NBCOT!!!!!!

An OTR working in a community mental health setting is using dialectical behavior therapy to guide intervention planning for a client who has a borderline personality disorder. The client works in a university setting and is at risk of losing the job due to verbal outbursts and erratic mood swings. The client is aware that behavioral changes are needed and reports a willingness to work toward these changes. Which type of intervention would be MOST BENEFICIAL for supporting progress toward this objective when using this approach?

!Group skills! training modules in mindfulness, interpersonal effectiveness, emotion modulation, and distress tolerance

An OTR is providing supervision to a rehabilitation health aide, who assists a client with bathing. During the initial OT evaluation, the patient identified independence in bathing as a priority goal and was assessed to require 25% assistance. However, the aide tells the OTR that the patient wants total assistance during bathing sessions and frequently asks the aide to complete tasks that the patient can perform. What is the FIRST action the OTR should take to support progress toward the patient's bathing goal?

Conduct a joint session with the client and the aide to review goals for bathing

A client is in the early stages of a slow, progressive upper motor neuron disease. Mild intention tremors and fatigue interfere with completion of typical daily tasks and ability to work a full day as an accountant. Currently, the client ambulates with a cane in the home and uses a wheelchair for community mobility. The client's goal is to remain working as long as possible. Which work accommodation meets the employer's obligation for this client as required by the Americans with Disabilities Act?

Consideration for modifying the client's current work schedule -NOT modifying doorways

A 5-year-old child sustained partial and full thickness burns on the volar surfaces of both wrists and forearms 3 months ago. Although the child wears pressure garments, scarring across the wrist is limiting wrist mobility. Which activity could be graded to MOST EFFECTIVELY help with increasing the child's wrist motion?

Creeping on hands and knees through a play tunnel maze-weightbearing=tissue lengthening

A school-based OTR is selecting seating alternatives for a student who has moderate hypotonia and has just transitioned to a full-day kindergarten program. The student uses a wheelchair for mobility and does not tolerate an upright sitting position throughout the school day. What type of positioning system would be MOST BENEFICIAL for this student?

Dense foam lateral supports and gel cushion for the current wheelchair

An OTR who works in a large, urban hospital is providing intervention to an inpatient who is preparing for discharge and has COPD, diabetes mellitus and morbid obesity. The patient lives alone in a rural community and has been readmitted to the hospital for recurrent exacerbation of respiratory distress and poor glycemic control 3 times over the past year. What is the FIRST intervention priority the OTR should address to positively influence the risk of a future readmission?

Recommend durable medical equipment for the patient to use during ADL -w/n the scoop of OT

Which of the following joint protection techniques should a client with rheumatoid arthritis use when completing kitchen tasks?

Transport items using a wheeled cart

proper sequence for donning PPE

gown, mask, goggles, gloves

Which interprofessional team member would be MOST BENEFICIAL for an OTR to refer a middle-school student who has expressed suicidal ideation?

physician

plate switch pneumatic switch phonation switch

requires minimal force sip or puff, uses air speech or sound

An OTR is fabricating a static orthotic for a client who has a partial thickness burn to the dorsum of the hand. The primary purpose of the orthotic is to maintain the length of the MCP joint collateral ligaments. How should the MCP joints, IP joints and wrist be positioned in the orthotic to achieve this goal?

-MCP joints in 60 - 70 degrees of flexion -IP joints in 0 - 5 degrees of flexion -wrist in 25 - 30 degrees of extension

Levels of Evidence: Level I Level II Level III

-Meta Analysis, Systematic Reviews, EB clinical practice guidelines based on systematic reviews -case studies, randomized control studies -background info, expert opinion

A 6-year-old child who has mild ataxic cerebral palsy has been referred to OT for handwriting skill development. When implementing treatment, what action should the OTR take FIRST?

-wrist in slight extension -45° of pronation

"average" T-score range

40-60

Parts of IDEA

A & B: eligibility procedures, regulations and services required for children 3 - 21 yo C: speaks of services for infants and toddlers. Part D: explains the activities that the federal government encourages in order to better the services for children with disabilities.

Outcome and Assessment Information Set (OASIS)

A standard core assessment data tool developed to measure the outcomes of adult patients receiving home health services under the Medicare and Medicaid programs (CMS 2013)

An OTR is completing a feeding evaluation of a 4-year-old child who has mild hypotonia, immature oral motor control, and oral hypersensitivity. The child sits in a standard dining chair during meals and requires moderate to maximum assistance from a caregiver for feeding. When attempting to swallow food the child hyperextends the neck, elevates both shoulders, and has poor lip closure. What information should the OTR include in the INITIAL caregiver instructions based on this observation?

Adaptive positioning techniques for promoting trunk alignment

A client sustained a TBI 3 months ago and is functioning at Level VIII (Purposeful, Appropriate, Stand-by Assist) on the Rancho Los Amigos scale. The client is participating in a meal preparation task. As part of the task, the client is asked to prepare vegetable soup using a five-step printed recipe. The client is able to read the recipe steps aloud but does not act on any of them. When the OTR covers over all but the first step of the recipe, the client follows through with the step. What conclusion can the OTR make about the client based on this observation?

Adaptive strategies compensate for attention deficits

An OTR is employed at a skilled nursing facility on an hourly basis and is typically scheduled to work 2 shifts each month. The facility-specific clinical protocol directs the OTR to use a standardized assessment tool that is unfamiliar to the OTR. What is the FIRST action the OTR should take in this situation?

Alert the therapy supervisor that additional training is needed

inhibition technique for spasticity

Apply firm, prolonged manual pressure

An OTR is teaching compensatory strategies to an older adult client who lives alone and receives weekly visits from a family member. One of the client's priorities is to be independent with IADL, including medication management. However, when filling the pill box, the client made 8 medication errors in the past month. To respect the client's stated priorities and to maintain client safety, which statement represents the BEST ethical action for the OTR to take?

Ask for medications to be pre-packaged at the pharmacy according to prescription instructions.

Which action should an OTR who works in a hospital setting take at the start of an intervention session with an inpatient who has frequent seizures?

Ask the patient if an aura is typically associated with seizure activity

An OTR working in a home health setting is collaborating with a client who has mild dementia to establish client-centered goals and to obtain informed consent for the intervention plan. Which action should the OTR complete NEXT as part of the informed consent process for this client?

Assess the client's decision-making skills

A 6-year-old child who has developmental delay is learning to self-dress. Over the past several months, the child has made significant progress and is now able to complete age-appropriate dressing tasks with the exception of independently tying shoe laces. The parent reports the child becomes extremely frustrated with this task and has behavioral outbursts when an adult provides assistance. Which technique should the OTR incorporate into the intervention to MOST EFFECTIVELY support the child's success with shoe-tying?

Backward chaining-Backward chaining technique is motivating to the child with a low frustration tolerance because it starts with having the child learn the final step of the task first, providing a rewarding experience.

An OTR who works in medical oncology plans to have an inpatient walk to the bathroom and complete all steps for showering. Prior to the session, the OTR reviewed the medical record and noted that the international normalized ratio (INR) value for the patient is greater than 5.0. What action should the OTR take based on this INR value?

Cancel the intervention session planned for the day -A patient with an INR=5 is at risk for bleeding and is typically placed on bedrest or activity restrictions

A family practice physician referred a client to outpatient OT for conservative treatment of carpal tunnel syndrome of the dominant hand. The client reports a 3 month history of numbness and difficulty manipulating objects. Symptoms interfere with work as a jack-hammer operator for a road works department. Evaluation results indicate loss of protective sensation, 11 mm two-point discrimination, and thenar muscle atrophy. Active ROM of the affected hand is within normal limits. What INITIAL actions should the OTR take in addition to fabricating a volar wrist orthosis?

Conduct Phalen's test and report findings of the overall evaluation process to the physician

An inpatient had a myocardial infarction 4 days ago. While sitting on a chair at the sink during a bathing session, the patient's systolic blood pressure increases by 10 mmHg above the patient's resting blood pressure. What INITIAL action should the OTR take based on this observation?

Continue to monitor vital signs and proceed with the planned intervention session -10 mmHg is okay for activity

An OTR is selecting a new seating system for a college student who has cerebral palsy and uses a wheelchair for all functional mobility. The client has flexible asymmetrical postures including scoliosis, kyphosis, and pelvic obliquity. The student wants to be able to sit upright for 12-14 hours per day. Which custom seating system would BEST support progress toward this goal?

Contoured-A contoured cushion is beneficial for any client who is at-risk for skin breakdown and has moderate positioning and seating needs

A patient with a borderline personality disorder was admitted to an inpatient facility 4 days ago secondary to an exacerbation of suicidal and self-mutilating behavior. The patient's condition is now stable and the patient is functioning at Allen Cognitive Level 5 (Exploratory Actions). The patient reports being overwhelmed by a new personal relationship, experiencing job dissatisfaction, and feeling a lack of control in most daily situations. Which intervention would be MOST BENEFICIAL for addressing problems in performance skills and patterns secondary to the concurrent symptoms?

Coping skills groups that address a variety of adaptive strategies

An OTR administered a criterion-referenced standardized developmental checklist to a 3 year-old-child who has mild developmental delay. The child did not meet the standard for snipping with scissors. For what purpose would these results be MOST USEFUL?

Determining developmentally appropriate activities to use in therapy

An OTR is developing an intervention plan for a 4-year-old child with pervasive developmental delay. The child demonstrates impaired ideation and has limited play skills. A primary goal is for the child to successfully interact with age-appropriate toys. Which strategy would be MOST BENEFICIAL to include in the intervention plan to support progress toward this goal?

Develop a social story with pictures of a peer using appropriate skills to play with the toy

A hospital-wide interprofessional continuous quality improvement (CQI) committee has identified reduction in pressure sores related to hospitalizations as an opportunity for improvement. After discussing the initiative with the rehabilitation manager, what should the OTR do NEXT to contribute to this process?

Develop a survey for the rehabilitation staff to determine the frequency of assessment and provision of interventions related to wound management and care

An OTR is completing home set-up for a client who has a C5 spinal cord injury and is transitioning from an inpatient setting to home. Which type of bed would be MOST BENEFICIAL for this client to use at home?

Electric hospital bed with adjustable side rails-A client with a C5 spinal cord injury has active elbow flexion and is able to use the side rails to assist with rolling and bed mobility

An OTR is working with a client who has a visual field deficit. Which option represents the BEST type of activity for teaching compensatory scanning techniques?

Everyday household activities such as paying bills and reading email

An OTR is establishing a pediatric private practice to provide comprehensive in-home services. According to Part C of the Individuals with Disabilities Education Improvement Act of 2004, what MUST the OTR include as part of each child's intervention?

Evidence of family-centered treatment sessions in the child's natural environment -needs to include location

A client had an open reduction external fixation of a distal radius fracture several days ago. Evaluation results indicate moderate swelling of the hand, decreased active ROM of the digits, and protective posturing of the involved arm close to the chest at all times. Which intervention would be MOST BENEFICIAL to include in sessions during this initial phase of the client's recovery?

Exercises to promote capsular gliding and ROM of the shoulder of the affected arm

An OTR is fabricating an orthotic for a client who has a claw-hand deformity secondary to an ulnar nerve injury several months ago. Which type of orthotic is indicated for this client?

Hand-based orthotic that positions the fourth and fifth digits in 30° - 40° of MCP joint flexion while allowing IP joint motion

A client who has schizophrenia lives independently in a studio apartment and uses a common laundry room that tends to be a lively social setting. The client frequently has verbal altercations with other residents in this space and recently received a warning letter from the building manager stating that the client's privileges to use the laundry facilities will be revoked if these behaviors continue. Which interventions would provide the BEST opportunity for supporting the client to maintain laundry privileges?

Have the client wear ear plugs when in the laundry room and schedule laundry tasks when the room is least busy-High stimulation and noisy environments may make clients with schizophrenia feel threatened and overwhelmed

An OTR is planning an intervention session for a 6-year-old child who has fetal alcohol syndrome. The child has difficulty coping when frustrated and frequently refuses to speak in social situations and during therapy. The OTR has attempted to engage the child using play therapy and sensory-based approaches, but the child refuses to participate. How should the OTR modify the intervention approach based on the child's responses during previous interventions?

Include expressive media using cartoon character puppetry-expressive media supports the child's engagement through the therapy process

An OTR is evaluating a client who was recently diagnosed with osteoarthritis of the CMC joint of the dominant hand. The client works as a chef and reports thumb pain and progressive difficulty in using cooking utensils to complete food preparation. The client wants to continue working as a chef. Which intervention should the OTR provide to support INITIAL progress towards this goal?

Instruction and practice using joint protection strategies

Which activity represents an effective sensory-based approach for improving tolerance to touch for a 5-year-old child who has mild tactile defensiveness?

Log-rolling to snuggly wrap the body in a blanket

how to increase soft tissue length for a contracture

Low load prolonged stretch is an effective technique for increasing the length of contracted soft tissue

A client who works as a hair stylist has cubital tunnel syndrome. The OTR is providing the client with instructions about work modification techniques the client should use to minimize exacerbation of symptoms. What should the OTR include as part of these instructions?

Maintain the affected elbow in 90° of flexion or greater when shampooing, cutting, and blow-drying hair.

Which option represents the final phase of the occupational therapy process?

Measuring outcome through assessment of participation, quality of life, performance, and/or satisfaction -The final step in the occupational therapy process is to administer a performance-based outcome measure

An OTR plans to use a sensorimotor approach to improve the handwriting skills of a 6-year-old student who has a mild learning disability. The student maintains a very tight grip on a pencil when writing, consistently uses a palmar grasp when holding the pencil, and has directional confusion when forming letters. Which activity would be effective to include as part of the INITIAL intervention when using this approach?

Painting letters using a wide-barrel brush on paper attached to an upright easel-upright orientation decreased directional confusion, provides proprioceptive feedback, and a more mature grasp pattern

An OTR who works in an intensive care unit is selecting a communication system for an inpatient who recently had a C2 spinal cord injury and uses a ventilator to assist with breathing. The patient has intact cognitive function but is unable to communicate verbally. Which option would be MOST BENEFICIAL to support the patient's functional communication needs?

Partner-assisted scanning with a picture communication symbol board-low tech is best since it is early in the recovery stage

An OTR is collaborating with a client and a building contractor to have wall-mounted grab bars installed in the client's bathroom. The client lives independently in a mobile home and is at-risk for falls due to cerebellar ataxia. The OTR determines the optimal placement of the grab bars to meet the needs of the client, however the contractor informs the OTR there are no available studs behind the wallboard in the recommended locations. Which alternative option would be MOST BENEFICIAL for the OTR to discuss with the contractor and the client?

Place blocks between the wall studs under the wallboard

A client in a home health setting had bilateral lung transplants one month ago and is participating in OT to improve activity tolerance for completing home management tasks. The client is currently able to perform laundry tasks but develops shortness of breath when standing for longer than 2 minutes. The client has a stacked washer and dryer located in the hallway between the kitchen and the main bedroom. Which energy conservation technique should the OTR teach this client to use to MOST EFFECTIVELY improve the client's activity tolerance during this home management task?

Place clothing on a wheeled cart to bring the clothes from the bedroom to the laundry area

An OTR working in an adult day care center is preparing activities to use during a gardening group for clients who have moderately severe cognitive decline secondary to dementia. The goal of the group is to increase levels of arousal and engagement. Which activity would provide the BEST opportunity for achieving this goal?

Planting flowers in an indoor raised garden bed-task needs to be structured, has immediate gratification and is not complex in demands.

An OTR working in an outpatient setting is planning intervention for a client who has a trigger finger of the third digit on the dominant hand and wants to avoid surgical intervention. The client reports symptoms associated with this condition are limiting the ability to participate in everyday activities. What should the OTR include as part of the INITIAL intervention with this client?

Prescribe a static immobilization orthosis to position the affected MCP joint at 0° and instructions to avoid MCP flexion

Which of the following is the BEST example of a primary objective for a health promotion program for people with chronic conditions?

Prevention of secondary conditions to enhance overall quality of life -wellness program: enhance quality of life by addressing lifestyle factors that prevent secondary conditions

An OTR has been providing home health services for 2 weeks to a patient who has had cardiac bypass surgery. The OTR determines that the patient could benefit from an outpatient cardiac rehabilitation program. The OTR informs the supervisor of these conclusions, but the supervisor recommends that the patient continue with home health services to maintain Medicare reimbursement. What action should the OTR take in this situation?

Provide justification for the referral in a discharge summary

A client with schizophrenia is being discharged from a long term care facility to a group home. The client is independent with self-care and enjoys cooking but requires assistance during meal preparation tasks due to a disregard for safety. The group home staff is willing to assist the client during meal preparation activities. What recommendations should the OTR provide the staff to maximize the client's participation in meal preparation?

Provide step-by-step verbal cues throughout a cooking task

A patient in an acute care setting is undergoing treatment for an exacerbation of cardiomyopathy. The patient reports avoiding most preferred activities because they typically cause shortness of breath and extreme exhaustion. Which self-monitoring assessment should the OTR teach the patient to use for supporting the patient's engagement in these preferred activities?

Rating scale of perceived exertion

An OTR who works in an outpatient setting receives a referral to evaluate a new client. The client and the OTR have several mutual friends, see each other regularly at social functions, and maintain contact through a social media platform. Which statement represents the BEST ethical action for the OTR to take?

Report the relationship to the supervisor and request the referral be passed to another OTR

A 12-month-old infant has moderate hypotonia resulting in developmental delay and poor oral motor control. Which position is recommended for this infant for promoting oral motor function during feeding?

Slightly reclined with trunk fully supported and the neck and head at midline

R - values of correlation

Strong: > 0.6 Moderate: 0.3 - 0.6 Weak: < 0.3 No correlation: 0 *needs to be .7 or above to be considered adequate*

An inpatient has been participating in rehabilitation since having bilateral transfemoral amputations 2 months ago. The patient has good balance and Fair plus (3+/5) upper extremity strength, is independent with bed mobility and self-care using adaptive equipment, and requires stand-by assistance during wheelchair transfers and with wheelchair management. The patient is preparing for discharge to live at home with the spouse and an adult son. Modifications have been made to the main entrance of the home and the bathroom. The OTR plans to provide family education for promoting the patient's safe transition to the home environment. What information would be MOST BENEFICIAL to include as part of this process?

Techniques the patient uses to transfer to a variety of surfaces -must be competent in all areas of care before working to improve anything

An OTR who works in an inpatient rehabilitation setting is using the FIM™ as a clinical measurement tool to evaluate and monitor the progress of a patient who had a stroke. What additional information can the OTR obtain from interpreting the results of the FIM™ with this patient?

The future discharge status of the patient related to level of assistance required for the patient to perform self-care tasks -The FIM™ is a measurement tool that has been shown to predict the discharge disposition for patients who have had a stroke

A patient who has hemiplegia and cognitive-perceptual deficits has been transferred from an acute care facility to a skilled nursing rehabilitation unit. When should discharge planning for this patient take place?

Throughout the rehabilitation phase of treatment

An OTR is fabricating a hand orthosis for a 10-year-old child who has progressive upper extremity symptoms secondary to Charcot-Marie-Tooth disease. What is the PRIMARY purpose for fabricating this orthosis?

To improve function for active grasp and release

An OTR is working with a client in a home health setting who has a wound on the lateral aspect of the proximal forearm. The wound is 1.57 in (4 cm) in diameter and is being treated by the wound care nurse with a hydrogel sheet dressing. The wound margins are pink and flat, and the wound is draining a low volume of serosanguinous exudate. What is the PRIMARY reason for using a hydrogel sheet dressing type for this client?

To keep bacteria out of the wound while promoting autolytic debridement-PRIMARY reason for using a hydrogel dressing is to establish a clean, moist wound healing environment to promote autolytic debridement

An OTR, who works in the hospital setting, is starting an ADL session at the bedside of an inpatient who has mitochondrial encephalopathy and flaccid hemiplegia. The patient is lying supine in bed and is wearing a prefabricated foot drop orthosis on the affected lower extremity. What is the PRIMARY purpose for having the patient wear a foot drop orthosis?

To offer pressure relief while supporting the foot in a neutral position

What is the PRIMARY reason for selecting a gel wheelchair cushion to relieve pressure on the sacrum of a client with a C7 spinal cord injury?

To provide a stable base of support

An OTR, who works in the home health setting, is teaching medication management strategies to an older adult client who has diabetes and low vision. One of the intervention goals for the client is to increase compliance in adhering to the prescribed medication regimen. In addition to teaching the client to combine the medication schedule with familiar ADL routines, what would be the MOST EFFECTIVE approach in improving medication adherence in this client?

Trial several types of adaptive aides for medication management

An OTR who works in an inpatient rehabilitation unit is completing an evaluation of a patient who had bilateral total knee arthroplasties 3 days ago. The patient is in generally good health, plans to live independently at home, and wants to resume volunteer work in the community. The patient currently requires OT services to increase independence in bathing, dressing, and toileting. What MUST the OTR consider when scheduling the patient for OT?

Understand documentation requirements for reimbursement by the third party payer -when writing intervention plans (scheduling) think of the doc. reimbursement requirements

An OTR is leading a community-based class for self-referred clients who have rheumatoid arthritis. Through class discussion and observation, the OTR determines that one of the clients in the class would benefit from bilateral hand orthotics. After discussing this observation with the client and determining the client intends to pay for services using insurance benefits, what action should the OTR take NEXT to address the client's needs?

Understand the state regulatory requirements for direct access to OT services.

A resident of a skilled nursing facility has Wernicke's aphasia secondary to a left CVA and is frustrated during intervention sessions. Which communication techniques should the OTR use to limit the resident's frustration?

Using hand gestures and tactile cues

A young adult client was diagnosed with axonotmesis of the ulnar nerve secondary to a crush injury of the forearm 2 weeks ago. After obtaining baseline assessment information, which technique would be MOST IMPORTANT for the OTR to teach to the client as part of the intervention during the initial phase of the client's rehabilitation?

Visual compensation -axonotmesis results in loss of protective sensation

final step of evidence review process

ensuring each step was performed effectively

An adult client with a moderate intellectual disability is beginning a supported employment program. The client typically has a hot lunch each day and wants to continue having hot lunches at work by bringing food from home that can be heated in the workplace microwave. An assessment indicates that the client requires some assistance to complete simple microwave meal preparation. Which strategy should the OTR implement next to MOST EFFECTIVELY achieve the client's goal?

forward chaining

An OTR is reviewing a research article investigating the role of peer support among members living in a retirement community. Data collection methods included observation, note-taking and semi-structured interviews conducted with members over a 6 month period. Constant comparison and open coding were undertaken to categorize core concepts. A conceptual model identifying 5 tiers of peer support was constructed based on members' experience. Which type of qualitative research design does this investigation represent?

grounded theory -continuous comparison between collected data and interpretation, which results in a set of categories and emerging theory

An OTR who works in a long-term acute care setting is following contact precautions when providing intervention to an inpatient who has MRSA. In addition to putting on gloves and gown, what other action MUST the OTR take?

hand hygiene

An OTR has completed the initial evaluation of an outpatient who has Medicare as the primary insurance. What MUST be included in the occupational therapy documentation to meet Medicare requirements for reimbursement?

plan of care certified by the physician, justification for the skills of an occupational therapy practitioner, and services specific to the needs of the patient.

appropriate food for a client with hemiplegia leading to poor oral control and strength

pureed food and thick liquids