Module 4: Injuries & Diseases

C) C6 SCI

4 months ago, a 35-year-old patient was involved in a MVA which resulted in his spinal cord being completely severed. The focus of his OT intervention has been on strengthening his wrist so that he can have the opportunity to actively participate in his dressing tasks, at home. The patient however has very weak wrist extensors and requires the assistance of a tenodesis splint. What level of spinal cord injury does this patient most likely have? A) C5 SCI B) T11 SCI C) C6 SCI D) L1 SCI

C) Sequencing the steps of a sink side grooming task

A client displaying ideational apraxia would MOSTLY likely have difficulty performing which task? A) Following verbal cues while performing therapeutic exercise B) Able to perform self care routine independently C) Sequencing the steps of a sink side grooming task D) Imitating the OT practitioner while completing a self care activity

B) Diplopia

A client recently sustained an injury to their right oculomotor nerve (CN III) and as a result is experiencing difficulty with their vison. What is the MOST likely deficit this client will experience? A) Cataracts B) Diplopia C) Diminished visual acuity D) Glaucoma

B) Phantom limb pain management strategies

A client status post (s/p) above the knee amputation, would benefit from which intervention MOST as part of a pre-prosthetic training phase? A) Practice using a body powered prosthesis B) Phantom limb pain management strategies C) Interventions geared towards independence with self care tasks D) Vocational Rehabilitation

A) As soon as possible

A client sustained a TBI (Traumatic Brain Injury) in a MVA (motor vehicle accident) and has been admitted to the ICU. When is the BEST time for the OT Practitioner to initiate family/caregiver education? A) As soon as possible B) Once the client has regained full consciousness C) Only when the family members ask to be involved in the client's care D) Caregiver education is not within the OT Practitioner's role

D) Metacognitive skills training approach

A client was recently admitted to an acute rehabilitation facility following a traumatic brain injury (TBI) after a boating accident. Currently, the client is focusing their OT sessions on executive function activities. Part of the intervention includes the client sequencing cards depicting home management tasks in the appropriate order. Which cognitive rehabilitative approach is the OTR® utilizing for this OT session? A) Remediation for improved cognitive skills B) Teaching the client adaptive strategies for their cognitive dysfunction C) Trial and error until desired outcome is achieved D) Metacognitive skills training approach

A) A stage 1 pressure ulcer

A patient with a high level SCI who resides in a nursing home has developed a reddened area on her sacral spine. The area is being monitored by nursing staff and they report that the area remains red for longer than one hour and it does not blanch when touched. What condition does the resident have? A) A stage 1 pressure ulcer B) A stage 3 pressure ulcer C) A contagious rash D) A first degree burn

A) Shearing

A patient with a newly acquired SCI (Spinal Cord Injury) is at risk for developing a pressure sore on his coccyx due to an ill-fitting wheelchair which is causing him to slide forward in his seat. Which specific type of force is MOSTLY contributing to the patient developing a pressure ulcer? A) Shearing B) Pressure C) Immobility D) Friction

B) Tenodesis splint and typing stick

A teenager is recovering from a recent C6 SCI which they sustained while playing rugby. They are an avid gamer and their main goal is to be able to use a computer to resume gaming. Which type of assistive device is the BEST to support this teenager in achieving their goal? A) Sip 'n Puff system B) Tenodesis splint and typing stick C) Head pointer D) Mouth stick

D) Ease of the patient's ability to access and operate the device

Bobby was involved in a MVA 2-months ago which resulted in him sustaining a C3 Spinal Cord Injury. He uses a sip-and-puff power wheelchair and is in the process of adapting his home to his needs. Bobby wants to be able to access the thermostat to adjust the temperature of his single-level condominium. What is the MOST IMPORTANT feature that should be considered when selecting an appropriate control interface? A) The size of the control interface B) The type of wireless system the client currently has installed in his home C) How frequent signal interference occurs with other devices in the condo complex D) Ease of the patient's ability to access and operate the device

A) The use of a long bottle or straw

What type of adaptive equipment would be best to recommend to patients at SCI C1-C4 to promote independence with drinking? A) The use of a long bottle or straw B) A wide and tall glass C) A cup with a wide brim D) A movable tray

C) First-degree burn

What type of burn only affects the epidermis? A) Second-degree burn B) Third-degree burn C) First-degree burn D) Fourth-degree burn

B) The best choice would be a cosmetic prosthesis

What would be the BEST prosthesis for a patient who has had an above-elbow amputation? Prior to the amputation, the patient was a secretary at a law firm but will be switching jobs and will now be answering phones using a headset. The patient is independent in all one-handed skills and is mainly concerned about the appearance of their residual limb rather than the function of the prosthesis. A) The best choice would be a hand prosthesis B) The best choice would be a cosmetic prosthesis C) The best choice would be a hook prosthesis D) The best choice would be a myoelectrical prosthesis

C) When is the patient going to become weak due to age-related changes in their musculoskeletal system

When assessing whether a patient is able to successfully age in place, safety in the home is a primary concern. Which factor will NOT help the OT practitioner decide whether the patient can safely age in place? A) Is the home in good repair B) Is there sufficient lighting and contrast C) When is the patient going to become weak due to age-related changes in their musculoskeletal system D) Is the patient cognitively able to understand whether risks are present

D) Make sure the compression glove exerts equal pressure, and if necessary, use a silicone gel pad under the garment to distribute the pressure more evenly

When fitting a pressure garment glove on a patient's right dominant hand, 6 weeks post burn injury, how can you ensure the best fit? A) Make sure the compression glove exerts equal pressure, but silicone gel pads should never be used as they are contraindicated for scar management B) The pressure garment is meant to exert equal pressure, but this is not achievable when using a glove for the hand due to the bony prominences C) Pressure garments should sit flush against the skin, and using inserts of any kinds will prevent this. Taking accurate measurements is the only way to ensure a good fit D) Make sure the compression glove exerts equal pressure, and if necessary, use a silicone gel pad under the garment to distribute the pressure more evenly

A) Skin inspection

When working with a client who recently had an above-knee amputation secondary to a diabetic peripheral neuropathy, what should the OT practitioner address FIRST before initiating any OT intervention? A) Skin inspection B) Asking the client about their roles and habits C) Prosthetic training D) Providing the client with a sugary drink

D) Intrinsic plus splint

Which splint would be appropriate for a patient who has second and third-degree burns on the dorsal surface of his right hand and forearm? A) Resting hand splint B) Cone antispasticity splint C) Dorsal flexor tendon repair splint D) Intrinsic plus splint

A) It is too soon post injury, to give a definitive prognosis

2 days ago, a patient was admitted to the ICU after sustaining a SCI. Based on the initial assessment, it appears as if the patient has injured his spine at the level of C5. During a ward round, the patient's wife asks the team about her husbands prognosis. What should the patient and his wife be told about his prognosis? A) It is too soon post injury, to give a definitive prognosis B) Not knowing one's prognosis is best as this help the patient to be optimistic C) The definitive diagnosis is that of a C5 SCI D) Both motor and sensory pathways have definitely been affected below the level of C5

D) S1-S5 Sacral Nerves

A 22-year-old male patient who was recently involved in a motorcycle accident, enquires about his prognosis. He is told that he will most likely be able to walk again but that he may have a loss of function in his hips and legs, as well as little or no voluntary control of his bowel and bladder. At which spinal cord level did this patient MOST likely sustain his injury and which nerves have therefore been affected? A) T1-T5 Thoracic Nerves B) C5-C8 Low-Cervical Nerves C) T6-T12 Thoracic Nerves D) S1-S5 Sacral Nerves

C) Font enlargement

A 42-year-old male songwriter has recently begun to experience difficulty reading what he has typed on his computer due to a visual impairment caused by early-stage cataracts. What is the best computer adaptation to recommend to this patient at this stage of his disease? A) Voice dictation B) Key guard C) Font enlargement D) Trackball

D) The myoelectric hand acts as the assisting hand and holds the vegetables to stabilize them

A 48-year-old client who is a sous-chef by profession, recently had to undergo an above elbow amputation of their right dominant extremity. The focus of OT intervention is on functional training of their myoelectric prosthesis. When addressing bilateral tasks such as cutting vegetables, what role does the client's myoelectric hand play? A) A myoelectric hand cannot be used in a kitchen setting B) A myoelectric hand cannot be used to perform such skilled tasks such as cutting vegetables C) The myoelectric hand acts as the dominant hand and holds the knife to cut the vegetables D) The myoelectric hand acts as the assisting hand and holds the vegetables to stabilize them

B) Accelerated aging due to secondary effects of the client's disability

A 50-year-old client sustained a T1 Spinal Cord Injury (SCI) when they were a teenager. Since their injury, the client has been functionally independent. However, over the past 3-years, the client has been experiencing difficulty performing their BADLs and is now reliant on a caregiver to help them. What is the MOST likely reason for the client's significant change in their functional abilities? A) The client now has the financial means to pay for a caregiver B) Accelerated aging due to secondary effects of the client's disability C) The client has become severely depressed D) The client is demonstrating features of a dependent personality disorder

B) On the same side as the hand the client will be using to reach for the items

A 65-year-old client is currently in an acute care hospital recovering from thoracic spinal surgery. To maintain spinal precautions while lying supine in bed, where should the client's frequently used items be placed? A) On the opposite side of the hand the client will be using to reach for the items B) On the same side as the hand the client will be using to reach for the items C) Under the pillow D) Reaching for any item is contraindicated post surgery

C) Retinopathy

A 76-year-old patient has recently been admitted to a rehabilitation facility following a fall at a local grocery store. The patient was diagnosed with Diabetes Mellitus Type II, 15 years ago and her diabetes is being controlled by medication. The patient reports that although her "sugars are good", she sometimes has "problems with her eyes", and this is the reason for her fall. Observing the patient, she demonstrates some difficulty navigating around the facility and she describes seeing floaters, having blurry vison at times and poor night vision. Based on these symptoms, what secondary complication has this patient MOST likely developed from her Diabetes? A) Preeclampsia B) Neuropathy C) Retinopathy D) Nephropathy

C) The client will utilize "self-talk" during new situations for increased insight and awareness

A client currently functioning at a Rancho Los Amigos 8 (Purposeful and Appropriate) would successfully accomplish which task? A) The client will be able to prepare a 3-ingredient cold meal B) The client will be able to play a board game for 30-minutes C) The client will utilize "self-talk" during new situations for increased insight and awareness D) The client will be able to complete their self care routine with set up assistance

A) Reducing distractions, giving clear concise cues, and increased time if needed

A client displaying Broca's aphasia would respond BEST to which type of intervention when focusing on improved independence with activities of daily living (ADLs) ? A) Reducing distractions, giving clear concise cues, and increased time if needed B) Using open ended questions only C) Using closed ended questions only D) Allowing the client increased time to respond to cues

- Teach the client how to follow a fatigue chart, monitoring endurance tolerance and planning tasks accordingly - Educate the client on a guided visualization program to encourage relaxation - Provide adaptive devices aimed at reducing fatigue, particularly with community mobility

A client who is currently undergoing chemotherapy is also experiencing chronic pain, fatigue, and dyspnea. This has caused the client to feel less inclined towards socializing with friends or leaving the house to complete community activities. As part of the client's palliative care goals and maintaining their quality of life, what is the most relevant information the OTR® should provide the client? Choose the 3 best answers. - Teach the client how to follow a fatigue chart, monitoring endurance tolerance and planning tasks accordingly - Provide education on a gentle home exercise program for increased strength - Educate the client on a guided visualization program to encourage relaxation - Reconfiguration of the home environment for modification and accessibility - Initiate a sleep hygiene program - Provide adaptive devices aimed at reducing fatigue, particularly with community mobility

B) Every 30 to 60 minutes

A client who recently sustained a C6 SCI (spinal cord injury) is being educated on how to prevent skin breakdown by using pressure relief techniques. When should the client perform weight shifts to prevent pressure sores from developing? A) Every 20 to 30 minutes B) Every 30 to 60 minutes C) When the patient complains of feeling uncomfortable D) Every 2 hours

- Provide psychological support - Prevention of joint and skin mobility loss. - Reduce Edema

A client who recently sustained a deep partial thickness burn would benefit MOST from which interventions during the acute care phase of healing ? Select the 3 best answers. - Provide psychological support - Explore return to work goals - Prevention of joint and skin mobility loss. - Dynamic orthosis fabrication - Restore function - Reduce Edema

C) 5 -10 days post-op

A client who was recently admitted to acute care after acquiring a full-thickness burn to both upper extremities requires skin grafting. How long after this surgical procedure can this client's AROM be assessed? A) 72 hours post-op B) On the first day of admission C) 5 -10 days post-op D) Once the patient can tolerate PROM

C) Provide the patient with cues to reposition, offer a cushion for comfort

A client with a diagnosis of Fibromyalgia presents to occupational therapy for an evaluation. Throughout the interview portion, the client displays pain behaviors such as guarded movement and facial grimacing. Using the numeric rating scale (NRS), the patient reports their discomfort at a 6/10. Which action should the OTR® initiate NEXT in response to this? A) Stop the evaluation, reschedule for another time when the patient is more comfortable B) Allow the patient a rest break, then continue with the session C) Provide the patient with cues to reposition, offer a cushion for comfort D) Continue with the evaluation as planned

A) Place tactile labels on knobs of appliances

A client with low vision is preparing to cook a hot meal. Which recommendation would be BEST to ensure that this activity is safe for this patient to perform? A) Place tactile labels on knobs of appliances B) Arrange labeled herbs and spices on an open shelf in alphabetical order C) Use a large crockpot D) Use a plastic cutting board with prongs to attach food for cutting

B) Insertion of silicone gel in pressure garments or splints

A client with recent 3rd degree burn injuries is at risk for developing hypertrophic scarring. The client has stated that they want to minimize any scarring as their role as a college campus tour guide involves interacting with the public. Which of the following strategies Is the BEST to use to prevent or minimize the development of hypertrophic scarring? A) Cover the burn area with gauze or a loose dressing. B) Insertion of silicone gel in pressure garments or splints C) Arranging the affected limb in a position of comfort D) Surgical release of skin wound tension is the only option

A) Visual discrimination

A five-year-old girl is working on a worksheet that asks her to match objects that are the same. What skill does this activity address? A) Visual discrimination B) Visual perception C) Visual-motor integration D) Visual tracking

C) Standard folding manual wheelchair

A former furniture mover was recently injured when a grand piano fell on him, causing a T10 spinal cord injury. What type of wheelchair would be best for this patient? A) Reclining wheelchair B) Standard rigid frame manual wheelchair C) Standard folding manual wheelchair D) Electric-powered wheelchair with desk arm

- Provide the client with a pill organizer with morning and afternoon slots with each day clearly labeled - Use visual reminders such as a dry erase board checklist in the bathroom - Intertwine medication regime into daily habits and routines such as mealtime, wake-up and sleep routines

A home health OT Practitioner is providing intervention to a client that is independent with their ADLs and uses a rolling walker for mobility. The client's main goal is to age in place and improve medication management. The client expresses stress and frustration around their medication routine as they have some doses which are time sensitive and they often miss taking them. Which recommendations would be BEST for the client to age in place? Choose the best 3 answer choices. - Provide the client with a pill organizer with morning and afternoon slots with each day clearly labeled - Instruct the client to bring their pill organizer in their robe pocket so they never forget - Use visual reminders such as a dry erase board checklist in the bathroom - Intertwine medication regime into daily habits and routines such as mealtime, wake-up and sleep routines - Have a family member or friend call as a reminder to take their medications on time - Ask the pharmacist to place the different medications in color coded containers

C) Occupational goals

A patient has been referred to OT post bariatric surgery. What should the OT practitioner focus on when working with this patient? A) Physical mobility B) OT practitioners do not have a role in treating obesity C) Occupational goals D) Tracking weight loss

A) Third-degree burn

A patient in the burn unit has been referred for OT intervention. The patient's chart reveals that the degree of burns they sustained from their injury has resulted in nerve damage. What degree of burn affects nerve endings? A) Third-degree burn B) Second degree, deep partial thickness burn C) First degree burn D) Second degree, superficial partial thickness burn

- Use lighting on a flexible arm - Use non-glare bulbs - Avoid using fluorescent lighting

A patient who has been diagnosed with AMD (Age-related Macular Degeneration) is having difficulty applying her make-up in the mornings. She routinely applies her make-up in her bedroom while sitting at her dressing table, using a regular freestanding mirror. The bedroom is lit by a large central fluorescent light and there is a small window next to the patient's dressing table. In terms of lighting, which adaptations are the MOST appropriate to recommend to this patient, to improve her efficiency when applying her make-up? Select the best 3 answers. - Use lighting on a flexible arm - Use non-glare bulbs - Avoid using fluorescent lighting - Stand facing the window to increase lighting - Encourage the patient to ask a family member to apply her make-up for her - Use light bulbs that are at most 50 watts

D) Use natural sunlight consistently throughout the day

A patient who has developed a progressive eye disease is being seen by the OT at her home. The goal of the session is to start introducing home adaptations/modifications that will be graded as the patient's condition progresses. What is NOT an example of an appropriate intervention for low vision? A) Use shades on all light sources to reduce glare B) Use overhead lighting to help eliminate shadows and keep rooms evenly lit C) Use a gooseneck lamp for tabletop activities D) Use natural sunlight consistently throughout the day

- Follow strict hand hygiene procedures - Keep wound covered - Disinfect surfaces and equipment after each use

A patient who recently sustained a Colles fracture has been referred to OT for intervention. While assessing the patient, the OTR® notices a boil on the patient's forearm and when enquiring about this, the patient discloses that before being admitted to hospital for her fracture, her family doctor had prescribed antibiotics to treat a staph infection. What are the MOST important precautions that need to be followed when working with a patient who has a staph infection? Select the 3 best answers. - Follow strict hand hygiene procedures - If patient acquired staph infection outside of hospital and is on antibiotics, it cannot be infectious - Drain the boil before proceeding with the evaluation - Keep wound covered - Keep wound open to assist healing - Disinfect surfaces and equipment after each use

C) Triceps

A patient with SCI C7 is able to complete a depression transfer using a sliding board. What muscle is innervated that allows him to complete this task? A) Finger flexors B) Wrist extensors C) Triceps D) Biceps

D) Power wheelchair equipped with a portable respirator and chin or breath controls

A patient with a C3 SCI is being evaluated for a wheelchair. The patient has stated that he wants to regain as much of his independence as possible. Which type of wheelchair is the MOST appropriate for this patient to enable him to achieve his goal? A) Power wheelchair equipped with chin, mouth stick or breath controls B) Tilt-in-space wheelchair C) Manual wheelchair D) Power wheelchair equipped with a portable respirator and chin or breath controls

D) Extensor carpi radialis longus and brevis

A patient with a C6 spinal cord injury is able to transfer in and out of bed with a transfer board as well as manage most hygiene tasks with the use of a universal cuff. Which muscles must still be innervated to allow for voluntary wrist extension required for both activities? A) Diaphragm, upper trapezius, and cervical paraspinal muscles B) Deltoid, biceps, and brachialis C) Pronator, flexor, extensor and abductor pollicis D) Extensor carpi radialis longus and brevis

B) Remove the shower door and replace it with a shower curtain or a folding plastic door

Adam, a 52-year-old male who is morbidly obese is having difficulty accessing his bathtub-shower combo as the glass shower door easily becomes dislodged when he is climbing into the shower. He manages to climb into and out of the bathtub with ease, holding onto a grab bar for support but due to his size, his body tends to dislodge the glass door from its frame. What is the BEST modification that can be made in this scenario, so that Adam can safely and independently enter his shower? A) Encourage the patient to rather sponge bath while sitting on a commode B) Remove the shower door and replace it with a shower curtain or a folding plastic door C) Encourage the patient to hire a caregiver to assist him with getting into the shower D) Remove the bathtub and install a walk-in shower

C) During dressing changes

An OT Practitioner (OTP) working in the burn unit is preparing to fabricate a splint for a client who presents with a deep-partial burn of their dominant upper limb. When should the OTP schedule this client's OT intervention? A) First thing in the morning B) Before pain meds are administered C) During dressing changes D) When client enters the rehabilitation phase

- Pain, edema, bulky dressings may limit full ROM - Although AROM is preferred, PROM should be measured if a patient is unresponsive or unable to move their extremity sufficiently - Pre-existing conditions that may alter expected AROM should always be considered

An OT Practitioner is assessing a client who recently sustained 3rd degree burns. To ensure accurate measurements when using a goniometer, what are the MOST important factors that should be taken into consideration? Select the 3 best answers. - When assessing PROM, all patients regardless of their age and gender, are measured according to the same standard protocol - Pain, edema, bulky dressings may limit full ROM - Although AROM is preferred, PROM should be measured if a patient is unresponsive or unable to move their extremity sufficiently - When taking measurements on a patient who incurred burns to their body, it is only necessary to measure AROM - Pre-existing conditions that may alter expected AROM should always be considered - It is not important to consider any pre-existing conditions that could impact on ROM as this is not relevant when working with burns because only soft tissue has been damaged

B) Suggest audio books or books on tape

An OT Practitioner is providing intervention to a 67-year old client who was recently diagnosed with glaucoma. Currently, the client lives alone in a 1-story home, and receives housekeeping services once a month for deep cleaning. The client enjoys reading, and doing crafts, however reports it has become difficult recently due to the visual limitations. Which adaptation would be MOST BENEFICIAL to encourage engagement in their preferred leisure tasks? A) Enlarged print for reading materials B) Suggest audio books or books on tape C) Recommend task lighting for work stations throughout the home D) Talk to text features for computer and smartphone

D) Level 3: Localized Response

An OT conducts a screening on a patient who recently sustained a traumatic brain injury. The patient is observed to be awake on and off during the day, turns towards the TV when it is on, and is able to squeeze the OT's hand when instructed to. What Rancho Los Amigos level is this patient functioning at? A) Level 1: No Response B) Level 5: Confused and Inappropriate C) Level 2: Generalized Response D) Level 3: Localized Response

D) Edge of the bed (EOB)

An OT enters a patient's room in the inpatient recovery wing of the hospital. The patient underwent a total hip arthroplasty 2 hours prior and is now lying supine in her bed. While conducting an evaluation, the OT asks the patient if she would be willing to sit up. What is the best seated position for the evaluation? A) Sturdy standard chair B) Place leg extenders on the bed C) Standard wheelchair D) Edge of the bed (EOB)

D) Patient demonstrates compliance with hip precautions

An OT is evaluating a 78-year-old woman who has undergone a total hip replacement. The OT notices that the patient leans forward and stops at 90 degrees of hip flexion when using a long-handled shoe-horn. What can the OT determine from this information? A) Patient shows poor retention of verbal cues B) Patient is not yet ready for such independent activity C) Patient is ready for discharge D) Patient demonstrates compliance with hip precautions

D) Cognitive status

An OT is scheduled to complete an initial evaluation of a patient who has recently undergone a total hip replacement. What is the most important factor the OT needs to consider when completing the evaluation? A) Social interests B) Kinesthetic status C) Levels of anxiety D) Cognitive status

C) Educate the patient on ways to don lower body dressing in bed and then direct the patient to transfer to a supported chair/wheelchair to complete upper body dressing

An OT is working at an inpatient rehabilitation facility with a patient who sustained a complete C8-T1 SCI. Currently, the patient requires maximal assistance with dressing. What technique is the BEST to incorporate into therapy sessions to improve the patient's independence in dressing? A) Lie the patient supine in bed to don shoes and socks, then have the patient sit in the bed to complete upper body dressing B) Provide the patient with adaptive equipment such a long-handled shoe horn and buttonhook C) Educate the patient on ways to don lower body dressing in bed and then direct the patient to transfer to a supported chair/wheelchair to complete upper body dressing D) While supine in bed, put on socks and shoes, then put on underpants and trousers by rolling side to side in bed

B) A deep partial-thickness burn typically resolves in 3-5 weeks

An OT is working with a patient in acute care who presents with a burn that has damaged the epidermis and deep layers of the dermis, including the hair follicles and blood vessels located in the dermis. The patient received this injury when taking a cake out from the oven. In the first treatment session, the patient asks the OT when the wound will heal. How should the OT best respond? A) A full-thickness burn will require skin grafting B) A deep partial-thickness burn typically resolves in 3-5 weeks C) A superficial partial-thickness burn typically resolves after 7-21 days D) A first-degree burn will resolve in 7 days

D) Patient became agitated and continues to demonstrate difficulty following instructions

An OT is working with a patient in the in-patient rehab department. The patient recently sustained a TBI during a MVA and has become very agitated. When the OT presents the patient with a simple grooming activity of brushing his teeth, he does not follow the OT's instructions and instead throws the toothbrush on the floor. He then states that he wants to be left alone. How should the OT best document the session in the "A" part of the SOAP note? A) Patient stated "he wants to be left alone" B) OT will continue to work on grooming activities with the patient C) Patient appears to be agitated and threw the toothbrush on the floor D) Patient became agitated and continues to demonstrate difficulty following instructions

- Figure ground - Visual motor integration - Visual Discrimination

An OT is working with a patient who presents with visual perceptual deficits secondary to a traumatic brain injury (TBI). During an intervention, the patient is handed a variety of small plastic shapes and boards on which patterns and pictures have been drawn. The patient is then asked to arrange the shapes directly onto the board to replicate these pictures and patterns. By using this activity, what 3 visual perceptual skills are being addressed? Select the 3 best answers. - Figure ground - Visual motor integration - Visual Sequential Memory - Visual memory - Form constancy - Visual Discrimination

D) Select and lay out a Thanksgiving table setting

An OT is working with an inpatient who is recovering from a recent TBI, using the model of human occupation (MOHO) frame of reference. This patient is motivated to host a Thanksgiving dinner for her family. What activity would be appropriate to use under the MOHO model to help the patient achieve her goal? A) Cook a 14-pound turkey in the OT kitchen B) Use the telephone to gather information about catering for Thanksgiving dinner C) Use Facebook to invite relatives to Thanksgiving dinner D) Select and lay out a Thanksgiving table setting

B) Back up to the chair, extend the operated leg forward, reach back for the armrests and slowly lower to the sitting position

An OT practitioner is providing client education regarding transfers to and from a chair while maintaining posterior total hip precautions. What method should the OT practitioner teach this client to use when sitting down from a standing position? A) Back up to the chair, extend the non-operated leg forward, reach back for the armrests and slowly lower to the sitting position B) Back up to the chair, extend the operated leg forward, reach back for the armrests and slowly lower to the sitting position C) Back up to the chair, keep both legs together, reach back for the armrests and slowly lower to the sitting position D) There are no specific precautions for transitioning from standing to sitting

D) Responds directly to the type of stimulus presented

An OT practitioner is working with a client who sustained a TBI and is currently functioning at a Rancho Level of 3. When using sensory stimulation as an intervention, what type of response would you expect from this client? A) Consistently responds to stimuli and follows simple directions B) Unresponsive to stimuli C) Responses may be physiological changes D) Responds directly to the type of stimulus presented

D) Straddle the seat and face the back of the toilet

An OT practitioner is working with a female patient who has a history of chronic lower back pain due to a herniated L4-L5 disc. The patient is finding using the toilet very challenging especially when her back pain is severe. What is the BEST way to structure this ADL to help the patient cope with attending to her toileting needs? A) Use a raised toilet seat B) Use a footrest C) Stand and bend forwards D) Straddle the seat and face the back of the toilet

C) The last line of print that is easily read on the reading acuity test card indicates the minimum size of the print

An OT practitioner is working with a patient who has a visual impairment. The focus of the session is on helping this patient manage his medication independently. As the patient has difficulty reading standard labels on medicine bottles, the OT practitioner identifies that reprinting the labels in a larger print is necessary. Using a reading acuity test card, how can the OT practitioner determine the minimum size print that should be used for re-labelling this patient's medication? A) The first line of print that is easily read on the reading acuity test card indicates the minimum size of the print B) Labels on medication bottles should never be enlarged C) The last line of print that is easily read on the reading acuity test card indicates the minimum size of the print D) The second last line of print that is easily read on the reading acuity test card indicates the minimum size of the print

A) Disguise exits with drapes and conceal door knobs to discourage wandering outside the home

An OT practitioner is working with a patient who has moderate cognitive decline secondary to Alzheimer's disease. The patient lives with his adult daughter and her family in a single story house. The patient is mostly independent in his ADLs but requires assistance for all IADLs. Over the past month, the patient has demonstrated a decrease in function and his daughter is concerned for her father's safety in the home. She states that: "Dad seems to wander more and has been more and more confused when he wakes up." What recommendation is the MOST appropriate at this stage, to promote patient safety in the home? A) Disguise exits with drapes and conceal door knobs to discourage wandering outside the home B) Install locks on all doors, including the patient's bedroom door to reduce the risk of wandering C) Have the daughter perform reality orientation techniques each time the patient wakes from sleep D) Install baby-gates in the doorways to keep the patient within a confined space

D) If the patient feels they are not getting enough oxygen, they should change the oxygen flow rate immediately

An OT practitioner is working with a patient who is recovering from Covid-19 and is currently using supplemental oxygen at home. The focus of the session is on conducting a home safety evaluation. From the options below, which of the following recommendations is NOT an appropriate precaution? A) Petroleum based products (such as Vaseline) should not be used on the face when oxygen is being used B) When cooking while using oxygen, the patient should make sure their tubing will not be able to touch the gas flame or electric burner C) Never use oxygen near an open flame or anything that can produce intense heat, flames or sparks D) If the patient feels they are not getting enough oxygen, they should change the oxygen flow rate immediately

C) Slowly lower the patient to the ground and then get help

An OT who is working in outpatient rehab, is assisting a patient who has been diagnosed with fibromyalgia with transferring from their wheelchair to a chair. As the OT is in the process of helping the patient with the transfer, the patient begins to fall. What is the best course of action for the OT to take NEXT? A) Call 911 B) Grasp the patient firmly and assist them back to the wheelchair C) Slowly lower the patient to the ground and then get help D) Lift the patient up by his legs and try to put him back in the wheelchair

C) Incomplete SCI- Motor function is preserved below the neurologic level, and more than half of key muscles below the neurologic level have a muscle grade less than 3

An OTR® has received a referral to evaluate a patient with an acute SCI. While reviewing the patient's medical chart, the OTR® reads that the patient has scored a grade C on the ASIA scale. What information does this ASIA grade indicate? A) Incomplete SCI- Motor function is preserved below the neurologic level, and at least half of the key muscles below the neurologic level have a muscle grade of 3 or more B) No impairment- motor and sensory function are normal C) Incomplete SCI- Motor function is preserved below the neurologic level, and more than half of key muscles below the neurologic level have a muscle grade less than 3 D) Complete SCI- Motor function is preserved below the neurologic level, and more than half of key muscles below the neurologic level have a muscle grade less than 3

B) Reducing crossing the legs by crossing at the ankles instead

An OTR® is assessing a client who recently underwent a posterior total hip arthroplasty (THA). The client is displaying difficulty recalling their precautions associated with the procedure. Which action should the OTR® encourage the client NOT to participate in as part of the client's hip precautions? A) Turning their effected foot/toe outward when turning a corner during mobility B) Reducing crossing the legs by crossing at the ankles instead C) Leaning back when sitting down ensuring decreased hip flexion D) Using grab bars for standing and sitting activities

C) The client may have difficulty discerning road signs or directions if partially occluded

An OTR® is completing a pre-driver screen on a client who was recently diagnosed with Parkinson's disease. The client presents with intact motor planning and cognition and memory are both within the normal functional limits for driving. However, the client struggles with visual closure. How might this present when driving? A) The client will have difficulty staying within the lines on the road B) The client will struggle to parallel park C) The client may have difficulty discerning road signs or directions if partially occluded D) The client won't be able to have their license renewed

D) Complete caregiver training and assess the SO's ability to provide assistance with the client's needs

An OTR® is discharge planning for a client who recently had a right knee replacement. The client continues to display difficulty performing dressing tasks independently. The client's discharge plan is to return home where they live with their significant other (SO) who is able to assist with ADL's as needed. What measures should be taken to ensure that this client's needs can be met once home? A) Recommend home modifications and adaptive equipment for increased independence with self care tasks B) Encourage the client to be as independent as possible C) Suggest the client stay at the rehabilitation facility an additional 1-2 weeks to continue working on their goals D) Complete caregiver training and assess the SO's ability to provide assistance with the client's needs

B) The Montreal Cognitive Assessment (MOCA)

An OTR® is evaluating a client who displays difficulty with cognitive function and memory. The client has been showing signs of visual perceptual deficits during self care tasks. Which assessment tool would be BEST for the OTR® to select as part of the evaluation? A) Assessment of Motor and Process Skills (AMPS) B) The Montreal Cognitive Assessment (MOCA) C) The Mini Mental Assessment D) Modified Ashworth Scale

D) Neck in neutral to slight extension

An OTR® is evaluating a client who sustained superficial partial-thickness burns to their face and neck after a grease fire. Which positioning is the antideformity position for this client? A) Neck in full extension B) Neck flexed, chin to chest C) Neck in neutral to slight flexion D) Neck in neutral to slight extension

C) Slowly turn the walker and back up to the front passenger seat, extend the unaffected leg to avoid over flexion

An OTR® is planning an intervention for a client who recently underwent a posterior total hip arthroplasty (THA). The client would like to learn the BEST way to transfer in and out of a 4-door sedan. How best should the OTR® instruct the client to get into and out of the car? A) Bend forward to avoid hitting the top of the car and scoot onto the passenger seat B) Lean against the edge of the seat, extend the unaffected leg, and scoot up towards the driver's seat C) Slowly turn the walker and back up to the front passenger seat, extend the unaffected leg to avoid over flexion D) Wedge the walker between the door and passenger seat and laterally slide onto the seat

A) The client will be able to lock their elbows in extension while rocking slightly forward and side to side as the caregiver places the board underneath their hips

An OTR® is providing caregiver education and training on how to assist a client who recently sustained a complete C6-spinal cord injury (SCI). The focus has been on transfers. Once the client is sitting on the edge of bed (EOB) what will they require assistance with NEXT? A) The client will be able to lock their elbows in extension while rocking slightly forward and side to side as the caregiver places the board underneath their hips B) The client will be able to push up with their arms to lift their hips onto the slide board C) While seated upright, the client will be able to weight bear through their lower limbs to briefly stand up while the slide board is placed under their hips D) The client will be able to perform the transfer without the aid of a slide board

B) Recommend the use of a lamp with a shade and enough height to flood the area and decrease glare

An OTR® is providing treatment to a 68-year-old client with macular degeneration who enjoys knitting in the evening hours. For increased lighting, the client sits next to a table lamp. The client reports to the OTR® it is becoming more difficult and would like recommendations for how to improve the environment for increased independence. Which intervention would be BEST for this client? A) Suggest using brightly colored yarn B) Recommend the use of a lamp with a shade and enough height to flood the area and decrease glare C) Recommend larger knitting needles D) Recommend prism glasses

B) Using a portable table throughout their home to aid in moving items from room to room

An OTR® is treatment planning for a client who has been diagnosed with a lower back injury/strain. Their physician has written orders to decrease bending and lifting tasks throughout their day and "rest" as much as possible. The client lives alone, in a one story home with no steps or uneven surfaces in the layout. Which adaptation would be BEST to assist this client in adhering to the physician's recommendations while participating in necessary occupations? A) Asking their next door neighbor to assist with unloading groceries B) Using a portable table throughout their home to aid in moving items from room to room C) Relaxation strategies incrementally each day D) Employing energy conservation techniques

D) Report the symptoms to the patient's charge nurse

An OTR® is working with a 72 year-old woman on a self-feeding task with the use of adaptive utensils. The patient has diabetes mellitus type II and hypertension. The OTR® notices that the patient's skin is pale, she is breathing deeply and a fruity odor on her breath is evident. She suddenly appears very weak and starts to complain of excessive thirst. What should the OTR® do IMMEDIATELY in response to this observation? A) Return the patient to her room and offer her a glass of juice to quench her thirst B) Check her blood pressure and recline her in her wheelchair with her feet elevated C) Teach the patient breathing techniques as a tool to cope with stress as she is experiencing anxiety D) Report the symptoms to the patient's charge nurse

A) Providing lightweight, built-up handle utensils.

An OTR® is working with a patient with a diagnosis of generalized weakness. The OTR® wants to use a top down approach to address the patient's difficulty holding onto eating utensils during meals. Which intervention reflects a top down approach? A) Providing lightweight, built-up handle utensils. B) Supination exercises using a Velcro exercise board. C) Lateral pinch exercises using soft exercise putty. D) General strengthening using overhead pulleys.

A) Provide the client advice on the importance of exposure to natural sunlight throughout the day

An elderly client with a diagnosis of rheumatoid arthritis with the goal of aging in place has employed paid caregivers who provide 4-hours of assistance 5-days per week. The client has recently started to display symptoms of chronic fatigue which is impacting the quality of their sleep. What is the BEST OT intervention for this client? A) Provide the client advice on the importance of exposure to natural sunlight throughout the day B) Advise the client to complete a series of gentle stretches prior to bedtime C) Encourage the client to read before bed D) Educate the client on listening to their "tired" cues and sleeping then

C) Address any of the patient's precipitating conditions such as pain, decreased range of motion, depression, anxiety that may be impacting on her sleep quality

An elderly patient who has rheumatoid arthritis has chosen to age in place and has the resources to employ a fulltime caregiver to assist her when necessary with her ADLs. The patient has recently started to display symptoms of chronic fatigue and her doctor has been unable to find a medical cause to account for this new development in her status. However, it has been identified that the patient is experiencing difficulty falling asleep and her sleep is disrupted as she wakes up frequently throughout the night. What is the BEST OT intervention for this patient, at this stage? A) Advise the patient to ask her doctor for medication to help her fall asleep B) Addressing sleep dysfunction is not within the scope of occupational therapy C) Address any of the patient's precipitating conditions such as pain, decreased range of motion, depression, anxiety that may be impacting on her sleep quality D) Encourage the patient to listen to her body and to only try to sleep when she feels exhausted

A) Place frequently used dishes on the countertop

Ethel has severe osteoarthritis in her neck and shoulders. She lives alone in her own home and is independent with most activities, but she has trouble reaching into the cupboards above the counter top of her kitchen to retrieve dishes. What adaptation is the BEST to help Ethel access her dishes? A) Place frequently used dishes on the countertop B) Provide a wheeled cart C) Place frequently used dishes in a cabinet below the countertop D) Suggest employing a home health aide

A) Focus on energy conservation

Gabriel, a 53-year-old patient who was recently diagnosed with leukemia, has just completed a grueling month of chemotherapy which has had an impact on his muscle strength and stamina. Gabriel is struggling to perform simple motor tasks such as standing during his BADLs and walking around his home. What should the focus of OT intervention be at this stage of his treatment? A) Focus on energy conservation B) Help the patient manage his medications C) Encourage the patient to walk around the block, to maintain his strength and ROM D) Encourage the patient to lift weights to improve his strength

C) CN 7

If a client presents with hemifacial weakness, which cranial nerve is MOST LIKELY being affected? A) CN 3 B) CN 6 C) CN 7 D) CN 4

C) Level 7: Automatic and Appropriate

If a patient is able to follow a set schedule and perform a self-care routine independently, at what Rancho level are they functioning? A) Level 6: Confused and Appropriate B) Level 1: No response C) Level 7: Automatic and Appropriate D) Level 5: Confused and Inappropriate

C) Massage should be performed in a circular motion, using gentle pressure initially and increasing the pressure gradually as tolerated

In burn management, massage is a recognized modality used to help soften and desensitize healed grafted areas and burn scars. What is the BEST massage technique for treating a burn scar that is hypersensitive? A) Massage should be performed in a stroking (effleurage) motion, with more pressure applied gradually as tolerated over time B) Massage should be performed using a kneading technique, with more pressure applied gradually as tolerated over time C) Massage should be performed in a circular motion, using gentle pressure initially and increasing the pressure gradually as tolerated D) Massage should be performed using any technique, with consistent pressure over time

A) Design treatment activities that simulate both functional activities and various work skills

Joel, a 37-year-old male who is a construction worker, recently incurred deep partial-thickness burns to both his upper extremities while lighting a barbecue grill with lighter fluid. Joel has stated that he needs to return to work as soon as possible, as his family depends on his income. When formulating an OT intervention plan for Joel, what is the MOST efficient way to help him achieve his goal of returning to work? A) Design treatment activities that simulate both functional activities and various work skills B) All stages of healing need to be achieved before reconditioning for returning to work can be addressed C) Addressing functional and work skills at the same time is not practical, especially when working with a patient who is recovering from burns D) Wait for the patient to regain independence in their ADLs and then prioritize addressing work skills

C) Help Judyth clear the clutter from her main hallway

Judyth is a 58-year-old woman who has been diagnosed with NPDR- non-proliferative diabetic retinopathy (early stage). At this stage, her only symptoms are occasional bouts of blurry vision. What home modifications should the OTR® recommend at this stage of Judyth's OT intervention? A) Order Judyth an audio clock B) Label Judyth's stove dials with Braille label tape C) Help Judyth clear the clutter from her main hallway D) Install low vision lighting

D) Transfer board

Kevin is a 32-year-old veteran who sustained a C7 spinal cord injury during active duty. During an ADL session the OT observes Kevin having difficulty transferring from his bed to his wheelchair. What piece of adaptive equipment would help Kevin complete this task with more independence? A) Standing wheelchair B) Pivot disk C) Hoyer lift D) Transfer board

D) Setting up a wall calendar and pill organizer as reminders

Laura, a 68-year-old patient with a history of Type 2 diabetes and hypertension, recently sustained a TBI (traumatic brain injury) when she was involved in a MVA. Laura is currently functioning at Rancho Los Amigos Level VIII (Purposeful, Appropriate) and the focus of OT intervention is on preparing her for being discharged from inpatient services. What is the MOST appropriate activity the OT practitioner and Laura should be working on at this stage of her recovery? A) Assessing if Laura can resume driving B) Practicing simple ADLs with assistance C) Setting up labels to be placed on drawers and closets for clothing and personal items D) Setting up a wall calendar and pill organizer as reminders

A) Beery Buktenica Developmental Test of Visual-Motor Integration (Beery VMI)

Post TBI, a 20-year-old patient's visual-motor skills are being assessed using a standardized assessment which requires him to copy a series of geometric forms which progress in difficulty. Which assessment is the OT MOST likely administering in this scenario? A) Beery Buktenica Developmental Test of Visual-Motor Integration (Beery VMI) B) Test of Visual-Perceptual Skills (TVPS) C) Occupational Therapy Adult Perceptual Screening Test (OT-APST) D) Motor-Free Visual Perception Test (MVPT)

C) 1- 2 years

Post burn injury, the use of pressure garments is widely used as a means of reducing hypertrophic scarring. What is the recommended time period that patients should wear their garments to ensure the BEST results? A) 6 months B) 2- 3 years C) 1- 2 years D) Not indicated for prevention of hypertrophic scarring

D) Phantom limb pain

Post upper limb amputation, an OT practitioner selects mirror box therapy as part of the intervention process for a patient who is experiencing severe pain. With which type of pain is this technique MOST widely used? A) CRPS (Complex regional Pain Syndrome) B) Neuroma C) Residual limb pain D) Phantom limb pain

A) Level VI

The hallmark feature of this RLA (Rancho Los Amigos Level) is that an attention span of 30-minutes is possible in a quiet environment? Identify the RLA level. A) Level VI B) Level III C) Level IV D) Level V

D) Passive range of motion (PROM)

Terence, a 22-year-old college student, recently sustained a C7 SCI when he was injured during a football game. Terence is currently in an inpatient rehab facility and has been referred to OT for intervention. Part of the OT evaluation includes assessing Terence's muscle strength in his upper limbs. Before performing any specific manual muscle testing, what should the OT determine FIRST? A) Individual muscle testing is contraindicated for this patient B) Active assisted range of motion (AAROM) C) Active range of motion (AROM) D) Passive range of motion (PROM)

D) Use nursing pillows and wedges to support the mother's arms during breastfeeding

Tyra is a 32-year-old woman who recently sustained a complete C6 SCI. Tyra is the mother of 2 young children and she has expressed her desire to resume breastfeeding her 3-month old daughter despite her injury. However, Tyra's milk production has been affected by her injury and her ability to handle her infant is impaired due to her poor hand function. With the help of medication and visualization, Tyra has started to produce some milk. How can the OTR® help Tyra handle her baby to promote successful breastfeeding? A) Lay supine in bed while the baby is held in prone to allow latching onto the mother's breast B) Place the child in a frontal sling carrier which has an opening, to support the baby's head and allow for the baby to allow latch onto the mother's breast C) Create an adapted handle on the bottle filled with baby formula D) Use nursing pillows and wedges to support the mother's arms during breastfeeding

B) A donut style cushion

What adaptation is contraindicated for a patient with paraplegia who wants to prevent pressure ulcers? A) A skin inspection mirror B) A donut style cushion C) A gel cushion for the patient's wheelchair D) A pressure relief bed

A) When a person lives in the home of his or her choice for as long as possible

What does "aging in place" mean? A) When a person lives in the home of his or her choice for as long as possible B) When elderly parents move in with their adult children C) When an elderly person must move to an assisted living facility D) When a person lives in the same home for his or her entire life

D) Elevation of body part

What is the BEST intervention for edema control in a patient admitted to acute care, 72 hours after a burn? A) Immobilization B) Adaptive equipment C) Gentle PROM D) Elevation of body part

D) The most likely reason would be phantom pain

What is the MOST LIKELY reason why a client who recently had their second digit amputated, would complain of pain and tingling in that missing digit, when there are no signs of swelling or inflammation in the affected hand? A) The most likely reason would be a psychological reaction to the loss of a limb B) The most likely reason would be nerve damage C) The most likely reason would be skin breakdown D) The most likely reason would be phantom pain

- Assist the client with anticipatory grief - Educate the client and family on palliative care - Provide bereavement support

What role does an OT Practitioner take on when working with a client who has been admitted to a skilled nursing facility (SNF) for hospice care? Select the 3 best answers - A rehabilitative approach - Assist the client with anticipatory grief - Educate the client and family on palliative care - A home exercise program for strengthening exercises - A remedial approach is best practice - Provide bereavement support

C) Stop the session and advise the client to seek medical assistance immediately

While fabricating a splint for a client who is 3-weeks postpartum, the client starts to complain that her right leg is cramping and becoming sore, and feels warm. The OTR® notes it appears to be larger when compared to the other leg. What action should the OT Practitioner take first in response to this client's current status? A) Provide the client a stool to elevate their lower extremities B) Check the client's vital signs C) Stop the session and advise the client to seek medical assistance immediately D) Provide the client a handout of home exercises which include lower extremity range of motion

B) Fall prevention

You are planning an educational talk for older adults who reside at an assisted living facility. The focus of your talk is on how you can help them achieve their goal of aging in place. What is the MOST important information that should be included in your presentation? A) Normal decline in functioning as related to aging B) Fall prevention C) Guidelines for employing the right caregiver D) Guidelines for selecting the most appropriate apartment complex for seniors