neuroDegenerative diseases.
A COTA® is treating a client in the recovery stages of Guillain-Barré syndrome (GBS). According to the biomechanical frame of reference, what is a preparatory method that would BEST address upper-body dressing? A. Instruct the client in hand-strengthening exercises using therapy putty. B. Provide night time resting hand splints to prevent contractures. C. Teach the client how to use a dressing stick. D. Develop a home exercise program for upper-body ROM.
A A correctly addresses hand weakness and its effects on fine motor tasks of dressing. The biomechanical frame of reference is a common theory used in practice and focuses on restoring or remediating skills to enhance occupational performance. A hand-strengthening program would restore needed ROM and muscle power to adequately perform fine motor tasks. ----- B, C: Splinting and teaching use of a dressing stick are interventions aimed more at compensatory strategies and therefore fall under the rehabilitative frame of reference. These types of interventions may be appropriate in the plateau stage when a client may be at risk for contractures and impaired ADLs requiring use of adaptive equipment. D: A home program would not be a preparatory method.
During an initial evaluation conducted by an OTR®, a client with Stage 1 Parkinson's disease (PD) identified grocery shopping as a valued occupation, but listed fatigue as a barrier and stated that occasional tremors could be embarrassing. What intervention approach would be meaningful as the COTA® prepares to accompany the client to the store for an occupation-based treatment session? A. Create a list of needed items and make a route to easily navigate the store. B. Provide the client with psychosocial support to focus on reducing the anxiety associated with symptoms. C. Instruct the client to don wrist weights to reduce tremors while reaching for items to put in the shopping cart. D. Instruct the client to use a rollator to take seated rest breaks while grocery shopping.
A A is the simplest approach; organizing a grocery list and planning the most efficient route through the store to obtain the needed items is an energy conservation technique that maintains dignity. ----- B: Psychosocial support is an ongoing intervention tool but not the most effective for successful participation in this client-chosen task. C: Donning wrist weights may help some clients with PD reduce tremors, but adding weights might increase fatigue and may also draw attention to the disability. D: A client with Stage 1 PD does not typically present with balance deficits; using assistive devices or a wheelchair may help conserve energy, but it is most likely inappropriate for this client and may enhance feelings of shame or disability.
A client who has Parkinson's disease reports increased tremors, problems knocking items over while eating, and poor articulation, leading to recent social isolation. Which intervention strategy would be MOST effective for this client? A. Educate about timing social activities when medication is most effective. B. Train in facial exercises to improve speech quality and communication. C. Provide utensils with built-up handles during mealtimes to decrease spills. D. Suggest a community support group to provide a social outlet.
A Activities should be timed during medication "on" times. Determining a client's optimal time of day for activities promotes increased success in occupational performance. --------- B: Facial exercises may help improve communication but do not address increased tremors. C: Adaptive equipment for mealtimes addresses motor impairments but does not address speech concerns. D: A community support group may be an effective intervention once the motor impairment and communication difficulty issues are addressed
A client in the early stage of Huntington's disease (HD) displays difficulty with initiation and completion of the morning grooming routine. What might be a good approach for the COTA® to use to help the client become more independent in this activity? A. Train the client in the use of checklists for completion of daily living tasks, including the morning grooming routine. B. Remove any barriers from the bathroom because they may impair the client's mobility and prevent the client from using the bathroom for grooming. C. Recommend that the client's caregiver offer as much physical assistance as possible to decrease frustration during the task. D. Suggest that the client move through the steps of the task as naturally as possible, not worrying about the quality of each step.
A Checklists for completion are an effective strategy that a COTA® might use with clients with HD who are having difficulty initiating and completing multistep tasks. ------ B: Barriers, although important, are probably not the reason that the client is having difficulty with the morning grooming routine. C: With clients with HD, it is important to encourage as much independence as possible to reduce caregiver burden and improve the client's quality of life. D: Each individual step of a task should be completed before moving onto the next step to ensure proper completion of a task.
The caregiver of a client with Alzheimer's disease questions the home health COTA® about a recent increase in the client's dosage of donepezil (Aricept) prescribed by the physician. The caregiver is particularly concerned about potential consequences of the increased dosage. What is the COTA®'s most appropriate suggestion for the caregiver? A. Observe the client for signs of dizziness, which increases potential for falls. B. Because the medication can cause photosensitivity, keep the client out of direct sunlight. C. Have the physician monitor the client closely for potential drug toxicity. D. Monitor the client's hydration carefully because the drug can cause dry mouth and constipation.
A Donepezil is a cholinergic-modulating drug that may improve memory and cognition and reduce negative mood, anxiety, and hallucinations; however, dizziness is a side effect.
What strategy might a COTA® appropriately recommend to caregivers of a client with Alzheimer's disease to assist with fall prevention? A. Engage the client in daily, structured activity. B. Provide visual reminders in the home environment. C. Install grab bars in the bathroom. D. Engage the client in an exercise program.
A Engagement in activity-based interventions, along with daily structure, has been documented to assist in fall prevention. ----- B, C, D: Visual reminders and installation of grab bars might be appropriate for clients with dementia, but the strongest evidence supports using structured activity to engage clients with AD to prevent falls. D: Exercise might improve balance, strength, and gait, which could have an indirect effect on falls, but the strongest evidence supports using structured activity to engage clients with AD to prevent falls.
A COTA® is treating an inpatient who has myasthenia gravis and is preparing for discharge to live alone at home. What information is MOST IMPORTANT for the COTA® to discuss with the patient? A. Precautions against overexertion, emotional stress, and fluctuations in temperature B. Types of communication devices and environmental control units that promote ADL independence C. The importance of resistive activities for improving muscular strength and endurance D. Compensatory strategies for adapting to changes in visual status
A Overexertion, emotional stress, and temperature elevations may exacerbate the symptoms of myasthenia gravis, and patients should be educated to minimize these situations. ----- B: Adaptive devices may or may not be necessary for a patient with myasthenia gravis and are not the most important information for a patient. C: Muscle weakness is not a primary symptom of myasthenia gravis, so resistive exercises are not the most important information for a patient. D: Compensatory strategies for visual changes may not be needed, and a patient would more likely benefit from environmental modifications in the patient's home to address visual changes.
A COTA® is completing a home health visit for a client who has Alzheimer's disease and lives alone. A family member reports finding an accumulation of uneaten meals in the refrigerator and the gas oven turned on. In addition to recommending a comprehensive home safety evaluation, what INITIAL action should the COTA® take based on this report? A. Provide resources and options for addressing the client's needs B. Help the family develop a schedule for mealtime family visits C. Recommend initiating Meals On Wheels community services D. Discuss with the caregiver the importance of aging in place
A Providing caregivers with available community and national resources is essential as the COTA® becomes aware of client and family needs. Offering reliable resources and making necessary referrals is important in providing the needed assistance for this family. ----- B: The COTA® should not assume that the family is able to provide daily mealtime visits; other resources may be needed to meet the client's needs. C: If the client is already being provided meals and they are not being eaten, Meals On Wheels may not be a reasonable solution. Meals On Wheels is one community resource that is available, although the caregivers should be aware of all resources and possible referrals that are needed to ensure the client's safety. D: Aging in place often requires support services and other resources, which the COTA® should provide for the caregivers.
Why might a client with early-stage dementia appear less spontaneous when performing daily routines? A. The client may be compensating for memory loss. B. The client may be compensating for decreased orientation. C. The client may be compensating for decreased spatial orientation. D. The client may be compensating for decreased temporal organization.
A The client may be aware of memory loss at this stage and compensate by becoming rigid in routines so that the client still appears to others to have intact memory skills. ----- B, C, D: These responses are deficits first noticed in early-stage dementia, but they would not have a direct impact on the client's ADL routine; IADLs would most likely be affected first.
A client with a recent diagnosis of dementia is receiving occupational therapy. The caregivers are most distressed about significant behavioral changes that have occurred since the client was diagnosed. The client has become increasingly impulsive and difficult to redirect. What type of dementia does this client MOST LIKELY have? A. Frontotemporal dementia B. Alzheimer's dementia C. Vascular dementia D. Dementia with Lewy bodies
A The distinguishing feature of frontotemporal dementia is behavioral changes with an increase in disinhibited behavior, decreased social tact, lack of empathy, and lack of interest. ---- B, C, D: None of these dementia categories has behavioral changes as a significant symptom.
A client with advanced amyotrophic lateral sclerosis (ALS) is new to a computerized communication device. What would the COTA® focus on for the first treatment session with the client with this device? A. The client's posture in the wheelchair for optimal use of the device B. Hand ROM exercises to enable the client to adequately reach the device C. Trunk strengthening to support upright sitting during use of the device D. Adapting the device with larger buttons and controls to enable independent use
A The simplest and first approach would be to ensure positioning so that the client can see the device and stabilizing the neck and shoulder (proximal muscles) to allow the most distal control. The placement of the device is also important for optimal use of device. ----- B, C: These are more remedial or restorative approaches that are not appropriate for a client with a progressive disease, especially in advanced stages. D: Adaptations such as larger buttons and controls may be appropriate if proper positioning alone is insufficient for independent use of the device.
A client presents with decreased orientation. What is the most effective strategy for a COTA® to implement to assist with this cognitive impairment? A. Use an orientation poster in a common area with personal and day-time information listed. B. Provide auditory reminders throughout the day that provide basic personal and day-time information. C. Provide the client with orientation information only when requested to prevent undue anxiety. D. Allow the client to establish his or her own routine, even if that means allowing the client to dress for the day in the middle of the night.
A Visual reminders are an effective strategy for deficits in orientation. ---- B, C, D: Auditory reminders may be effective, but visual reminders that can be referred to throughout the day are more effective.
A COTA® is working with the caregiver of a person with Alzheimer's disease (AD) to provide strategies to reduce the burden of caregiving. What strategies might the COTA suggest? Select the 3 BEST choices. A. Engage the client in appropriate activities during unoccupied time to improve daily structure B. Avoid overstimulation in the environment to reduce behavioral symptoms C. Compensate for declining function in the least restrictive environment D. Allow the client to continue cooking independently with adapted cooking utensils to improve safety E. Challenge the client's daily routine by maintaining moderate distance during routine tasks F. Take a short break outside the home each morning after the client has taken medication to avoid burnout
A,B,C A: Providing structure for unoccupied time is an important consideration to prevent behavior problems and maintain quality of life for clients with AD. In addition, structure promotes an increase in goal-directed activity and may aid in more regular sleep patterns. B: Overstimulation can lead to behavioral issues, so avoiding overstimulation in the environment can improve optimal functioning. C: Intervention should support and maintain capabilities or compensate for a decline in function. ----- D: Providing education to the caregiver about potentially dangerous tasks is important; cooking is best done with supervision. E: Providing challenge to a client with AD can be frustrating and lead to an increase in confusion or agitation. F: People with AD should be supervised at all times because of the tendency to wander or become disoriented, impaired judgment, and increased fall risk.
A COTA® in an inpatient rehabilitation unit observes a newly evaluated patient with Parkinson's disease eating breakfast while seated in a bedside chair. The COTA observes a fork on the floor and milk spilled on the patient's gown and tray. The patient begins coughing and spitting up pieces of pancake, and then says hello with unswallowed food in the mouth. What should the COTA's next steps be with this patient? Select the 3 BEST choices. A. Instruct the patient on the use of adaptive feeding equipment and positioning recommendations to minimize spillage of foods and liquids B. Discuss with the patient an immediate switch to a mechanical soft diet C. Recommend the patient stop drinking the milk and proceed with using adaptive utensils to improve eating the pancake D. Clear the unswallowed food from the patient's mouth and then notify the nurse supervisor E. Notify the collaborating OTR® and speech-language pathologist of the incident F. Collaborate with the physical therapist to readjust the chair for optimal seating and positioning of the patient
A,D,E A: The use of adaptations to improve eating should be introduced during the initial stages of the care plan. D: Dysphagia care is provided by a multidisciplinary team that includes nurses. Communication to initially identify issues related to dysphagia need to happen at first signs to avoid future complications. E: Excessive coughing or choking before, during, or after swallowing can indicate a potential problem with aspiration. Further swallowing assessment by qualified professionals might be warranted.
A client with middle-stage Parkinson's disease demonstrates tremor and rigidity bilaterally in the upper extremities, mild difficulties with executive functioning, and increased fatigue during ADL and IADL performance. Which interventions should the COTA® consider? Select the 3 BEST choices. A. Stabilization of both upper extremities on a counter or tabletop to reduce the intensity of tremors B. Progressive resistive exercises to improve fine motor control and reduce the intensity of tremors C. Adaptation of the home with environmental control units to address fatigue and fine motor skills D. Modification of clothing with minimal fasteners or hook-and-loop closures to reduce fine motor demands E. Task simplification by having tools readily available for decreased energy expenditure F. Splinting to minimize tremor and to provide wrist and finger stability during fine motor coordination tasks
A,D,E A: Use of adaptive techniques to reduce the effects of tremor is recommended for improved ADL and IADL performance. D: Modifying or eliminating clothing fasteners decreases demand on fine motor coordination for a client experiencing tremors. E: Energy conservation or energy effectiveness strategies are indicated interventions for maintaining independence and participation in people with Parkinson's disease. ----- B: Resistive exercises do not improve fine motor control; they are used to increase gross motor control. C: Provision of environmental control units is most common in the late stages of Parkinson's disease to provide the person with some control over the environment. F: Splinting the neurologically impaired upper extremity is directed at preventing soft tissue contractures and restoring functional positioning. The tremors of Parkinson's disease do not create issues related to these conditions.
Which task might a person with early-stage dementia have difficulty performing as a result of typical psychosocial and cognitive abilities present during this stage? A. Completing the morning ADL routine consistently B. Balancing a checkbook C. Maintaining social interaction with family D. Cooking a simple meal
B Balancing a checkbook is a higher level cognitive task that will most likely be difficult for a client with early-stage dementia. Typically, people with early-stage dementia have the most difficulty with IADLs that require executive function, such as money management and driving. Other IADLs and ADLs become impaired as the disease progresses. -------- A: A morning ADL routine will be maintained by people with dementia until the middle stages. C: Social interactions will begin to deteriorate during the middle stage, as a result of memory loss. Marked loss of social interaction will occur during the middle stage, when the client has also lost sense of time. Late-stage dementia is characterized by minimal interaction and verbalization. D: The ability to plan for and cook for others will begin to decline in the early stage, but the ability to cook a simple meal will be maintained into the middle stage of dementia.
A client with middle-stage Huntington's disease (HD) is displaying fatigue during lower body dressing tasks. What would be an appropriate intervention strategy for the COTA® to use with this client? A. The COTA® should engage the client in an intense cardiovascular exercise routine. B. The COTA® should encourage the client to take frequent breaks during lower body ADL tasks. C. The COTA® should train the client in the use of lower body adaptive equipment such as a sock aid. D. The COTA® should educate the client's caregivers on appropriate assistance to provide for the client during dressing.
B Because the client's primary complaint is fatigue, taking rest breaks would be appropriate. ----- A: Given that HD is a progressive loss of motor control, an intense exercise routine would most likely be too difficult for the client. C: Incoordination and decreased motor control would make learning adaptive equipment difficult. D: Although caregiver education would be important, encouraging independence in ADLs as the client is able is still important to reduce caregiver burden and stress.
COTA®s can assist caregivers of clients with Alzheimer's disease (AD) with reducing stress and burden by providing what type of intervention? A. Habit training to improve independence in ADLs B. Education related to the progression of AD C. Environmental modifications to the home D. Recommendations related to assistive technology
B Education related to the progression of AD would be the most important intervention because such knowledge would allow the caregiver to have more control in choosing what types of intervention would be appropriate for the client and would, in turn, reduce caregiver stress. In addition, they would learn to distinguish the normal progression of AD from abnormal progression to advocate for better care of the client with AD. ---- A: Habit training would not be an appropriate intervention strategy for clients with AD, because it is likely to be ineffective. New learning diminishes as the client progresses through the stages of dementia. C, D: Environmental modifications and assistive technology would be appropriate interventions for clients with AD; however, caregiver education is more important because it puts the caregiver more in control when collaborating with the OTR®.
A client with Alzheimer's disease (AD) reports getting lost when going to a daughter's apartment. The client's daughter has been living in the same apartment building for more than 10 years, but she lives 3 hours away from the client. In what stage of dementia is this client? A. End B. Early C. Middle D. Late
B In the early stage of AD, higher level executive functions that affect IADL performance are the first observed signs of the disease process. --------- A: People in the end stage of AD will be unable to carry on conversation and unable to participate in any independent mobility, including community mobility. C: People with middle-stage dementia will also continue to have skills in habitual ADLs and routines. They can maintain conversation, but they will have lost the ability to complete most IADLs. D: People in late-stage dementia need assistance for all areas of function, both ADLs and IADLs.
A client with Parkinson's disease is experiencing difficulty in executive functioning. The client's spouse would like the client to continue participating in leisure activities. Which intervention would be the MOST appropriate for this client? A. Recommend environmental modifications to support engagement in activities. B. Suggest that the spouse provide checklists or reminders that use simple instructions. C. Provide a facial exercise program to improve social expressions. D. Instruct the client and spouse in simple leisure activities.
B Providing simple instructions best addresses the client's difficulty in executive functioning. ------
When dealing with clients who have dementia, what would be the primary role of the COTA® in addressing caregiver burden? A. Provide recommendations about community resources B. Provide recommendations about medication management C. Provide recommendations related to home modifications D. Provide recommendations related to safe transfers
C COTA®s have specific skill in providing recommendations about home modifications. Home modifications can benefit clients with dementia and their caregivers by providing a safe environment that prevents unsafe wandering and provides optimal occupational engagement for reduced caregiver burden. ----- A, D: COTA®s can provide information about community resources and safe transfers at various stages of the process, but home modification, which is a skill unique to occupational therapy, will have the most benefit to caregivers of clients with dementia. B: COTA®s should avoid providing recommendations about medication management but should refer caregivers to other health care providers who would be able to provide this information to them.
Which of the following clients is MOST likely to be characteristic of a person in the middle stage of Alzheimer's disease (AD)? A. A client who sees imaginary images B. A client who has gait and balance issues C. A client who is confused by simple directions D. A client who becomes extremely excited over simple events
C Confusion is commonly associated with the middle stage of AD. ------- A: Hallucinations are not usually associated with dementia. B: A person will develop difficulties with gait and balance in the late stages of AD. D: Elation is not typically a symptom of AD.
Which statement BEST describes an important consideration for COTA®s working with clients with dementia and their caregivers? A. Providing a variety of new occupations creates a sense of well-being for the caregiver and care recipient. B. A brief respite from caregiving benefits the caregiver but is detrimental to the care recipient. C. Everyday occupation is central to a caregiver's sense of well-being. D. Psychologically resisting the inevitability of chronic illness improves satisfaction with caregiving.
C Embracing everyday occupation has been shown to improve a sense of well-being in the caregiver and offers a suitable context for caregiving. ---- A, B, D: These choices do not support the principle of use of occupations and activities that are meaningful to the client during occupational therapy intervention.
A client with multiple sclerosis (MS) states that fatigue is negatively affecting work performance. What is the BEST action for the COTA® to take next? A. Discuss with the OTR® the need for the client to have a worksite evaluation for energy conservation techniques and environmental modifications. B. Collaborate with the client to problem-solve work demands, such as breaking tasks down, increasing rest breaks, and performing more challenging tasks earlier in the day. C. Instruct the client to complete a journal identifying energy levels for tasks in preparation for collaborative COTA® and OTR® treatment planning. D. Advise the client to take frequent rest breaks during the day and further assess cognitive abilities for difficulty with executive functioning.
C Further evaluation is needed to determine appropriate interventions; this approach goes beyond typical energy conservation education and involves the COTA® and OTR® working with the client to identify the specific work tasks that cause fatigue.Work tasks must be identified before determining work demands. ------ A: A worksite evaluation is an unlikely option due to insurance regulations, depending on the treatment setting. Occupational therapists who work in a hospital or rehabilitation facility are not able to provide worksite evaluations. Only in certain settings would a workplace evaluation be appropriate (e.g., work hardening). B: Collaboration with the client to problem-solve work demands is a key component of energy conservation, which is helpful for a client with MS; however, this approach is less client centered than that described in option C. D: Rest and cognition do not necessarily contribute to on-the-job fatigue; therefore, focusing on these areas does not address the client's immediate concerns.
What skills might a client with middle-stage dementia have difficulty performing on the basis of typical psychosocial or cognitive abilities present during this stage of dementia? A. Speaking B. Swallowing and chewing C. Managing finances D. Posture and balance
C In middle-stage dementia, a person will begin having moderate impairment in IADLs, such as finances, shopping, medication management, and complex meal preparation. --- A: Although comprehension of written and spoken language is affected in the middle stage of dementia, speaking itself is not affected until the late stage. B, D: Problems with swallowing and chewing, as well as and posture and balance difficulties, are most likely encountered by clients with late-stage dementia.
A client with middle-stage dementia has maintained the ability to complete repetitive tasks common in middle adulthood. For example, if given a basket of socks, the client will reflexively fold them until the task is complete. Given this information, what recommendation would be appropriate for the COTA® to give caregivers? A. Provide challenge to the client by placing the laundry basket at various heights to improve trunk stability and balance. B. Provide challenge to the client by putting various types of clothing into the laundry basket, which will aid in maintaining this skill. C. Provide the client with a basket of socks at a set time each day, determined by the client's arousal level, to give structure to the client's day. D. Provide the caregivers with information about how they can use a basket of socks to decrease agitation in the client.
C Interventions to control the daily structure of a person with dementia have been documented to provide balance between the times the person is in high arousal versus low arousal. ----- A, B: Providing too much challenge to a client with dementia might increase agitation; providing structure to the client's day is the best option to decrease agitation and promote better balance. D: Engaging a client in a task once the client is agitated might be difficult; providing structure to the client's day is the best option to decrease overall agitation and promote better balance.
A COTA® is reading the occupational therapy intervention plan for a client with Stage IV amyotrophic lateral sclerosis (ALS). On what will the home environment goal MOST LIKELY focus? A. Modifications to support the client's preferred occupations and activities B. Moving frequently used items within easy to reach. C. Creating a safe and accessible living space D. Technology changes, such as a motorized stair lift
C Someone with Stage IV ALS is likely to have severe weakness in the lower extremities, causing an inability to ambulate. Working with a client and his or her family to create a safe, accessible living environment is the best option; the client and family will need recommendations for moving furniture, creating spaces that a wheelchair or power chair can navigate, and the most appropriate durable medical equipment such as a hospital bed and specialized mattresses to prevent pressure sores. ----- A: ALS is progressive, and the client will need to change his or her lifestyle to adapt to increasing disability. B: Environmental adaptations may be appropriate for the earlier stages of ALS, when a client is more mobile. D: A stair lift would not be the best option for a client at this advanced stage because a family member would be required to carry the wheelchair to the opposite end of the stairs.
A client with Alzheimer's disease (AD) perseverates on having to pick up children from daycare. At which stage of the disease process is this client likely at? A. End B. Early C. Middle D. Late
C The middle stage of AD is characterized by clients' thinking that they are back in an earlier stage of life. ---- A: People in end stages of AD will be unable to carry on conversation and will have limited function of even the basic ADLs. B: People in early-stage dementia are likely to begin having difficulty within the community and with IADLs but have intact ADL performance. Their short-term memory loss becomes an issue that affects their safety in the community. D: People in late-stage dementia need assistance for all areas of function, both ADLs and IADLs. They would not have the conversational skills to perseverate on a topic.
A client will initiate dressing at the appropriate time of the day but does not choose clothing appropriate to the day, temperature, or season. The client is able to don clothing slowly but has difficulty with fasteners or fails to see errors in the back (i.e., not tucking in the shirt). At what Allen Cognitive Level is this client? A. 2.0 B. 3.0 C. 4.0 D. 5.0
C The question describes typical dressing behaviors of clients at Mode 4.0; a client would attend to visible sensory cues and ignore what is not in plain sight (e.g., not tucking in the back of the shirt).
An OTR® receives a referral to evaluate a client with dementia. What type of assessment would the OTR® likely use to evaluate this client? A. Nonstandardized assessment tool that assesses memory B. Standardized assessment tool that assesses hand function C. Observation of client and interview with caregivers D. Assessment tool that examines occupational performance and performance skills in detail
C When assessing clients with dementia, observation and interview of caregivers are the primary method of assessment. ----- A, B, D: Although having information about hand function and memory would be helpful, observation will yield more information about how these performance skills affect the client's daily life. The comprehensive assessment might not be possible with a client who has dementia; it might lead to fatigue and frustration and limit the OTR®'s ability to establish rapport.
Which behavioral symptom might a client with early-stage dementia display? A. Pacing B. Violence C. Rude language D. Suspicion
D A client with early-stage dementia might become suspicious; it is common for clients to think misplaced items have been stolen or that their spouse may be unfaithful. ----- A, B, C: Pacing, violence, and vulgar or rude language are all common behavioral symptoms of middle-stage dementia related to loss of impulse control and difficulty communicating needs.
At what stage of Alzheimer's disease (AD) does nerve cell damage cause significant motor impairments that limit the ability to complete life tasks? A. Mild cognitive impairment B. Early stage C. Middle stage D. Late stage
D By the late stage of AD, nerve cell damage has become so significant that not only are cognitive processes impaired, but motor skills are also affected. ---- A, B, C: Motor skill deficits are minimal in middle-stage dementia and imperceptible in earlier stages of AD.
An OTR® has completed an initial evaluation with a client who has relapsing and remitting multiple sclerosis. Sensorimotor skills assessment indicates that the client's daily activities are limited by low endurance and decreased upper-extremity coordination. In addition, the client has been unable to remain in a job as a clerical worker. What additional information, that the COTA® can gather, is MOST important before developing an intervention plan? A. All medical test results, including blood test results, neurological and imaging exams B. Availability of home care services to support the client in the home C. Reports of other health professionals currently involved in the client's care D. Contextual and environmental factors that support the client's ability to adapt
D Contextual and environmental factors provide information about a client's available support systems, which can influence his or her ability to adapt to the diagnosis. ----- A, B, C: Although these sources provide important information, this information is not critical in devising an intervention plan for the client.
A client with a diagnosis of dementia has memory loss. The COTA® observes that the client has visual hallucinations. In addition, the client has decreased spontaneous motor movements and rigidity. What type of dementia does this client MOST LIKELY have? A. Frontotemporal dementia B. Alzheimer's disease C. Vascular dementia D. Dementia with Lewy bodies
D Distinguishing features of dementia with Lewy bodies are visual hallucinations and Parkinson-like motor symptoms. ----- A, B, C: Frontotemporal dementia, Alzheimer's disease, and vascular dementia all have memory loss as a key feature, but the various types of dementia are categorized on the basis of unique features.
A COTA® is asked to treat an older adult client with moderate-stage dementia who resides in a long-term care facility once the occupational therapy evaluation was completed. While the COTA® is conducting the intervention, it becomes apparent that the client is becoming agitated. The client expresses concern that the COTA® is going to make the client late to pick up the client's children from day care. What is the BEST approach for the COTA® to take in this situation? A. Remind the client that the children are grown adults. B. Attempt to engage the client in an alternative activity. C. Leave the client alone and plan to return later in the day. D. Assure the client that the children will get picked up on time.
D It is important to use therapeutic use of self with clients who have dementia. By acknowledging the client's issue, the COTA® is able to establish rapport and demonstrate empathy. In addition, by living in the client's reality, the COTA® will be able to observe how the client responds to stimuli and how to approach the client in the future and plan interventions. ----- A: Arguing with a client with dementia is never a good idea; people with dementia lack insight into their condition, and an argument is likely to increase agitation. B: Asking a client with dementia who is agitated to complete any new task would not be wise; it might increase the client's agitation. C: Abandoning a client with dementia would not be wise because the COTA® might be able to calm the client with therapeutic use of self.
A client with middle-stage Parkinson's disease demonstrates tremor and rigidity bilaterally in upper extremities, mild difficulties with executive functioning, and increased fatigue during ADL and IADL performance. Which is the BEST occupational therapy intervention for a client in the middle stages of Parkinson's disease? A. Splinting to minimize tremor and to provide wrist and finger stability during fine motor coordination tasks B. Progressive resistive exercises to improve fine motor control function and to reduce the intensity of tremors C. Adapting the home with environmental control units to address fatigue and fine motor skills D. Modification of clothing with minimal fasteners or hook-and-loop closures to reduce fine motor demands
D Modifying or eliminating clothing fasteners decreases the demand on fine motor coordination for a client experiencing tremors. ------ A: Splinting is not an intervention for tremors. B: Resistive exercises do not improve fine motor control. C: Home modification is most common in the last stages of Parkinson's disease.
A client with amyotrophic lateral sclerosis reports functional limitations when completing his daily routine. The OTR® has completed ADL and IADL assessments as part of the evaluation. The OTR® asks the COTA® to administer an assessment of the client's upper-extremity motor control. Which assessment would be MOST effective for assessing this client's upper-extremity ability, and appropriate for the client to perform after? A. Modified Ashworth Scale B. Trigger point evaluation C. FIM™ D. Purdue Pegboard test
D The Purdue Pegboard test is a timed test of upper-extremity function and is useful in determining a client's functional limitations. ---- A, B, C: These do not assess functional ability of the upper extremities. The Modified Ashworth Scale is a measure of spasticity. Trigger point evaluation is a measure of localized soft-tissue pain. The FIM is a measure of ADL independence.
A client presents with decreased awareness of cognitive deficits. What is the most effective strategy for a COTA® to implement to intervene with this cognitive impairment? A. An auditory signal that cues the client when he or she is not acting in a safe manner B. Reduction of the number of choices presented to the client at any given time C. Mental rehearsal of a task before participation to increase the likelihood that all steps will be completed D. Instruction in the use of a self-evaluation checklist (i.e., "Did I complete all the steps?")
D Use of self-evaluation or self-reflection before or after a task are the most effective strategies for decreased awareness. ---- A: Auditory signals might be frustrating for someone with decreased awareness of cognitive deficits. B: Reducing choices is an intervention strategy useful for decreased attention and decreased memory. C: Mental rehearsal is most helpful with motor planning issues.
A client with Parkinson's disease complains of difficulty with bed mobility resulting in difficulty changing position during the night. Which environmental modifications address this client's difficulties with bed mobility? Select the 3 BEST choices. A. Put pillows on one side of client for side lying positions B. Place a nightlight in the bedroom to improve ability to see during bed mobility C. Move the bed against the wall to provide stability during changes in sleeping positions D. Change to lighter bedding to decrease resistance during bed mobility E. Place bed rails or bed ladders on either side during rolling F. Use a firm mattress to promote rolling and bed mobility
D,E,F D, E, F: Environmental modifications for improving bed mobility include using light bedding (e.g., changing from flannel to satin sheets), using a bed rail or ladder for support, and using a firm mattress. ----- A: Positioning a client in side lying will not address the client's ability to complete bed mobility, because doing so only modifies the client's static position. B: Providing illumination will not address the client's physical ability to complete bed mobility. C: Moving the bed closer to the wall is an environmental modification that, in the case of Parkinson's disease, does not support bed mobility.
