow back in the distal limb. They can be painful when pressed but are not necessarily visible.
An OTR® supervises a COTA® who works with a group of adults who are continuing their recovery from alcohol and drug addiction by living in a halfway house. The OTR® suggests that the COTA® become familiar with a particular group intervention in working with these clients. What type of intervention would the OTR® MOST likely suggest?
The right answer is D Most substance abuse programs include one or more self-help groups that use a classic 12-step process. Most substance abusers seek help through self-help groups. Occupational therapists working with this population are likely to become involved in facilitating or supporting these groups.
