REVIEW QUESTIONS FOR TEST TWO

complex regional pain syndrome

A 35-year-old man named Todd has expressed to his doctor that he has been experiencing excruciating pain in his hip and upper leg region. He recently had hip surgery a little less than a month ago and explains that he is feeling a continuous burning sensation within this region of his body. Upon further examination, his doctor notices that his skin has a shiny, rough look to it. Based on these symptoms, what type of pain is Todd experiencing??

Hypoglycemia

A 53 year old client you are currently working with was diagnosed with diabetes. They are complaining of a headache. During your therapy session they are becoming confused on what you are asking them to do. They cannot complete the activity due to dizziness and weakness, and are becoming irritable when they can't finish. You should check their glucose levels because they are experiencing symptoms of what?

System: somatosensory Disturbance: paresthesia

A client comes in complaing of tingling and a prickling sensation in her right arm and it is beginning to impact her everyday occupations. After taking an occupational profile, you discover that she typically sleeps with her right arm above her head as she finds this to be the most comfortable position to sleep in. Name the system that is being effected and the specific disturbance.

Hypoglycemia

A client is reporting a headache, is sweating and reporting weakness. You are a smart OT and know you should contact the nurse because they could be experiencing:

Allodynia

A client reports feeling pain on their arms when wearing long sleeve shirts. This client may be experiencing _____________.

Work hardening

A client was referred to you after hurting his back at a factory he works at. He cannot return back to work yet. Through intervention you work with him to maximize his function. One of his job in the factory is stacking boxes, and lifting boxes. You simulate his work through his intervention. You make him stack a variety of boxes. While he is doing this, you educate him on proper body mechanics. You also, incorporate heavy boxes so he can work on his strength. After a short 8 weeks he can return to work, and return safely. What industrial rehab did the client attend?

Pain- heat- cold- light touch

Adam recently sustained a PNS injury that has affected several areas of sensation. In order from first to last, which sensations will return during his recovery?

Hypernatremia

After reviewing your client's chart you enter your clients room. You notice your client seems very restless and is extremely agitated when you proceed to ask him any questions. Joe keeps asking you for a glass of water. What might these be signs of?

Testing stereognosis

After suffering a stroke, Mary is having trouble identifying objects in her hands. She started noticing this problem after her husband handed her the car keys, but didn't know what was in her hand until she looked at it. What test would best for the OT to give Mary?

PNS

Alex is a 23 year old male that has recently graduated college, where he was a member of the baseball team. He has recently began a new job as a sales rep for a medical technology company. He notices numbness and tingling in his right ring and little fingers when he is working from his iPad. He has trouble typing and finds himself waking up at night with numbness in the ring and little fingers or his right hand. It is reveled that Alex has ulnar nerve entrapment. Is this a CNS diagnosis or a PNS Diagnosis?

Polio Diabetes Multiple sclerosis<- Herniated discs

All the following diagnoses cause peripheral nervous system deficit, except

Getting her small white pill for blood pressure from the medication container

Amy is a 74-year-old female. She has diabetic neuropathy in her hands and feet. You assess her two-point discrimination and she can feel it at 9mm. Which of the following most likely will she have the most difficulty doing?

False- you must have light touch to test two-point discrimination

An OT is testing Molly's light touch. It is observed that Molly has no perception of light touch on the volar surface of her right hand. True or False: The OT should move on and test two-point discrimination on Molly's right hand

complex regional pain syndrome

Barb is a 38 year old woman who recently sprained her left ankle during a pick up basketball game. Since sustaining her injury, Barb has complained of a severe burning sensation in her left ankle that radiates through her foot and leg. She also reports pain that prohibits her from participating in daily activities and she spends most of her days in her recliner with no brace on her ankle because the brace causes additional pain. What pain syndrome is Barb most likely suffering from?

Pain is the first PNS sensation to return after injury, next to return is typically sensations of heat, cold, and then last is light touch.

Betty is a 65 y/o female with Diabetes who recently had a L CVA. She has hemiparesis and sensory loss effecting her R side. She has intact deficit awareness. She has been receiving OT and PT regularly for 3 weeks. Today, during your pointy and dull evaluation, she was able to correctly identify the sharp and dull sides of the q-tip when applied in the C5 dermatome. This excites her so she then asks you what should happen next in her recovery, what is your response?

Rheumatoid

Betty, a 50-year-old woman has been complaining about pain in her hands. Betty has been a homemaker for the past 30 years and enjoys crocheting and cooking for her family. She recently visited an occupational therapist because she has been having flare ups of pain which is limiting her in her occupations that she values most. The occupational therapist noticed that on Bettys right hand there is increase joint deformity causing ulnar drift. What pain syndrome does Betty most likely have?

Hypokalemia

Billy is a 53 year old male living at home with his wife and two dogs. He recently went to his doctor because he was experiencing Cardiac arrhythmia, muscular weakness, mental confusion, nausea and vomiting. Billy could be experiencing symptoms of what?

Hyperkalemia

Billy, a 75-year-old man is currently in a skilled nursing rehab facility. Billy is receiving occupational therapy to work on his occupations to return home. The occupational therapist noticed that Billy has not been himself lately. Billy has been feeling nausea, shows sign of bradycardia, and seems to be falling into depression. From these symptoms, what might Billy be suffering from?

Work hardening

Bob is getting ready to return to work as a machine operator. His OT is working with other professionals during his rehab process to complete a job site evaluation, work simulation, graded activities, and education in order to prepare him to return to work as quickly as possible. What type of program are they completing?

Moving/ dynamic

Bob the OT is using a DiskCriminator to test Jenna's touch sensation. She recently suffered a stroke and is having trouble feeling things. Previously she could not feel anything very well, but has made some progress. Should Bob expect her to be able to feel the DiskCriminator in a static position first, or should he expect her to feel when it is moving across her skin first?

False. Cancer pain can also be caused by surgery, chemotherapy and radiation.

Cancer pain refers to the pain clients feel that is caused by the cancer itself.

Allow Cheryl to tell stories about her past and help her reflect on what her faith meant to her before the accident. The OT can help Cheryl adapt her lifestyle and come up with ways to participate in her faith post car accident injury.

Cheryl is a 47 y/o female who was in a car accident and was left with left side paralysis from the waist down. The occupational therapist is evaluating Cheryl and finds out that Cheryl is strong in her Christian faith. She questions why God has allowed this to happen to her and has no motivation to strengthen herself. What is the best course of action for the OT to take?

The therapist is wrong and Henry should be using a wheeled walker

Henry is 78 years old and is currently using a standard walker. Sometimes he trips over his walker as he starts to walk quicker than he can move the walker out of his way. The therapist suggests he keeps he slow his gait so that he stay in the space of the walker.

Routine

Herb has just returned home after spending time at the hospital recovering from a heart attack. He is working with an OT on medication management and when to take each pill. After speaking with Herb, the OT learned that each morning he wakes up he makes a pot of coffee. The OT wants Herb to place his medication next to the coffee pot and remember to take it as the pot boils every morning. What is the OT trying to establish with Herb?

True

Holly has worked as a secretary at a dentist office for the past 15 years and has developed pain in her wrist. Her hands have become numb with a pins and needle sensation. After going to her doctors she was diagnosed with carpal tunnel syndrome. Carpal tunnel syndrome is damage to the peripheral nervous system.

Education, play/leisure, social participation

Jim just found out that he has a chronic illness and has been having a tough time dealing with it. What areas of occupation have a higher chance of being "lost" first?

Thrombocytopenia

John finds that bruises very easily even when he barely bumps into an object. He may have?

C7

If a client has sensory deficits in their second and third digit of their hand as a result of a CNS injury, it is probable that they have damage to the nerve at ___.

Complex regional pain syndrome

If a client is experiencing extreme discomfort from a laceration to the hand and its almost healed, but they still feel severe burning pain and hypersensitivity, what pain syndrome will they most likely be experiencing?

4-5

In acute care, a therapist is working with a client who has recently had a medication change resulting in blood work. The nurse comes into the room to report the client's INR levels. What range of levels would be dangerous for a therapist to continue the session due to severe risk of bleeding?

Light touch- cold- heat- pain

In what sequence does PNS loss occur?

start with assessments, help him adapt his lifestyle and surroundings so he can engage in his spiritual endeavors such as going to church. He might need to be in a wheelchair and may not be able to sit in a pew, but as long as you get him there that is what is important

Jane has been Catholic her whole life and recently was involved in a car accident where she now has limited movement in her lower limbs and finds that it has become a struggle to get to church. Jane expresses to you that this is important to her and she wants to be able to go every Sunday. What can you do as the OT to help Jane?

Self-guided core value assessment, Barrett Values, Centre Personal Values Assessment, HOPE questions, Informal assessment/listening to the client's stories

Jane is a 34 year old stay at home mom of two children ages 3 years old and 36 months old. Her husband has a full time job and is the sole financial provider. The family would previously attend church during the holidays but weren't consistent attendees. Jane recently suffered from a SCI and now feels that she is losing her identity as a mother due to her lack of being able to care for her children as she used to and had to hire a nanny to help her during the day. She is very angry that this happened to her and questions her faith. List two ways that you as an OT could evaluate Jane and her spirituality.

Functional capacity evaluation

Jeff recently had a work injury that he is getting rehabilitation for. He wants to go back to work ASAP but the doctors are not sure if he will be able to with his injury. They want the OT to do an evaluation to see how he performs with work-related tasks in order to see if he can return to work. What kind of evaluation could be done?

Feelings about pain

Jenny has acute pancreatitis and is hospitalized every few months due to elevated lipase levels and extreme pain in her abdomen. During her stays, the nurse has to insert an IV into her arm to administer pain medication and fluids. Jenny gets upset when the nurse is not careful and takes many tries to find her vein therefore causing her pain. She gets offended by the lack of concern the nurse has for her pain especially because she is already suffering from intense abdominal pain. What part of the biopsychosocial model of pain is Jenny experiencing?

Yes, Jenny is exhibiting hypoglycemia, since her glucose is at a level 65 and normal is 80-110

Jenny has just returned to her facility after a surgery last week. You review her chart and see that she is reported at a 4.2 Potassium level, 15 Blood Urea Nitrogen and 65 Glucose. Is there anything you should be concerned about or is Jenny within normal ranges? If there are any concerns, what are they named?

Fibromyalgia

Jessica is a 26-year-old female who has struggled with abnormal pain throughout her body for about 2 years now for no known reason. She is currently 6 months pregnant and her body is going through a lot of hormone changes. The pain throughout her body has become increasing worse since she found out she was pregnant, and it is mostly in her muscles and ligaments. What could be the cause of Jessica's pain and diagnosis?

Pain behavior

John has been experiencing pain following his recent hip replacement surgery. He lets you know that because of his pain he has been very cranky towards his family and he has been acting aggressive because of his pain. He avoids family parties so that he doesn't act out due to his pain. He mostly just lays in bed to avoid moving around to much. Which of the elements of the Biopsychosocial Model of Pain does this describe?

Functional capacity evaluation

John has been seeing an OT for rehab after an MVA. One of John's primary goals is to return to work. What evaluation would the OT use to assess John's readiness to return to work?

Work readiness program

John is 45 years old and is married with 2 children. He worked as a grounds maintenance worker for his local country club. He mowed lawns, trimmed hedges, cleaned the pool and tended to the gardens. Unfortunately, John sustained an injury when trying to repair a hedge trimmer that caused him to lose his dominant hand and index finger on his non dominant hand. He believes he cannot return to working as a grounds maintenance man and is nervous about how to provide for his family. What type of service could an OT provide for John to help him with finding work?

Carpal tunnel

John is a receptionist that sits and types for long hours. He has been sent to you due to complaints of numbness and tingling in fingers 1-3 in his R hand. He mentions that it feels weak and he is having trouble completing his routines due to that weakness. He's been treating the discomfort with OTC pain medications, like Tylenol, but has felt no relief. What might John have?

Functional capacity evaluation

John is returning to work after an injury. His OT is looking to see if he can perform work related activities needed for his duties. The OT is completing a _____________.

Complex regional pain syndrome

Johnny is recovering from surgery on his left hand. He complains of continuous, severe, burning pain of his left hand. What might Johnny be experiencing?

Allodynia

Justin Bieber is a patient in your acute care facility. He is showing signs and symptoms of peripheral neuropathy. Whenever you touch his hand or arm, he yelps in pain; even when you lightly touch his hand with a Q-tip. What somatosensory disturbance is J Biebs exhibiting?

Myofascial pain syndrome

Kevin has recently been experiencing dull muscle pain in his neck and shoulders. He reports having a trigger point in his neck that causes severe pain down his shoulders. What is most likely Kevin's diagnosis?

Allodynia

Leslie would like to wear a necklace for her 25 year anniversary dinner. When she puts the necklace on, it feels painful against her skin. What somatosensation issue might Leslie have?

Potaassium 5.5

Lori is a 76 y/o woman that you are treating and when you see her for treatment you notice that she is experiencing muscle weakness with voluntary movement. She mentions that she feels depressed today and that she feels slight nausea. The nurse also reports that she had diarrhea this morning and brachycardia. Which lab value pairing is mostly likely to be seen in Lori's chart?

Ritual

Lucy plays softball for her high school team. She says an Hail Mary before every at bat. This is an example of

Dysethesia

Maggie has been complaining of an itching sensation. No matter what she does the itching does not subside and no one can figure out what is causing it. Maggie is experiencing:

UTI

Marie lives in a nursing home. An OT comes in to work with her on some iADLs and notes she is severely confused. A quick look at the chart tells the OT that her white blood cell count is high. What could be a cause of Marie's cognitive changes?

Boleyguages or diskcriminator

Mary is a 65 year old female who was recently referred to you for OT services. Her chart indicates that she is experiencing difficulty with her touch sensations. What two pieces of equipment could you choose to use to test Mary's touch sensations?

complex regional pain syndrome

Mikayla is 4 weeks S/P of a right complex wrist fracture. She has been complaining of continuous serious pain in the limb and is experiencing symptoms of temperature changes as well as hypersensitivity to temperatures and touch. Mikayla could be experiencing which of the following:

CNS, C7, pinched nerve

Mr Bennet is experiencing a tingling sensation and pain which runs down the back of his right arm and hand specifically to digits 2 and 3. He often reports this pain while gardening, doing yard work and playing golf with his friends Is this CNS or PNS and what diagnosis?

Ergonomic evaluation

Mr. Jones is a 30-year old man who works in an industrial factory. He was recently injured on the job because of improper lifting and heavy strain on his shoulders and back. What kind of evaluation would be most appropriate for the OT to conduct?

Pain behavior

Mrs. Hall is a 45 year old woman who has recently been given a diagnosis of rheumatoid arthritis. She is married and has two teenage children that live at home. Her family reports that she has been sad, withdrawn, ad has not been participating in activities that she usually enjoys. Which part of the biopsychosocial model of pain does this express?

PNS, radial nerve damage

Pam, a 58-year-old women, has recently been having trouble completing tasks on an everyday basis. She has noted that she has difficulty feeling any sort of pressure in her hands and has experienced numbness. She has been diagnosed with diabetes, but never had this problem until recently. Her therapist decided to assess her level of touch pressure. After the test was completed, the therapist noticed that Pam has diminished protective sensation near her thumb and pointer finger. This most likely results in damage to what system and nerve?

Functional capacity evaluation

Patty is an OT who is evaluating Bob. Bob is recovering from a work-related accident. Patty is doing an objective assessment of his ability to perform work-related activities by reviewing his medical records and evaluating his physical performance to see if he is ready to return to work. Patty is performing a ______?

Pain - Heat - Cold - Light touch

Peripheral nervous sensation recovery happens in the following sequence

No, because the INR level is between 4-5, leaving the client at risk for severe bleeding

Prior to evaluating Peggy, you review her medical chart and recent complete blood count lab levels, her levels are as follows: Hematocrit = 40%, Platelets = 100,000, INR = 4.8, WBC = 7,500; after reviewing this chart should you continue with the evaluation, if not, explain why?

Complex regional pain syndrome

Prior to evaluating a client you read over their chart and noticed they were in a traumatic car accident with a tractor trailer and survived the crash with very little injuries. The accident required your client to receive surgery on their R hand as it was crushed during the accident. When evaluating your client you notice they are complaining of continuous severe burning in their R hand. When observing the clients hand, you notice their skin looks shiny, what might this be?

Complete work hardening program to maximize function and job capacity evaluation to return to meaningful jobs

Rob recently fell and broke his hip. You are meeting with him for the first time today, and during your occupational profile he shares that his biggest concern is returning to work. He was working at a machining company before his injury, and is worried he won't be able to return to this job. He also expresses the need to return to his volunteering at the animal shelter on the weekends, and lists this as a top priority below returning to his paid job. As the occupational therapist, what are your responsibilities in regards to work with Rob?

CNS, stereognosis

Sally is having difficulty identifying objects only using touch (no vision). What skill is she having difficulty and is it a CNS or PNS injury

Fibromyalgia

Sue has been experiencing widespread pain throughout her body. She says that she feels this pain in her muscles, ligaments, and tendons. She has not experienced physical trauma or been diagnosed with anything to explain why she is experiencing so much pain. Sue also said that her pain gets worse when she is under a lot of stress. What I she most likely experiencing?

CNS

Sue is a 56 y/o woman complaining of numbness and tingling in her 2nd and 3rd digits. She states that she has been having difficulty locating her keys in her purse and often has to pull out several different objects before she is able to find her keys, which is frustrating for her. Is this a CNS or PNS diagnosis?

complex regional pain syndrome

Sue, a 24 year old, has recently sustained a laceration to her hand. Although it is almost fully healed now she is complaining of server burning pain, heat retention difficulty, and shinny skin. What type of pain is Sue experiencing?

Hyperkalemia

Susie is your patient in the inpatient rehab unit. She was admitted due to falling in her bathroom and breaking her L hip. The pt. c/o nausea and was vomiting when you walked in. Pt. also c/o diarrhea and the urge to use the bathroom. Pt. attempted to sit at EOB, but seems tired and weak. She 'flops' to her side in attempt to sit upright. You check her heart rate and it is at an alarming 46 bpm. Her heart rate is arrhymic as well. What should you particularly check for in her notes? What could she be presenting with?

PAMs (hot and cold), education on proper body mechanics, medication, energy conservation, activity tolerance

Tammy has myofascial pain from poor posture and it is affecting her work. She has been referred to OT because the pain is so bad and she needs a way to manage it. Make 3 recommendations for Tammy in order to reduce the pain and increase her participation at work.

White blood cell count

The levels of this lab value are important to note if you are completing a cognitive screen/evaluation:

medication, body mechanics, PAMS, biofeedback

Tim has been hurt at work and can no longer perform his janitorial duties. He has pain running up his back due to bending down to clean the floors in the bathroom. Which interventions for pain control would best work for helping Tim? (name atleast 3)

Do not continue evaluation until Tom's glucose levels normalize, they should be in the 80-110 range. Report the high glucose level to a nurse.

Tom is a 62 y/o male who was admitted to the hospital after experiencing a fall due to blurred vision and fatigue. The occupational therapist goes in to evaluate him but after reviewing his chart sees that he has been diagnosed with early onset diabetes. So, she checks his glucose levels before starting the evaluation and sees that Tom's blood sugar level is 182. Should she continue the evaluation? If not, why and what should she do?

The AMPS

Tom is a 68-year-old man who suffered a stroke about 2 weeks ago. He has recently started occupational therapy. The OT wants to evaluate Tom's performance skills during morning ADLs to determine if he needs to go to a skilled nursing facility or to see if he is able to return home. What assessment should the OT use?

CNS C7

Tom is having trouble interpreting sensations with his right hand's pointer finger and middle finger. Which spinal nerve has Tom most likely damaged? Is this a CNS injury or a PNS injury?

False, as OT's we are not allowed to prescribe or direct clients to take medication, but we can use probing questions and make suggestions about speaking to their doctor as soon as possible

True or false? After evaluating a client who is experiencing pain, the client revealed they have not been prescribed any medication, this gives the occupational therapist the go ahead to direct the client to take over-the-counter medication to manage their pain until they see their doctor.

PNS, median nerve

Walter is a 73-year-old male. Walter is retired, but still is socially engaged. He attends his local senior center. Walter is very interested and talented in wood working. He spends most of his time in the garage wood working and creating different furniture. Lately, he has been complaining about weakness in both of his hands. Also, complains of tingling in digits 1-3 on both hands. His doctor diagnosed him with carpal tunnel syndrome. Does Walter have a CNS or PNS diagnosis and what nerve or dermatome is it effecting?

1: Vigilance, Stage 2: Disruption, Stage 3: Enduring the self, Stage 4: Striving to regain self

What are the stages of adjustment regarding disability?

Work hardening

What do we do for the rehabilitation of injured workers when trying to return them to work as safely and quickly as possible?

Pivot

When Liz gets her groceries out her car- she twists from the front seat to reach behind her to grab her bags. Which component of the APPLAUSE acronym is Liz neglecting.

Allodynia

When a client goes outside they are feeling pain when a breeze is blowing across their skin. This pain sensation is called?

H - What provides sources of hope, comfort and strength (not focusing on religion) O - importance of organized religion in their life? P - What is their personal spirituality and practices that are meaningful E - What are the effects of spirituality and beliefs on medical care and end of life issues

When evaluating a client's spirituality what types of questions would you ask when following the HOPE method

PNS

When performing a two-point discrimination evaluation on a client, the therapist notices a lack of sensation on the client's right thumb. The client complains of difficulty when turning pages in books and sorting money. Most likely, is this client suffering from a CNS or PNS deficit?

Narcolepsy

When talking with a client about their sleep patterns and routines, the client mentions that they have excessive daytime sleepiness and fall asleep uncontrollably. What is the client experiencing?

Do not evaluate, the client is at high risk for bleeding; even from a minor bump or scrape.

You are an OT working in an acute care setting, you just received a script from the doctor requesting the evaluation of a 36 y/o male who was recently admitted. During your chart review, you notice that the client glucose, potassium, and sodium levels are all within the normal ranges and the INR is rated at a 4.6. What is your next step?

BUN, any number higher than 20

You are evaluating a client perform an ADL. The client is trying to put on the shirt but keeps forgetting the steps. You tell them to take their time and try to remember what step is next. The client says they cannot remember the steps, so you must help. The client keeps getting SOB when they are trying to put their shirt on. Once the evaluation is done the client says she must sit down because she feels nausea and thinks she needs to vomit. From this evaluation you believe that the client could have an abnormal lab value. What lab value could be abnormal according to these symptoms? And what is a possible lab value number that she could have according to these symptoms?

Myofascial pain syndrome

You are seeing Jennifer for the first time in your outpatient clinic. She is 35 years old and is complaining of back and shoulder pain. Jennifer explains the pain as a dull, aching pain that has trigger points. What type of pain syndrome might Jennifer be experiencing?

HOPE

You are seeing a new 21-year-old client who has just suffered from a serious car accident and is recovering from a SC injury at T6. She has referenced that she was very involved in the community before her accident and often mentions feeling lost and unsure of her purpose anymore. She doubts why this would happen to her. What tool could you use to further evaluate these feelings?

Work hardening

You are working with Jacob, he is 30 years old. He suffered a work-related injury and now will have OT for several weeks. Jacob works at a chemical plant as an operator. The goal is to get Jacob back to doing his job at the chemical plant. You begin simulating work activities to see how Jacob is doing and you also educate him on what he should do regarding posture and lifting. What type of program are you doing with Jacob?

Medication, activity tolerance and relaxation

You are working with a client who has widespread musculoskeletal pain with no known cause. What are three interventions that you can use to help with their pain level?

Central, Proprioception, Stereognosis, Cerebral, Dermatomes

You have a new client coming in today diagnosed with MS which is a diagnosis involving the _____________ nervous system. Knowing this you know she most likely has deficits in ________________ and _________________ due to the ______________ portion of the sensation. You will document the regions affected using ____________.

Light touch

Your client cut his hand on a knife while cutting chicken. He damaged his ulnar nerve and has recently started feeling cold temperatures in his hand again, what is the next sensation that your client will be able to feel?

Heat

Your client has been recovering from peripheral nerve sensation loss in their hand. They are excited that they were able to feel pain when the nurse pricked their finger. They ask you what the next thing they will be able to feel is. In the sequence of PNS sensation recovery, the sensation that follows pain is ___.

Sensory deficits- stereognosis and proprioception with injury likely in CNS.

Your patient has been admitted to the IRU (inpatient rehab unit) in which you work. They describe that since their traumatic work accident they haven't been able to identify objects placed on their bedside in the middle of the night (with lights off). She also hasn't been able to reach in her purse without looking and find objects. She has difficulty standing upright at EOB. What sensory deficits is this patient experiencing? Has her injury most likely occurred in the PNS or CNS?

CNS, C6

ling numbness on on their wrist (pinky side). What do you think is happening to her?? Is this a PNS or CNS diagnosis?

no. results are too high and put the client at risk

upon reviewing your client's chart, you see that the INR test results indicate a level 5 platelet count. should you begin your OT evaluation?