NBCOT Prep B

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B16. To develop social interaction skills, an occupational therapist implements a group program for students with autism spectrum disorder (ASD). Which group is best for the therapist to include in this program? a A directive group. b A topical group. c A developmental group. d A task-oriented group.

B132. A college is converting an historical building into wheelchair-accessible dormitory space. To allow for a 360° turning radius, which dimensions are best for the occupational therapist to recommend as the minimum space between the students' desk and bed? a Four feet by four feet. b Five feet by five feet. c Six feet by six feet.

B142. A client with a lower brain stem injury is referred to occupational therapy. During the evaluation, which reflex would the person most likely demonstrate? a Tonic lumbar. b Body-on-body righting. c Tonic labyrinthine. d Labyrinthine righting.

B70. An occupational therapist conducts an on-site accessibility assessment with a building contractor who is remodeling an apartment building. The therapist recommends modifications for doorways which do not meet minimum accessibility width standards. The contractor states the building's owner wants to exceed minimum standards without incurring unreasonable costs. Which is the most preferred doorway measurement for the occupational therapist to recommend the contractor use for the remodeling? a 36 inches. b 32 inches. c 34 inches. d 38 inches.

B34. An adult who incurred a severe traumatic brain injury (TBI) is entering the second week of care at a longterm TBI rehabilitation center. The patient's family visit regularly and frequently asks multiple questions of the treatment team. A team and family conference is planned to address family concerns. Which is the most important information for the team to share with the family? a Realistic and clear information about the individual's current status and care plan. b Each team member's expert opinion about the expected prognosis and discharge recommendations. c Reimbursement information about each professional service to assist in determining treatment choices. d Community resources that are available to support the family and provide respite care.

B4. An occupational therapist receives a referral to provide home-based services to an older adult who lives alone in a fourth floor walk-up apartment. Upon entering the apartment, the therapist notes the sweltering heat. The apartment has no fans or air conditioners. The client's skin is hot, dry, and red, and breathing is labored. The therapist offers the client a glass of water and places ice compresses on the arterial pressure points to help with cooling. Which is the most important action for the therapist to take next? a Cancel the intervention session and call for an ambulance to provide emergency medical services. b Proceed with the planned intervention session and include documentation about client's environmental conditions in the intervention report. c Contact the home health agency's case manager to report the client's environmental conditions and then proceed with the planned intervention session. d Cancel the intervention session and advise the client to speak to a doctor on how to best address the impact of hot weather on personal health.

B77. The parents of an 18-month-old bring their child to a free community developmental screening. The child can attend to shapes and use them appropriately. However, the parents are worried because the child cannot match shapes or manipulate different shaped objects into a shape sorter. Which is the best response for the occupational therapist to make in response to the parents' expressed concern? a Advise the parents that the child is showing a typical, age-appropriate skill. b Complete an occupational therapy evaluation of the child's cognitive skills. c Refer the child to the early intervention program for developmental delay. d Provide the parents with activity recommendations to develop shape recognition.

B83. An occupational therapist plans intervention for an individual with cognitive perceptual deficits. In deciding whether to use a dynamic interactional approach or a deficit-specific approach, which is most important for the occupational therapist to consider? a The client's auditory processing skills. b The availability of familial support. c The client's social interaction skills. d The client's problem-solving skills.

B88. An individual who is acutely psychotic has been brought to the hospital by a legal guardian. The individual neither responds to questions nor attends to visual stimuli in the room. Who should the therapist collaborate with to determine the individual's short-term goals? a The guardian. b The individual. c The psychiatrist. d The case manager.

Questions B92 to B96 are based on the following information. An individual is transferred from an acute care hospital to a subacute rehabilitation unit in a long-term care facility. The patient incurred a left cerebral vascular accident (CVA) in the middle cerebral artery (MCA) one week ago. The individual is referred to occupational therapy. The referral states that the patient has right hemiplegia and a subluxed right shoulder. B93. The occupational therapist also advises the direct care staff on proper positioning of the patient's right arm while the patient is seated in a wheelchair. Which is the most appropriate recommendation for the therapist to make for positioning of the patient's right arm? a Rest the person's arm on a wheelchair lap board. b Rest the arm in the person's lap with the hands folded. c Have the person wear a shoulder sling throughout the day.

B13. A person with a traumatic brain injury (TBI) is assessed to score a 6 on the Glasgow Coma Scale. Which should the occupational therapist use to initiate intervention with this person? a Demonstrated directions. b Sensory stimulation. c Verbal cues. d Hand-over-hand assistance.

B18. A non-English-speaking family attends a discharge planning session. The assigned occupational therapist does not share the language of the family. Which action should the therapist take first? a Make a referral for a home care therapist to visit the family to provide in-home education. b Obtain a translator to communicate with the family during the session. c Attempt to communicate with the family through nonverbal communication. d Consult with the case manager to develop a discharge plan.

B2. The parents of a five-year-old with attention deficit with hyperactivity disorder (ADHD) express difficulty managing the child's aggressive behavior toward older siblings. Which is the most effective strategy for the occupational therapist to recommend to the parents? a. Allow the child to vent aggressive feelings on a stuffed animal or doll. b Redirect the child's energy into acceptable and safe play activities. c Provide consistent punishment for aggressive behavior. d Send the child to stay with a family member or close friend for an extended "time-out."

B20. Following an acute hospitalization for the medical management of a CVA, an individual receives homebased occupational therapy services. The occupational therapist is working on dressing skills with the patient. During one session, the therapist has the individual dress in the bedroom and during the next session the therapist has the client dress in the bathroom. During the following session, the therapist has the client don and doff a sweater and coat in the living room. Which motor learning technique is the therapist using? a Variable activities. b Variable conditions. c Repetition. d Generalization.

B25. A toddler with severe congenital anomalies and an irreparable cleft palate has a do not resuscitate (DNR) order. While being fitted for a molded seat for a wheelchair, the child stops breathing and turns blue. The entry-level occupational therapist determines that the child has a brachial pulse. Which of the following is the first action the therapist should take in response to this situation? a Inform the physician about the situation and the child's DNR order. b Implement the facility's emergency procedure. c Perform obstructed airway maneuver and monitor heart rate for five minutes.

B32. In an acute inpatient psychiatric facility, an occupational therapist designs a therapeutic activity group for individuals with poor orientation to reality. Which is the best activity choice for the therapist to provide in this group? a A discussion of the effects of hospitalization on occupational roles. b The assembly of wooden toys for a children's unit. c Guided imagery for stress management. d Structured verbalizations of personal assets and limitations.

B33. An occupational therapy professional education program provides an after-school play program for typically developing children to help students understand typical development. The students observe a child who is beginning to use blunt scissors to snip paper. The child opens and closes the scissors and moves them in a controlled forward motion, but the child cannot cut circles or figure shapes. At which age are these behaviors typical? a Two years old. b Three years old. c Four years old. d Five years old.

B37. A single parent of two school-aged children is employed as a truck driver working the 11 p.m.-7 a.m. shift. The client was hospitalized for a major depressive episode following the sudden death of the client's spouse one year ago. The deceased spouse's primary role had been home maintainer. The client was rehospitalized this past weekend for another major depressive episode. Which skills are most relevant for the occupational therapist to evaluate? a Interpersonal. b Self-management. c Cognitive. d Leisure.

B38. An individual with a body mass index (BMI) of 35 is joining a community-based wellness program conducted by an occupational therapist. When formulating an individualized wellness plan, which condition should the occupational therapist take into consideration as an increased risk for this person? a Hypothermia during exertion. b Hyperthermia during exertion. c Rapid weight loss during the initial weeks. d Increased anxiety and depression.

B41. An individual with rheumatoid arthritis (RA) is currently in a stage of remission. During this inactive chronic phase of this disease, the occupational therapist works with the client to maintain range of motion (ROM) and muscle strength. Which of the following is most effective for the therapist to recommend the client include in a daily home exercise program? a Passive ROM. b Active ROM. c Isotonic exercises. d Progressive resistance.

B42. An occupational therapist employed in a pediatric clinic participates in an initial performance appraisal. The supervisor identifies an area needing improvement as handling skills in working with children with various types of cerebral palsy. Which is the most effective way for the occupational therapist to improve handling skills? a. Observe an experienced occupational or physical therapist use handling techniques. b. Participate in an advanced-level experiential course on handling techniques. c. Participate in a teleconference on handling techniques for children with cerebral palsy.

B52. An adult diagnosed with bipolar disorder has been taking lithium for five years. Prior to a weekly occupational therapy vocational planning group, the client reports noticeable functional changes since the last group session. In describing these changes, the client reports symptoms that may be indicative of a possible lithium overdose. With the client's permission, the therapist contacts the psychiatrist to describe the client's concerns. Which symptom would the therapist most likely report as indicative of this problem? a Reduction in mood swing. b Gross hand tremors. c Decreased velocity of speech. d Fine hand tremors.

B56. An occupational therapist is scheduled to give a one-hour presentation to a support group of parents of infants with a diversity of developmental disabilities. Which of the following is the most important focus of the therapist's presentation? a Demonstration of infant positioning techniques. b Discussion of typical areas of concern addressed by OT practitioners. c Demonstration of different types of developmental assessments. d Discussion of the Individual Family Service Plan (IFSP).

B57. Several adolescents with behavior problems attend a school-based after-school program. They work at an egocentric-cooperative level in a group dealing with issues related to school performance and peer pressure. Which of the following would be most likely for the occupational therapist to observe the participants doing in the group? a Actively taking on roles such as energizer, coordinator, or opinion giver. b Focusing on the group tasks rather than the feelings of the participants. c Making decisions with minimal to no supervision from the group leader.

B62. An occupational therapist conducts a sensory evaluation of an individual recovering from a left cerebral vascular accident. The individual has right hemiplegia and expressive aphasia. During the evaluation of stereognosis, which should the therapist have the client use to identify responses to the testing stimuli? a Pictures of the objects. b A set of identical objects. c Cards with "one" and "two" printed on them. d Cards with "yes" and "no" printed on them.

B81. An occupational therapist provides an accessibility consultation to a business that has hired a new employee who uses a wheelchair for mobility. The only entrance to the business has four steps, each seven inches high. Which ramp length is best for the therapist to recommend the business have constructed? a 14 feet. b 28 feet. c 35 feet. d 46 feet.

B84. A child with developmental delay has mastered the ability to cut simple figure shapes with scissors. Which scissor activity is best for the occupational therapist to introduce to the child during their next intervention session? a Cutting simple geometric figures. b Cutting complex figure shapes. c Cutting multiple circles.

B91. The residents of a halfway house plan a community leisure activity for a Saturday. Two residents state that they cannot participate in Saturday activities due to religious observances. The other residents express strong interest in the activity. Which is the occupational therapist's best response to this situation? a Schedule an in-house Saturday leisure activity for the two observant residents. b Explore with the group an alternative schedule for a community leisure activity. c Schedule an in-house Saturday leisure activity for all residents. d Recommend the two observant members seek approval from their religious leadership to attend the Saturday activity.

Questions B92 to B96 are based on the following information. An individual is transferred from an acute care hospital to a subacute rehabilitation unit in a long-term care facility. The patient incurred a left cerebral vascular accident (CVA) in the middle cerebral artery (MCA) one week ago. The individual is referred to occupational therapy. The referral states that the patient has right hemiplegia and a subluxed right shoulder. B94. While completing the screening, the occupational therapist observes that the patient uses only their left side to participate in activities. The therapist suspects that the patient has unilateral neglect and difficulties with body scheme. Which should the therapist have the patient do during the OT evaluation to determine if these deficits are present? a Point to various body parts named by the therapist. b Complete upper and lower extremity dressing. c Complete the draw-a-person test.

Questions B92 to B96 are based on the following information. An individual is transferred from an acute care hospital to a subacute rehabilitation unit in a long-term care facility. The patient incurred a left cerebral vascular accident (CVA) in the middle cerebral artery (MCA) one week ago. The individual is referred to occupational therapy. The referral states that the patient has right hemiplegia and a subluxed right shoulder.B92. The occupational therapist meets with the nursing staff that will be providing primary care to the patient at the patient's bedside. The occupational therapist recommends that the direct care staff position the patient in left sidelying. Which is the best bed position for the therapist to recommend for placement of the patient's right arm? a In 90° of humeral abduction and internally rotated. b Protracted with arm forward on a pillow and the elbow extended or slightly flexed. c On the person's side, adducted and internally rotated. d In 90° of abduction of the humerus with neutral rotation.

B12. The occupational therapist completes an intake interview for a work hardening program. As the individual is leaving, the person gives the therapist a hug and expresses much gratitude. The individual then tries to kiss the therapist on the lips. Which action is best for the therapist to take in response to this situation? a Forcibly push the individual away while telling the person that the behavior is inappropriate and unacceptable. b Say nothing but decline the person's admission to the work hardening program based upon the person's inappropriate behavior. c State that the individual's behavior oversteps professional boundaries and makes the therapist uncomfortable. d Tell the person the behavior is inappropriate and unacceptable and decline the person's admission to the program.

B3. An individual with rheumatoid arthritis has developed several boutonniere deformities. Which of the following is the most accurate description for the occupational therapist to include in documentation of the individual's presenting signs? a Hyperextension of the PIP joint and flexion of the DIP joint. b Ulnar deviation and subluxation of the MCP joints. c Flexion of the PIP joint and hyperextension of the DIP joint. d Heberden's nodes at the DIP joints and Bouchard's nodes at the PIP joints.

B30. A new outpatient mental health facility offering occupational therapy services opens in a community of 100,000. The occupational therapy director of an established outpatient program is concerned that the new program will affect service delivery. Which action is best for the director of the established program to take in response to this potential competition? a Wait for the new facility to implement services and develop services in the areas not covered by that facility. b Offer the same services that the new facility offers and advertise a competitive price. c Conduct a program evaluation and develop a marketing plan based on the results. d Design an intensive marketing campaign to local consumers and third-party payers.

B49. The administrator of a large rehabilitation hospital reviews the occupational therapy staffing schedules. The administrator determines that of the 12 full-time therapists, six work full-time in the inpatient department, two work full-time in the outpatient department, two divide their hours equally between the inpatient and outpatient department, and two divide their hours equally between administrative/managerial work and direct care provision on the inpatient unit. Which is most accurate staffing for the administrator to document for the occupational therapy inpatient department in the annual report? a Twelve full-time equivalent employees. b Ten full-time equivalent employees. c Eight full-time equivalent employees. d Six full-time equivalent employees.

B53. A school-based occupational therapist is teaching orientation and mobility skills to an adolescent with a degenerative visual disorder. Which is the most effective motivational technique for the therapist to use with this student? a Provide concrete structure and frequent feedback to ensure accurate orientation and safe functional mobility. b Keep sessions short to allow time for emotional adjustment to orientation and mobility challenges. c Treat the student as an adult and incorporate the student's orientation and mobility goals into intervention sessions. d Limit anxiety by practicing the techniques in a quiet and self-contained environment (e.g., an empty classroom).

B60. Several newly homeless veterans with a variety of mental health diagnoses attend an occupational therapy community reentry group conducted in a community-based shelter. Which should be the primary focus of the initial group session? a Development of home management skills such as meal preparation. b Determination of financial assets and money management skills. c Identification of local resources such as soup kitchens and thrift stores. d Exploration of vocational interests and employment possibilities.

B63. A young adult with a T9-T10 spinal cord injury wishes to engage in sports activities. Which wheelchair features are best for the occupational therapist to recommend to this client? a A heavy-duty foldable frame with a high back. b An ultra-light foldable frame with a high back. c An ultra-light rigid frame with a low back. d A heavy-duty rigid frame with a low back.

B68. An individual is referred by a physician to an outpatient occupational therapy program for an evaluation. The person's insurance company does not cover outpatient OT services. Which action is best for the therapist to take in response to this situation? a Follow the physician's order and let the person pay the bill when it is received. b Refuse to accept the referral and advise the person to seek additional insurance coverage. c Explain the limitation of the insurance coverage and let the person decide whether to complete the evaluation. d Request that the program's billing department submit a bill using a code that is covered by the insurance company.

B71. An occupational therapist works in a school system with a child with developmental delays. One of the goals of treatment is to develop prewriting skills. The child exhibits the ability to grasp a pencil proximally with crude approximation of the thumb, index, and middle fingers and the ring and little fingers slightly flexed. The therapist develops an intervention plan. Which grasp should be the focus for the implementation of intervention? a Digital pronate grasp. b Static tripod posture grasp. c Dynamic tripod grasp. d Palmar supinate grasp.

B74. Occupational therapy services are provided to the residents of a psychogeriatric unit in a skilled nursing facility. An occupational therapist presents an in service on restraint reduction to the unit's direct care staff. Which of the following would the therapist identify as a permissible use of a restraint? a A bed guardrail to prevent a confused resident from wandering in the evening. b A lap board to enhance a resident's engagement in self-determined activities. c A wheelchair with a lap belt to prevent a resident d with ataxic gait from falling.

B78. A young adult recently diagnosed with schizophrenia is referred to an occupational therapy day treatment program. Which should the occupational therapist do first with the client? a Determine short-term and long-term goals for program participation. b Model desired behaviors during occupational therapy groups. c Have the client complete an occupational interest checklist. d Encourage the client to maintain a daily log of medication intake.

B98. An occupational therapist working in a school system must incorporate the Individuals with Disabilities Education Act (IDEA) in the program. In which location should the therapist provide intervention? a Regular classroom while general education classes are not in session. b Special education classroom while other children with disabilities are present. c Regular classroom while general education classes are in session. d Private occupational therapy room designed for children with disabilities.

Questions B43 to B47 are based on the following information. An adult who incurred a traumatic brain injury three months ago is referred to a home care agency to receive OT services. The client's referral states that cognition is at Level VII of the Rancho Los Amigos scale and that grasp and shoulder mobility are limited. During the initial interview, the client reports being frustrated by the inability to independently engage in the previously enjoyed and personally meaningful activity of cooking. The client reports frequently losing place when reading recipes and an inability to "find" things in the kitchen. B45. The client responds well to the compensatory approach when performing countertop meal preparation tasks. The therapist decides to use a dynamic interactional approach as the theoretical foundation for cognitive perceptual intervention for other meal preparation activities. During a session to train the client in scanning strategies, the client accurately finds two items in a refrigerator. Which is the therapist's most appropriate initial response to the client's task success? a Praise the client for successful task completion. b Ask the client to now find three items in the refrigerator. c Ask the client how they know that the items are correct. d Ask the client to now find two items in the pantry.

B24. An individual with moderate intellectual disability moves into a group home. An initial goal established for this resident is the development of socially acceptable table manners. The occupational therapist uses a behavior modification approach to achieve this goal. Which intervention technique is best for the therapist to include in the design of the group home dining experience? a Negative reinforcement for socially inappropriate behaviors. b Clear explanations of behaviors expected during dining. c Clear explanations about the effects of inappropriate behaviors on others. d Rewards for socially appropriate dining behaviors.

B29. A patient who is status-post left frontal lobe ischemia has difficulty bearing weight through the right lower extremity during reaching activities (e.g., standing at a sink during morning self-care routine). The occupational therapist implements a Motor Re-Learning Program (MRP). Which is the best intervention for the therapist to provide according to this approach? a Therapeutic handling to affect the central nervous system. b A stool to sit on during reaching activities. c Joint compression to the right lower extremity during reaching activities. d Verbal and visual feedback while practicing reaching.

B31. An individual with obsessive-compulsive personality disorder participates in a vocational program. The client asks the occupational therapist to speak to the supervisor of the transitional employment program (TEP). The client is concerned that compulsive behaviors are interfering with job performance and may result in the loss of a new TEP placement. Which is the therapist's best response to these expressed concerns? a Instruct the client to speak directly to the TEP supervisor about the right to receive reasonable accommodations. b Schedule a reevaluation of the client's work behaviors and skills. c Assure the client that it is natural to have initial difficulties at a new job. d Schedule an appointment with the client and the TEP supervisor.

B39. The supervisor of an acute inpatient unit requests that a recently hired entry-level therapist write summaries of several evaluation sessions that were completed by another therapist. The evaluating therapist had to leave work unexpectedly due to a medical emergency and is not expected to return to work. Which is the best response for the therapist to make in response to this request? a Comply with the supervisor's request but ask for the supervisor to co-sign the notes. b Request time to complete an independent evaluation of each individual previously evaluated. c Report the supervisor's request to the facility's administration. d Suggest that the therapist's evaluation results be documented by the supervisor.

B85. A high school student is referred to occupational therapy for ADL training. The student has nonspastic cerebral palsy resulting in right side hemiparesis and decreased muscle tone. During a transition planning meeting, the student's teacher reports the student has had several accidents during a meal preparation class (i.e., incurring cuts when using a knife and burning hands when taking items out of the oven). As part of the transition plan, the occupational therapist will teach the student adaptive techniques used in a kitchen setting to compensate for right-side weakness. Which of the following adaptations should the therapist recommend to improve the student's independence in preparing meals safely? a Prepare foods that do not require cutting. b Use a microwave oven to cook food. c Use a weighted knife to cut food. d Use oven mitts that extend to the elbows.

B89. In an outpatient rehabilitation clinic, an occupational therapist is treating a high school student with spina bifida resulting in full motor paralysis and sensory deficits below L1 spinal cord level. The client is a competitive swimmer and is able to transfer independently from the wheelchair to the pool without an assistive device. The client's goal is to learn how to mount and ride a horse. Which is best for the therapist to do initially to help the client attain this goal? a Implement a home-based transfer training program for the client's family to learn how to assist with mounting a horse. b Develop an exercise program for the client to do at home on a daily basis to increase upper extremity strength. c Encourage the client to extend scheduled swimming sessions and practice mounting large inflatable tubes in the pool. d Consult with a stable owner to discuss alternative methods of mounting a horse.

Questions B43 to B47 are based on the following information. An adult who incurred a traumatic brain injury three months ago is referred to a home care agency to receive OT services. The client's referral states that cognition is at Level VII of the Rancho Los Amigos scale and that grasp and shoulder mobility are limited. During the initial interview, the client reports being frustrated by the inability to independently engage in the previously enjoyed and personally meaningful activity of cooking. The client reports frequently losing place when reading recipes and an inability to "find" things in the kitchen. B44. During meal preparation tasks, the client ignores items on the left side of the counter. The therapist decides to use a compensatory functional approach to improve the client's performance. Which is the most appropriate method for the therapist to use during intervention to develop meal preparation skills? a Encourage bilateral activities. b Place all items on the right side of the counter. c Practice scanning activities. d Place a brightly colored placemat on the left side of the counter.

Questions B92 to B96 are based on the following information. An individual is transferred from an acute care hospital to a subacute rehabilitation unit in a long-term care facility. The patient incurred a left cerebral vascular accident (CVA) in the middle cerebral artery (MCA) one week ago. The individual is referred to occupational therapy. The referral states that the patient has right hemiplegia and a subluxed right shoulder. B96. Upon evaluation, the therapist determines that the patient has right homonymous hemianopsia. The therapist provides recommendations to modify the patient's room to enhance independence. Which are the most appropriate recommendations for the therapist to make for the placement of the patient's call button and cell phone? a Call button on the left side and the cell phone on the left side. b Call button on the right side and the cell phone on the right side. c Call button on the right side and the cell phone on the left side. d Call button on the left side and the cell phone on the right side.

B86. An individual recently discharged from an acute psychiatric unit interviews for a position in a transitional employment program (TEP). The person answers the interviewing therapist's questions in a direct yet subdued manner and rarely looks at the therapist. Which is most accurate for the therapist to document in the summary of the interview? a The individual should have medications evaluated before starting the TEP. b The individual demonstrated limited eye contact. c The individual exhibited poor social interaction skills. d The individual appeared depressed.

B17. A home-care occupational therapist plans intervention for an individual with agoraphobia with panic attacks. The occupational therapist plans to use a cognitive-behavioral approach. Which approach is best for the therapist to use with the client during the intitial intervention session? a A token reward system. b Behavioral extinction. c Relaxation techniques. d Systematic desensitization.

B64. An entry-level occupational therapy assistant (COTA®) recently hired for an outpatient rehabilitation clinic requires supervision during the direct supervisor's scheduled vacations. To maximize departmental efficacy, who should provide supervision to the COTA®? a The rehabilitation clinic's administrator. b A COTA® with one year of experience. c An occupational therapist. d A COTA® with advanced credentialing.

Questions B92 to B96 are based on the following information. An individual is transferred from an acute care hospital to a subacute rehabilitation unit in a long-term care facility. The patient incurred a left cerebral vascular accident (CVA) in the middle cerebral artery (MCA) one week ago. The individual is referred to occupational therapy. The referral states that the patient has right hemiplegia and a subluxed right shoulder. B95. During the initial ADL evaluation, an occupational therapist notes that the patient cuts food awkwardly and consistently spills food when moving the food from the plate to the mouth. When recording this observation, which deficit should the therapist identify as a primary focus for intervention? a Ideational apraxia. b Asomatognosia. c Motor apraxia. d Tactile agnosia.

B11. During a group session at an adult day care program, an older adult consistently complains that everyone is mumbling. After the group, which action should the occupational therapist take in response to these statements? a Notify the client's primary care physician that the person exhibited evidence of paranoia. b Collaborate with the program director to remove groups from the client's program plan. c Document objective data about the complaints in the person's chart. d Notify the primary care physician that the person may need an audiological evaluation.

B105. An adult is referred to occupational therapy for ADL training. The patient incurred a fracture of the right proximal humerus and is using a shoulder immobilizer for the first two weeks to aid healing and help control pain. The patient is right-hand dominant. Which activity will be the most difficult for the patient? a Putting on a pullover top. b Taking off a heavy coat. c Brushing their teeth.

B112. An adult incurred an injury to the anterior spinal artery at the T12 level. The occupational therapist completes a sensory evaluation with this client. Which sensation is most likely for the therapist to document that the individual has retained? a Proprioception. b Pain. c Crude touch. d Temperature.

B117. An individual is recovering from deep partial-thickness burns on the upper extremities, chest, and lower neck. The occupational therapist provides equipment to prevent positions that can result in contractures. Which are the most important positions for the therapist to prevent? a Positions of comfort. b Antideformity positions. c Positions resulting in edema. d Positions of pain.

B124. An occupational therapist establishes a program for a new acute psychiatric unit at a community hospital. The therapist designs the physical layout of the occupational therapy department to include storage for arts and crafts materials. Which of the following should the therapist recommend to store these materials? a A ventilated locked metal cabinet accessible only to staff. b Open shelving accessible to patients. c Shelving next to a sink for easy clean up. d A locked closet outside of the intervention area to ensure safety.

B130. An individual attends a community day treatment program to assist in recovery from a major depressive disorder. The client has fair eye contact and responds verbally to interactions initiated by others. The person's cognition is intact. Which group level is best for the occupational therapist to recommend this client attend? a Project. b Parallel. c Cooperative. d Mature.

B133. An occupational therapist working for a home care agency is vacationing and sees a colleague at an all-day concert. Upon return from the vacation, the therapist notices that this colleague had billed for a full day of home visits on the day of the concert. Which action is best for the therapist to take first in response to this situation? a Inform the home care supervisor. b Contact the state regulatory board. c Contact the National Board for Certification of Occupational Therapy. d Ask the colleague to clarify the situation.

B137. A young adult with a ten-year history of serious mental illness is being discharged home in two days. The client collaborates with the care coordination team to plan discharge with the client's primary family members. The team consists of a psychiatrist, a registered nurse, a social worker, and an occupational therapist. The team conducts a predischarge family meeting to provide family members with information to assist them in supporting the client's recovery. Which is the most relevant information for the occupational therapist to provide to the client's primary family members at this meeting? a Family role activity suggestions and potential adaptations. b The therapeutic effects and potential side effects of medications. c Advocacy strategies and consumer/family resources. d Family dynamics information and family support groups.

B146. An occupational therapist provides caregiver training to the spouse of an individual with cerebellar cortical degeneration. The focus of the session is on community mobility using a wheelchair. The individual is dependent upon the spouse's assistance for mobility. Which of the following is most effective for the therapist to recommend the spouse do when descending a steep grade? a Go down backward with all wheelchair wheels maintaining contact with the ground surface. b Tilt the wheelchair backward to its gravitational balance point and then go down forward. c Tilt the wheelchair backward to its gravitational balance point and then go down backward. d Push forward as on flat surfaces but lean body back for extra drag.

B147. An adult has been referred to occupational therapy. The individual demonstrates decreased ROM in the dominant hand secondary to a nerve injury. Active thumb ROM for the IP and MP is within normal limits. Active ROM of the IPs of all four fingers is 0°-60°. The individual wants to be able to hold a knife, spoon, and fork. Which utensils are best for the therapist to recommend to this person? a Utensils with cylindrical foam handles, 1½" in diameter. b Standard utensils with no adaptations. c Utensils with custom-built handles made of low temperature thermoplastic splinting material. d Utensils held in a universal cuff.

B153. During an intervention session in a school, the occupational therapist observes a young child turn the pages of a book. The therapist identifies this behavior as an example of an in-hand manipulation task. Which task should the occupational therapist document the child is capable of performing? a Shift. b Simple rotation. c Translation. d Translation without stabilization.

B155. An individual recovering from hepatitis, type C has decreased upper and lower extremity muscle strength and hypertension. Six months ago the client had an angioplasty and is very fearful of having a heart attack. Which should the occupational therapist instruct the client to perform to increase muscle strength? a Isotonic exercises. b Isometric exercises. c Contract-relax exercise. d Muscle contractions and holds.

B158. An adult with amyotrophic lateral sclerosis frequently coughs and chokes when eating finely chopped foods and drinking thin liquids. The speech pathologist and occupational therapist collaborate and recommend a videofluoroscopy procedure. Which behavioral information would be most relevant for the occupational therapist to include on the referral? a The client demonstrates minimal limitations in cognitive level. b The client is able to consume chopped foods and apple juice with no difficulty. c The client demonstrates only oral stage problems during eating. d The client cannot tolerate therapy focused on improving feeding and swallowing skills.

B163. An individual with a spinal cord injury at C7 reports noticeable redness on the ischial tuberosity during self-exam with a mirror. Which action is most effective for the occupational therapist to recommend in response to client's observations? a Integrate weight shifting into daily activities. b Use a tilt-in-space wheelchair. c Use an angled foam cushion. d Self-direct caregivers to assist with weight shifting at least once every 30 minutes.

B167. A preschool-aged child with recurring headaches and decreased gross and fine motor skills is hospitalized on an acute care unit for a diagnostic workup. Just prior to the occupational therapy evaluation, the parents are told that their child has cancer. The parents are upset when they bring their child to the evaluation session. Which are the best actions for the therapist to take in response to this situation? a Recommend the parents speak to their spiritual advisor or the social worker and proceed with the OT session. b Cancel the OT session and recommend the parents speak to their spiritual advisor or the social worker. c Spend the OT session providing support to the parents and addressing the parents' acceptance of the diagnosis. d Recommend the parents speak to their spiritual advisor or the social worker and reschedule the OT session for later in the week.

B168. After six months of rehabilitation for a T2 spinal cord injury, a patient is being discharged. The occupational therapist conducts a home visit to evaluate accessibility. The individual lives with two roommates in an apartment in a private home. The doorway measurements currently range from 30 to 32 inches throughout the apartment. The patient's landlord is amenable to making changes in the apartment but has no financial resources. Which recommendation is best for the therapist to make for independent accessibility in the apartment? a Install offset hinges on all doors. b Remove doorframes of doorways less than 32 inches and install wider frames. c Remove all doors except for the apartment entrance door. d Remove all doorframes and install 36-inch-wide doorframes.

B170. A high school student with a diagnosis of borderline personality disorder and a history of self-abusive behaviors attends a transitional school-to-work program co-led by an occupational therapist and a COTA®. During the vocational skills group, the student expresses feelings of hopelessness about the future and questions the point of participating in the program. The student asks to leave the group due to being too tired to concentrate as a result of sleepless nights. The occupational therapist asks the COTA® to assume leadership of the group while the therapist addresses the student's concerns. Which action is best for the therapist to take in response to the student's statements? a Pull the student aside from the group and ask if the student is feeling self-destructive. b Allow the student to leave the group after reminding the student to relay concerns to the guidance counselor. c Support the validity of the student's feelings and encourage the student to remain in the group. d Remind the student that in a work setting the norm is to work even if fatigued.

B82. A middle school-aged child with right upper extremity amelia attends occupational therapy to learn how to dress independently. Which of the following is most beneficial for the occupational therapist to focus on during intervention? a Donning and doffing a variety of shirt types of personal preference. b Donning and doffing only shirts that can be donned overhead. c Donning and doffing shirts that button in the front. d Donning and doffing shirts with Velcro tabs sewn on to replace buttons.

B103. An older adult with a diagnosis of osteoarthritis in both knees is referred to inpatient occupational therapy. During screening, the patient expresses a desire to return home to live alone independently. Which should the occupational therapist do first in response to the patient's stated goal? a Recommend adaptations to the patient's home environment to increase safety. b Evaluate the patient's BADL and IADL using a standardized measure. c Teach the patient energy conservation techniques to use during IADL tasks. d Train the patient in a home resistive exercise program to build strength and ROM.

B113. An occupational therapy administrator implements a quality improvement program at a large private hand therapy clinic. The administrator determines that the clinic's certified occupational therapy assistants (COTA®s) are not completing their assigned initial screenings in a timely manner. This has resulted in scheduling delays for complete functional evaluations. Which initial action is most effective for the administrator to take in response to this situation? a Counsel the COTA®s on the need to adhere to screening schedules. b Examine the organizational structure of the screening process. c Assign the occupational therapists to complete all screenings. d Redesign the screening to simplify the process.

B118. A cooking group meets for 1 1/2 hours each week at a partial hospitalization program. During the group, members do not smoke, they wait for everyone to be served before eating, and they clean up after the meal. When reporting these observations, which of the following is the most accurate statement for the therapist to make? a The group protocol is clear. b Group norms are being followed. c Group sanctions are effective.

B123. A homemaker and parent is hospitalized for a major depressive disorder and prescribed Parnate to treat depressive symptoms. The patient's hobbies are gardening and jogging. Upon discussing the functional effects of medications with the patient, which is the most important precaution for the occupational therapist to review? a Photosensitivity. b Dietary restrictions. c Orthostatic hypotension.

B127. An occupational therapist plans individual and group activities for a child with oppositional defiant disorder. Which is most important for the therapist to address during group activities? a The child's willingness to take on a variety of group roles. b The child's ability to attend to and complete a task. c The child's self-regulation of energy and activity levels.

B136. A school-based occupational therapist receives an evaluation referral for a third-grader. The teacher reports that the student has illegible handwriting, poor attending behaviors, questionable visual skills, and problems with pencil management. After speaking with the teacher, reviewing classroom work samples, and reading the student's history, which action should the therapist take next? a Provide pencil grips and specialized paper as a trial to determine interventions. b Directly observe the student during a naturally occurring writing time. c Administer a standardized visual perceptual and visual motor assessment. d Administer a standardized handwriting assessment.

B139. An occupational therapist provides home care services to a neonate with significant developmental delays. Two hours before the next scheduled home visit, the child's parent informs the therapist that one of three older children has developed chicken pox. While the other children do not show signs of chicken pox, the parent expresses concern that they are contagious. Which is the therapist's best response to this situation? a Cancel the scheduled session and reschedule after two weeks have passed. b Complete the scheduled session using airborne precautions. c Complete the scheduled session using standard precautions. d Complete the scheduled session using droplet precautions.

B141. An older client with a diagnosis of major neurocognitive disorder lives with family members. On the last three occasions, the client attended OT sessions with bruises and cuts on both legs. When asked about this, the client replies that a family member caused these injuries. Which is the first action the occupational therapist should take? a Confirm the client's statements with the family. b Immediately report potential abuse according to the facility policy. c Call the police to report elder abuse. d Administer a cognitive evaluation before taking further action.

B143. Ten members of a community reintegration group are not working well together and show decreased levels of trust. The occupational therapist's goal is to enhance the level of cohesiveness in the group. To begin the next group session, which is the best action for the therapist to take? a Read inspirational phrases to increase motivation. b Verbally review the goals and purposes of the group. c Have each person contribute a line about childhood memories to group poem. d Ask each person to talk about silly mistakes to provide some levity.

B145. An occupational therapist observes that an 18-month-old child is not able to creep more than a few steps. When the child looks up, both hips and knees flex and the child ends up W sitting with both arms extended and propped forward. When documenting this observation, which is most accurate for the occupational therapist to report the child is demonstrating? a The influence of the symmetrical tonic neck reflex (STNR) resulting in delayed gross motor skills. b An obligatory asymmetrical tonic neck reflex (ATNR) resulting in delayed gross motor skills. c An intact tonic labyrinthine reflex which facilitates balance responses.

B148. The residents of an urban homeless shelter include individuals with histories of chronic alcohol abuse who are at risk for developing peripheral neuropathy. The occupational therapist consulting at this shelter monitors the residents' status to ensure early detection of this problem. Which is the most important observed status change for the therapist to report? a Progressive deterioration in visual acuity. b Progressive deterioration of sensorimotor functions of the lower extremities. c Rapid onset of intention tremors. d Rapid loss of sensorimotor functions of the facial and neck muscles.

B156. During a home care intervention planning meeting, the team discusses a client with a right CVA. The physical therapist states the individual's ambulatory status is now within functional limits. Physical therapy services will be discontinued because the person is no longer homebound. The occupational therapist reports that the individual is frequently confused during home management task performance and becomes extremely anxious when community activities are discussed. Which recommendation should the therapist make? a Refer the individual to a psychiatrist for a mental status evaluation. b Continue OT services as the person should continue to be considered homebound. c Discontinue OT services as they are nonreimbursable since the person is no longer considered homebound. d Contact the physician to discuss the need for OT services on an outpatient basis and for psychosocial counseling.

B159. An adult recently diagnosed with scleroderma receives occupational therapy services to deal with the functional changes caused by this disease. Which recommendation is best for the occupational therapist to make to this individual? a Dress in lightweight clothing for thermal comfort. b Dress in layers for neutral warmth. c Use pull-on clothing to ease donning and doffing. d Use Velcro or a button hook to ease fastening.

B161. The family of a two-year-old in a spica cast asks the occupational therapist to modify the child's car seat. The child cannot fit in the car seat due to the cast. Which action is best for the therapist to take in response to this request? a Pad the area between the car seat and the child's back with a pillow to accommodate for the lack of hip flexion. b Recommend the family purchase a car seat designed for a child with a spica cast. c Cut down the sides of the car seat to allow the cast to hang out of the sides of the car seat.

B166. An occupational therapist works with a child with pervasive developmental disabilities in order to develop self-care skills. In teaching the child to brush teeth, the therapist places the toothbrush in the child's hand and guides it to the mouth. To help the child learn to complete the activity the therapist uses the somatosensory system. Which of the following is most effective for the therapist to use next during intervention with this child? a Tell the child to brush up and down. b Provide hand-over-hand assistance to brush the child's teeth. c Touch the child's hand to prompt hand-to-mouth movements. d Instruct the child to follow a pictorial sequence card depicting toothbrushing.

B169. An individual recovering from myasthenia gravis has fair minus (F-) muscle strength in both upper extremities. The occupational therapist develops an intervention plan to include the goal of increasing muscle strength. According to the biomechanical approach, which should the therapist work on with the patient during intervention? a Complete active ROM with gravity decreased. b Complete active ROM against gravity. c Incomplete active ROM against gravity. d Complete active ROM against gravity and slight resistance.

B8. A four-month-old with arthrogryposis remains in position when placed and shows little spontaneous movement. The occupational therapist implements intervention to work on rolling. Which positional changes should the therapist include in the intervention session? a Prone to supine. b Supine to side-lying. c Prone to side-lying. d Supine to prone.

Questions B150 to B152 are based on the following information. An individual recovering from flexor tendon repair surgery is two days post-operation. The surgeon refers the client to occupational therapy with a prescription to use the Kleinert protocol to guide intervention. B152. The client is now seven weeks post operation. Which are the most appropriate intervention activities for the occupational therapist to use with this client? a Home management activities such as doing laundry. b Light ADL such as grooming. c Strengthening exercises using high-resistance TheraBand. d Passive exercises using a dynamic splint.

B104. An older teenager with a congenital right below-elbow amputation had never wanted a prosthesis before. Now the teen wants a prosthesis "to look good at the prom and more 'normal' when doing things with my friends." Which action would be most beneficial for the occupational therapist to take to meet the teen's expressed needs? a Recommend a prosthesis with a cosmetic passive hand. b Recommend a prosthesis with a voluntary opening hook. c Recommend a prosthesis with a myoelectrically controlled hand. d Recommend counseling to explore the client's sudden preoccupation with body image.

B106. An occupational therapist is treating an individual with Parkinson's disease in an outpatient setting. The therapist observes that the person attends regularly but has little energy and is difficult to engage during intervention. The person reports limited performance of the activities prescribed for their home program. Which is the best action for the therapist to take in response to these observations and the person's self-report? a Ask the person's physician to complete a referral for a psychiatric evaluation. b Tell the person that the completion of the home program is vital to recovery. c Interview the person and complete a standardized depression scale. d Defer intervention until the person's depression is treated.

B111. A child with congenital anomalies has severe developmental delay. The child demonstrates motor and cognitive skills at the nine-month level. Which is the best adaptation for the occupational therapist to use during intervention to develop the child's visual and auditory awareness? a A hand-held rattle of the child's favorite cartoon character. b A wrist bracelet with blinking lights that makes noise when moved. c A button switch that activates a CD player when the switch is pressed.

B115. A person fell and sustained bilateral Colles' fractures. The client wore bilateral short-arm casts for six weeks. After cast removal, the client began OT sessions to increase endurance and strength prior to returning to work. The client tends to work hard when performing resistive exercises with both wrists. The therapist monitors the client for overexertion. Which behavior would indicate overexertion? a Increased ability to achieve full ROM of the wrist. b Complaints of pain in the wrist extensors. c Consistent strength in wrist extension activities.

B126. A school-based occupational therapist consults with a teacher regarding a nonspeaking student who uses a wheelchair and an augmentative communication device. The teacher reports that the student has been making many errors on the communication device but that no difficulties had been observed when the student used the device in the past. Which is the most effective initial action for the therapist to take in response to the teacher's report? a Advise the teacher to contact the student's parents and recommend that they bring the child to a physician for an exam. b Reassess the student's motor and communication abilities to determine needed modifications. c Evaluate the position of the student in the wheelchair and the device on the wheelchair. d Reposition the communication device on the wheelchair to facilitate access and increase accuracy.

B128. A single parent with rheumatoid arthritis and two school-aged children reports difficulty completing a home exercise program. The parent states that multiple familial, work, and home management responsibilities fill the day and additional activities cannot fit into the day. Which is the best action for the occupational therapist to take in response to these realities? a Explain and reinforce the importance of active range of motion exercises for remediation of dysfunction. b Provide intervention to develop time management skills and enable temporal adaptation. c Incorporate the parent's engagement in a diversity of role activities into the home program. d Increase the frequency of OT sessions to compensate for lack of follow-through with the home program.

B129. An individual with a spinal cord injury (SCI) at the level of T1 is practicing a stand pivot transfer in the OT department of a rehabilitation center. The patient complains of dizziness and nausea. Which action is most important for the occupational therapist to take first? a Call for help according to facility procedures. b Return the patient to the wheelchair for a five-minute rest break. c Return the person to the wheelchair and immediately recline it. d Return the patient to the wheelchair and transport the patient back to rest in bed.

B134. A caregiver support group meets weekly at a community center. A new member attends the group for the third time and listens intently. The person nods in agreement when others speak but does not participate verbally. Which action is most effective for the occupational therapist to take to facilitate the individual's engagement in the group? a Reiterate the group's norm that active participation is expected from all group members. b Ask the individual several questions to encourage verbal participation. c Invite the individual to join in the discussion, if the person would like. d Refer the individual to the center's social worker for individual, nongroup counseling.

B135. During a topical work preparation group for individuals recovering from mental illness, a member expresses concern about answering questions related to personal psychiatric history during a job interview. Which action is best for the occupational therapist to take in response to these expressed concerns? a Refer the client to a vocational rehabilitation counselor. b Encourage the other members of the group to share their interview experiences. c Lead a group discussion on the legal rights afforded in the interview process. d Support the client in not disclosing past psychiatric history.

B140. An individual with borderline personality disorder incurred a back injury while working as a stockperson for a large warehouse. The individual attends a work hardening program. The occupational therapist evaluates the individual and determines that the client's level of productivity is just below the warehouse minimum standards. The individual complains of pain when lifting the heaviest of boxes. The client frequently becomes angry and verbally abusive in response to directions or feedback. Which is the most important initial focus of the work hardening program for this individual? a An increase in productivity to meet minimum standards. b The development of strength and ergonomic lifting abilities. c The development of affective work behavior skills.

B144. An individual with developmental disabilities scores a Level 3 on the Allen Cognitive Level Test. Which activities should the occupational therapist include in the intervention plan to help meet the client's functional needs? a Community mobility activities such as taking a bus. b Home management activities such as preparing a food shopping list. c Self-care activities such as brushing teeth. d Leisure activities such as completing a 50-piece puzzle.

B160. An individual is status post carpal tunnel release. When the occupational therapist conducts a sensory test for sharp/dull (pain), the person reports dull as sharp on the palmar surface of the thumb and index finger. All other responses were correct. Which is accurate for the therapist to document about the individual's sensation? a Impaired for pain along C5 and C6 dermatomes. b Hypersensitive along the ulnar nerve distribution of the palmar surface of the hand. c Hypersensitive along the median nerve distribution of the thumb and index fingers. d Absent for pain along the median nerve distribution.

B162. A Level II fieldwork student's first assigned case is an individual with right hemiplegia. The supervising therapist reminds the student that primitive reflexes can emerge when someone incurs a CVA. The therapist demonstrates this point by rotating the client's head to the right and stating that the observed response demonstrates a subtle asymmetrical tonic neck reflex (ATNR). The therapist asks the student to describe the client's reaction that resulted in the therapist's interpretation. Which is most accurate for the student to state the client is exhibiting based on this observation? a Increased flexor tone of the right upper extremity. b Increased extensor tone of the left upper extremity. c Increased extensor tone of the right upper extremity. d Increased extensor tone in both upper extremities.

B165. An occupational therapist completes a cognitive screening for a person with chronic schizophrenia, undifferentiated type. The therapist uses Allen's cognitive disabilities model to guide the evaluation process. During the screening, the person is able to imitate the whipstitch but cannot imitate the single cordovan stitch. Based on these results, the occupational therapist determines that further evaluation is indicated. Which ability is most relevant for the therapist to assess? a Performance of multistep tasks using overt trial and error problem-solving. b Performance of multistep tasks using analytical reasoning. c Performance of simple tasks independently using visual cues. d Performance of simple tasks with long-term repetitive training.

B80. An individual with Parkinson's disease exhibits difficulty moving from sitting in a chair to standing. Which technique is best for the therapist to recommend the person use to help successfully complete this functional mobility activity? a Rise from the chair while sitting with buttocks against the back of the chair. b Extend both legs so that both feet are away from the chair while rising. c Sit at the edge of the chair and rock back and forth before rising. d Rise while weight-bearing on one foot and pushing up with both arms.

Questions B150 to B152 are based on the following information. An individual recovering from flexor tendon repair surgery is two days post-operation. The surgeon refers the client to occupational therapy with a prescription to use the Kleinert protocol to guide intervention. B150. The occupational therapist plans the client's early mobilization program. Which is the most appropriate exercise routine for the occupational therapist to use within the limits of a dorsal block splint? a Active flexion/passive extension. b Active flexion/active extension. c Active extension/passive flexion. d Passive flexion/passive extension.

Questions B150 to B152 are based on the following information. An individual recovering from flexor tendon repair surgery is two days post-operation. The surgeon refers the client to occupational therapy with a prescription to use the Kleinert protocol to guide intervention. B151. The occupational therapist meets with the client to ensure compliance with the prescribed splinting protocol. Which is the most important outcome of this session? a The client's adherence to a written splint wearing schedule. b The client's ability to independently don and doff the splint. c The client's understanding of the purpose(s) and procedure(s) of the splint protocol. d The completion of functional training in the use of the splint.

B101. An occupational therapist works in a program for survivors of domestic violence. The therapist applies a client-centered approach to guide intervention. When using this approach, which is best for the therapist to do? a Offer specific concrete behavioral suggestions for dealing with confrontations. b Respond to the participants' self-deprecating comments with positive feedback on personal characteristics. c Reinforce only the participants' neutral comments about themselves and personal skills. d Reflectively paraphrase the participants' statements and ask for their verification.

B102. A patient is recovering from a right CVA resulting in severe left hemiplegia and visuospatial deficits. Their left lower extremity has pitting edema. Which wheelchair would be best for the occupational therapist to recommend for this patient? a A powered wheelchair with a joystick control and dual elevating leg rests. b A lightweight active duty wheelchair with dual elevating leg rests. c A one-arm drive chair with an elevating leg rest on the left. d A hemiplegic chair with an elevating leg rest on the left.

B116. The administrator of a home care agency tells the occupational therapist to submit all intervention plans to the client's third party payers, prior to the implementation of treatment. Which is the most accurate term for the therapist to use when documenting these actions? a Concurrent review. b Peer review. c Utilization review. d Prospective review.

B119. An older adult recovering from a myocardial infarction is referred to occupational therapy for a home care evaluation. The referral states that the client has high blood pressure and medication-related orthostatic hypotension. Which precaution is most important for the occupational therapist to observe with this client? a Adherence to dietary restrictions during meal preparation activities. b Avoidance of activities that require movement against gravity. c Delay of the OT evaluation until the client's medications are stabilized. d Avoidance of activities that require sudden postural changes.

B120. An occupational therapist measures a person for a wheelchair. The widest point across the person's hips and thighs is 16 inches and the greatest length from the person's posterior portion of the buttocks to the popliteal fossa is 18 inches. Which wheelchair seat dimensions should the therapist recommend? a 18 inches wide by 20 inches deep. b 18 inches wide by 18 inches deep. c 16 inches wide by 18 inches deep. d 18 inches wide by 16 inches deep.

B121. An occupational therapist provides bed mobility training for an individual recovering from a left CVA. The therapist notes that the person's right calf is swollen and warm. The person complains that it is painful. Which action should the therapist take initially? a Elevate the leg and provide retrograde massage. b Advise the person to tell the physician about the symptoms during the physician's next bedside visit. c Continue with the training and document the symptoms in the medical record. d Contact the charge nurse immediately to report symptoms.

B125. A person with arthrogryposis undergoes serial casting with weekly cast changes of the right wrist. Upon cast removal during the fourth week, the therapist notes a small open area 0.25 cm by 0.25 cm and a red rash over the ulnar styloid. Which is the therapist's best response to these observations? a Pad the area and apply another cast. b Refer the individual to the wound care team. c Fabricate a static splint that does not impede on the ulnar styloid. d Contact the physician and describe the observations.

B131. An adolescent with spina bifida at the C8 level wants to access the new computerized play system that was received as a birthday gift. Which is the best adaptation for the occupational therapist to recommend the adolescent use to access this system? a A chin switch. b A tenodesis splint. c A universal cuff. d A joystick control.

B138. A Sensory Profile completed by a caregiver indicates that an elementary school-aged child has modulation impairments and sensation seeking patterns. The occupational therapist observes the child frequently wandering, bumping into objects in the room, and fidgeting. Which is the best intervention approach for the therapist to use to address this child's deficits? a Strategies to increase random sensory input and encourage high physical activity at home. b An obstacle course that requires diverse movements for varied proprioceptive and tactile input. c Sensory experiences that focus on body awareness and grading control during play activities. d A sensory diet that includes controlled sensory input integrated into the child's daily routine.

B149. A middle school student with learning disabilities exhibits no behavioral problems in the classroom. However, whenever the class is in a line waiting to switch classrooms, the student becomes agitated and often pushes classmates. The occupational therapy consultant advises the teacher that this behavior may be indicative of an underlying disorder. Which of the following is most accurate for the therapist to identify as a potential disorder warranting further evaluation? a Gravitational insecurity. b A conduct disorder. c Antisocial tendencies. d Tactile defensiveness.

B154. A rehabilitation hospital is interested in starting a driver rehabilitation program. Which must the occupational therapist hired to develop this program do first? a Determine the cost of commercially available driving rehabilitation programs. b Develop admission criteria for program participants. c Develop a marketing plan to obtain referrals. d Learn the state's driving laws and requirements.

B157. An older adult with Parkinson's disease has a secondary diagnosis of a major depressive disorder. During home-based occupational therapy service provision, the client exhibits increased confusion and disorientation. Which action is best for the home care occupational therapist to advise the client's primary caregiver to take in response to the client's change in status? a Schedule a neurological evaluation to rule out a neurocognitive disorder. b Seek support from a caregiver's respite program. c Discuss placement alternatives with the social worker. d Contact the client's physician to request a medical evaluation.

B164. A graduate student with an anxiety disorder reports feeling confused about the future. During the OT evaluation, the client relates decreased feelings of competence for their chosen field of study and overall poor personal causation. Which is the best initial action for the therapist to take in response to the client's stated concerns? a Administer a vocational interest inventory. b Provide activities related to the client's chosen field of study. c Refer the client to the state office of vocational and educational services. d Establish short-term goals with high potential for attainment.

B87. An adult is hospitalized and diagnosed with mild chronic obstructive pulmonary disease (COPD). During the discharge planning session, the person identifies a desire to exercise regularly. Which of the following should the occupational therapist recommend the client pursue? a The hospital wellness program's yoga group. b Low-impact aerobics at a local gym. c Weight-lifting under the direction of a personal trainer. d Jogging in a local park with friends.

B10. Following nerve injury repair surgery, an individual is evaluated for sensory return. Which measurement tool is best for the occupational therapist to use to assess for the return of vibration? a A tuning fork. b Nylon filament. c A disk-criminator.

B108. An individual has had a brain tumor removed from the cerebellum. The occupational therapist conducts a screening to determine the need for further evaluation. During the screening the therapist observes deficits that indicate the need for further evaluation. Which would be most relevant for the therapist to evaluate based on this screening? a Proprioception and coordination. b Tactile and sensory integration. c Vision and visual-perception. d Audition and communication.

B109. A client participates in occupational therapy for intervention following a rotator cuff injury. The therapist provides progressive resistive exercises. When grading these exercises, which of the following is best for the therapist to increase? a The amount of resistance provided with a stronger level of therapy band. b The proximal load on the muscles the client uses during the exercises. c The repetitions of external rotation exercises with less distal weight.

B114. An occupational therapist designs a qualitative research study to examine the efficacy of an after-school play based program for the development of social interaction skills. Which method of data collection is best for the therapist to use? a The therapist's observations of the participating children in the classroom and during recess. b The completion of a social skills Likert-scale questionnaire by the participants' teachers. c The completion of a social skills Likert-scale questionnaire by the participants' parents. d The administration of a social skills evaluation pre- and postintervention.

B26. A seven-year-old child with spina bifida at the C7 level receives home-based occupational therapy services. Which ability is most relevant for the occupational therapist to focus on during intervention? a Dressing the lower body. b Dressing the upper body. c Playing tabletop games.

B9. An occupational therapist designs a dining rehabilitation program in a long-term care facility. The occupational therapist instructs paraprofessional staff in proper feeding techniques. Which point is most important for the therapist to include in this staff training? a Meals should occur in a homelike environment with staff conversing with the residents being fed. b Residents with swallowing difficulties should be fed in a group so that staff can remind them to c swallow at the beginning of each meal. c Placing three fingertips on the throat and pressing firmly will stimulate a swallow response. d The head should be tilted slightly backward during feeding to facilitate an assisted swallow.

B59. The occupational therapist plans intervention for a client with a recent diagnosis of complex regional pain syndrome (CRPS) Type I. Which intervention approach is most effective to use to reduce pain and increase function? a Hot packs. b Biofeedback. c Paraffin. d Passive range of motion.

Questions B43 to B47 are based on the following information. An adult who incurred a traumatic brain injury three months ago is referred to a home care agency to receive OT services. The client's referral states that cognition is at Level VII of the Rancho Los Amigos scale and that grasp and shoulder mobility are limited. During the initial interview, the client reports being frustrated by the inability to independently engage in the previously enjoyed and personally meaningful activity of cooking. The client reports frequently losing place when reading recipes and an inability to "find" things in the kitchen. B46. During an intervention session focused on the development of grasp and shoulder mobility, the occupational therapist asks the client to move numerous identical one pound cans of vegetables from the counter top to the cabinet shelf above the counter. According to contemporary motor learning approaches, which type of practice has the therapist designed this activity to provide to the client? a Random practice. b Blocked practice. c Contextual practice.

Questions B43 to B47 are based on the following information. An adult who incurred a traumatic brain injury three months ago is referred to a home care agency to receive OT services. The client's referral states that cognition is at Level VII of the Rancho Los Amigos scale and that grasp and shoulder mobility are limited. During the initial interview, the client reports being frustrated by the inability to independently engage in the previously enjoyed and personally meaningful activity of cooking. The client reports frequently losing place when reading recipes and an inability to "find" things in the kitchen. B47. The client is attending a vocational rehabilitation program three days a week but is frequently late due to difficulties with getting ready in the morning. The client asks the home-care therapist for suggestions to address this problem. Which is the most appropriate action for the occupational therapist to take in response to the client's request? a Advocate that the vocational program provide the client with a flexible start time. b Develop a visual chart with the client, depicting the necessary sequence of their morning activities. c Advise the client to call the vocational program to tell staff when they are running late. d Advise the client to wake up one hour earlier on vocational rehabilitation program days.

B100. An occupational therapist working in an outpatient clinic observes the clinic's administrative assistant leaving patient records open on the clinic's reception counter. The assistant has left the clinic to go for lunch. Which action is best for the therapist to take in response to this observation? a Remind the administrative assistant of the need to keep patient records private when they return from lunch. b Immediately contact the administrative assistant's direct supervisor to report this observation. c Pick up the records and place them in a location out of public view. d Discuss the issue with the clinic's director during their next scheduled supervision session.

B107. An occupational therapist working for a home care agency provides an inservice to new employees on Medicare reimbursement guidelines for durable medical equipment (DME). Which item would the therapist describe as reimbursable by Medicare? a A raised toilet seat for a patient after a hip replacement. b A reacher for a person with arthritis in both hips. c A walker for a person who cannot ambulate in the home without one. d Grab bars in the bathroom for a person who cannot bathe or toilet without them.

B110. A toddler with developmental delays attends an early intervention program. Over the past two weeks, the toddler has successfully completed the activities the occupational therapist has provided in order to develop a palmar grasp. Which action should the therapist take next in response to the child's progress? a Continue providing the child with the activities to refine palmar grasp. b Review the initial evaluation to determine new goals. c Provide activities to develop a radial palmar grasp. d Provide activities to develop an ulnar palmar grasp.

B122. An individual with bilateral proximal weakness identifies a goal of independence in self-feeding. Which equipment is most beneficial for the occupational therapist to recommend for goal attainment? a Extended long-handled utensils. b Built-up handled utensils. c An electric feeder. d Mobile arm supports.

B67. A person with scleroderma has limited upper extremity ROM. Coordination is within functional limits. The occupational therapist assesses the individual's computer inputting capabilities and provides a recommendation to improve efficacy. Which adaptation would be most effective for this person? a An expanded keyboard. b A concept keyboard. c A key guard. d A contracted keyboard.

B69. An elementary school-aged child with Duchenne's muscular dystrophy receives occupational therapy services. The family establishes a goal of maintaining the child's leisure and social participation. Which is the best activity for the occupational therapist to recommend the family pursue with this child? a Electronic sports (e.g., Wii bowling). b Adapted little league baseball. c Wheelchair basketball. d Recreational swimming.

B79. An occupational therapist working in a skilled nursing facility observes a resident with cognitive disabilities don slippers by putting them on the wrong feet. The resident plans to go visit a friend on another floor and does not seem aware that the slippers are on the wrong feet. Which is the best action for the therapist to take in response to this situation? a Say nothing for this error may embarrass the resident. b Say nothing but follow the resident to the friend's room to ensure a safe arrival. c Ask the resident to look at the slippers to see if the error is noticed. d Approach the resident and advise the resident to reverse the slippers.

B7. An occupational therapist consults with a home care agency interested in starting a falls prevention program. Which should the occupational therapist do first? a Review available evaluation protocols. b Review available screening tools. c Create a new screening tool. d Design an evaluation protocol.

B66. A client recovering from a left CVA demonstrates increased flexor tone in the dominant right upper extremity while trying to re-learn to write with the left hand. Which of the following is most accurate for the therapist to state the client is exhibiting when documenting this observation? a An associated reaction. b A crossed flexion reaction. c An asymmetrical tonic neck reflex.

B73. During an occupational therapy screening session, the therapist observes that a child bangs objects on a tabletop but is unable to give up a toy upon request. The occupational therapist documents these behaviors. Which developmental level is indicated by the child's observed behaviors and would be the most accurate for the therapist to report? a 3-4 months. b 7-8 months. c 9-10 months.

B15. An individual recovering from an exacerbation of multiple sclerosis is referred by a primary care physician to an outpatient OT clinic. The referral requests that the occupational therapist complete a functional capacity evaluation. Which is the most likely reason for this referral? a Determination of cognitive level. b Determination of disability status. c Assessment of instrumental activities of daily living. d Assessment of return-to-work capabilities.

B55. An occupational therapist conducts an intervention session with a client recovering from a CVA to develop transfer skills. The client has a comorbidity of epilepsy with primary generalized seizures. As the client stands to complete a transfer from the wheelchair to the bed, the client reports feeling sensations that are indicative of an aura. Which is the best immediate action for the therapist to take in response to this situation? a Provide reassurance and ask for guidance from the physician. b Return the client to a seated position in the wheelchair until the sensations pass. c End the session so the client can rest. d Guide the person into a sidelying position on the bed.

B90. An occupational therapist provides intervention to develop independent feeding skills in an 18-month-old child with significant developmental delays. The child has mastered the ability to hold a spoon and bang it on the tray of the high chair. The child can also hold and suck on a cracker. Which activity is best for the therapist to provide next during intervention? a Finger-feeding soft foods. b Scooping food and bringing it to the mouth. c Taking cereal from a spoon held by the therapist. d Bringing a filled spoon to the mouth.

B51. An individual cannot independently get from a supine position to a sitting position. The person has good scapular, shoulder, and elbow muscle strength. Which of the following should the occupational therapist recommend as most effective for the client to use to improve bed mobility? a A leg lifter. b A bed rail assist. c A log roll technique. d A rope ladder.

B65. A child with developmental delay has poor oral motor control. Which should the occupational therapist do to facilitate lip closure? a. Give pressure with the index finger under the jaw. b. Firmly place a spoon with food on the back part of the tongue. c. Place the thumbs on the lateral ends of the mandibles. d. Give a slight upward sweep of the index finger from the lower jaw to the lower lip.

B1. An occupational therapist provides consultation services to a psychogeriatric unit for individuals with moderately severe cognitive decline. In designing the activity program, which groups are best for the occupational therapist to include? a. Reality orientation. b. Sensory stimulation. c. Reminiscence. d. Coping skills.

B97. In an outpatient rehabilitation clinic, an occupational therapist is developing a fall prevention group for at-risk older adults with Parkinson's disease. The clients live alone and have had at least three falls within the past six months. When presenting strategies to prevent falls, which is the most common risk factor for falls in the older adults that the therapist should review with the clients? a Ascending and descending stairs. b Dressing while seated in a chair. c Walking with a walker with wheels. d Transferring out of the shower with grab bars.

B99. An occupational therapist conducts an in-service at an outpatient wheelchair clinic for individuals with central nervous system dysfunction. According to the principles of wheelchair prescription, which of the following statements is accurate for the therapist to make during the presentation? a Firm seats are needed to provide stability. b Soft seats are needed to prevent decubiti. c Back heights should be extended to facilitate weight shifting. d Seat angles should be 45° to prevent falling forward.

B23. A child with a diagnosis of traumatic brain injury (TBI) is evaluated by an occupational therapist. The child presents with extension of both upper extremities and flexion of both lower extremities following a stimulus of neck extension. When interpreting this observation, which statement is most accurate for the therapist to document? a The presence of + ATNR, which is "abnormal" and has reappeared after the TBI. b The presence of a + STNR, which is "normal" and not affected by the TBI. c The presence of a + ATNR, which is "normal" and not affected by the TBI. d The presence of a + STNR, which is "abnormal" and has reappeared after the TBI.

B50. A person recovering from a cerebral vascular accident has left-sided weakness and dysphagia. Which of the following is the most effective direct intervention approach to help the person successfully swallow ingested food? a Provide pureed, thick liquids. b Provide thermal stimulation to the inferior faucial arches. c Tilt the person's head back and toward the left side. d Provide small, warm boluses.

B72. An older adult diagnosed three years ago with a neurocognitive disorder has been admitted to the hospital for regulation of medication. The occupational therapist determines that the person demonstrates diminished memory skills since the previous evaluation but is still able to live independently at home with support and supervision. During the discharge planning meeting, which activity should the therapist recommend family members perform for the patient? a Weeding the garden. b Sorting and folding laundry. c Preparing cold sandwiches. d Cooking hot meals.

B14. An occupational therapist working in an outpatient cardiac rehabilitation center develops an intervention plan for an individual who has entered Phase 2 of cardiac recovery. Which activities should the therapist recommend be included in this intervention plan? a Weeding a garden and doing low-impact aerobics. b Putting away groceries and keyboarding. c Washing dishes and playing tabletop board games. d Carrying groceries upstairs and playing basketball.

B22. An occupational therapist provides intervention for an individual with a swallowing disorder. To elicit a swallow reflex, the occupational therapist provides sensory input to the inferior facial arches. Which should the therapist use to provide this intervention? a A tongue depressor. b A moistened cotton swab. c A chilled dental examination mirror. d A warmed metal teaspoon.

B5. An occupational therapist observes a COTA® having difficulty transferring a client with athetoid movements from a mat to a wheelchair. Before the therapist can cross the room to help with the transfer, the COTA® slides with the client to the floor. The therapist assists the COTA® in safely returning the client to the wheelchair. They assess that the client appears to be unharmed and return the client to the unit for a medical evaluation. Which action should the therapist take next? a Counsel the COTA® on the need to ask for assistance with difficult transfers. b Require the COTA® to attend a transfer training inservice. c Document the COTA®'s unsafe actions in the personnel record. d Complete an occurrence report according to facility standards.

B61. An occupational therapist provides home-based services to a home maintainer who incurred a right CVA eight months ago. The individual and the therapist have chosen to focus on kitchen activities during the intervention session. The therapist has the client stand in front of the counter with an open dishwasher to the left. The therapist asks the client to put the clean dishes into an overhead cabinet to the right of the client using the affected UE. By setting up the activity in this manner, which proprioceptive neuromuscular facilitation (PNF) technique is the therapist using? a Heavy work/mobility superimposed on stability. b Reciprocal inhibition/innervation. c Diagonal patterns of D2 flexion/extension. d Diagonal patterns of D1 flexion/extension.

B40. An individual prepares for discharge home following rehabilitation for a left cerebrovascular accident (CVA). Residual difficulties include fair dynamic balance and decreased proximal upper extremity (UE) strength. The individual's stated priority is to be able to ambulate safely to the senior center located in the client's apartment building. Which ambulatory aid would be most effective for the occupational therapist to recommend to this client? a A hemi-walker. b A rolling walker. c A side-stepper walker. d A standard walker.

B35. An occupational therapist supervises a Level II Fieldwork student regarding the evaluation procedures of a work hardening program. The therapist explains that some individuals attending the program magnify their symptoms to retain benefits; therefore, the validity of some evaluation measures may be compromised. Which assessment tool does the therapist identify as providing the most valid results? a A volumeter. b A dynamometer (all five positions). c A standardized pegboard test. d A total active motion (TAM) evaluation.

B36. Two COTAs working for a school district are assigned to two different schools. One school has a supervising occupational therapist, the other school does not. The COTA without a supervising therapist expresses concern to the COTA who is supervised about the lack of supervision. Which is the best response for the supervised COTA to take in response to this situation? a Report the situation to their OT supervisor. b Share information acquired during supervisory sessions with the unsupervised COTA. c Advise the unsupervised COTA to contact the state regulatory board. d Report the situation to the school district's administration.

B54. An occupational therapist working in a skilled nursing facility conducts an inservice on validation therapy for the recently hired staff of a new psychogeriatric unit. Which fundamental principle of validation therapy is important for the therapist to include in this presentation? a Listen to the words an individual uses to ascertain the person's underlying message. b Provide highly structured activities to refocus the individual on reality. c Provide unstructured activities to facilitate the expression of feelings. d Listen to the words an individual uses and provide reality orientation for invalid statements.

B58. An occupational therapist leads a social skills group for children aged 10-12 with conduct disorders. One of the children complains that the group activity is stupid and boring. Which is the most effective response for the occupational therapist to provide in response to this complaint? a Encourage the child to complete the activity with the group. b Allow the child to leave the group since they are uninterested. c Allow the child to suggest a different group activity. d Tell the child the complaint will be discussed at the next family meeting.

B19. The parents of an infant born at 32 weeks' gestation are about to take the baby home after four weeks in the neonatal intensive care nursery. Which is most important for the occupational therapist to instruct the parents to avoid? a Placing the infant in the prone position for sleeping. b Placing the infant in the supine position for sleeping. c Using an infant swing with a head support for calming. d Presenting toys in the mid-line with the infant in the prone position for playing.

B6. A teenager with spinal muscle atrophy shows decreased trunk balance and strength. Upper extremity strength and ROM are unchanged from the last evaluation. Which is the best recommendation for the occupational therapist to make? a A re-evaluation of the client be completed. b The client be referred to an orthotist for a soft spinal support. c The client be measured for a power wheelchair. d A trunk strengthening program be initiated with the client.

B21. An occupational therapist provides bedside BADL training to a patient recovering from multiple injuries incurred during a motor vehicle accident. The patient's children arrive for a visit and ask the therapist to let them look at their parent's chart while they wait outside the room for the session to conclude. Which response is best for the therapist to make in response to this request? a Tell the family members that they must have the permission of their parent before they can look at the chart. b Commend the family members for their interest in their parent's status and give them the chart to read. c Tell the family members to ask the unit's charge nurse for permission to look at the chart.

B76. Several residents of a skilled nursing facility report that they are bored with their individual daily range of motion exercise programs. The occupational therapist collaborates with the physical therapist to design a group format to facilitate participation in range of motion exercises. Which would be most beneficial for the therapist to recommend incorporating into the proposed group? a The use of several exercise videos with diverse exercise styles and music. b The pairing of residents to perform gentle range of motion on each other. c The use of exercises performed in rhythm to a marching band video. d The provision of coffee and cake after the group.

B75. A client attends a work hardening program. The client arrives on time for the scheduled session but complains of significant substernal pain, extreme discomfort in the epigastric area, indigestion and nausea. Which is the best action for the occupational therapist to take in response to the client's expressed complaints? a Initiate the session and provide breaks and activity modifications as needed. b Cancel the session and immediately call emergency medical services (EMS). c Cancel the session and tell the client to call to reschedule when feeling better. d Cancel the session and call the client's physician to discuss the client's complaints.

B48. An occupational therapist works with adolescents with intellectual disabilities who are participating in a community integration program in an urban area. When implementing a community mobility group focused on the use of public transportation, which should the occupational therapist have the group do first? a Read a subway or bus map. b Take a subway or bus as a group. c Determine a destination. d Purchase a subway or bus fare card.

B27. An OT administrator is designing a patient satisfaction questionnaire to be administered upon discharge from the OT program. The administrator designs the questionnaire so that individuals will indicate their level of agreement with a series of statements by circling a number with 1 = very dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, and 5 = very satisfied. Which method of data collection is the administrator using? a Gutman scale rank ordering. b A Likert scale. c A semantic differential.

B28. A 10-year-old with congenital anomalies wears bilateral ankle-foot orthoses. The parents want the child to be able to don and doff shoes independently, but the child cannot tie shoes. Which is the best footwear recommendation for the therapist to make for the child to wear? a Leather slip-on loafers. b Slip-on tennis shoes with no laces. c Running shoes with Velcro shoe closures. d Hi-rise sneakers with sliding adapters on the laces.

NBCOT Prep B

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