Therapy Ed Exam A

A two-year-old child is placed in foster care due to child abuse and neglect. The child was frequently beaten and locked in a dark closet. The child is fearful and suffering from sensory deprivation. Which sensory input is best for the occupational therapist to recommend the foster parents provide for the child? A. Slow rocking. B. Fast rocking. C. Bright lights. D. Upbeat music.

A. Rationale: Intervention for sensory deprivation should begin with slow linear movements such as slow rocking. The other options can lead to sensory overload due to the severity of the child's sensory deprivation.

An occupational therapist receives a referral to construct a splint for an individual with Erb's palsy. Which orthosis would be most effective for this condition? Answer Choices: A. A flail arm splint. B. An elbow lock splint. C. A figure-of-eight splint. D.A deltoid sling.

B. An elbow lock splint. Rationale: Erb's palsy results from injury to the fifth and sixth brachial plexus roots. The resulting clinical picture is that the arm hangs limp with the shoulder rotated inward due to atrophy and paralysis in the biceps, deltoid, brachialis, and brachioradialis muscles. This significantly limits functional movement. The elbow lock splint stabilizes the elbow to enable the individual to position the hand closer to or away from his/her body for functional use. A flail arm splint is recommended for a brachial plexus injury of C5-T1 resulting in whole upper extremity involvement. It provides the needed stability at both the shoulder and elbow for functional positioning of the hand. A figure-of-eight splint is used for a combined median ulnar nerve injury and to prevent MP hyperextension. A deltoid sling is used for upper extremity muscle weakness.

A toddler with spastic quadriplegic cerebral palsy demonstrates a consistent gag reflex. What technique should the occupational therapist use to help inhibit this reflex? A. Move a spoon from side to side on the tongue B. Walk a spoon down the tongue, going from proximal to distal with even pressure C. Press a spoon down firmly on the center of the tongue D. Stroke the tongue in a circular motion with a firm object

C. The best approach to decrease a gag reflex is to press down firmly on the center of the tongue and to apply pressure from distal to proximal. Lateral and circular motions can facilitate the gag reflex

A nine-year-old girl with the diagnosis of cystic fibrosis is hospitalized in a small rural hospital. Currently, there are no other children in the hospital and the hospital does not have a pediatric play area. The head nurse asks the occupational therapist to suggest appropriate play activities that hospital volunteers can provide for the child. Which is the most age appropriate activity for the therapist to suggest?Answer Choices: A. Dressing paper dolls. B. Coloring in coloring books. C. Playing card games. D. Cutting and pasting pictures onto cards.

C. Playing card games. Children aged 7-12 are developmentally able to participate in games with rules, competition, and social interaction. The other activities reflect creative play that is developed between ages the ages of 4 and 7. In addition, they are solitary activities and do not afford opportunities for competitive fun and socialization. Hospitalization can be lonely and frightening so having volunteers play with the child can be psychological, beneficial, as well as developmentally appropriate.

An individual with hemiplegia has inadequate ankle dorsiflexion on the affected side. Which of the following equipment is best for the occupational therapist to recommend the person use to compensate for this deficit and facilitate safe and effective ambulation? A. An ankle-foot orthosis (AFO). B. A wide-based quad cane (WBQC). C. A narrow-based quad cane (NBQC). D. A knee-ankle-foot orthosis (KAFO).

Correct Answer: A. Rationale: An AFO will provide the needed stability to the ankle joint to enable safe and effective ambulation. In this case, the knee is not involved so a KAFO is not indicated. A WBQC and a NBQC would be indicated for an individual with poor balance. Although canes can be very helpful ambulation aids, the concern in this case was to provide equipment to compensate for the lack of ankle dorsiflexion.

An individual recovering from hip replacement surgery prepares for discharge home. The client has a second. ary diagnosis of gastric esophageal reflux disease (GERD). Which is the best bed position for the occupational therapist to recommend to this client?Answer Choices: A. Supine with elevation of the shoulders and head. B. Sidelying with the neck in neutral. C. Sidelying with elevation of the shoulders and head. D. Supine with elevation of the hips.

Correct Answer: A. Rationale: In GERD, the lower esophageal sphincter (which acts as a valve between the esophagus and stomach) becomes weak or relaxes when it should not. This results in the stomach contents rising up into the esophagus. Elevation of the head above the stomach when the person is reclined may decrease the upward retropul sion of the bolus from the stomach. The other positions are not effective for an individual with GERD and they are contraindicated for a person recovering from hip surgery.

An individual recovering from a traumatic brain injury is assessed to be at Level VI of the Rancho Level of Cognitive Functioning Scale. Which should the occupational therapist use to implement treatment? A. Sensory stimulation activities such as moving to music. B. Repetitive self-care tasks such as brushing hair. C. Community re-entry activities such as taking a bus. D. Simple meal preparation tasks such as making a sandwich.

Correct Answer: D. Rationale: At Level VI the individual is appropriate and goal-directed but can become confused. Cues are required. Community re-entry activities are too high-level for an individual at Level VI. They are more appropriate for Level VII and VIII. Sensory stimulation activities such as moving to music would be appropriate for Level III. Repetitive self-care tasks would be appropriate for Level V.

The family of an individual being admitted to a rehabilitation center offers the occupational therapist a cash gift. The therapist refuses the money but the family continues to insist that the therapist take the cash gift. After thanking the family for their generous gesture, which is the therapist's best response? A. Donate the money to the hospital. B. Donate the money to charity. C. Use the money to purchase an item for the OT department. D. Decline the gift.

Correct Answer: D. Rationale: In accordance with the OT Code of Ethics, OT practitioners should not enter into transactions that could be interpreted as financially exploitive. Accepting a substantial cash gift would bring into question the ethical issue of financial gain; therefore, declining the gift is the best response. In certain circumstances, it could be appropriate to suggest a donation to the department or facility (e.g., if the family is determined to concretize their gratitude. In some cultures, it is appropriate to offer tokens of appreciation to staff. It might be considered rude and offensive to some persons to refuse a small gift. Some facilities may alter their policies about accepting gifts in these cases

A three-year-old child with left spastic hemiplegia due to cerebral palsy is evaluated for early intervention services. During the evaluation of the occupational therapist observes behaviors that seem to indicate the presence of visual deficits based on these observations, which action should the occupational therapist take? A. Completion of a motor free visual perceptual assessment B. Completion of a developmental vision assessment C. Refer the child to an optician D. Refer the child to a optometrist

D. Prior to conducting a visual perceptual evaluation, and anatomical visual assessment to determine visual acuity is required. Optometrist are the professionals who are qualified to perform examinations to determine visual acuity, level of visual impairments, and damage to or disease in visual system.

An occupational therapist plans a task-oriented activity group for adolescent girls recently diagnosed with anorexia nervosa. Which is the best activity for the therapist to include in the initial session of this group? A. Making cards to send to veterans in a local hospital. B. Baking cookies for the residents in a homeless shelter. C. Performing low impact aerobic exercises. D. Composing lyrics and melody for a group song.

D. Composing lyrics and melody for a group song. A task-oriented group utilizes a psychodynamic approach to increase participants' understanding of their needs, values, ideas, feelings, and behaviors. Activities are selected and designed to facilitate self-expression needs, values ideas, feelings, thoughts, and behaviors. Composing a song is a self-expressive activity that allows each member to contribute his/her thoughts and feelings. It is an activity that can be stopped to discuss behaviors, feelings, and issues that arise during the group. The other activity choices do not provide this self. expression opportunity. In addition, baking and exercising are not the best initial activities for a person wild eating disorders.

A large general hospital in an urban area initiates several quality improvement committees that include occupational therapists. Which of the following does participation in these committees provide to the occupational therapists? A. The ability to develop personal performance skills. B. The capability to enhance leadership skills. C. The power to promote occupational therapy services. D. The opportunity to improve overall service delivery.

D. The opportunity to improve overall service delivery. Quality improvement (QI) involves a prospective analysis of specific services to improve service quality and meet the needs of a population. The QI approach is designed to use a team effort to empower employees to improve service quality. Participants may develop skills while working on the committee, but personal performance and leadership development are not the goals of QI. Participating in a QI committee can provide opportunities for the occupational therapists to informally promote occupational therapy services, but this is not the purpose of a QI committee.

A 19 year old with diagnoses of dysthmic disorders during narcissistic personality disorder attends a vocational rehabilitation program. When the client arrives for the work adjustment group, the therapist notes that the client demonstrates an unsteady gait and slurred speech. The clients breath smells of alcohol. Which is the best action for the therapist to take in response to These observations? A. Follow program procedures to arrange for transportation to bring the client home B. Introduce the topic of alcohol effect on work performance as the focus of the scheduled group session C. Have the client meet with the social worker to discuss treatment options for potential alcohol abuse D. Contact the clients parents to pick the client up to bring the client home

A. The person is showing signs of being under the influence of alcohol. It is not appropriate at this time to use the group or an individual session to discuss the observed behaviors and/or potential treatment needs. In the clients current state, he/she is impaired and cannot fully participate in this discussion. The client is a 19-year-old adult so there is no need to contact the clients parents.

An individual with advanced Huntington's chorea is newly admitted to a skilled nursing facility. The resident weighs 280 pounds and cannot independently transfer. What is the best recommendation for the occupational therapist to make to the resident's direct care staff to ensure a safe transfer? Answer Choices: A. A mechanical lift transfer. B. A two-person lift transfer. C. A stand pivot transfer. D. An assisted sliding board transfer.

A. A mechanical lift transfer. A mechanical lift transfer is the safest for both the resident and the staff. The other transfers require motor and cognitive abilities that are beyond the capacity of an individual with advanced Huntington's chorea. Huntington's chorea, an autosomal dominant neuromuscular disease, is characterized by choreiform movements, progressive intellectual deterioration, and psychiatric disturbances. The individual's movement disorder combined with potential confused and/or agitated behaviors requires the use of a mechanical lift for safe and efficient transfers.

A woman with a complete spinal cord injury at the C5 level has given birth to her first child. The client seeks suggestions on methods to facilitate independent and safe parenting. Which of the following is most beneifical for the occupational therapist to recommend the mother use to help her independently feed her child? A. A pillow to support the mother's arms during breast feeding. B. Bottles with pre-measured formula. C. Bottles that have molded easy to grip shapes. D. A sling to support the infant's head during breast feeding.

A. A pillow to support the mother's arms during breast feeding. Providing support of the mother's upper extremities will enable her to independently breastfeed her child Breastfeeding is physically the easiest method for feeding an infant and it is the healthiest for the infant. The individual with a C5 spinal cord injury has sufficient upper extremity function to be able to support the infant's head without the use of a sling, especially since the mother's arms will be supported by a pillow to decrease fatigue. Pre-measured formula is not indicated in this case. The individual would need a splint or other piece of adaptive equipment to hold a baby's bottle.

An occupational therapist conducts aa initial home visit to a family with a premature infant who, at four months and 5 pounds, has just been sent home. The child has multiple disabilities. Which is the best primary goal for the therapist to work on with the family during this first session? A. Communicate effectively to develop a therapeutic relationship with the family B. Teach the family proper body mechanics for lifting the child C. Teach the family assertiveness training to develop advocacy skills D. Determine whether adaptive aids or positioning equipment is needed

A. Communicate effectively to develop a therapeutic relationship with the family During first visit, it is essential that the therapist practice effective communication and work on developing a therapeutic relationship with the family. Since the child has multiple disabilities, the occupational therapist will need to work closely and frequently with the family to address their child's needs over an extended period of time. The other choices can be addressed when, and if the need evolves. In addition, one cannot assume that the family will need assertiveness service training

An occupational therapist receives a referral from a physician that outlines a specific course of treatment. Following the evaluation of the person, the therapist believes that a different course of treatment would be more beneficial. Which course of action is best for the therapist to take? A. Contact the physician and discuss the alternative treatment. B. Provide the prescribed treatment on a three to four-week trial. C. Combine the prescribed treatment with the therapist's preferred treatment. D. Provide the treatment the therapist believes would be more beneficial for the person.

A. Contact the physician and discuss the alternative treatment. This action enables the occupational therapist to share his/her professional expertise with the physician in a collaborative manner. The other choices do not do this.

An entry-level occupational therapist is hired to work on an acute psychiatric unit. The occupational therapy supervisor orients the therapist to hospital policies and procedures. Which are the most important policies and procedures for the supervisor to include in the initial orientation session? A. Crisis intervention. B. Reimbursement. C. Employee benefits. D. Group program scheduling.

A. Crisis intervention. Crises can occur at any time in any acute facility. All employees must immediately learn the policies and procedures for dealing with crises to ensure the safety of patients and staff. Reimbursement issues and group program scheduling can be reviewed during regular supervisory sessions. These issues are not immediate concerns. Employee benefits are the responsibility of the personnel/human resources department.

An occupational therapist evaluates a client using the Allen Cognitive Level (ACI) Screen. The client successfully completes three running stitches. Which step should the therapist take next? A. Demonstrate the whip stitch and ask the client to imitate this and complete three stitches. B. Demonstrate the single cordovan stitch and ask the client to imitate this and complete three stitches. c. Demonstrate the double cordovan stitch and ask the client oimitate this and complete three stitches. D. Document that the person demonstrates a cognitive level consistent with Level 3 of the Cognitive Disabilities model.

A. Demonstrate the whip stitch and ask the client to imitate this and complete three stitches. According to the Allen Cognitive Level (AC) Screen, after the completion of three running stitches the person should move on to the next step in the screening process, which is the completion of three whip stitches. After the completion of three whip stitches, the therapist then points to the single cordovan stitch and asks the client if he/she can do the stitch. If the client is unable to complete the stitch, the therapist provides an orienting verbal cue. If the client cannot complete the stitch with this cue, the therapist demonstrates the stitch. A maximum of two demonstrations can be provided. The double cordovan stitch is not used in the ACL Screen. The documentation of a person's cognitive level should be completed after the person has had the opportunity to perform all components of the evaluation.

An occupational therapist provides home-based services to a person recovering from a recent CVA. The individual lives alone and receives home care Medicare Part A benefits. The therapist arrives at the client's house at the scheduled session time, but there is no response to the knocking on the door. A neighbor reports seeing the client leave with a friend. Which is the best action for the therapist to take in response to this situation? A. Document that no one answered the door and that the appointment will be rescheduled. B. Call the nurse case manager to report the missed appointment and the need to reschedule. C. Document that no one was home and that the appointment will be rescheduled. D. Document that the client is engaged in community mobility activities and should be evaluated for discharge.

A. Document that no one answered the door and that the appointment will be rescheduled. Rationale: Documentation must state that no one answered the door. This is factually correct and allows the individual to continue to receive home care service reimbursement from Medicare. To receive Medicare home care reimbursement, an individual must be homebound which means he/she can only leave home according to specific criteria. See Chapter 4 for these criteria. The client may have left for a reason that would meet these criteria. It is best not to document any behaviors that may jeopardize a person's homebound status. It is not necessary to notify the nurse case manager about a missed appointment. The therapist can speak directly to the individual. One missed appointment is not a basis for discharge.

An occupational therapist completes an early intervention screening of an 8-month-old child. The results indicate that the child is able to sit independently by propping forward on both arms. Which is the best action for the occupational therapist to complete next? A. Evaluate the child's sensorimotor skills using a standardized evaluation. B. Inform the parents that the child exhibits typical behavior. C. Develop goals to improve sitting balance. D. Provide play activities to develop sitting balance

A. Evaluate the child's sensorimotor skills using a standardized evaluation. The screening indicated a sensorimotor delay, which requires further evaluation. Sitting with arms propped forward is typical of a 5-6 month-old. At 8 months, a child tpically sits without support; therefore tune evaluation of the child's sensorimotor status is indicated. The therapist cannot set goals or prescribe acting. prior to the completion of a full evaluation.

An occupational therapist constructs a splint for a person who incurred full thickness facial and anterior neck burns. In which position should the therapist splint the neck. A. Extension B. 15° flexion C. 15° lateral flexion D. 15° hyperextension

A. Extension The neck should be splinted in extension. A major focus of acute burn care is proper positioning to maintain involved areas in anti-deformity position. Because the contracture tendency of an anterior burn to the neck is flexion, the anti-deformity position is extension. The other positions are contraindicated. A full thickness burn involves the epidermidis and dermis, hair follicles, sweat glands, and nerve endings. Skin grafting is required and healing time can take months. Post operative occupational therapy care following skin graphs involves the wearing of a splint at all times

A two-year-old child receives home care early intervention services The occupational therapy intervention plan includes a goal to develop the child's pincer grasp. Which is the most appropriate activity for the occupational therapist to work on with the child during an intervention session? A. Finger-feeding of O-shaped cereal B. Picking up marbles. C. Drawing with jumbo crayons D.Stacking one-inch cubes.

A. Finger-feeding of O-shaped cereal Rationale: Picking up O-shaped cereal to finger-feed will facilitate the use a pincer grasp. While picking up marbles also uses a pincer grasp, this activity presents a potential choking hazard, as two-year-olds frequently put items they pick up into their mouths. Drawing with a jumbo crayon uses a gross grasp. Stacking cubes uses a radial digital grasp.

A client with a right below-elbow amputation begins prosthetic training with a body-powered myoelectric Prosthesis. The occupational therapist collaborates with the client to begin training in the use of the terminal device to grasp and release objects. Which elbow position is best for the therapist to place the client's elbow in during grasp and release activities? A. Flexed at 90° with neutral degrees of pronation/supination. B. Flexed at 90° and pronated 60° C. Flexed at 120° and with neutral degrees of pronation/supination. D. Flexed at 90° and supinated 60°

A. Flexed at 90° with neutral degrees of pronation/supination. Rationale: The elbow flexed at 90° with neutral degrees of pronation/supination is the easiest position in which to begin grasp and release activities. It is also the most functional and natural. The other positions are more difficult positions and can be attempted after achievement of the mentioned position, if needed.

A child with juvenile rheumatoid arthritis where is bilateral night resting splits with wrist in 0° of extension, MPs and IPs flexed, owner deviation of 10°, and thumbs in opposition. The child complains of pain in the wrist upon awakening. no redness is noted upon removing splints. Range of motion measurements show owner deviation of 5°. Which action should the occupational therapist take in response to this complaint in these observations? A. Modify the splints at the wrist. B. Pad the owner aspect of the inside of the wrist. C. Discontinue the splints and monitor the status of paying for two weeks D. Construct volar cock up splints for use during the day

A. Modify the splints at the wrist The splints should be adjusted by use of heat to accommodate to the current position of owner deviation padding is frequently used to attempt to modify the position of a splint, but it does not correctly allow distribution of pressure. Discontinuing the splints will serve to increase deformities and pain. The child might benefit from day splints, but this does not address the issue of splints causing pain and being set at an incorrect angle for the child's ulnar deviation measurement.

The supervising occupational therapist meets to plan the workload of the recent hired OTA's. Which is an appropriate task for them to assign to the OTAs? A. The in-home evaluation of the adult clients instrumental activities of daily living B. The determination of long-term goals to include in the adult clients occupational therapy home care intervention plan C. The design of home-based sensory integration protocols for infants and toddlers with sensory processing disorders D. The administration in interpretation of the Hawaii early learning profile to infants and toddlers

A. The in-home evaluation of the adult clients instrumental activities of daily living In OTA can complete IADL evaluation under the supervision of an occupational therapist. The interpretation of the evaluation results and the determination of goals are the responsibility of the occupational therapist. The design of sensory integration protocols and the completion and interpretation of evaluation's cannot be completed by an OTA. And OTA can contribute to these processes but cannot independently complete them.

A young adult with a diagnosis of schizophrenia, Paranoid type is scheduled to be discharged from an inpatient setting to a halfway house and psychosocial clubhouse. The occupational therapist is assisting the team with the discharge plan. Which is the most important information for the therapist to provide to the team about this person. A. The persons instrumental ADL skills B. The possible effects of medication on the persons performance C. The persons vocational potential D. The persons social interaction skills

A. The persons instrumental ADL skills Knowledge of the persons level of skills for the performance of IADL is essential for the occupational therapist to share with the team. They can provide the halfway house staff with information that can be used to determine the level of structure and support this person may need to make a successful transition. In a halfway house, residents are typically responsible for the maintenance of the rooms and personal items. They are also expected to contribute to the maintenance of the entire household. Successful adjustment to the halfway house will require the performance of instrumental ADL whether independent or with assistance.

An occupational therapist reviews the use of the occupational therapy departments resources to determine medical necessity and cost efficiency. Which service management task is the therapist performing? A. Utilization review B. Retrospective peer review C. Total quality management D. Risk management

A. Utilization review Utilization review is a plan to review the use of resources within a facility to determine medical necessity and cost efficiency. It is often a component of a continuous quality improvement or a performance assessment in improvement system. Total quality management is the creation of an organizational culture that enables all employees to contribute to an environmental of continuous improvement. Risk management is a process that identifies, evaluates and takes corrective action against risk; and plans, organizes and controls the activities and resources of OT services to decrease actual or potential losses. Retrospective review involves the auditing of medical records by third-party payers to ensure appropriate care was rendered. Peer review is a system in which the quality of work by a group of health professionals is reviewed by their peers

An occupational therapist interviews an OT for a position at a high school for gay and lesbian youth. The position involves the provision of transitional vocational programming and life skills training. The OTA uses a wheelchair for mobility and has dysarthric speech. Which of the following is most relevant for the occupational therapist to ask the OTA about during the interview? A. Verbal group leadership skills B. Sexual orientation. C. Personal beliefs about homosexuality. D. Accommodations needed due to the evident disabilities.

A. Verbal group leadership skills Rationale: The other questions are in violation of civil rights legislation and the ADA. One can ask an applicant about his/her ability to perform essential job tasks. Vocational programming and life skills training is most often done in group settings; therefore inquiring about the applicant's verbal group leadership skills is appropriate and legal. It is up to the applicant to declare a disability and to request any reasonable accommodations needed to perform essential job tasks. An interviewer cannot directly question an individual about his/her disability nor needed accommodations.

Following medical treatment for a brain tumor, a client is referred to OT home care services for a functional evaluation. During the initial interview, the client reports difficulty locating desired items. For example, at lunchtime the client could not find a can of soup in the pantry. Based upon this self-report, which functional ability should the occupational therapist evaluate? A. Visual scanning. B. Visual acuity. C. Spatial relations. D.Topographical orientation.

A. Visual scanning. Rationale: Visual scanning is the ability to systematically observe and locate items in the environment. Visual acuity is the clarity of both near and far. Spatial relations is the ability to relate objects to each other (i.e., above/ below). Topographical orientation is the ability to find one's way in space.

A young adult with a 10-year history of bulimia nervosa participates in an outpatient vocational exploration group and completes a vocational interest inventory. This evaluation identifies four possible areas for a care Which career choice is best for the occupational therapist to advise the client to explore further? A. Web designer. B. Dietitian. C. Athletic trainer. D. Fashion designer.

A. Web designer. Persons with eating disorders have inaccurate and distorted body images and their self-evaluation is unduly influenced by their body shape and weight. There is a strong preoccupation with food and exercise activities may be pursued excessively in order to decrease weight. Consequently, web design would be the best choice for vocational exploration of the four listed because it offers many options that do not focus on food, exercise or personal appearance. While a dietitian's job focuses on the science of food and provides education about nutrition, this constant contact with food might be difficult a person with a long history of an eating disorder. An athletic trainer is involved with exercise on a daily basis which might contribute to over-exercise and prove stressful for the client. Fashion design lends itself to a constant emphasis on body image and consistent contact with thin women in the fashion industry. This would also be contraindicated.

An occupational therapist provides consultation services to members of a town chamber of commerce who have expressive interest in improving their businesses accessibility. Which is the minimum door width that the occupational therapist should recommend to the chamber members as accessible and not requiring modification? A. 28 inches B. 32 inches C. 30 inches D. 34 inches

B 32 inches The minimum clearance width for doorways to allow for wheelchair access is 32 inches. Measurements are less than 32 inches must be modified. Measurements equal to or greater than 32 inches are acceptable

An occupational therapist advises the parent of an 18-month-old with developmental delays on techniques to facilitate feeding. The child has a reflexive bite. Which utensil is most beneficial for the therapist to recommend the parent use when feeding the child? A. A deep-bowled soup spoon. B. A narrow shallow coated spoon. C. A traditional teaspoon D.A plastic spork.

B. Rationale: The use of a narrow shallow coated spoon will help the food slide off. Deeper spoons or a spork will make it more difficult for the food to slide off, which would not be indicated for a child with a reflexive bite. In addition, the prong edges of the spork may hurt the child as he/she bites.

During a wheelchair evaluation, an individual with limited functional mobility expresses concern about the ability to continue volunteer work at a local church. The church's doorways are 31 inches wide. The client knows (from a recent home remodeling project) that 32 inches is the minimum width recommended for wheelchair access. Which recommendation should the occupational therapist make to the client to most effectively address the client's concerns and functional mobility needs? A. Have the church widen its doorways to comply with ADA requirements. B. Order a wheelchair with wraparound armrests. C. Have the client explore alternative volunteer activities in accessible locations. D. Order a customized narrow adult wheelchair.

B. Rationale: Wraparound armrests (also called space saver armrests) reduce the overall width of a wheelchair by one inch. A customized chair can be very expensive. The case does not indicate the individual's measurements, so it is not possible to ascertain if a narrow wheelchair would actually fit the person. Religious organizations are exempt from ADA accessibility requirements. The individual does not need to explore alternative volunteer experiences since valued established activities can continue with an appropriate wheelchair.

An occupational therapist measures the active range of motion of an individual's index finger. The measurements are MCP 0-45, PIP 10-60, and DIP 10-40. Which is most accurate for the therapist to document as the finger's total active motion (TAM)? A. 62.5° B. 125.0° C. 72.5°. D. 145.0°

B. 125.0° To obtain the TAM measurement, the extension deficits are added and then subtracted from the flexion measurement total. In this scenario, the extension deficits total 20°. The flexion measurements total 145°. 145 minus 20 equals 125.0°.

A child with mild spastic diplegia wants to participate in neighborhood activities with peers. The family's main goal for the child is to ride a bicycle. Which bicycle is Best for the occupational therapist to recommend? Answer Choices: A. A hand-propelled bicycle with hand brakes. B. A foot-propelled bicycle with hand brakes. C. A foot-propelled bicycle with foot brakes. D.An adapted tricycle with foot brakes.

B. A foot-propelled bicycle with hand brakes. Mild spastic diplegic cerebral palsy is characterized by mild lower extremity involvement and minimal to no upper extremity involvement. The use of legs to propel the bicycle increases lower extremity strength while encouraging lower extremity dissociation. Hand brakes are best for safety because the child usually has better control of the upper extremities than the lower extremities. Hand propulsion is not the best option since a bicycle will provide an excellent opportunity to develop lower extremity strengthening and dissociation. An adapted tricycle would be more suitable for a child with more involvement and less control of lower and upper extremities.

During an occupational therapy session, a veteran recovering from bilateral traumatic lower extremity amputations express several concerns about having a changed body and questions its sexual appeal. which response is best for the therapist to take in response to clients concerns? A. Refer the client to the primary care physician. B. Ask open-ended questions to explore the concerns further. C. Reassure the client that the concerns are a normal part of the recovery process. D. Explain that positioning can compensate for changes in functional mobility.

B. Ask open-ended questions to explore the concerns further. Sexuality and sexual expression are within occupational therapy's domain of concern, therefore, there is no need to refer the person to the physician. The therapist should immediately recognize the validity of the individuals concerns and provide the client with the opportunity to discuss these concerns further. Providing individuals does not deal with the concerns at the moment. Discussing positioning alternatives can occur after the person's concerns have been identified.

An occupational therapist develops a task group for the newly admitted patients of a psychiatric inpatient unit of a busy city hospital. The therapist considers several activities to use for the group's first session. Which activity is best for the therapist to present to the group members? A. Planning a weekend pizza party for the patients and their visitors. B. Decorating styrofoam cups and planting cuttings in them. C. Publishing a weekly newsletter about city attractions for patients on the unit. D. Painting a large mural to cover one wall of the day room.

B. Decorating styrofoam cups and planting cuttings in them. Decorating cups and planting cuttings is a simple, concrete, and safe task, which can be structured to ensure successful completion by individuals with acute psychiatric disorders who have been newly admitted to an acute psychiatric hospital. In addition, individuals on an acute unit have a short length of stay and require activities that can be completed in one session. The other choices require multiple sessions, which are not realistic on an inpatient unit.

A 15 year old with a symptomatic HIV attends an outpatient clinic. The occupational therapy protocol for patients diagnosed with HIV includes presentation of information on same sex. The adolescence parents refuse to allow this information to be presented to their child. Which is the best action for the therapist to take in response to this action? A. Ask the patient's opinion and act on the patient's refusal or consent. B. Document that the parents refuse the intervention for their child C. Refer the family to the social worker for counseling. D. Have the parents sign a waiver that they refused the intervention for their child.

B. Document that the parents refuse the intervention for their child The therapist should document that the information was refused. Parents are the teenagers legal guardians and have the right to refuse treatment for him/her. If this refusal constitutes a life-threatening situation, a facility can take legal action on behalf of the child. This situation is not considered life-threatening. Although teenagers will often make important personal decisions, and including ones about their personal behavior, legally, parents can't make decisions about their children until they are 18 years old. The information about the parents refusal should be documented to ensure that other team members do not violate the parents rights. This also protects the setting from potential liability. Asking the teenaged patient his/her opinion is irrelevant for the therapist could not act on the patient's wishes if they defied the parents stated wishes about the course and scope of treatment. The therapist may refer the case to the social worker or bring the issue up in a team meeting, but this team collaboration about a difficult issue does not preclude the need to accurately document what has occurred. The parents do not have to sign a waiver to refuse treatment options.

An individual incurred a spinal cord injury at the C5 level. During an occupational therapy session focused on developing the ability to feed independently using adaptive equipment, the occupational therapist notes that client is flushed and sweating excessively. The client requests that the session end early due to a pounding headache. Which action is best for the occupational therapist to take first in response to this situation? A. End the session and call the transporter to return the client to the client's room. B. Empty the client's filled catheter bag and maintain the client's upright position. C. Return the individual to the unit and report symptoms to the head nurse. D. Stop the session and recline the individual in the wheelchair for a rest break.

B. Empty the client's filled catheter bag and maintain the client's upright position. the clients symptoms are indicative of autonomic dysreflexia. This is an extreme rise in blood pressure cause by a noxious stimulus. This complication is deemed a medical emergency that must be treated immediately by quickly removing the noxious stimulus that caused the problem. Common stimuli are blocked catheters biting on sharp objects. Other symptoms of autonomic dysrefexia include profuse sweating and a pounding headache. The other choices do not deal with this medical emergency in an appropriate or timely manner. in patient should remain in an upright position to help manage the rise in blood pressure.

An elder diagnosed with dementia, Alzheimer's type was recently admitted to a skilled nursing facility (SNF). The OTA working with the resident reports to the occupational therapist that during the morning care session, the OTA observed bruises on the resident's back and upper arms. Which action is best for the occupational therapist to initially take? A Talk to the resident to obtain more information. B. Follow facility procedures for investigating resident safety. C. Contact the resident's family to obtain more information. D.Contact the state office for adult protective services.

B. Follow facility procedures for investigating resident safety.

During a classroom screening an 8-year-old is observed holding a pencil with A light grip. The student appears to rely heavily on visual cues to assist during both fine and gross motor tasks. During gross motor activities, the student moves in an uncoordinated manner. The occupational therapist uses a sensory integrative frame of reference to interpret evaluation data. Which impairment should the therapist document as needing further evaluation? A. Vestibular processing dysfunction. B. Proprioceptive system dysfunction. C. Hyporesponsive tactile system. D. Hyperresponsive tactile system.

B. Proprioceptive system dysfunction.

A 21-month-old child with severe spastic quadriplegia is evaluated by an occupational therapist. The therapist determines that the child is cognitively intact, exhibiting age-appropriate cognitive skills despite major sensorimotor deficits. The therapist recommends a play activity to enhance these cognitive abilities and provide the child with a fun and pleasurable experience. Which is the best object for the therapist to recommend? A. A multi-colored mobile of objects of interest placed over the child's stroller. B. A mechanical toy with a chin controlled on/off switch. C. A shape sorter with foam squares, triangles, and circles. D.A battery controlled hammock swing.

B. Rationale: At 21 months, a child is cognitively able to operate and control mechanical toys. The chin controlled switch will enable this child to self-direct his/her play despite the spastic quadriplegia. A mobile is cognitively too low for this child's ability. It is a passive activity that would not provide active engagement of the child. The ability to identify and sort shapes does occur at 21 months, but the use of a shape sorter requires motor abilities beyond this child's capacity.

Following the performance of a home exercise program prescribed one week ago, an individual with bilateral upper extremity muscle weakness reports experiencing pain in both shoulders and elbows. The pain is consistent for up to eight hours. The individuals occupational therapist is on vacation for two weeks and a recent hired entry-level therapist has been assigned to cover the vacationing therapist caseload. Which is the most appropriate action for the covering therapist to make in response to this individuals reporting symptoms? A. Stop exercising completely until the primary therapist returns and can reevaluate the persons status B. Reduce the intensity of exercise by 50% and reassess the person during the next intervention session C. Continue with current exercise program to develop tolerance D. Advise the individual to take a pain relief medication 30 minutes prior to exercising.

B. Reduce the intensity of exercise by 50% and reassess the person during the next intervention session A decrease in the exercise by 50% allows for the continuation of the treatment regimen and addresses the individuals complaint of excessive pain. The person needs to maintain the exercise program in order to address range of motion deficits and muscle weakness, however the intensity is causing excessive pain.

A six year old has thumb weakness, noted mostly and poor ability to perform thumb opposition. During evaluation, which activity will the therapist most likely observe the child having difficulty performing? A. Holding a penny on the ulnar side of the hand while moving a nickel from the palm to the tip of the thumb and the index finger B. Rotating a pencil 180° C. Sliding the fingers up and down a pencil while rolling the pencil in a tripod grasp D. Moving a ring from pad to pad pinch position to the palm

B. Rotating a pencil 180 Rotating a pencil describes simple rotation of 180°. Complex rotation is 360°. The child with poor thumb opposition has the most difficulty performing this skill of all of the in hand manipulation skills. the penny example describes translation with stabilization. Sliding the fingers across the pencil is shift. Moving a ring describes translation without stabilization.

An individual recovering from a CVA has received extensive motor learning intervention. The client can now transfer a learned motor skill to different contexts. The client also demonstrates the ability to successfully motor problem solved during activities in different contexts. In documenting the clients progress which stage of motor learning is most accurate for the occupational therapist to document the individual has achieved? A. Skill acquisition B. Skill retention C. Practice context D. Generalized context stage

B. Skill retention During the skill retention stage of motor learning, the individual can successfully retain the motor skill and transfer its application and use to a diversity of contexts. In these different settings and situations the person must modify his/her timing, sequencing, posture, and many other neuroma for component skills. These modifications and adjustments reflect successful motor problem solving abilities. During the skill acquisition stage of motor planning, the individual will make frequency errors and motor performance is inconsistent and inefficient. Although practice, context, and generalization are important motor learning concepts they are not considers stages of motor learning Stages of motor learning 1. Skill acquisition 2. Skill retention 3. Skill transfers

An occupational therapist becomes aware of the practice of a colleague who teaches an energy conservation class to persons with arthritis. This colleague has been sending the names of class participants to a vendor who sells adaptive equipment. Which action is best for the occupational therapist to take in response to the situation? A. Ignore the situation for it does not harm anyone. B. Speak to the therapist privately and tell him/her this action is unethical. C. Advise the therapist to disclose this practice and if he/she refuses report the therapist to the state regulatory board. D. Report the therapist's unethical behavior to the state regulatory board.

B. Speak to the therapist privately and tell him/her this action is unethical. This occupational therapist should talk directly to the colleague to allow the person to self-correct his/her behavior by ending this practice. Ignoring the situation is incorrect for it allows an unethical practice to continue. Advising the therapist to disclose this practice makes the assumption that this practice will continue. Reporting the therapist to the state regulatory board is over-reactive at this time and would result in little action for these boards only regulate issues of potential harm and/or fraud. Providing a vendor with the names of potential clients may be of questionable ethics, but it is not illegal or dangerous.

During an early intervention planning meeting, an occupational therapist explains the results of a play ases ment to the parents of an 18-month-old toddler with multiple developmental disabilities. The child has bee assessed as delayed by 6-8 months in all developmental parameters. Which intervention approach is mos effective for the therapist to recommend using first to develop the toddler's play skills? A. The use of toys that encourage creative and imaginative play. B. The use of toys that are visually and auditorily stimulating. C. Participation in a small parallel play group with other toddlers. D. Engagement in activities that use sensorimotor skills prerequisite to play.

B. The use of toys that are visually and auditorily stimulating. Providing toys that are visually and auditorily stimulating will help engage the child in the intervention process. As the child explores the sensory properties and characteristics of these toys, he/she will engage in activities that will facilitate developmentally appropriate play. Through this process, the child will develop sensorimotor and cognitive skills. Many toys that provide visual and auditory stimulation also provide opportunities to explore relationships between actions and objects (e.g., striking a colorful keyboard to produce music). The exploration of relationships between actions and consequences is typical of the cognitive development of a 9-12 month-old, which is this child's developmental age. Creative play occurs developmentally at 4-7 years, so this option is not developmentally appropriate for this child. Placing a toddler with the developmental age of a 10-12 month-old into a parallel play group is not age appropriate. Engaging the child in activities that use sensorimotor skills prerequisite to play would not achieve the stated aim of developing play skills. It is more effective to directly use play activities during intervention to develop play skills.

A patient with a complete injury of the spinal cord at the C5 level completed inpatient rehabilitation which concentrated on increasing independence in activities of daily living. In the discharge documentation, which is most likely for the occupational therapist to state the client is able to do? A. Button buttons using a button hook. B. Use mobile arm supports for feeding. C. Tie shoes using thick shoelaces. D. Brush teeth using a tenodesis splint.

B. Use mobile arm supports for feeding. Mobile arm supports are likely to be able to be used by a person with a C5 level of injury. The ability to complete grooming tasks using a tenodesis splint and buttoning with a button hook are likely skills for a person with a SCI at the C6 level. A person with a C8 level of SCI would likely be able to tie shoes.

a child with tactile defensive sensory modulation disorder attends a private early intervention clinic. The OT collaborates with the child's parents to develop strategies and guidelines to help the child handle the symptoms of this disorder at home which is the best recommendation for the Therapist to make to the parents? A. Avoid the use of swings and other moving equipment during play activities B. Encourage the use of swings and other moving equipment during play activities C. Soften the child's clothing by repeated laundering and removing tags D. Provide a variety of textures in the clothing the child wears

C. Children with tactile defensive sensory modulation disorder find stiff clothing, textured clothing, and clothing tags aversive. The use or avoidance of, swings and other moving play equipment is indicated for vestibular processing disorders

A single parent is hospitalized for an exacerbation of schizophrenia. Actively psychotic upon admission, the client has been stabilized on medication. The client is currently not demonstrating hallucinations or delu-sions. Residual deficits include several negative symptoms and decreased cognitive skills. At the team meeting, the psychiatrist decides to discharge the client within 48 hours. The client lives with his/her elementary-school aged children. Which is the best recommendation for the occupational therapist to make during this team meeting? Answer Choices: A. An extension of hospitalization to further evaluate cognitive skills. B. A family meeting to discuss the need for the children to assume home management tasks. C. A home visit to assess the client's safety skills within the home environment. D.A referral to social services to explore foster care for the children.

C. A home visit is necessary to determine the individual's ability to safely carry out home management and parenting responsibilities. The therapist should recommend a home visit to determine if the physician's recommendation is appropriate and/or if home-based services are needed. It is not necessary to extend the hospital stay to evaluate cognitive skills. It is most effective to evaluate cognitive skills in the home setting where the individual will be carrying out occupational tasks. While children can help with home manageme tasks, they should not fully assume these responsibilities. There is no information in the scenario to indicate that the children need foster care.

The accountant ask the private practitioners to present their budget for anticipated direct expenses of their growing practice. Which is the most appropriate item to include in their budget request? A, The rent and utilities of the practice primary office B. An integrated computer system for paperless documentation by all staff C. Staff vacation and sick time D. Supplies of items used in in-home therapy sessions

C. Direct expenses include costs related to OT service provisions such as salaries and benefits. Vacation time are benefits that must be budgeted. An integrated computer system will cause a substantial amount of money which renders it a capital expense. As noted above capital expenses are in the item above a fixed amount. Capital items are available from other expenses due to their depreciation in value and potential tax credits that may be available for purchases and/or investments. Supplies are considered a variable expense since this expense will change in direct proportion to the amount of services provided rent is a fix expense. Utilities are indirect expenses.

A school-aged child who is right-hand dominant complains of numbness and tingling after writing for more than 15 minutes. A neurological exam shows no reason for the numbness and tingling. Which action would be most beneficial for the occupational therapist to recommend to the child? A. Use a pencil held in a universal cuff to complete writing activities. B. Elevate the right upper extremity at night and whenever possible during the day. C. Stretch the right upper extremity every 15-20 minutes during writing activities. D. Use a custom-molded pencil grip made of splinting material when writing.

C. Rationale: The neurological exam is negative. The best choice is to educate the child in active ROM and stretching of the upper extremity to increase circulation and to attempt to prevent numbness and tingling. The universal cuff and custom-molded grip are adaptations that do not address treatment of numbness and tingling. Elevation can reduce edema; however, edema is not a symptom here.

A religious congregation Obtained private funding to build a ramp so that members with disabilities can attend services. The entrance to the congregation's building has six steps with a rise of 7 inches each. Which is best for the occupational therapist hired by the congregation to recommend for construction of this ramp? A. 42 feet long. B. 48 feet long. C. 42 feet long with a 5 inch x 5 inch landing at the ramps midpoint. D. 48 feet long with a 5' x 5' landing at the ramps midpoint

C. 42 feet long with a 5 inch x 5 inch landing at the ramps midpoint. A ramp should provide 1 foot of slope for every inch of rise. Six steps that have a rise of 7 inches results in a total rise of 42 inches. A 42 foot ramp may be too long for some individuals to independently access. Therefore, a landing at the ramps midpoint would be best to allow the opportunity to safely take a rest break. For many years a 4" x 4" landings were considered adequate. Current ADA guidelines now recommend 5" x 5inch landings

To ensure the provision of best practice, the new entry-level occupational therapist will be provided with supervision of their caseloads. At what level should the supervision be provided? A. routine. B. General. C. Close D. Minimal

C. Close It is recommended that entry-level occupational therapist receive close supervision that is daily, direct contact from patient care. Immediate level occupational therapist can receive routine supervision, every two weeks to General supervision at least monthly. Advanced practitioners need minimal supervision, on an as-needed basis for patient care

A child with attention deficit with hyperactivity disorder (ADHD) and conduct disorder attends an after school program that utilizes sensory-integrative and behavioral management approaches to achieve intervention goals, snacks are provided and occasionally used as rewards. A parent insists that a child not be given a foods containing sugar. Which is the occupational therapist's best response to this request? A. Discontinue providing sugary snacks but continue their use as rewards in the behavioral management program. B. Provide the parent with recent research that refutes the link between sugar and problem behaviors. C. Discontinue providing sugary snacks for the child to comply with the parent's request. D. Inform the parent that the therapist will discuss the issue with the program's administrator to determined be best course of action.

C. Discontinue providing sugary snacks for the child to comply with the parent's request. The parent's request must be respected and honored. While a therapist may provide a parent with research information related to a child's condition, it is not the therapist's role to attempt to prove the parent wrongin his/her beliefs. The therapist can directly address the issue with the parent and does not need to discuss the is sue with the administrator prior to responding. Behavioral rewards and appropriate snacks that do not contain sugar can be used in the program. The use of non-sugar items can also be beneficial for children at risk with a secondary diagnosis of diabetes or other medical conditions.

An individual who has Parkinson's disease presents with poor trunk rotation during ambulation and while performing activities of daily living. According to Neurophysiologic approaches, which is the most effective therapeutic intervention for the occupational therapist to use with this person? A. Facilitation of trunk rotation using neurodevelopmental handling techniques B. Slow rolling with the person supine with knees and hips flexed C. Engagement in activities of daily living using diagonal patterns D. Provision of a rolling walker to compensate for limited rotation and enhance mobility

C. Engagement in activities of daily living using diagonal patterns A person is presenting with poor trunk rotation during ADL and functional mobility. This is typical in individuals with Parkinson's disease according to neurophysiologic approaches, The most appropriate approach is to use a technique to facilitate rotation during activity performance. PNF diagonal are the best choice because many activities (e.g. loading/unloading the washer, putting away groceries) can be performed using diagonal patterns. NDT handling techniques and the rude technique of slow rolling may facilitate rotation; however, they do not incorporate functional activities. Therefore, they are not the best choice. The provision of a rolling walker is a compensatory approach and does not directly address the effects of poor rotation on the persons performance of activities of daily living.

A child with spinal muscle atrophy can no longer reach beyond 90° of shoulder abduction in 90° of shoulder flexion the parents state that the child can no longer DON or doff a T-shirt. Which is the best approach for the occupational therapist to recommend the child use for dressing? A. Place the tshirt directly on the child's lap , ave the child don the arms first then don the head of the tshirt B. Have the child learn to don and doff front opening shirts instead of T-shirts C. Have the child support the elbows on a table at chest height to don the shirt over the arms , then don over head D. Have the child sit with the trunk well supported, lean to the right and don't right arm, repeat to the left, and then don the head of the T-shirt

C. Have the child support the elbows on a table at chest height to don the shirt over the arms , then don over head Spinal muscle atrophy is a progressive disorder and the therapist needs to prepare the child and family for progressive loss of skills the best technique, as shoulder range of motion decreases, is to use a table for support to DON arms then over the head.

he occupational therapist employed at a day treatment center for dients with psychiatric disorders is conducting a leisure planning group. The members of the group decide to take a day trip to the local sculpture garden. Which side effect of psychotropic medications is most important for the therapist to discuss preventative precautions for with the group? A. Orthostatic hypotension. B. Akathisia. C. Photosensitivity. D. Tremors.

C. Photosensitivity. Photosensitivity results in severe sunburn which can occur during an outdoor trip. The other answer choices identify potential side effects of medications but they are not exacerbated by being outside.

Following a left CVA, and individual receives OT services at a subacute rehabilitation facility. The patient's personal goal is to be independent in dressing. The patient demonstrates decreased memory, poor sequencing skills, and ideational apraxia. Which of the following is most effective for the therapist to provide when teaching one-handed dressing techniques to this patient? A. Step-by-step verbal instruction B. Sequence photographs of the steps in dressing C. Physical prompts to initiate the steps in dressing D. A full length mirror for the client to observe self addressing performance

C. Physical prompts to initiate the steps in dressing Ideational apraxia is the breakdown in the knowledge of what is to be done and how to perform specific activities. This means that one cannot perform a task whether spontaneously or upon request. However, the sensorimotor aspects needed to perform the activity can be intact. Providing physical prompts to initiate dressing can be a sufficient cue for the individual to begin and then complete the task. Providing verbal instructions or sequence photos will not address The fundamental deficit of ideational apraxia and therefore would not enhance performance. Observing one's self dressing in front of a mirror results in a view opposite of actual performance. This can increase confusion, especially with apraxia

An occupational therapist providing home-based occupational therapy services implements a bed positioning plan for a person recovering from a cerebral vascular accident. The person is receiving care from family members and personal care assistants employed by a home care agency. Which action should the therapist take to ensure the accurate implementation of this plan by the client's caregivers? A. Provide verbal step-by-step directions of the desired positions to the client's caregivers. B. Post written step-by-step directions of the desired positions on the wall by the client's bed. C. Post pictures of the desired positions next to the headboard of the client's bed. D. Require each caregiver to demonstrate the replication of the desired

C. Post pictures of the desired positions next to the headboard of the client's bed. A visual representation of the exact positions desired can decrease any misinterpretations of a written description. Placing this picture by the bed's headboard will ensure that it is visible to all caregivers. It is the most effective method provided to ensure compliance. Providing verbal step-by-step directions for positioning is reliant on the caregiver's memory which can be incomplete or faulty. Posting written step-by: step directions is reliant on the initiation of all caregivers to read the documented procedures and on the caregivers' accurate interpretation of the written word. These methods may also assume a knowledge base (e.g., 30° of shoulder abduction) that is beyond the level of some of the client's caregivers. Requiring caregivers to demonstrate replication of the positions can be helpful but it is highly unlikely that the therapist would be able to access every personal care assistant who will be providing direct care to this client. In addition, home care agencies often use on-call per diem staff that would not be available to participate in a demonstration session.

An individual who had a CVA one year ago continues to demonstrate unilateral inattention. The individual drives daily to therapy despite several suggestions from the occupational therapist to discontinue this activity. The therapist has determined that the client is an unsafe driver. Which is the best action for the therapist to take in response to this situation? A. Report the individual to the department of motor vehicles B. Suggests that the individual attends a driving training program C. Report the information to the physician D. Tell the individuals family that the client is at risk for injury self and others while driving.

C. Report the information to the physician The therapist must report the information to the physician, who is responsible to take action on the individual's ability to drive. The drivers license agency addresses the issues of administration of licenses. The agency does not address cognitive evaluation or remedial issues concerning driving. A driver training program is a good suggestion to help the individual improve skills but it does not address the unsafe driver on the road the option to inform the family can be present in the context of the skills that OT addresses, such as unilateral inattention. However it does not address the safety issue.

The occupational therapist completes the pain evaluation. What additional evaluation methods should the therapist use to assess this client? A. Vigormeter. B. Dynamometer. C. Volumeter. D.Sphygmomanometer.

C. Volumeter. Rationale: One of the client's major presenting problems is edema. The volumeter is an assessment tool that objectively measures edema based on the displacement law of physics. A dynamometer, vigormeter, and sphygmomanometer are tools that can be used to measure grip strength. An evaluation using these measures would be contraindicated at this time due to the client's presenting complaints of severe pain and stiffness.

An adolescent student with Duchenne muscular dystrophy and depression is being evaluated for a power wheelchair. Which is the most important area to be considered during the occupational therapy evaluation of the student to determine the student's readiness for the wheelchair? A. Level of interest. B. Fine motor skills. C. Cognitive skills. D. Postural control.

C. cognitive skills Cognitive skills include alertness, spatial operations, judgment, decision making and problem-solving which can be affected by depression. Since these abilities are needed for the safe operation of a power wheelchair, it is essential that the occupational therapist assesses the student's cognitive level. An individual's level of interest can help engage him/her in mobility training but it is not the most important area to assess. Fine motor skills and postural control are likely absent due to the progression of Duchenne muscular dystrophy. Wheelchair adaptations can compensate for decreased fine motor skills and poor postural control.

An elder with peripheral neuropathy resulting from the chronic effects of diabetes expresses concern over the ability to have a satisfying relationship with a partner. Which is most beneficial recommendation for the occupational therapist to make to the elder? a. experiment with different positions during sexual expression activities b. focus on intact senses and areas of intact sensation c. schedule sexual expression activities around rest periods d. advise the elder to accept decreased abilities in sexual expression as a normal part of aging EXAMPLE WHY!

CORRECT ANSWER: B. Focus on intact senses and areas of intact sensation Peripheral neuropathy results in sensory loss; therefore, focusing on intact senses and intact areas on sensation can help the elder and his/her partner achieve satisfying methods for sexual expression INCORRECT: A - experiment with different positions during sexual expression activities This is an effective recommendation for individuals with neuromuscular or musculoskeletal deficits C - schedule sexual expression activities around rest periods This is an effective recommendation for someone who experiences fatigue that limits activity such as Multiple Sclerosis D - advise the elder to accept decreased abilities in sexual expression as a normal part of aging While the effects of aging may decrease some abilities in sexual expression, the desire to engage in sexual expression does not necessarily diminish with age. Sexual desire and interest in pursuing sexual expression activities are deeply personal and highly individualized. Advising the elder to accept decreased abilities as a normal part of aging reflects an AGEIST BIAS

The parents of a two-vear-old child with bilateral congenital upper extremity amputations express concer o the homecare occupational therapist about their child's complete disinterest in toilet training. At which poi should the occupational therapist advise the parents to begin toilet training? A. When the child indicates discomfort with being wet or soiled. B. Immediately, because toileting is a developmentally appropriate task. C. When the child is three years old, as this is the typical developmental age for toilet training. D. By placing the child on a "potty" chair for five minutes per hour each day.

Correct Answer: A. Rationale: The first toileting skill developed is the child's recognition of being wet or soiled as uncomfortable. All children develop differently and typical developmental time tables include a range of ages for skill development. In addition, these ranges can vary for children with congenital disabilities. Typical Developmental Sequence of Toileting 1 • Indicates discomfort when wet or soiled • Has regular bowel movements 1½ - Sits on toilet when placed there and supervised (short time) 2 - Urinates regularly 2½ • Achieves regulated toileting with occasional daytime accidents - Rarely has bowel accidents • Tells someone that he or she needs to go to the bathroom • May need reminders to go to the bathroom • May need help with getting on the toilet 3 • Goes to bathroom independently; seats himself or herself on the toilet • May need help with wiping • May need help with fasteners or difficult clothing 4-5 • Is independent in toileting le.g., tearing toilet paper, Rushing, washing hands, managing dothing)

An individual with borderline personality disorder is admitted to the hospital following a suicide attempt. After attending an occupational therapy orientation group, the patient tells the occupational therapist, You are the only therapist who has ever been really helpful." The patient asks to meet with the therapist privately on a regular basis instead of the assigned primary individual therapist. Which action is best for the therapist to take in response to the patient's request? A. Refer the patient to the assigned primary individual therapist. B. Agree to meet with the patient since a positive therapeutic connection has been expressed. C. Tell the patient that an occupational therapist provides only occupation-based group treatment. D. Explain that this type of manipulative behavior is not acceptable.

Correct Answer: A. Rationale: The patient must be referred to the primary individual therapist assigned to his her case. Although the patient has responded favorably to the initial occupational therapy group session, this does not preclude the patient's need for individual therapy. On inpatient psychiatric units, occupational therapy practitioners often serve as primary individual therapists in addition to their group therapist role. However, the assignment of caseloads is not (and cannot be) based upon patients' requests. Labeling the individual's behavior as manipulative is judgmental and can be considered antagonistic.

An occupational therapist conducts a satisfaction survey to evaluate the quality of OT services in an outpatient program. The questionnaire developed by the therapist asks respondents to rate their responses to quality statements according to a 4-point Likert scale of agreement. Which statement best reflects an adequate measure of satisfaction? A. "The amount of time devoted to stress management was adequate." B. "Setting my own goals was important to me." C. "My experience in occupational therapy helped me." D. "The OT staff was respectful and fair to me."

Correct Answer: A. Rationale: The response "The amount of time devoted to stress management was adequate" is the most helpful for those listed because it provides concrete information to evaluate service quality and improve service provision. Statements that reflect the personal value of an item to an individual, or that are vague and non-measurable do not measure satisfaction with the services delivered. As a result, they do not meet the measurement requirements of a satisfaction survey.

An occupational therapist designs a dynamic splint for an individual recovering from tendon repair. At which angle should the therapist position the outrigger?An occupational therapist designs a dynamic splint for an individual recovering from tendon repair. At which angle should the therapist position the outrigger? A. 45° to the joint. B. 90° to the joint. C. 60° to the joint. D. 110° to the joint.

Correct Answer: B. Rationale: 90° is the appropriate angle of pull for it provides the most effective application of force. The application of a perpendicular force prevents unwanted traction on the joint and shearing stress. As the person's condition improves and mobility increases, the therapist must adjust the outrigger to maintain the 90° angle of pull.

An occupational therapist leads a transitional planning group for high school students with conduct disorders. The school fire alarm goes off five minutes before the group's scheduled termination. There have been six false alarms during the past three days at the school. Several of the students laugh and say, "There it goes again." Which is the occupational therapist's best response to this situation? A. Call the school's main office to determine the validity of this alarm. B. Escort the students to the nearest fire exit. C. Conclude the group with a discussion about the implications of false alarms. D. Escort the students back to their homeroom classrooms to await directions.

Correct Answer: B. Rationale: All alarms must be taken seriously to ensure safety. In the event of an actual fire, any delay can be deadly. All the other choices are incorrect for they place students at potential risk.

The occupational therapist plans intervention to address the client's goals to engage in meaningful occupations. Which physical agent modality (PAM) should the occupational therapist use in preparation for functional activity? A. Transcutaneous electrical nerve stimulator (TENS). B. Contrast baths. C. Whirlpool. D. None; PAMs are contraindicated for this diagnosis.

Correct Answer: B. Rationale: CRPS Type I is a vasomotor dysfunction. The use of contrast baths facilitates the opening and closing of the vascular and lymphatic vessels and is the preferred modality for CRPS. Initially, treatment of CRPS focuses on the reduction of pain and edema and then progresses to functional movement. Techniques to address pain and edema are a priority and should be used gently and as tolerated. Contrast baths are the gentlest PAM intervention listed. Other options include cold packs, retrograde massage, Coban wraps, and desensitization. TENS may be too painful to implement initially. Whirlpools are typically used to clean and debride wounds and are not indicated in this case.

An individual who successfully completed an inpatient drug rehabilitation program returns to the setting to thank staff members for their assistance with recovery. The individual offers to share personal insights and experiences with the members of the OT values clarification group scheduled for the next hour. After thanks, the individual, which is the best response for the occupational therapist to make in response to this offer? A. Welcome the individual as a guest to the group to share personal perspectives on recovery and inspire grog members. B. Inform the individual that former clients cannot visit the group due to the need to maintain member confidentiality. C. Ask the individual to prepare a presentation on how values clarification aided in recovery for the next scheduled group session. D.Tell the individual that the therapist will discuss this offer with the group and afterwards inform the individual regarding the group decision.

Correct Answer: B. Rationale: Confidentiality of all members of a group on an inpatient unit must be preserved at all times. Even if the therapist discussed the possibility of a guest speaker with members and the members verbally agreed to this visit, the therapist could not be certain that all members are in complete agreement. More reticent members may be hesitant to voice their opposition to a visit. The therapist is professionally responsible to maintain confidentiality.

The parents of an 8-month-old child bring their child to a free community health developmental screening program. The occupational therapist evaluates the oral motor development of the child and determines that the child's development is within normal limits. When documenting this determination, which is most likely for the therapist to state the child demonstrates? A. Rotary chewing. B. Diagonal jaw movements. C. Effective mastication. D. Cup drinking with a firm jaw.

Correct Answer: B. Rationale: Diagonal jaw movements can develop as early as 7 months and would be evident by 8 months. Effective mastication typically develops at 9 months. Cup drinking with a firm jaw and rotary chewing are typical for a child at 12 months.

A teenage girl with juvenile rheumatoid arthritis (IRA) identifies a goal of applying her own makeup. Which adaptation is most beneficial for the therapist to recommend? A. Silver ring splints to hold makeup applicators. B. Enlarged soft foam handles on makeup applicators. C. Long thin handles on makeup applicators. D.A universal cuff to hold makeup applicators.

Correct Answer: B. Rationale: Enlarged soft foam handles will facilitate independent grasp and increase independence in makeup application. Silver ring splints are not designed to hold objects. They are used on individual fingers to prevent boutonniere deformities which can contribute to improved functional grasp. However, there is no mention of the presence of boutonniere deformities in this item's scenario. Long thin handles would increase the difficulty of holding applicators. A universal cuff is an adaptation for a person with no ability to grasp. It is not indicated in this case.

A client with a diagnosis of paranoid schizophrenia is participating in an initial evaluation session at a psychiatric day treatment program. Halfway through the completion of an activities configuration, the dent states the referral to this day program is inappropriate and unnecessary because it was made by an incompe. tent psychiatrist. The client becomes visibly upset and loud when talking about the unfounded referral and psychiatrist's incompetence. Which is the best initial action for the occupational therapist to take in response to the client's statements? A. End the evaluation session and tell the client to call to re-schedule when feeling better. B. Assure the client of the referring psychiatrist's competence and advise the client to discuss concerns with the doctor. C. Acknowledge that the client appears upset and ask if the client is able to focus on the remaining evaluation D. Contact the day program's chief psychiatrist to report the client's stated concerns about the referring psychiatrist's competence.

Correct Answer: C. Rationale: A simple acknowledgement of the individual's concerns can validate his/her feelings in a non-threatening manner without validating potentially delusional thought content. Asking the person in a calm business- like manner if he/she can return to the task at hand can diffuse the situation. If the client states he/she is not able to regain focus, the therapist can then provide the needed support. Immediately ending the evaluation does not deal with the issue of potentially escalating behavior and does not provide the individual with the opportunity to engage in a therapeutic relationship. Continuing the evaluation can allow concrete opportunity ties for support and reality testing. Assuring the client of the doctor's competence could contribute to further escalation if the client's concerns are based on a delusional thought process, which is unshaken by external explanations. There is no need to report the client's concerns for there is no concrete evidence of physician incompetence at this time. The therapist should relay the client's expressed concerns at the next team meeting.

An occupational therapist and an OTA co-lead a work adjustment group. One member has become progressively more dependent on the OT for directions, praise, and input throughout the group activities. Which action should the group leaders initially take in response to these behaviors? A. Schedule several individual sessions with the OTA and group member to examine the issues of dependency and transference. B. Inform the attending psychiatrist that the group member is exhibiting signs of dependency and transference C. Have the OT work with the person during group sessions to develop independence in task completion D. Have another therapist co-lead the group with the occupational therapist and reassign the OTA to another group.

Correct Answer: C. Rationale: This question addresses therapeutic use of self and effective group process. The best answer is to utilize the group situation and have the OTA function as a change agent during the group's activities. It is not necessary to devote individual sessions to this issue. Notifying the psychiatrist is not necessary as these behaviors are m indicative of a need for a modification in the person's medication regimen and does not address the potent of modifying behavior through the group process. Removing the OTA is not a good choice because it dos as provide the member a chance to work through these issues and develop needed skills. This also does not git an opportunity for the member to benefit from the therapeutic use of self by the OTA.

An occupational therapist working in a school has been asked to recommend technological devices for a student with severe spastic quadriplegia and dysarthria. Which action should the therapist take prior to recom mending specific equipment? A. Determine access capabilities in collaboration with the speech language pathologist. B. Identify funding source(s) in collaboration with the social worker. C. Obtain family support in collaboration with the psychologist. D. Determine intervention goals in collaboration with the student.

Correct Answer: D Rationale: Establishing the goals of technological interventions in collaboration with the student is essential to ensure that all equipment recommendations are meaningful and relevant to the student's unique needs and desired goals. For example, technology can facilitate interpersonal communication, functional mobility, engagement in leisure activities, and/or the completion of schoolwork. Determining access capabilities is an important step to take after the goal of the device is established. Funding for a device would be provided by the school in accordance with IDEA. While obtaining family support is always important and is required by IDEA, the occupational therapist must be able to explain the need and rationale for the recommended equipment to effectively obtain this support.

The transition plan for a high school senior with developmental delay includes a referral to a vocational rehabilitation (sheltered) workshop job setting. The student has set a goal to live independent of family. Which is the best living environment for the occupational therapist to recommend for this student? A. An apartment in a subsidized housing project. B. A group home with case managers available on-call. C. A supported apartment with a roommate. D.A group home with daily on-site supervision.

Correct Answer: D. Rationale: A person with developmental disabilities who meets the referral criteria for a vocational rehabilitation (formerly called sheltered) workshop will typically have cognitive deficits that require structure and supervision to successfully and safely complete tasks. A group home with on-site staff would provide this type of support. In addition, since this student has lived with family for all of his her life, it is likely that he/she will need training to develop instrumental activities of daily living skills (IADL). Upon the attainment of lADL skills in the group home and vocational skills in the vocational rehabilitation (sheltered) workshop, the person may be able to progress to a higher level of independence in work and home management. The person would have to first develop IADL skills to live more independently in a housing project apartment, unsupervised group home, or supported apartment.

An occupational therapist working on an acute psychiatric inpatient unit conducts a series of groups for de newly admitted to the unit Which group leadership style is most effective for the therapist to assume when leading these groups? A. Advisory. B. Facilitative. C. Laissez-faire. D. Directive.

Correct Answer: D. Rationale: Directive leadership involves the provision of structure, clear directions, and immediate and consistent fad back. These qualities are needed in a group whose members are acutely ill with psychiatric disorder. The other choices do not provide the structure or organization needed for individuals whose symptoms of include decreased attention span, distractibility, poor social skills, and/or thought disorders.

A middle school-aged child with osteogenesis imperfecta reports feelings of low self-esteem, social isolation, boredom, and lethargy. The occupational therapist collaborates with the child to identify resources for after-school leisure activities to promote socialization and community participation. Which of the following activities is best for the therapist to explore with the child? A. Team sports. B. Therapeutic horseback riding. C. Scouting programs. D. Computer clubs.

Correct Answer: D. Rationale: Osteogenesis imperfect results in brittle bones that fracture easily. Fracture prevention through activity restrictions is a primary focus. This can result in social isolation, decreased self-efficacy, and depression. Exploring different computer clubs can provide the child with a number of age-appropriate viable options for leisure activities that the child can successfully pursue after school without risking fractures. The other options involve more physically-based activities that would be difficult for the child to safely pursue. These activites would highlight what the child is unable to do, rather than his/her abilities. This would be contraindicated in the treatment of depression. In computer clubs, physical abilities are not needed, for any physical deficit can be readily compensated for with adaptations and modifications.

The occupational therapist evaluates the client's pain by asking the client which movements or activities elicit pain. Which of the following is the therapist assessing? A. The quality of pain. B. The location of pain. C. The intensity of pain. D. The triggers of pain.

Correct Answer: D. Rationale: Pain triggers are those activities and/or movements that result in pain. The quality of pain is determined by asking the person to describe the pain; common descriptors are sharp, throbbing, burning, tender, and shoot ing. The intensity of pain is measured by pain scales; a O to 10 scale is most commonly used. The location of pain is determined by having the person describe or point to the location

The staff of an acute inpatient medical unit consists of an occupational therapist and an entry-level occupational therapy assistant (OTA). The admission rate has increased and the occupational therapist is having difficulty completing evaluations in a timely manner. Which is the best action for the therapist to take in response to these practice realities? A. Evaluate patients screened by nursing staff as appropriate for occupational therapy. B. Plan intervention based on the physical therapy evaluation. C. Train the OTA to independently complete the evaluation process. D. Redesign the program to allow more time for evaluation.

Correct Answer: D. Rationale: Since the lengths of stay on acute care units are very short, it is most important to complete assessments that can help with prioritizing interventions and planning discharge. Effective interventions cannot be implemented and relevant discharge plans cannot be made without the benefit of an evaluation. Interventions must be continued after discharge so it is essential to identify a person's functional status to ensure a proper recommendation for aftercare. The occupational therapist can redesign the program to include evaluation methods that are more efficient. The occupational therapist can also redesign the program to include supervision of the OTA in the completion of structured standardized evaluations, and the implementation of the intervention plan. While nursing staff can refer clients to occupational therapy, only occupational therapy practitioners can screen for occupational therapy. The physical therapy evaluation can be informative but its usefulness for planning OT interventions is limited. Only OT practitioners can complete an OT evaluation. OTAs can contribute to the evaluation process with the supervision of an occupational therapist, but they cannot independently carry out the evaluation process.

An individual presents with intention tremor, dysmetria, decreased equilibrium and nystagmus caused by a cerebellar lesion. The person expresses difficulty with routine tasks. Which intervention is best for the occupational therapist to provide? A. A cone and pegboard activity with wrist weights to control tremors. B. Quick stretch to lateral trunk muscles during a functional activity. C. A power wheelchair to prevent falls during routine activities. D. Upper extremity weight bearing during self-care activities at a sink.

Correct Answer: D. Rationale: The treatment goals for persons with cerebellar dysfunction are focused on strengthening proximal muscles improving postural responses, and increasing stability. Weight bearing of the upper extremities can increase shoulder girdle stability. A cone and pegboard activity does not describe a functional activity and would not generalize to activities of daily living. This activity is also very difficult to complete with dysmetria and inten. tion tremor. Quick stretch is not an intervention method. It is a method to assess spasticity. It is applied in a direction opposite the pull of the muscle group being tested and then graded utilizing a "minimal/moderate severe" rating scale. A power wheelchair is not indicated in this scenario nor would a power wheelchair help the person perform routine tasks with intention tremors and dysmetria

A clubhouse program hires an occupational therapist as a consultant. The clubhouse board of directors requests that the OT consultant focus on the development of evening and weekend leisure activities. Which recommendations should the therapist make for the selection and completion of the group activities? A. Activities to be selected and completed by clubhouse members according to guidelines provided by the therapist. B. Activities to be selected by the therapist with written instructions provided to the group attendees for activity completion. C. Activities to be selected by clubhouse members with activity completion led by the clubhouse members. D. Activities to be selected by the therapist and completed by the clubhouse members after demonstration by the therapist.

Correct answer: C. Rationale: Clubhouse programs utilize a consumer empowerment model that emphasizes the active involvement of all participants in the decision-making and implementation process of the clubhouse. the other choices are too directive for this model

An elementary school teacher has been recently diagnosed with multiple sclerosis. Which adaptation is best for the occupational therapist to recommend a teacher use to accommodate for the effects of MS on classroom teaching. A. Large print written material to compensate for visual impairments B. A daily list of tasks to compensate for cognitive deficits C. A motorized scooter to compensate for decreased endurance D. A high stool to compensate for lower extremity weakness

D. A high stool to compensate for lower extremity weakness Lower extremity weakness is common in the early stages of MS. Using a high stool will provide the teacher with an alternative to standing while maintaining visibility to the entire class. In addition the use of a stool can help minimize the effects of fatigue which is often common in all stages of MS. Visual impairments, cognitive deficits, and/or decrease endurance are not common in the early stages of MS.

An individual with myasthenia gravis is being discharged home after a hospitalization for the treatment of pneumonia. The person's spouse has expressed concern about caregiving responsibilities and the client's ability to function in the home. Which is the most beneficial recommendation for the occupational therapist to make to address the spouse's concerns and the client's needs? A. The extension of client's length of stay to allow for caregiver training. B. The extension of client's length of stay to provide intervention to develop ADL skills. C. A referral for the client to an adult day care program to relieve caregiver stress and to develop functional skills. D. A referral to a home care agency for a functional evaluation and home assessment.

D. A referral to a home care agency for a functional evaluation and home assessment. A functional evaluation in the client's home and an assessment of the home environment is the best choice listed to provide accurate information about the client's functional status and caregiver needs. This information will enable the home care team to collaborate with the family to develop an appropriate intervention plan to address their identified needs. An extension of length of stay is very difficult to justify because the individual was hospitalized for the medical treatment of pneumonia. Once this illness is effectively treated, discharge must occur. In addition, it is more effective to provide caregiver and ADL training in the person's home environment. A referral to adult day care may be determined based on the home care therapists evaluation.

The private practitioners meet with their accountant to plan fiscally for their expanded practice. how would the accountant classify the fees that the practice receives from their early intervention contract? A. Account payable B. Capital assets C. Productivity standards D, accounts receivable

D. Accounts receivable Accounts receivable are the payments received by program, setting, or institution for services rendered. They are the assets in a budget. Accounts payable are the payments that are due for purchases by or services rendered to a program, setting, or institution. They are the debts in a budget. Capital assets are improvements or purchases that cost more than a set amount (often $500 or $1000) and that are expected to last more than a year such as a new ADL kitchen, or computer equipment. Productivity standards establish the amount of direct care and reimbursable services each therapist must provide each day.

An adult is hospitalized in the recovery phase of Guillain-Barré syndrome. The patient complains of tingling, aching, and weakness in both hands, causing difficulty in grasping grooming supplies. The patient requests relief from the hand symptoms. Which action should the occupational therapist take to address the patient's concerns? A. Provide soft tissue massage to both hands prior to grooming activities. B. Apply hot packs to both hands and complete stretching exercises prior to grooming activities. C. Refer the client to a neurologist for follow-up of possible condition regression. D. Educate the patient about sensory deficits and related adaptive ADL strategies.

D. Educate the patient about sensory deficits and related adaptive ADL strategies. Guillain-Barré (GBS) is characterized by ascending motor weakness in the limbs, usually beginning in the hands and feet. Paresthesias and pain are also a common occurrence. The best approach to this patient is to educate the patient about the sensory deficits that are common to the condition and provide adaptive strategies for ADL so the patient is successful. Soft tissue massage will not remedy the aching in the hands as the inflammation of the peripheral nerves must decrease for this to resolve. Hot packs are contraindicated in this situation due to the potential for burns from altered sensation. Referral to a neurologist is not needed as the symptoms are typical of the syndrome.

An older adult who is recovering from a cerebral vascular accident attends occupational therapy two times per day. The intervention environment is highly structured and not over-stimulating, yet the occupational therapist observes that the clients mood often changes abruptly. Within one session, the client will laugh and then become tearful with no apparent precipitant. Which is most accurate for the occupational therapist to document the client is exhibiting in the clients daily progress note? A. Early Alzheimer's disease. B. Anhedonia. C. A response to auditory hallucinations. D. Emotional lability.

D. Emotional lability. Emotional lability describes abrupt changes in mood without external precipitants. It is often observed in persons recovering from CVAs. Anhedonia is the inability to experience pleasure. There is no information in this case that would substantiate a conclusion that the individual is developing Alzheimer's disease or responding to the internal stimulation of hallucinations.

A newly hired OTA is instructed by the Director of rehabilitation to supervise to hospital volunteers as they learned how to assist patients in safely completing bed to wheelchair transfers. The OTA informed the supervising occupational therapist of the directors request. Which is the first action the occupational therapist should take in response to this request? A. Advise the OTA to comply with the request B. Advise the OTA to refuse the request C. Observe the OTA to access service confidence in transfer training D. Explain to the Director of rehabilitation why the request is inappropriate

D. Explain to the Director of rehabilitation why the request is inappropriate Volunteers are not trained health care professionals and they cannot perform transfers with patients. There-fore, the OTA cannot comply with the director's request to supervise volunteers in performing transfers. The occupational therapist is responsible for the practice of the OTA he/she supervises; therefore, he/she must inform the director of rehabilitation of the inappropriateness of this request. While it is appropriate for the OTA to decline the director's request, it is most important that the rationale for this denial be explained by the OT supervisor in order to prevent future inappropriate requests of the OTA.

The private practitioners pay for their newly hired occupational therapists registration for an advanced course on pediatric assessment. Which is the most important outcome of attending this course for the occupational therapist? A. Fulfillment of continuing education requirements for independent credentialing agencies B. Keeping up to date on current trends in occupational therapy C. Networking with other pediatric professionals D. Improvements of their professional skills and competence

D. Improvements of their professional skills and competence The most important goal of continuing professional education is to improve skills and develop competence for service delivery. Networking opportunities, keeping up-to-date with trends in the fulfillment of external credentialing requirements are all a benefit of participation in continuing education. However, they are not the primary aim of professional development activities.

An occupational therapist works with an individual with chest and upper extremity burns. During the intervention session, the client expresses vague fears about personal safety at home and asks the therapist to advocate for an extension in the discharge date. According to the medical record, the client had incurred the burns during a cooking accident. Which is the therapist's best initial response to the client's stated concerns? A. Encourage the client to speak to the social worker about discharge plans. B. Assure the client that pre-discharge fears are normal and expected. C. Document the client's concerns and recommend an extension of the length of stay. D. Invite the client to expand upon the nature of these concerns.

D. Invite the client to expand upon the nature of these concerns. The occupational therapist needs more information to determine the basis for the client's fears and evaluate for appropriate interventions. Referring the client to the social worker can be helpful, but it will not address his her concerns at this moment. A delay may result in the client deciding that his/her concerns are not worth mentioning. Many clients find it difficult to express fears so it is important to respond immediately when they do. This is of particular importance in cases of domestic violence, which this case (and any case) can have as a contributing and complicating factor. In addition, the client's fears may be functionally based and the therapist can address these immediately in the current intervention session. Assurance that fears are normal and expected does not address the issue at hand. A request to extend a client's length of stay requires a documented need for inpatient services. Client's stated concerns about home safety are not sufficient justification for a length of stay extension.

Which is the most appropriate activity for the occupational therapist to recommend for the person to complete at home? A. Doing light craft work. B. Playing a table-top game. C. Performing relaxation exercises. D. Manually washing a car.

D. Manually washing a car. Manually washing a car involves scrubbing and the carrying of buckets of water which are STRESS LOADING activities. Stress loading is a recommended intervention for CRPS, Type I (formerly known as reflex sympathetic dystrophy or RSD). Light crafts, table-top games, and/or visualization relaxation exercises can be meaningful and relevant to the person, but they do not provide any weight bearing. Therefore, these activities are not indicated as an intervention approach for this disorder.

The parent of two elementary school-aged children receives home care hospice services due to metastasized bone cancer. The client is in pain and has poor endurance and decreased muscle strength. The client requires moderate assistance with self-care and dressing. Which is the best intervention for the occupational therapis to incorporate into sessions with this parent? A. Training in energy conservation techniques for self-care and dressing. B. Training in joint protection techniques for self-care and dressing. C. Using biofeedback to reduce the client's pain. D. Exploring play activities for the parent to do with the children.

D. Rationale: A major focus of hospice care is to maintain the individual's control over his/her life while enabling engagement in meaningful activities that are related to the person's valued roles. Although the person is dying, he/she is still a parent and will likely enjoy playing with his/her children when they are not in school. There are many play activities suitable for elementary school-aged children that can be completed by a person with decreased endurance and muscle strength. In addition, research has found that diversional activities can decrease the intensity of an individual's pain experience. There is no indication of a need to train the client in techniques for self-care or dressing. The client currently is in pain and requires moderate assistance due to functional deficits. It is likely that the client will continue to need this assistance due to the fact that his her cancer is at the terminal stage. Even with training in energy conservation or joint protection, the individual would still need assistance with these tasks due to the effects of advanced cancer. Biofeedback is not effective in managing pain that results from metastasized bone cancer.

A client expresses an interest in playing a computer game with another group member during a leisure skills group. The occupational therapist reviews the clients cognitive evaluation and agrees that the game is a good choice for the clients cognitive level. After 15 minutes of engaging in the computer game, the client rubs both eyes, looks around, and reports trouble focusing. What should the therapist do in response to these observations and client statements? A. Provide verbal encouragement for the client to complete the game before taking a break B. Suggest the client and the other member play a different video ga,e that is easier for the client C. Discontinue the session and advise the client to select a different leisure activity to do with the other member D. Suggest the client and the other member talk about the games progress in between completing their turns

D. Suggest the client and the other member talk about the games progress in between completing their turns The client appears to be experiencing visual strain which can be caused by staring at a computer screen without a break. Consequently, the best choice is to decrease the visual strain by providing periodic brief breaks from looking intently at the screen. Having the clients talk between taking turns will facilitate them looking at each other rather than the computer screen.

After evaluating a client with right-sided weakness and decreased motor control an occupational therapist decides to use interventions based on the proprioceptive neuromuscular facilitation (PNE) approach. When applying PNF principles, which of the following actions should the therapist have the client do during an intervention session to increase use of the right upper extremity and hand? À. Reach overhead with the right hand to retrieve a dish out of a higher cabinet and set it down on the countertop in front. B. Reach to the right side to retrieve an item out of refrigerator at hip height and place it into the left hand to set it on the countertop to the left. C. Use both hands together to pour juice out of a heavy pitcher into a glass on a countertop. D. Take items out of a dishwasher on the right side and reach across the body to place them in the upper cabinet on the opposite side.

D. Take items out of a dishwasher on the right side and reach across the body to place them in the upper cabinet on the opposite side. Rationale: PNF (proprioceptive neuromuscular facilitation) is a technique which involves use of diagonal patterns of movement and involves rotational trunk movement. Using the right upper extremity to reach down to one side to take items out of a dishwasher and reaching across one's body (trunk rotation) to place these items into a higher cabinet on the opposite side of body creates this diagonal pattern and encourages use of the affected side to increase motor control and volitional movement. The other answer choices do not include activities which require diagonal movements of the upper extremity or trunk rotation. Thus, they are not consistent with a PNF approach.

An individual is evaluated for a repetitive stress disorder. The individual complains of numbness and tingling of the thumb, index, middle, and radial half of the ring finger and aching pain in the proximal forearm. The client states that these symptoms are not evident at night. The occupational therapist notes a positive Tinel's sign. Which site should the therapist document as the location of this sign for this client? A. The wrist. B. The Guyon's canal. C. The elbow. D.The forearm.

D.The forearm. The presenting signs described in this case scenario indicate pronator teres syndrome. A positive Tinel's sign at the forearm is consistent with this syndrome which is a medial nerve compression between the two heads of the pronator teres. Symptoms are similar to carpal tunnel syndrome (CIS) except there is aching pain in the forearm and no night symptoms. A person with CIS has paresthesias occurring at night, does not have pain in the forearm, and has a positive Tinel's sign at the wrist. A positive Tinel's sign that is noted at the Guyon's canal indicates Guyon's canal syndrome which is a compression of the ulnar nerve with sensorimotor symptoms reflecting ulnar nerve distribution. A positive Tinel's sign at the elbow is indicative of cubital tunnel syndrome. This is an ulnar nerve compression at the elbow that has the symptoms of numbness and tingling along the ulnar aspect of the forearm and hand, and pain at the elbow with extreme elbow flexion.

An individual with amyotrophic lateral sclerosis requires the use of an environmental control unit (ECU) to assess electrical devices and a personal emergency response system. The individual lives alone and self-directs personal care attendants to perform ADLs. During instruction to the individual on the capabilities and use of the ECU, which is most important for the occupational therapist to discuss? a. The EDU's back-up power source and charging instructions b. additional assistive technology available c. augmentative alternative communication options d. funding for assistive technology

a. The EDU's back-up power source and charging instructions back-up systems for electronic devises must be specified, especially if the device is used to access emergency assistance. Batteries used as back-up systems often have very strict schedules for charging.

A nine year old child identifies the assembly of a model as the most desired play activity. The occupational therapist determines that the child would have difficulty completing the selected model. Which action is most effective for the therapist to take during the next intervention session? a. allow the child to work on the model and provide maximum assistance as the cild completes the project b. explore with the child why completing the model is desired by the child and provide alternative project choices c. break the project down into accomplishable segments and instruct the child to complete one segment at a time d. explain to the child several reasons why the selected model is not the best choice for the child and provide alternative project choices

c. break the project down into accomplishable segments and instruct the child to complete one segment at a time The child is in the concrete operational phased of cognitive development according to Piaget. It is best to give specific information with clear guidelines at this age. allowing someone to do a project or activity that he/she cannot accomplish is inappropriate. The OT can use their activity analysis skills to break the model down in achievable steps which allows the child to successfully engage in the activity of interest. The exploration of motivation and the rational explanation of a decision require higher cognitive abilities that are consistent with Piagets formal operation period, from age 11 through teen years

A patient has been discharged from a rehabilitation facility six months ago. A staff therapist who works at the facility sees the former patient and the senior therapist who treated the patient in a dating situation. The senior therapist confirms involvement in a personal relationship with the former patient. Which is the staff therapist's best response to this situation? A. Report the therapist to the NBCOT®. B. Advise the facility director. C. Do nothing. D. Report the therapist to the OT supervisor.

c. do nothing A health care practitioner can date a former but not a current patient. This is no evidence that they dated while the person was a patient. The therapist is doing nothing wrong and there is no need to take any action.

A child with myelomeningocele meets the short term goals of achieving functional gross grasp and lateral pinch. After several additional weeks of occupational therapy, the child does not meet the goals of demonstrating pincer grasp and three jaw chunk. Consequently, the therapist modifies the child's intervention plan. Which intervention is best to include in the revised plan? a. splint the index finger in 30 degree PIP flexion and 30 degree DIP flexion to achieve pincer grasp b. increases strength of lateral pinch as a basis to develop pincer grasp and three jaw chunk c. teach the child to use gross grasp and lateral pinch for functional activities d. teach the child to use ulnar grasp for functional activities

c. teach the child to use gross grasp and lateral pinch for functional activities the child can use gross grasp and lateral pinch to do most functional activities including buttoning, zipping, and playing. splinting in the manner described will not increase pincer grasp and may actually impede development of pincer grasp. increasing strength of lateral pinch does not contribute to the coordination needed for pincer grasp and 3-jaw chunk.

An individual attends an outpatient parenting skills group. The person has a hx of serious recurrent depression and is take Nardil. The client complains of recurrent headaches and difficulty focusing during the day (e.g., when helping children with their homework). Which action is best for the occupational therapist to make in response to the clients expressed concerns? a. instruct the client of stress reduction techniques b. ask the for suggestions on how to deal with the parenting stress of homework c. suggest that the individual consult with a nurse practitioner for headache relief strategies d. tell the client you will be notifying the psychiatrist of these complaints

d. tell the client you will be notifying the psychiatrist of these complaints Nardil is a monoamine oxidase inhibitor (MAOI). it has a serious side effects when a person east foods that contain the amino acid tyramine. Tyramine increases blood pressure and may lead to stroke or other cardiovascular reactions. Headache and heart palpitations are the first sign of a problem. This must be considered a serious medical situation and the physician must be contacted. to assume headaches are stress related is dangerous.