NBCOT Neurologic Impairments Exam Prep

Which occupational therapy assessment tool for motor and sensory function would BEST be used with the population with spinal cord injury in determining baseline performance? A. American Spinal Injury Association (ASIA) Scale B. Canadian Occupational Performance Measure (COPM) C. Modified Ashworth Scale (MAS) D. Manual muscle testing

A. American Spinal Injury Association (ASIA) Scale

A COTA® is preparing to perform bedside ADLs with a client with spinal cord injury. As the COTA®assists the client into a sitting position, the client reports dizziness and nausea. What action is the MOST APPROPRIATE for the COTA® to take? A. Assist the client in returning to a reclining position and elevate the client's feet. The COTA® should alert the client's nurse, physician, and supervising OTR® as soon as possible. B. Place the client upright, remove restrictive devices, and check the client's catheter. The COTA® should alert the client's nurse, physician, supervising OTR® as soon as possible. C. Ensure the client is seated and quickly leave to alert the nurse or physician. D. Encourage the client to remain seated, with assistance, and wait for symptoms to pass. The COTA® should alert the client's nurse, physician, and supervising OTR®as soon as possible.

A. Assist the client in returning to a reclining position and elevate the client's feet. The COTA® should alert the client's nurse, physician, and supervising OTR® as soon as possible.

Performing a functional transfer with a client with CVA, the COTA® 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? A. Assisted stand pivot B. Bent pivot transfer C. Maximum assist transfer D. Dependent lift transfer

A. Assisted stand pivot

A client who had a CVA is now being discharged from a hospital setting to home. The client continues to show signs of right-sided weakness and decreased balance. The COTA® provides information regarding the client's progress and current status in preparation for discharge. What referral for occupational therapy services is MOST appropriate for the COTA® to make? A. At home with a home health occupational therapist B. In an outpatient center C. In the acute-care hospital D. In a subacute rehabilitation hospital

A. At home with a home health occupational therapist

A client who had a CVA 4 weeks ago is participating in a self-care session in an inpatient facility. The COTA® observes that the patient's shoes are very tight because of a significant increase in lower-extremity edema. The patient reports discomfort in both legs. What actions should the COTA take initially on the basis of this information? Select the 3 BEST choices. A. Contact the charge nurse to report the edema and discomfort B. Elevate the patient's legs for the duration of the session C. Have the patient rotate the ankles to pump the fluid from the legs D. Provide the patient with antiembolism hosiery to wear E. Stop the session immediately because of safety concerns F. Explain to the patient that the session must not continue

A. Contact the charge nurse to report the edema and discomfort E. Stop the session immediately because of safety concerns F. Explain to the patient that the session must not continue

An inpatient who had a CVA 4 weeks ago is participating in a self-care session. The COTA® observes that the patient's shoes are very tight due to a significant increase in lower extremity edema. The patient reports discomfort in both legs. What INITIAL action should the COTA® take based on this information? A. Contact the charge nurse to report the findings B. Elevate the patient's legs for the duration of the session C. Have the patient rotate the ankles to pump the fluid from the legs D. Provide the patient with anti-embolism hosiery to wear

A. Contact the charge nurse to report the findings

An inpatient who has hemiplegia and unilateral neglect is progressing toward documented ADL goals but continues to have poor balance and requires verbal cuing during self-care. The case manager informs the COTA® that the insurance company has not authorized continued therapy and the patient will be discharged in 2 days to live at home with family. In addition to informing the OTR® about the patient's discharge, which task should the COTA® complete NEXT? A. Determine family and caregiver training needs B. Provide the patient with a written home program C. Modify the patient goals to reflect the discharge date D. Schedule the patient for outpatient occupational therapy services

A. Determine family and caregiver training needs

A COTA® is teaching a client with stroke compensatory strategies to don a pullover shirt. The client has hemiparesis that limits upper-extremity movement in the affected side. What is the FIRST step the client should be taught? A. Dress the affected arm by placing the sleeve over the affected arm B. Put the head through the neck opening by bending the neck forward C. Place the unaffected arm into the sleeve by placing the sleeve over the unaffected arm D. Rub the affected arm on the leg to straighten the sleeve

A. Dress the affected arm by placing the sleeve over the affected arm

A COTA® is performing upper-extremity activities with a client experiencing left hemiparesis. The COTA® notes a decrease in ROM in the left upper extremity. What factors BEST describe this decrease in ROM? A. Edema, joint contracture, and weakness B. Edema, muscle tone, and sensation C. Sensation, muscle tone, and proprioception D. Sensation, ataxia, and proprioception

A. Edema, joint contracture, and weakness

A COTA® and OTR® are discussing wheelchair options with a client with incomplete T3 spinal cord injury. The client asks whether the purchase of an electric wheelchair should be considered. How would the OTR® and COTA® BEST respond? A. Electric wheelchairs are useful for long distances, although a manual wheelchair can promote improved function. B. Electric wheelchairs are very expensive and may not be covered by primary payer sources. C. Electric wheelchairs are large and bulky and will prevent accessibility in the home and community. D. Electric wheelchairs may stunt future progress in rehab.

A. Electric wheelchairs are useful for long distances, although a manual wheelchair can promote improved function.

A client with stroke is taught to dress the weaker side first when donning a button-down shirt. The client then initiates putting the weaker lower extremity into the pant leg. What learning has occurred for the client? A. Generalization B. Transfer C. Automaticity D. Acquisition

A. Generalization

A client with traumatic brain injury is at Rancho Level IV (i.e., confusion with agitation). The client is demonstrating the ability to use mental repetition with cues from the COTA® during basic self-care routines. The COTA wants the client to be less reliant on the verbal cues and able to self-monitor performance during the tasks. What strategy is appropriate for the COTA to use? A. Have the client estimate and report the difficulty of a task before completing it B. Provide the client with a verbal description of the client's task performance C. Organize increasingly complex self-care routines by providing highly structured practice D. Give consistent, reliable tactile cues throughout self-care completion

A. Have the client estimate and report the difficulty of a task before completing it

A COTA® is working with a client with traumatic brain injury to promote orientation to place and time. The client is at Rancho Level IV (i.e., with confusion and agitation). What intervention is appropriate to improve the client's orientation to place and time? A. Have the client use a logbook that provides a calendar with the current therapy session schedule B. Engage the client in a daily self-care routine of showering, dressing, and grooming C. Allow the client to guide intervention sessions by providing minimal structure to the sessions D. Organize an orientation group in which the client can share perceptions of orientation

A. Have the client use a logbook that provides a calendar with the current therapy session schedule

A COTA® is preparing a client with T1 spinal cord injury for discharge to home alone. What is the BEST recommendation for required home assistance? A. Homemaking assistance for a few hours a daily B. Attendant care 24 hours a day C. Attendant care 12 hours a day D. Homemaking assistance for several hours daily

A. Homemaking assistance for a few hours a daily

A COTA® is working with a client who has cognitive deficits after a stroke. The OTR® wants the client to be able to complete transfers when the client discharges to home. What strategies should the COTA use to enhance the client's ability to transfer at home? Select the 3 BEST choices. A. Instruct the client to use a global strategy such as "goal, plan, do, check" to orient to daily occupations B. Address transfers in the client's hospital room, the clinic treatment area, and the hospital recreation room C. Provide the client with visual feedback on trunk posture by having the client sit in front of a mirror during toileting D. Practice bridging in the client's hospital room bed to increase trunk extension E. Train the client in the use of external memory strategies for transfers such as step-by-step photos or a checklist F. Complete multiple transfers in the client's hospital room throughout the day

A. Instruct the client to use a global strategy such as "goal, plan, do, check" to orient to daily occupations B. Address transfers in the client's hospital room, the clinic treatment area, and the hospital recreation room E. Train the client in the use of external memory strategies for transfers such as step-by-step photos or a checklist

A client who has mild hemiplegia and constructional disorder is participating in home-based occupational therapy. The COTA® is observing the client's ability to use the dishwasher after a meal preparation activity. Which aspect of using a dishwasher would be MOST CHALLENGING for this client? A. Loading the dishes into the dishwasher B. Pressing the button to turn on the dishwasher C. Pouring dishwashing soap into the dispenser D. Pulling out the empty upper and lower dish baskets

A. Loading the dishes into the dishwasher

A COTA® is working with a client who has an L2 spinal cord injury. What clinical signs relative to the injury level is the COTA likely to find 1-2 months postinjury? Select the 3 BEST choices. A. Lower-extremity muscles are spastic. B. Muscles are spastic relative to the level of injury. C. Sympathetic functions are hypoactive. D. Muscles are flaccid throughout innervation. E. Senses are elevated throughout the body. F. Sacral segments are spastic below the level of injury.

A. Lower-extremity muscles are spastic. B. Muscles are spastic relative to the level of injury. F. Sacral segments are spastic below the level of injury.

A COTA® is performing wheelchair training with a client with T1 spinal cord injury (SCI). What is the BEST method to instruct the client in pressure relief techniques? A. Perform weight shift by pushing up on armrests with upper extremities. B. Perform weight shift by leaning toward the feet. C. Perform weight shift by enlisting aide or caregiver assistance. D. Perform weight shift by grabbing a door handle and standing.

A. Perform weight shift by pushing up on armrests with upper extremities.

A COTA® is working with a client in the active phase of C6 spinal cord injury. What piece of durable medical equipment would be BEST suited for assisting in the client's community mobility? A. Power recliner with standard arm drive B. Lightweight folding wheelchair C. Power recliner with head control D. Manual rigid wheelchair

A. Power recliner with standard arm drive

A client with traumatic brain injury is able to live in a supportive home environment and complete light housekeeping and laundry. What area is most appropriate for the COTA® to address next with the client? A. Practice shopping skills B. Establish a self-care routine C. Reestablish skills for washing a car D. Provide a noise-free environment

A. Practice shopping skills

For a client with C5 spinal cord injury (SCI) in the acute phase of rehabilitation, what is the BEST position to place the client's forearms in? A. Pronation B. Supination C. Flexion D. Extension

A. Pronation

A COTA® is approaching a client with stroke to begin an intervention session in inpatient rehabilitation. The client is sitting at the dining table in a wheelchair with hips extended and is leaning on the unaffected left upper extremity. What should the COTA's FIRST approach be? A. Reposition the client in the wheelchair with hips flexed at 90° and the upper extremity resting in the lap B. Transfer the client to another wheelchair that provides a lap tray for upper-extremity support C. Transfer the client to a standard chair with arms for positioning in posterior pelvic tilt D. Recommend further assessment by the OTR®; to determine the client's postural needs

A. Reposition the client in the wheelchair with hips flexed at 90° and the upper extremity resting in the lap

A client with traumatic brain injury has a field loss resulting in decreased scanning ability. The client has a goal to improve environmental scanning for tasks such as locating foods in the refrigerator and finding items in the grocery store. What intervention activity would be MOST appropriate for the client? A. Scan the kitchen cupboards for meal preparation items B. Cross out horizontal lines on a piece of paper C. Read a paragraph of standard-size newsprint D. Use the Dynavision scan board in the clinic

A. Scan the kitchen cupboards for meal preparation items

An inpatient is functioning at Level V (confused, inappropriate) on the Rancho Los Amigos Scale after having a TBI 3 weeks ago. What should be the focus of intervention during this phase of rehabilitation? A. Simple, familiar activities B. Multisensory stimulation C. Compensatory strategies for self-care D. Dressing using assistive devices

A. Simple, familiar activities

A client who has a T2 spinal cord injury is learning to independently transfer to a variety of surfaces. Which type of transfer is BEST for this client to use when transferring from a wheelchair to a car? A. Sliding board B. Stand-step C. Stand-pivot D. Bent-pivot

A. Sliding board

A client who has a C5 spinal cord injury wants an electronic aid to daily living for operating devices in the home. Which feature is MOST IMPORTANT for the device to have? A. Speech recognition B. Contoured trackball C. Joystick control D. Touch screen

A. Speech recognition

A client with a C5 spinal cord injury wants to read a book. Which assistive technology devices will help the client perform this activity? Select the 3 BEST choices. A. Speech recognition software B. Long opponens splint C. Joystick control D. Touch screen E. Contoured trackball F. Adaptive devices for page turning

A. Speech recognition software B. Long opponens splint F. Adaptive devices for page turning

A patient in an inpatient facility sustained a TBI 2 weeks ago and is currently functioning at Level IV (confused-agitated) on the Rancho Los Amigos scale. Which methods should the COTA® consider for getting the patient's attention at the start of a session at bedside? Select the 3 BEST choices. A. State the patient's name in a calm voice and establish direct eye contact B. Firmly rub the patient's sternum until the patient responds C. Pass a strong-smelling substance back and forth under the patient's nose D. Hold the patient by the chin so the patient cannot look away E. Listen for possible confabulation by the patient in responses to questions F. Be aware that the patient may not be able to differentiate between persons and objects

A. State the patient's name in a calm voice and establish direct eye contact E. Listen for possible confabulation by the patient in responses to questions F. Be aware that the patient may not be able to differentiate between persons and objects

A COTA® is considering how to prevent skin breakdown in a client with an incomplete spinal cord injury. Which methods are appropriate for preventing pressure sores? Select the 3 BEST choices. A. Teaching the client to inspect the skin on a daily basis B. Relieving and eliminating all pressure points C. Regularly turning or moving the body to different positions D. Removing after-market cushioning from the wheelchair E. Applying moist heating pads to areas of discomfort F. Encouraging the client to remain still in bed

A. Teaching the client to inspect the skin on a daily basis B. Relieving and eliminating all pressure points C. Regularly turning or moving the body to different positions

A COTA® was informed by the supervising OTR® that an evaluation was just completed on a client who has recently experienced traumatic brain injury. The client's chart lists a Glasgow Coma Scale (GCS) score of 7. What does this score imply? A. The client has experienced a severe head injury and will provide minimal feedback. B. The client has experienced a moderate head injury and may not be able to provide discernible feedback. C. The client has experienced a mild head injury and may be confused but able to follow simple commands. D. The client has experienced an extreme head injury and will provide minimal feedback.

A. The client has experienced a severe head injury and will provide minimal feedback.

A COTA® is working with an adult male client with an incomplete spinal cord injury. The client has expressed some concern regarding his ability to sexually perform with his partner. Which statement regarding the client's sexual function is MOST accurate? A. The client's sexual drive and need for emotional intimacy has not been altered. B. The client's ability to have an erection and to ejaculate has not been altered. C. The client's sexual function is not affected by his altered body image. D. The client's sexual function is not appropriate for the COTA® to discuss.

A. The client's sexual drive and need for emotional intimacy has not been altered.

An OTR® recently completed an evaluation with a client with T4 spinal cord injury (SCI). The COTA®will begin treating this client the next day. In development of a client-centered intervention plan, what INITIAL activity may the client need assistance with? A. Transfer training B. Eating training C. Cognitive training D. Dexterity training

A. Transfer training

A COTA® is treating a client who is in a vegetative state after a traumatic brain injury (TBI). The OTR®; has identified the need to use restorative strategies with the client. Which restorative strategy is MOST appropriate for this client? A. Upright positioning strategies in a wheelchair to normalize muscle tone and facilitate arousal B. Sensory stimluation program to facilitate simple command following C. Self-feeding program that simplifies the task and provides success for the client D. Behavioral reinforcement program to reinforce the client's on-task performance

A. Upright positioning strategies in a wheelchair to normalize muscle tone and facilitate arousal

A COTA® is working with a patient who has spastic hemiplegia and decreased trunk control secondary to a CVA. The patient is beginning to ambulate using a quad cane with standby assistance. The COTA®observes that the patient has decreased trunk stability during dressing activities. Which activity would promote increased trunk control during a dressing task while seated? A. Using the unaffected arm to reach for clothing positioned next to the affected side B. Putting the affected arm in a shirt sleeve while looking into a mirror C. Reaching with the unaffected arm to pick up a shoe from the floor D. Weight-bearing on the affected arm while buttoning a front-opening shirt with the unaffected hand

A. Using the unaffected arm to reach for clothing positioned next to the affected side

A COTA® is working with a client with C5 spinal cord injury. The OTR® asked the COTA® to make a splint for the client. What is the BEST position in which to splint the wrist to prevent deformity in the acute stage of injury? A. Wrist extension, thumb opposition B. Wrist neutral, thumb opposition C. Wrist extension, thumb adduction D. Wrist extension, thumb free

A. Wrist extension, thumb opposition

What piece of adaptive equipment is MOST useful for a client with an incomplete T2 spinal cord injury? A. A weighted spoon B. A long-handled sponge C. A plate protector D. A button hook

B. A long-handled sponge

A client has C6 complete tetraplegia. Which hand functions can this client be expected to demonstrate? A. Limited grasp to pick up an item between the proximal and distal interphalanges B. Ability to pick up an object by stabilizing it between the palms of both hands C. Inability to use the hands for any functional tasks or object manipulation D. Ability to manipulate the power control of a wheelchair using the tips of the fingers

B. Ability to pick up an object by stabilizing it between the palms of both hands

A COTA® is working with a client who has cognitive deficits after a stroke. The OTR®; wants the client to be able to complete transfers when the client discharges to home. What strategy should the COTA use to enhance the client's ability to transfer at home? A. Complete multiple transfers in the client's hospital room throughout the day B. Address transfers in the client's hospital room, the clinic treatment area, and the hospital recreation room C. Provide the client with visual feedback on trunk posture by having the client sit in front of a mirror during toileting D. Practice bridging in the client's hospital room bed to increase trunk extension

B. Address transfers in the client's hospital room, the clinic treatment area, and the hospital recreation room

A COTA® is treating a client who has had a CVA. During the session, the COTA® notices the client is having trouble communicating through speech. Which of the following disorders BEST describes what the COTA® is observing? A. Apraxia B. Aphasia C. Paresis D. Hemiplegia

B. Aphasia

The movements of a client diagnosed with a TBI are exaggerated and oscillating. What term BEST describes the client's movements? A. Spasticity B. Ataxia C. Bradykinesia D. Tremor

B. Ataxia

The upper-extremity movements of a client diagnosed with a traumatic brain injury (TBI) are exaggerated, and the client consistently over- or underreaches for an item. What term BEST describes the client's movements? A. Spasticity B. Ataxia C. Bradykinesia D. Tremor

B. Ataxia

A client with T1 spinal cord injury exhibits headache, sweating, congestion, hypertension, and bradycardia. What is the client MOST likely experiencing? A. Spasticity B. Autonomic dysreflexia C. Orthostatic hypotension D. Hypertonia

B. Autonomic dysreflexia

A COTA® is working with a client in the active phase of a T2 spinal cord injury. The client reports a terrible headache and is sweating profusely. What is the BEST method to address the client's symptoms? A. Check blood pressure and alert nurse. B. Bring upright and remove restrictive clothing. C. Recline quickly and elevate legs. D. Bring upright and apply abdominal binder.

B. Bring upright and remove restrictive clothing.

An OTR® receives evaluation orders for a client who has recently experienced a traumatic brain injury. The COTA® will be treating the client after the evaluation is completed. The client is swearing and anxiously looking for something. What Rancho Los Amigos level BEST corresponds with the client's behavior? A. VI B. IV C. V D. II

B. IV

A patient who has a complete C7 spinal cord injury is learning adaptive dressing techniques. What dressing goals should the patient be expected to achieve? A. Independence with upper and lower body dressing with contact guard assistance B. Independence with upper body dressing and minimal assistance with lower body dressing C. Minimal assistance with upper and lower body dressing using assistive devices D. Standby assistance for lower body dressing with adaptive equipment

B. Independence with upper body dressing and minimal assistance with lower body dressing

Orthostatic hypotension is a common complication of spinal cord injury (SCI). What should the COTA®do for the client when it occurs? A. Sit the client up. B. Lean the client back. C. Call the nurse. D. Nothing; the client is not at risk

B. Lean the client back.

A COTA® 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? A. Low-load prolonged stretch B. Maintenance of joint ROM C. High-low limited stretch D. Application of leg wraps

B. Maintenance of joint ROM

A COTA® is working with a client with traumatic brain injury (TBI) who has exaggerated and oscillating movements. What client movements is the COTA likely to observe during a dressing activity at the edge of the bed? Select the 3 BEST choices. A. Spasticity in the bilateral ankles B. Mild instability in the trunk and neck regions C. Severe incoordination in the bilateral upper extremities D. Tremors in the dominant upper extremity only E. Bradykinesia in the bilateral lower extremities F. Inability to produce smooth movement in the bilateral lower extremities

B. Mild instability in the trunk and neck regions C. Severe incoordination in the bilateral upper extremities F. Inability to produce smooth movement in the bilateral lower extremities

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? A. Senses are elevated. B. Muscles are spastic. C. Sympathetic functions are hypoactive. D. Muscles are flaccid.

B. Muscles are spastic.

A client with a C6 spinal cord injury (SCI) is performing a dressing task. Which type of equipment would the COTA® most likely give the client to assist with buttoning a shirt? A. No adaptive equipment would be needed B. Palmar-cuff buttonhook C. Extended buttonhook D. Standard buttonhook

B. Palmar-cuff buttonhook

During a commode-to-bed transfer with the use of a gait belt, the client begins to slip from the COTA®'s grasp. Which actions are appropriate for the COTA to take? Select the 3 BEST choices. A. Continue with the transfer and try to get the client to the bed as quickly as possible B. Push forward against the pelvis and pull back on the anterior chest C. Ease the client to the floor, then get assistance D. Call for help and get the attention of the client's nurse E. Support the client with the use of the gait belt F. Have the client return to the commode

B. Push forward against the pelvis and pull back on the anterior chest C. Ease the client to the floor, then get assistance E. Support the client with the use of the gait belt

A client with stroke demonstrates deficits in visual-perceptual skills. One of the client's goals is to be more independent with dressing. What activity would be appropriate for the intervention session? A. Drawing a clock diagram on paper B. Putting on a button-front shirt C. Copying a pegboard design from a pattern D. Completing a bed-to-chair transfer

B. Putting on a button-front shirt

A COTA® is positioning in bed a client who has weakness on one side of the body resulting from a traumatic brain injury. Which position is most appropriate for the client? A. Supine with head supported on a pillow B. Side lying with affected extremity on top placed on a pillow C. Supine without a pillow to support head D. Side lying with affected extremity on top resting on abdomen

B. Side lying with affected extremity on top placed on a pillow

While reviewing the chart of a client with spinal cord injury, the COTA® notices that the client has experienced past episodes of autonomic dysreflexia in the hospital. What is the BEST recommendation the COTA® can make to the client concerning dysreflexia? A. Suggest that the OTR® treat the client because the COTA® is unfamiliar with the condition. B. Suggest the client carry an emergency card describing the condition for medical personnel and others. C. Suggest the client wear elastic stockings and abdominal binders to increase blood pressure. D. Suggest the client leave sessions early if experiencing symptoms.

B. Suggest the client carry an emergency card describing the condition for medical personnel and others.

A client with traumatic brain injury is demonstrating agitation. What strategy would minimize the client's frustration and confusion? A. Provide tactile stimulation by tapping the client's upper extremity B. Tell the client orientation information about his or her location and what will occur in session C. Ask the client to state why he or she is in the hospital D. Have the client complete a fine motor task as a distraction

B. Tell the client orientation information about his or her location and what will occur in session

During passive range of motion (PROM) exercises for a client with stroke, the client's shoulder is resistant to flexion beyond 90°, although the client reports being pain free. What does this finding suggest to the COTA®? A. Shoulder subluxation is inhibiting movement. B. The scapula is not gliding to produce full flexion. C. The humerus is locked in against the acromion. D. Spasticity is preventing the shoulder from reaching full range.

B. The scapula is not gliding to produce full flexion.

What would be considered the first line of treatment in the acute setting for the medical management of a cardiovascular accident (CVA)? A. Anticoagulants B. Thrombolytic agents C. Antiplatelet treatments D. Nonsteroidal anti-inflammatory drugs

B. Thrombolytic agents

A COTA® is working with a client with C5 spinal cord injury. What is the BEST splinting strategy to use to encourage sensory feedback? A. Use of padded splints B. Use of dorsal splints C. Use of hand-based splints D. Use of dynamic splints

B. Use of dorsal splints

The COTA® is treating a client who presents with hemiplegia from a cardiovascular accident. The client's hand is flaccid. To fabricate a custom resting hand orthosis, in what position should the COTA® place the wrist and metacarpophalangeals (MCPs)? A. Wrist at 10° flexion and MCPs at 0° flexion B. Wrist at 25° extension and MCPs at 55° flexion C. Wrist at 45° flexion and MCPs at 10° flexion D. Wrist at 60° flexion and MCPs at 0° flexion

B. Wrist at 25° extension and MCPs at 55° flexion

A COTA® in an acute care setting is working on a dressing program with a client with spinal cord injury. What statement by the COTA is appropriate to facilitate positive coping for the client? A. "I have selected these clothes for you today." B. "Would you like to wear the blue or the red shirt?" C. "What clothes do you want to wear today?" D. "You should wear these clothes today."

C. "What clothes do you want to wear today?"

An OTR® receives evaluation orders for a client who has recently experienced a traumatic brain injury. The OTR® asks the COTA® to score the client on the Glasgow Coma Scale, because service competency in this assessment has been established. The client only opens the eyes when the COTA® applies a mild pinch to the client's arm. What score should the COTA® give the client on the Glasgow Coma Scale Eye-Opening Response category? A. 7 B. 3 C. 2 D. 4

C. 2

A COTA® is assisting a client with an incomplete T2 spinal cord injury (SCI). The client is anxious and concerned about being able to live independently. Which response is the MOST accurate for the COTA®to give the client, based on the COTA®'s knowledge of the typical recovery pattern of a client with a T2 SCI? A. Suggest the client make arrangements for a long-term residential facility with support. B. Advise the client not to be concerned with the future and to concentrate on rehabilitation. C. Advise the client that recovery from SCI is often unpredictable, and people with SCI can live fulfilling, active lives. D. Suggest the client move to a supportive apartment when available to increase independence.

C. Advise the client that recovery from SCI is often unpredictable, and people with SCI can live fulfilling, active lives.

The extremities of a client with brain injury in an acute care unit are in a position of spastic extension, adduction, and internal rotation. The client is displaying symptoms of which condition? A. Decorticate rigidity B. Torticollis C. Decerebrate rigidity D. Athetosis

C. Decerebrate rigidity

A COTA® is working with a client in the active phase of C6 spinal cord injury. What is the MOST IMPORTANT treatment activity to consider? A. Providing accessibility recommendations B. Educating on preventative health measures C. Developing pressure relief methods D. Recommending durable medical equipment

C. Developing pressure relief methods

A COTA® is preparing a forearm splint for a client with a high complete spinal cord injury. What surface of the client's forearm should the base of the splint rest upon? A. Ulnar B. Medial C. Dorsal D. Volar

C. Dorsal

During a commode-to-bed transfer, the client begins to slip from the COTA®'s grasp. What action is best for the COTA® to take? A. Continue with the transfer, and try to get the client to the bed as quickly as possible. B. Have the client return to the commode. C. Ease the client to the floor, then get assistance. D. Call for help, and get the attention of the client's nurse.

C. Ease the client to the floor, then get assistance.

A COTA® was asked to treat a client in the acute phase of spinal cord injury. What is most likely the COTA®'s INITIAL role during this phase? A. Evaluation of the client's ADL ability B. Evaluation of the client's strength C. Evaluation of total body positioning D. Evaluation of possible discharge location

C. Evaluation of total body positioning

A COTA® is working with a client in the active phase of C5 spinal cord injury. The client voices concern about increased discomfort from sitting in his/her chair. What is the BEST recommendation regarding frequency of pressure relief technique? A. Three times B. Every hour C. Every 30 minutes D. Every 3 hours

C. Every 30 minutes

An OTR® evaluated a client who has sustained a traumatic brain injury and used the Glasgow Coma Scale (GCS) to record the client's conscious state using the combined score. The COTA® reviews the GCS score in the client's chart in preparation for the first intervention session. Which of the following three responses is recorded with the GCS? A. Verbal, threat, autonomic B. Appropriate, motor, autonomic C. Eye opening, motor, verbal D. Eye opening, verbal, autonomic

C. Eye opening, motor, verbal

An OTR® receives orders to evaluate and treat a client with an S1 spinal cord injury. The COTA® will be assisting with the evaluation by performing a standardized assessment. Which instrument is MOST appropriate for assessing the client's current level of independence? A. Canadian Occupational Performance Measure (COPM) B. Nine-Hole Peg Test C. FIM™ D. Adult Sensory Profile

C. FIM™

The upper-extremity movements of a client with traumatic brain injury (TBI) are exaggerated, and the client consistently overreaches or underreaches for an item, such as during a feeding activity. How can the COTA address the impact of this condition? Select the 3 BEST choices. A. Allow the ataxic limb to move freely B. Provide a weighted-vest for mealtime C. Grasping a solid surface for stability D. Provide wrist weights for stabilization E. Apply resistance to reduce exaggerated movements F. Weight utensils to reduce the effects of movements

C. Grasping a solid surface for stability E. Apply resistance to reduce exaggerated movements F. Weight utensils to reduce the effects of movements

A COTA® is providing dressing skills training for a client with traumatic brain injury (TBI). The client has a sequencing deficit. What strategy is appropriate for the COTA to use with this client? A. Use picture cards of dressing and have the client put the steps of dressing in order B. Have the client write out the steps in dressing using paper and pencil C. Hand the client each item of clothing and provide assistance in donning the item D. Ask the client which clothing item should be selected next

C. Hand the client each item of clothing and provide assistance in donning the item

A patient has hemiplegia secondary to having a recent CVA. The patient is nearing discharge from an inpatient rehabilitation facility to live at home with a spouse. What is MOST IMPORTANT to educate the patient and spouse about prior to discharge from the facility? A. Exercises for maintaining joint mobility and strength B. Assistive technology to increase independence during ADLs C. Home modifications needed to maximize mobility and safety D. Techniques to transfer from a wheelchair to a variety of surfaces

C. Home modifications needed to maximize mobility and safety

A client who had a CVA is setting the table during a cooking group. The COTA® observes that the client consistently positions the eating utensils for each place setting to the right of the plate. What INITIAL action should the COTA® do based on this observation? A. Determine whether this functional deficit is evident during other tasks B. Ask the OTR® to evaluate the client for figure ground deficits C. Identify the typical routines the client uses for this task at home D. Teach the client proper techniques for preparing the dining environment

C. Identify the typical routines the client uses for this task at home

A client who sustained a traumatic brain injury is asked to perform a bedside dressing ADL. The client's clothes are laid out on the bed, but the client requires prompting to begin the activity. Which performance component may explain the client's behavior? A. Memory B. Attention C. Initiation D. Impulsivity

C. Initiation

A COTA® is planning a feeding session with a client with a C5 spinal cord injury (SCI). Which feeding utensil or adaptive equipment would be MOST APPROPRIATE to introduce during the session? A. An electric self-feeder B. Utensils with built-up grips C. Mobile arm support D. Tenodesis orthosis

C. Mobile arm support

A COTA® is working with a client with a T2 spinal cord injury. While performing ADLs, the client reports a pounding headache and is sweating profusely. What action is MOST APPROPRIATE for the COTA® to take to help the client? A. Ensure the client is seated and quickly leave to alert the nurse or physician and the OTR®. B. Recline the client and elevate the legs until the symptoms diminish, alerting the client's nurse, physician, and supervising OTR® as soon as possible. C. Place the client upright, remove restrictive devices, and check the client's catheter, alerting the client's nurse, physician, and the supervising OTR® as soon as possible. D. End the session early to allow the client some rest, and alert nursing staff.

C. Place the client upright, remove restrictive devices, and check the client's catheter, alerting the client's nurse, physician, and the supervising OTR® as soon as possible.

A client with stroke is receiving occupational therapy services to increase independence with feeding, grooming, hygiene, and toileting. What area of function is likely to MOST influence the client's performance in these ADLs? A. Decreased upper-extremity range of motion (ROM) B. Limitation in swallowing ability C. Postural instability for sitting and standing D. Deficits in visual-perceptual skills

C. Postural instability for sitting and standing

What should a COTA® do for the affected upper extremity when positioning a client with hemiparesis in side lying on the affected side? A. Place in adduction B. Place on the humeral head C. Protract forward D. Support in internal rotation

C. Protract forward

The COTA® 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? A. Visual acuity B. Literacy C. Spatial neglect D. Ocular motor control

C. Spatial neglect

An inpatient is functioning at Level IV (confused-agitated) on the Rancho Los Amigos scale after sustaining a TBI 2 weeks ago. What method should be used to get the patient's attention at the start of a session at bedside? A. Pass a strong-smelling substance back and forth under the patient's nose B. Firmly rub along the patient's sternum until the patient responds C. State the patient's name in a calm voice and establish direct eye contact D. Hold the patient by the chin so the patient cannot look away

C. State the patient's name in a calm voice and establish direct eye contact

A client with spinal cord injury has been on bedrest for several days. The COTA® is preparing to begin mobility activities with the client. What device is best to use for mobilizing the client? A. Stander or standing table B. Standard wheelchair C. Tilt-in-space wheelchair D. Mat table for sitting

C. Tilt-in-space wheelchair

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 COTA®? A. Fit the upper extremity with a sling B. Recommend that the client not use the upper extremity C. Train the client and caregiver in safe handling of the upper extremity during transfers D. Provide PROM to minimize contractures of the upper extremity

C. Train the client and caregiver in safe handling of the upper extremity during transfers

An OTR® has received evaluation orders for a client who recently experienced traumatic brain injury. The COTA® will be treating the client after the evaluation is completed. The client displays severe memory impairment and can only respond to simple commands without being distracted. What Rancho Los Amigos level BEST corresponds with the client's behavior? A. VII B. III C. V D. II

C. V

A COTA® is completing an intervention to address a client's decreased postural stability when performing tasks in standing. The client has hemiparesis after a stroke. The COTA wants to elicit a postural response at the trunk when completing an intervention activity. Where should the COTA place task objects FIRST to elicit a trunk response? A. Above the client's head B. Within arm's reach C. On a moveable surface D. Beyond arm's reach

D. Beyond arm's reach

A COTA® is educating a client with C7 spinal cord injury to use tenodesis grasp. What is an appropriate explanation to the client of how tenodesis works? A. To hold on to an item, bring the wrist back, which opens the fingers. B. Drop the wrist down to activate the grasp and hold on to an item. C. Press one hand against the other to flex the fingers. D. Bring the wrist back, and the fingers will grasp to hold on to an item.

D. Bring the wrist back, and the fingers will grasp to hold on to an item.

An inpatient who has a C6 spinal cord injury has met all occupational therapy goals and is preparing for discharge to live at home with caregiver assistance. What type of device should the OTR® recommend the patient use to maximize independence during self-care activities at home? A. Electronic aid to daily living B. Power wheelchair with head control C. Wheelchair-mounted mobile arm supports D. Custom-fitted tenodesis splint

D. Custom-fitted tenodesis splint

A patient who has a moderate hemiparesis is participating in homemaking activities. Which activity would MOST EFFECTIVELY incorporate graded weight bearing through the involved upper extremity? A. Vacuuming floors B. Washing dishes C. Folding towels D. Dusting a table

D. Dusting a table

A COTA® 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? A. Allow the client to dangle the hemiplegic upper extremity alongside the chair B. Position the client in side lying on the hemiplegic side with internal rotation and scapular retraction C. Use overhead pulleys with prolonged stretch at end range D. Emphasize activities that allow external rotation, shoulder flexion within 90°, and scapular protraction

D. Emphasize activities that allow external rotation, shoulder flexion within 90°, and scapular protraction

What test is MOST APPROPRIATE to determine the level of consciousness of a client with a traumatic brain injury (TBI)? A. Canadian Occupational Performance Measure (COPM) B. Mini-Mental State Examination (MMSE) C. Minnesota Multiphasic Personality Inventory (MMPI) D. Glasgow Coma Scale (GCS)

D. Glasgow Coma Scale (GCS)

A client with T5 spinal cord injury is having difficulty with lateral trunk flexion, which is limiting independent transfers. The client is returning to work as a banker and will be spending 4 to 6 hours continuously in a wheelchair. Which activity intervention should the COTA® consider FIRST? A. Have the client move in diagonal patterns of movement over a therapy ball B. Provide verbal cues for the client to realign the trunk during tasks C. Place objects on the floor that the client has to reach for D. Have the client practice weight shifting in the wheelchair for pressure relief

D. Have the client practice weight shifting in the wheelchair for pressure relief

A COTA® is preparing to discharge a client with a complete L2 spinal cord injury who is planning to go home. Which IADLs would the client likely need assistance with? A. Financial management B. Meal preparation C. Use of technology D. Home maintenance

D. Home maintenance

A COTA® is working on bed mobility with a client in the active phase of C8 spinal cord injury. The client becomes dizzy and nauseous when brought to the sitting position. What is the BEST action for the COTA® to take? A. Apply antiembolism stockings and continue activity. B. Return to the lying position and loosen clothing. C. Transfer to wheelchair and elevate legs. D. Return to the lying position and elevate legs.

D. Return to the lying position and elevate legs.

A client with traumatic brain injury is displaying decorticate rigidity. How would the client's upper-extremity position BEST be described? A. Flaccid and extended, with internal rotation and adduction B. Spastic and flexed, with external rotation and abduction C. Flaccid and flexed, with external rotation and abduction D. Spastic and flexed, with internal rotation and adduction

D. Spastic and flexed, with internal rotation and adduction

To prevent skin breakdown in a client with an incomplete spinal cord injury, which method is BEST for preventing pressure sores? A. Remove after-market cushioning from wheelchair. B. Apply moist heating pads to areas of discomfort. C. Encourage the client to remain still in bed. D. Teach the client to inspect the skin on a daily basis.

D. Teach the client to inspect the skin on a daily basis.

To prevent skin breakdown in a client with an incomplete spinal cord injury, which method is BEST for preventing pressure sores? A. Removing after-market cushioning from wheelchair B. Applying moist heating pads to areas of discomfort C. Encouraging the client to remain still in bed D. Teaching the client to inspect the skin on a daily basis

D. Teaching the client to inspect the skin on a daily basis

A client is 2 days poststroke in acute care with right hemiparesis and requires moderate to total assistance for basic ADLs. The client's FIM™ scores on admission to occupational therapy are 2 for dressing, 1 for bathing, and 3 for feeding. Which intervention is MOST appropriate to provide first? A. Refer the client for a driving evaluation in preparation for community reentry B. Educate the client and caregiver about a home program addressing right-side awareness C. Supervise the client in completing hygiene tasks standing at the sink while emphasizing use of the right arm D. Train the client in postural activity at the edge of the bed to increase supported sitting

D. Train the client in postural activity at the edge of the bed to increase supported sitting

A COTA® is working with a client with traumatic brain injury who is displaying decorticate rigidity. What clinical characteristics can the COTA expect to find? Select the 3 BEST choices. A. Upper extremities are flaccid, with internal rotation. B. Upper extremities are spastic, with external rotation. C. Upper extremities are flaccid, with external rotation. D. Upper extremities are spastic, with shoulder internal rotation and elbow flexion. E. Lower extremities are spastic, with hip internal rotation. F. Lower extremities are spastic, with ankle plantar flexion.

D. Upper extremities are spastic, with shoulder internal rotation and elbow flexion. E. Lower extremities are spastic, with hip internal rotation. F. Lower extremities are spastic, with ankle plantar flexion.