(Answered) TrueLearn Random Test 2, OTR Prepathon, OP III NBCOT Practice Qs, exam prep 2022

Document Content and Description Below

TrueLearn Random Test 2, OTR Prepathon, OP III NBCOT Practice Qs&As, exam prep Test Bank_ 2022. An OTR is treating a client with complex regional pain syndrome (CRPS) in the dominant hand. The clie... nt is very protective of the hand secondary to pain and edema and becomes nauseated when the hand is touched. What is the therapist's BEST response to this situation? A. Avoid touching the hand and promote use of the non-dominant hand B. Provide a structured exercise program that includes the shoulder C. Do not initiate therapy until the pain and edema has resolved D. Avoid movement of shoulder and focus specifically on the hand function A continuous, severe burning pain that is often out of proportion to the severity of the injury characterizes complex regional pain syndrome (CRPS). Although the hand is the affected area, CRPS often triggers shoulder pain and stiffness; therefore, the shoulder must be incorporated into an exercise program in order to maintain or prevent shoulder dysfunction.CRPS is treated by reducing sympathetic stimulation and is most responsive in the early stages with the first goal of intervention to reduce pain and hypersensitivity. An OTR is working with a client with hemiparesis of the dominant upper extremity following a cerebrovascular accident (CVA). The client has significantly low tone in the upper extremity and no functional use. Which is BEST for the OTR to address when working with this client? A. Risk of joint and soft tissue injury during activities of daily living (ADLs) and bed mobility B. Constraint-induced movement therapy to decrease learned non-use C. Weight-bearing through the upper extremity and use for support D. Using supported reach tasks and moving objects across a table During the low tone stage, joints are at an increased risk for injury due to instability and are more likely to become misaligned. With low tone, the muscles do not provide the typical or normal stabilization around the joints, increasing the opportunity for misalignment to occur. In order to protect the unstable joints, the OTR must address the risk, maintenance, and protection of the joints and soft tissues during activities of daily living (ADLs) and bed mobility. An OTR is planning group intervention utilizing a cognitive-behavioral frame of reference. Which intervention is MOST appropriate to utilize during group activities? A. Use open-ended questions to obtain understanding B. Provide feedback for members to help one another C. Explore client feelings through movement activities D. Practice and rehearse techniques learned in group The cognitive-behavioral frame of reference promotes that the best strategy for change is reinforcements. Change occurs when behavior is reinforced in some way. Practice and rehearsal of technique learned, or role-playing, allows clients to practice newly learned behaviors in a safe, therapeutic, and supportive environment. A 14-year-old client is working with a OTR to expand his social engagement and participation with peers. He presents with challenges connecting with peers and making friends. The client has indicated a personal goal to increase social engagement and friendships. What is the BEST way for the OTR to gain a perspective on the client's needs? A. Use a parent report to determine targeted areas to improve social engagement B. Use a client report to determine the youth's feelings and experiences in context C. Use parent report to determine cognitive and social engagement skills D. Use standardized testing to determine targeted areas to improve cognitive skills and work preferences During a chart review, an OTR notes the client has experienced extensor tendon injury in zone I of the hand. Which BEST describes what the client is experiencing? A. Mallet deformity B. Clawhand deformity C. Complex regional pain D. Finger contractures Mallet deformity is the result of a disruption of the terminal extensor tendon and manifests itself as distal interphalangeal (DIP) extensor lag, specifically in zone 1 of the hand. A mallet finger is characterized by flexion of the DIP joint resulting in the finger losing the ability to extend the distal phalanx. Clawhand deformity is the result of high level ulnar nerve involvement resulting in the hyperextension of the metacarpophalangeal (MCP) joints of the ring and small fingers. The hyperextension is the result of the overaction of the extensor digitorum communis that results in a clawing appearance of the hand. Answer C: Complex regional pain syndrome is not unique to this injury and is a group of disorders that involve pain and dysfunction with the severity out of proportion to the initiating event. Complex regional pain syndrome can develop with any injuries and is not specific to hand injuries. Answer D: Contractures result in tissue shortening due to lack of passive motion and are not unique to this zone of the hand. A client presents with severe rheumatoid arthritis of both shoulders and hips and is limited in his ability to perform self-care activities. He lives at home with his wife. He expressed that he has not been able to help his wife with homemaking tasks and would like to avoid being a burden to his wife. He would like to be able to dress himself and complete his own bathing and grooming. Which of the following assistive devices is MOST appropriate for the client? A. Button hook B. Long-handled sponge C. Built-up handle toothbrush D. Mounted nail clipper An OTR is making an early intervention home visit to a family in a rural community. The grandmother, mother, and mother's sister are present during the session, and the grandmother is bottle-feeding the 8-month-old infant when the OTR arrives. The OTR's goal for the child is to work with the family on further developing the child's motor skills. What INITIAL action should the OTR take in the session with this family? A. Wait until the child finishes eating for the mother to begin therapy with the child in order to work on motor skill development B. Re-schedule the child's therapy session due to concern that motor activities are contraindicated after bottle-feeding C. Focus the treatment session on feeding skills to incorporate the natural routine and habits of the family D. Engage the caregivers in conversation about the child and the progress made since the last therapy visit33.8% of Users Answered Correctly A client is beginning phase 2 of cardiac rehabilitation in an outpatient setting. After assessing the client's risk factors and cardiovascular response to exercise, the OTR develops the intervention plan to incorporate discontinuous exercise. Which is the BEST benefit for this recommendation? A. Multiple muscle groups are utilized B. Completion of 40 minutes of exercise C. Specific muscle groups are targeted D. Mimics home exercise programs Discontinuous exercise allows the patient to stay on one piece of equipment for one-half or one-third of the allotted time and provides an opportunity for multiple muscle groups to be utilized, boredom to be minimized, and exposure to a variety of equipment. Discontinuous exercise provides a broader rehabilitation program secondary to focusing on multiple muscle groups. An OTR is working with a patient who had a cerebrovascular accident on increasing his/her functional hand use. What is the MOST BENEFICIAL activity to develop radial-ulnar dissociation needed to increase in-hand manipulation skills? A. Watering a plant using a spray bottle B. Wearing a serpentine splint at night C. Playing a card game of Go-Fish D. Completing a 100-piece puzzle Watering a plant using a spray bottle deliberately separates the radial side of the hand (the thumb, second, and third digits) from the ulnar side (fourth and fifth digit) of the hand to practice working on the dissociation of the hand to improve hand use. Working in an acute care setting, an order is received for acute post-operative repair of boxer's fracture of the right dominant upper extremity. The patient has been immobilized post-operatively with gauze and ace wrapping. The surgeon has ordered an occupational therapy evaluation and treatment including splinting. What is the MOST appropriate plan of treatment, including the most appropriate splint fabrication and the most appropriate approach to post-operative edema control for this patient. A. Forearm-based resting hand splint with wrist extension at 20 degrees, begin active and passive tendon glides to promote wrist and digit mobility, positioning, and/or light massage to promote edema control B. Forearm-based ulnar gutter splint with 4th and 5th metacarpophalangeal joint flexed to 60 degrees, begin active and passive tendon glides for wrist and digit mobility, positioning, and/or light massage to promote edema control C. Forearm-based wrist cock-up splint with wrist extension at 30 degrees to allow for metacarpophalangeal joint flexion, begin passive tendon glides and active-assisted range-of-motion exercises for wrist and digital mobility and light massage to promote edema control D. Volar hand-based ulnar gutter splint with 5th metacarpophalangeal joint flexed to 45 degrees, begin tendon glides for wrist and digit mobility and positioning to promote edema control According to current research and evidence-based practice, ulnar gutter splints with mild wrist extension and metacarpophalangeal joint flexion to 60 degrees, if possible, is recommended. Early mobilization through tendon gliding and range of motion is indicated to promote early return to active sports in athletes with boxer's fracture. An OTR is working with a kindergarten classroom teacher in developing seating options for all students in her classroom. The teacher shared that her students are seated on the floor during several academic instruction times. They are positioned in a circle and often students struggle with keeping their hands to themselves and their bodies in their own space. What type of chair might the OTR recommend to the teacher? A corner chair B Infant sitter C cube chair D Howda Hug Chair A cube chair is a common chair used in preschool and kindergarten classrooms. It provides support as well as cues on personal space. A cube chair can provide an organized workspace for children and may help with sensory needs. Answer A: A corner chair provides external support for children with inadequate postural control of the neck, head, and trunk and who are inclined to fall sideways or back if they overstretch. This type of chair would likely be too adapted for the general population. Answer B: Infant sitters are generally designed for a smaller frame and would not meet the needs of this age group. Answer D: The Howda Hug chair provides proprioceptive feedback to those needing extra sensory input. Not all students in the classroom may benefit from this type of seating option. A client with low vision lives with a spouse and has difficulty navigating the home environment safely. The spouse often leaves cabinet doors open, the dishwasher open, and moves furniture regularly. Which strategy would be BEST for the OTR to implement with this client and spouse in order to improve safety in the home? A. Task lighting B. Organization C. Use of contrast D. Mobility training A client is participating in occupational therapy following a cerebrovascular accident (CVA) with hemiparesis of the dominant upper extremity. The therapist provides assistive devices in order to promote occupational engagement. Which of the following interventions are BEST for the therapist to introduce? A. Rocker knife and elastic shoe laces B. WBing on the UE C. Splinting and positioning programs D. Supported reach tasks with BADLs A client works in a factory warehouse, stacking boxes on shelves. The client is recovering from a shoulder injury and was referred to occupational therapy to facilitate return to work. Which of the following is the BEST method when measuring range of motion? A. The OTR only measures joint range of motion below shoulder level if he or she suspects an unhealed fracture B. The OTR should hold the goniometer in place while moving the shoulder through range of motion C. The OTR observes the client's posture and compensatory motions when measuring the range of motion D. The OTR measures the scapular movement only with functional reaching tasks using the goniometer An OTR is working with a group of clients at level 5 Allen Cognitive Level in a community mental health center. They are concrete thinkers and can imitate new procedures and remember several steps at a time. What type of group intervention is MOST EFFECTIVE for clients at this level? A. Prepare and cook a simple meal B. Collate forms and stuff envelopes C. Practice medication management D. Perform basic daily grooming tasks B- level 3 C- Practicing medication management is a major problem because clients at Level 5 have a lack of abstract thinking which prevents them from understanding the nature of their illness or the effects of medication D- level 3 A client was recently diagnosed with a hemorrhagic stroke that affected the upper trunk of the middle cerebral artery. He demonstrated abnormal muscle tone in the right arm. Which of the following behaviors will MOST LIKELY be observed based on the pattern of impairment and cortical involvement? A. The client does not dress the left side of the body B. The client has slow, labored, and telegraphic speech C. The client is unable to locate items on the left of the table D. The client has double vision and a drooping eyelid Clients who experience a stroke of the upper trunk of the middle cerebral artery in the left hemisphere present with Broca aphasia and contralateral hemiplegia. The client, in this case, presented with hemiplegia of the right arm, which is contralateral to the affected left hemisphere. An OTR is working in an outpatient clinic and is seeing a client with borderline personality disorder. Which of the following would the therapist do when using a client-centered approach? A. Provide strong limit setting during group settings that focus on self-help and relationships with and among peers B. Focus on the here and now; provide calmness and consistency without being drawn into power struggles C. Provide opportunities for spontaneity, productiveness, and focus on feelings and emotions rather than routines and habits D. Provide courtesy, honesty, and respect in order to gain the confidence of the client while allowing slow attempts to engage An OTR working in an outpatient rehabilitation clinic receives a referral for a client with a high-level radial nerve laceration from a car accident. Upon evaluation, the OTR determines that the client would benefit from a splint. Which is the MOST effective splint for the OTR to create? A. Dynamic extension splint B. Long dorsal blocking splint C. Strong Velcro "buddy" splint D. Multi-dynamic flexion splint The radial nerve innervates the extensor-supinator group of muscles of the forearm, including: brachioradialis extensor carpi radialis longus extensor carpi radialis brevis supinator digiti minimi abductor pollicis longus extensor pollicis brevis extensor pollicis longus extensor indicis proprius Due to the innervation of the extensor muscles, a high-level radial nerve injury would result in the inability for the hand to extend. A dynamic extension splint provides wrist extension, metacarpophalangeal (MP) extension, and thumb extension, positioning the hand into a functional position. Answer B: A long dorsal blocking splint limits the full extension of the hand and is used to immobilize the joints of the hand in order to promote healing. This is often utilized following flexor tendon repair. A splint that promotes extension would be needed for a complete radial nerve injury. Answer C: A strong Velcro "buddy" splint is used to protect a finger after a fracture or to encourage movement of a stiff finger. A buddy splint would not be beneficial for a high-level radial nerve injury, as, none of the fingers have extension with this injury. Answer D: Dynamic flexion splints are utilized with median nerve injuries to promote flexion of the hand. The flexors remain intact with a radial nerve injury, making a splint that promotes flexion inappropriate. A client has developed edema in the right hand after it was immobilized in a cast. She is right-hand dominant and has difficulty using her left hand for tasks that require dexterity. She lives alone and needs to use both hands for instrumental activities of daily living (IADLs) such as meal preparation and cleaning. The OTR wants to recommend a temporary method to provide compression. Which of the following compression materials is MOST appropriate for the client? A. Low-stretch bandage B. Coban wraps C. Compression glove D. Custom-made garment A client is referred for inpatient occupational therapy following hip surgery. What is the FIRST thing the OTR must do prior to evaluating a client's activities of daily living (ADLs) and functional ambulation? A. Confer with the client's physical therapist regarding the client's ambulatory status B. Review the client's medical record for demographics, current status, and precautions C. Review the client's most recent vital signs with the attending nurse D. Ask the client about the prior level of function, ambulation, and community mobility The OTR applies metal cylinders that vary in temperature to a client with a hand injury. The client demonstrates no response to all cylinders applied to the hand. Which BEST describes this client's impairment? A. Decreased pain and touch awareness B. Decreased temperature sensation C. Decreased stereognosis awareness D. Decreased proprioception sensation An entry level OTR implements a group program for clients with rheumatoid arthritis. During a session focused on meal preparation, one client demonstrates significant pain when opening a jar. How should the OTR advise the client? A. Use two hands to open B. Utilize a jar opener C. Rest between attempts D. Ask for help from others An OTR is seeing a client post-surgery with range-of-motion (ROM) limitations due to edema. Which is MOST appropriate for the OTR to recommend in order to reduce the effects of edema on ROM? A. Elevate the injured extremity B. Apply heat to the extremity C. Massage from proximal to distal A 2-month-old client is struggling with food refusal and the parents are worried of failure to thrive. An OTR has been placed on consultative services to determine possible concerns related to feeding challenges. The OTR observes several clinical presentations of feeding refusal behaviors. Which of the following is the BEST example of a feeding refusal behavior in an infant? A. Refusing the nipple/spoon by closing mouth B. Coughing when food is swallowed C. Intolerance to cow's milk and vomiting D. Eye redness or watery eyes during feedings A client recently diagnosed with multiple sclerosis is referred for occupational therapy. During the initial evaluation, the client does not have many significant limitations or concerns; however, the client is concerned about the future with this diagnosis. Which is the BEST method for the OTR to take when developing a plan of care with this client? A. Encourage the client to identify a caregiver for future decision-making B. Address self-management skills, modifications, and techniques C. Encourage the client to continue to work only with physicians at this time The OTR completes testing for touch sensation using two-point discrimination for a client following a nerve repair. Which rationale BEST describes why this assessment was chosen for this client? - map nerve repair and test receptor density A 62-year-old client with rheumatoid arthritis is seen in an acute inpatient rehabilitation facility for recent "flare-up." The client is employed as a certified public account (CPA) and has at least 3 more years of work to reach retirement age. When teaching the client ergonomic principles, what strategy is MOST BENEFICIAL for the OTR to recommend? n important ergonomic principle is balancing daily work (and home) schedules in order to strive to balance activities with rest. Light and heavy tasks should alternate throughout the day to minimize fatigue and impact on joints. An OTR is planning group programming in an acute care psychiatric setting for individuals with severe mental illnesses who display disorganized thinking and difficulty functioning in many occupation areas. What type of group is MOST APPROPRIATE for this population? irective group. The format in directive groups is consistent, involving orientation, introduction, a warm-up, selected activities, and a wrap-up. Goals of a directive group are participation, interaction, attention, and initiation. An activity group is a - "doing group", emphasizing active participation to elicit change in the areas of occupation - specifically activities of daily living (ADLs)/instrumental ADLs (IADLs). This type of group would be the next step after progress is made in a more structured directive group that focuses on participation. Psychoeducational groups have a clear objective: - to teach specific information or techniques to clients and their families. They are also typically time limited and utilize cognitive behavioral and social learning theory. For example, a group for people with eating disorders may provide facts on nutrition and the medical consequences of eating disorders to the population and their families. Neurodevelopmental groups utilize - movement activities, often based on sensory integration theory and techniques. The groups can include imitative and gross motor movements involving sensory input. This would likely be disorienting to a person displaying disorganized thinking. It is best used for people with chronic severe mental illness like schizophrenia. A OTR is evaluating a client who sustained traumatic brain injury following a boating accident. The evaluation results reveal that the client is operating at a level VI in cognitive functioning on the Rancho Los Amigos Scale. The client demonstrates goal-directed behavior when cued by the staff and recognizes family members and some nurses. What other activities are MOST APPROPRIATE to assess during the occupational therapy evaluation? ssessing the ability in basic activities of daily living (ADLs) and instrumental ADLs provides the OTR an opportunity to observe the client's cognition, perceptual skills, and behavioral appropriateness. A client presents to an occupational therapist with age-related macular degeneration. Which BEST reflects how this diagnosis impacts the client's vision? ecreased visual acuity Reduced peripheral vision is a characteristic of - Glaucoma A client is receiving OT services in an outpatient rehabilitation setting. The client asks the OTR to review the most current note from a mental health provider and asks for a printed a copy of the medical documentation from that visit. How should the OTR respond to this client's request for documentation by another provider? - In order to provide consistency in care, the client should be referred back to the provider or medical records department that can assist with accessing the appropriate medical records. An OTR is working with a 4-year-old child with developmental delays. The goal of occupational therapy for this child is to promote hand function, allowing the child to hold a crayon more efficiently. Which activity is MOST EFFECTIVE in developing this hand skill? - Eye dropper painting: promotes a precision grasp. Rolling clay into a ball is an activity that works on - the regulation of pressure through the hand instead of grasp development. Finger painting is an activity which involves the development of - tactile awareness and finger isolation Crumpling paper is an activity that is best suited to develop evelop the in-hand manipulation skill of translation (finger to palm). A client with a complete laceration of ulnar nerve is refered for an occupational therapy evaluation. Which deformity is MOST LIKELY to be observed and documented by the OTR during the evaluation? lawhand deformity due to the hyperextension of the metacarpophalangeal (MP) joints and lack of innervation of the flexor hand muscles. Ape hand deformity is the result of - median nerve injury and is characterized by the inability to move the thumb away from the rest of the hand secondary to median nerve injury Mallet finger deformity is the result of tendon related injury, which does not allow for the finger to fully extend. Wrist drop deformity is the result of - radial nerve injury at the wrist, which does not allow for the wrist or hand muscles to move. A client presents for occupational therapy intervention with age-related macular degeneration. Which strategy is MOST BENEFICIAL to promote successful engagement in the intervention during therapy sessions? - Increase contrast A client exhibits visual deficits following a cerebrovascular accident. Which of the following are MOST IMPORTANT for the OTR include in the initial occupational therapy evaluation? - Visual field loss and oculomotor control An OTR uses a neurodevelopmental therapy approach and inhibition techniques in preparation for a dressing activity with an individual who has a traumatic brain injury with resulting hypertonicity. Which choice BEST illustrates inhibition techniques for hypertonia using a neurodevelopmental therapy approach? - Weight-bearing or light joint compression An OTR conducts a comprehensive home assessment with a physical therapist and social worker for an elderly client with a long-standing herniated nucleus pulposus of C5-7 with partial paralysis of the upper extremities. The home assessment was conducted prior to the client's planned discharge home from a skilled nursing facility. The assessment reveals that the client is unable to drive and lives alone in a multi-level home without strong family support in the area. What would be the MOST APPROPRIATE recommendation for the OTR to make to facilitate the client's safe return home? - Home health services with a live-in caregiver A OTR is planning treatment sessions for adolescents diagnosed with eating disorders in an outpatient, voluntary community mental health complex. Which goal is MOST IMPORTANT to address INITIALLY? - Increasing self-awareness with expressive activities An individual with back pain continues to fatigue during daily activities. Which is the BEST course of action for the OTR to encourage the client to take in order to promote activity tolerance and facilitate completion of daily activities? - set priorities An OTR is completing an initial evaluation of a client diagnosed with multiple sclerosis. The client's medical information was already reviewed prior to the session. What information is MOST important for the OTR to collect prior to an intervention plan? - performance patterns An OTR is working in a shelter for women experiencing domestic violence and creates a new series of group activities. Which of the following is NOT a step in the process of developing a group protocol for activities at the shelter? onducting a focus group A 58-year-old mother was admitted to a skilled nursing facility to continue rehabilitation following a right internal carotid artery stroke. The client's occupational therapy notes from the hospital indicate that ideational apraxia is present. What behavior is the OTR MOST likely to observe in this client during an activity of daily living (ADL) assessment at the skilled nursing facility? - The client will not know what the shirt is for when presented A child is referred to occupational therapy to address poor handwriting skills. The OTR observes the child holding the pencil with a lateral grasp, the paper moves on the desk when writing, and the child's posture is slumped over the desk. What is the most appropriate INITIAL activity to address this child's handwriting? ctivities in prone build core strength to create stability for upper extremity use A client is recovering from a recent exacerbation of congestive heart failure. The client has a history of coronary artery disease and is diagnosed with class IV cardiovascular disability using the Specific Activity Scale. The client was referred to occupational therapy with a goal to help with instrumental activities of daily living. The client experiences shortness of breath at rest. Which of the following instrumental activities of daily living can the OTR include INITIALLY in the plan of care? riving an automatic car because it requires 1-2 metabolic equivalent units (METs). Clients with class IV cardiovascular disability cannot perform any activity that requires more than 2 METs. A OTR is completing an evaluation with a client and assessed the client's muscle tone with a score of 2 on the Ashworth Scale. Which performance assessment would be MOST affected by the Ashworth Scale score? - manual muscle testing Which of the following is NOT a part of a swallow screening for clients with potential dysphagia? - intraoral and extraoral sensation The Gugging Swallowing Screen begins with a preliminary investigation or indirect swallowing test. The client must be alert for at least 15 minutes. The client is asked to cough or clear the throat twice, then asked to swallow. The OTR observes for drooling or voice change. The OTR then proceeds with a direct swallow test using semisolid, liquid, and solid food consistencies, which are performed in the order below: - The client is asked to swallow to observe deglutition. The OTR observes for coughing before, during, and after swallowing. The OTR then observes for drooling. The OTR listens to the voice after swallowing and compares this with the voice before swallowing. An 80-year-old was admitted to a skilled nursing facility after surgery to repair a fractured hip. The client was transferred to the facility from the hospital to regain independence in activities of daily living and mobility. The client was working in the garden and lost balance; however, did not sustain a fall to the ground. Although the client did not fall, the sudden movement led to a broken hip. During the evaluation, the client was unsure why the hip broke since a fall did not occur. Which of the following conditions is MOST LIKELY the largest contributor to the injury? - Osteoporosis Osteopenia is a ecrease in bone volume to below normal levels since bone resorption exceeds bone synthesis leading to loss in bone strength. However, the loss is not as significant as in osteoporosis. A break without a fall is more likely due to osteoporosis. A 9-year-old child is referred to an outpatient pediatric clinic for a screening for occupational therapy services. The mother reports to the OTR that the child constantly breaks pencils while doing math homework, frequently falls out of the chair at home, and hugs family and friends at inappropriate times. Based on the mother's observations, which intervention goal area is MOST APPROPRIATE to focus on for the child? - Increasing proprioceptive awareness Children with poor proprioceptive awareness on't receive reliable information about their body position in space, which may be the cause of the frequent falling out of the chair. Other attributes include too much force in activities such as writing or keyboarding. Praxis - the ability to conceptualize, plan, and execute a non-habitual motor act. Problems are often referred to as dyspraxia or problems with motor planning. Children appear clumsy and awkward. Before meeting with a client for an initial evaluation, the OTR should etermine if there are any contraindications/precautions, complete a chart review to determine if a doctor's order for services has been provided, determine the diagnosis and co-morbidities of the client during a chart review, note the client's social and living history and obtain the client's prior functional level. Prior to establishing an intervention plan, the OTR should omplete an occupational profile and assessment, assess client pain and determine the amount of caregiver support available after discharge. To determine therapy goals, the OTR should onsider a guiding theory and work with the client to determine goals. Before discharge the OTR will ssess the ability of the caregiver to safely assist in transfers and provide recommendations for home safety. During a home care session, a client with Alzheimer disease describes to the OTR an event where the client drove to the grocery store and had difficulty finding the way home. What is the MOST APPROPRIATE way for the OTR to respond? - perform an assessment to determine a client's driving safety An OTR is preparing to evaluate a client with low vision. Before the client arrives to the clinic, the OTR reviews the chart and prepares for the evaluation. Which definition BEST describes low vision? ilateral vision impairment that is unable to be corrected medically, surgically, or by refraction (the use of glasses or contacts) A client with an extensive history of alcohol abuse is referred for an occupational therapy evaluation. What type of assessment is MOST APPROPRIATE for the OTR to choose? - Occupational performance, self-efficacy, and role competence are most appropriate to assess in order to construct the client's occupational profile and collaborate to develop meaningful and realistic goals. An OTR is discussing home modifications to allow a 35-year-old client to return home after sustaining a C8 spinal cord injury. The client lives at home with two children, spouse, and elderly mother-in-law. Which of the following home modifications reflect the principles of universal design? - Installing a toilet seat with a switch to adjust it to a comfortable height An OTR is fabricating a splint for a client with median nerve injury. What position should be avoided to protect the client's wrist and hand? - Metacarpophalangeal hyperextension A splint for a median nerve injury should prevent - hyperextension due to the unopposed pull of the extensor digitorum communis, which is innervated by the radial nerve. An OTR is conducting a feeding evaluation in a family's home. The OTR observes the child stuffing solid food into the mouth during feeding. The parents seem worried that the child will choke due to the overstuffing behavior. Which feeding issue is the child most likely experiencing? - oral hyposensitivity, tends to lack sensory awareness in the mouth An OTR is working with a 2.5-year-old child in an early intervention program who was premature at 25 weeks gestation. The child presents to occupational therapy with upper extremity weakness and poor grasping. The child's mother would like for the child to self-feed independently. Currently, the child does not use a spoon and relies on finger feeding using a raking grasp. The meal process is slow and the mother continues to feed the child in order to meet nutritional needs. Which is the MOST APPROPRIATE intervention to promote self-feeding independence? light-weight, built-up handle on the spoon or universal cuff diabetic retinopathy - occurs when the small blood vessels in the retina develop swelling or bleeding, resulting in loss of vision. impacts all aspects of visual functioning, including loss of central vision, loss or peripheral vision, loss of color vision, decreased night vision, and fluctuations in vision. 10-year-old child with cerebral palsy is working in the classroom on signing work. The OTR has been facilitating written name production during direct intervention times; however, the task is tedious and frustrating to the child. The OTR has consulted with the teacher and decided to incorporate some adaptive equipment to provide positive feedback to the child as well as identify the child's work. Which is the MOST appropriate adaptive equipment to use with this child? - name stamp A client with left homonymous hemianopsia following a cerebrovascular accident is experiencing difficulty with reading. Previously, the client enjoyed reading novels, newspapers, and magazines. Which is the MOST EFFECTIVE intervention to promote the client's return to reading? vertical line on the left side of the page An OTR is working with a 12-year-old child diagnosed with emotional disturbance. The child has a history of being off task, poor social skills, and becoming overly upset about things when something does not go as anticipated. The child attends middle school and the teacher reports that the child has difficulty following directions, completing schoolwork, and has frequent outbursts resulting in visits to the principal's office. What intervention or strategy is MOST EFFECTIVE for improving school behavior and performance? token economy or contingency method to reinforce cooperation and task completion The OTR is planning an INITIAL intervention session with a client who is in the acute manic phase of bipolar disorder. Which intervention strategy is MOST IMPORTANT to achieve maximum participation? - provide an environment with minimal distractions A client has been receiving OT in an outpatient rehabilitation center for six weeks and is at the end of the plan of care. The client is preparing to return to work in a busy legal firm with multiple demands. Which goal area would be MOST APPROPRIATE for the OTR to implement in order to prepare the client for return to work? - Work hardening A client attends a group intervention program to address substance abuse. The client is aware that the number of therapy sessions are limited. Which is the MOST BENEFICIAL assessment for the OTR to conduct with this client based on the limited number of sessions? - Use a tool that Allows the client to self-identify occupational challenges An OTR is fabricating a splint for a client who sustained radial nerve damage from a motor vehicle crash. Based on the nerve injury, which is the BEST position for the splint to place the wrist and hand during the healing phase? - To reduce flexion and overstretching of the extensor tendons, the splint should support the wrist, metacarpophalanges, and thumb in extension, placing the hand in functional position. Which of the following approaches is MOST APPROPRIATE for a client with edema of the upper extremity? iomechanical approach (massage, compression, and active range of motion) Which of the following movements allows the OTR to evaluate the strength and control of the client's trunk flexors? - The client leans backwards and holds the position, then forward to sit up A client diagnosed with depression and anorexia nervosa attends an evening support group for 90 minutes each week. The client reports limited occupational engagement. The OTR collaborates with the client to develop a plan to increase involvement in avocational activities. The client expresses interest in exercise and volunteerism. In high school, the client was captain of the swim team, played tennis, and worked in an after-school program for young children. Which is the MOST APPROPRIATE activity for the client to explore? - local elementary school for volunteer opportunities An OTR is planning treatment sessions for adolescents diagnosed with eating disorders in an outpatient, voluntary community mental health complex. Which goal is MOST IMPORTANT to address INITIALLY? - Increasing self-awareness with expressive activities OTR is working with an adult with a substance abuse disorder in a community-based setting. The client has maintained sobriety for 1 year; however, the evaluation results indicate that the client has inadequate adaptive skills, poor hygiene, and low self-esteem. What INITIAL goal is MOST BENEFICIAL to include in the intervention plan to improve occupational performance and participation? cquisition of basic life skills for greater independence A client is recovering from a recent exacerbation of congestive heart failure. The client has a history of coronary artery disease and is diagnosed with class III cardiovascular disability using the Specific Activity Scale. The client was referred to occupational therapy to increase independence with instrumental activities of daily living. Which of the following instrumental activities of daily living can the OTR INITIALLY include in the plan of care? - Making the bed (2 METS) The definition of low vision is bilateral vision impairment that is unable to be orrected medically, surgically, or by refraction (the use of glasses or contacts). An OTR is completing an initial evaluation of a client diagnosed with multiple sclerosis. The client's medical information was already reviewed prior to the session. What information is MOST important for the OTR to collect prior to an intervention plan? - Performance patterns client with an extensive history of alcohol abuse is referred for an occupational therapy evaluation. What type of assessment is MOST APPROPRIATE for the OTR to choose? - Occupational performance, self-efficacy, and role competence Facilitation techniques of NDT include: - Includes light stroking, fast brushing, tapping the tendons or muscle belly, and heaving joint compression An OTR is planning group programming in an acute care psychiatric setting for individuals with severe mental illnesses who display disorganized thinking and difficulty functioning in many occupation areas. What type of group is MOST APPROPRIATE for this population? irective group Before discharge, the OTR must observe ________________________. - while the spouse / primary caregiver assists the client in completing a variety of transfers, such as from bed to commode, in and out of a car, and during ADLs to ensure the safety of both participants. An OTR is completing a chart review for a client following a stroke that affected the left hemisphere of the brain. One of the nurses notes that the client requires assistance for meals in order to locate the food on the meal tray. The OTR suspects that the client may have deficits impacting the visual field. Which of the following behaviors can the OTR expect to observe while working with this client? - The client is unaware of missing items on their tray Which of the following behaviors can be observed in clients with anorexia nervosa? - Perceive themselves as less competent than others A client with low vision lives with a spouse and has difficulty navigating the home environment safely. The spouse often leaves cabinet doors open, the dishwasher open, and moves furniture regularly. Which strategy would be BEST for the OTR to implement with this client and spouse in order to improve safety in the home? - Organization A 10-year-old child with cerebral palsy is working in the classroom on signing work. The OTR has been facilitating written name production during direct intervention times; however, the task is tedious and frustrating to the child. The OTR has consulted with the teacher and decided to incorporate some adaptive equipment to provide positive feedback to the child as well as identify the child's work. Which is the MOST appropriate adaptive equipment to use with this child? - Name stamp A client is recovering from a recent exacerbation of congestive heart failure. The client has a history of coronary artery disease and is diagnosed with class III cardiovascular disability using the Specific Activity Scale. The client was referred to occupational therapy to increase independence with instrumental activities of daily living. Which of the following instrumental activities of daily living can the OTR INITIALLY include in the plan of care? - Making the bed A 58-year-old mother was admitted to a skilled nursing facility to continue rehabilitation following a right internal carotid artery stroke. The client's occupational therapy notes from the hospital indicate that ideational apraxia is present. What behavior is the OTR MOST likely to observe in this client during an activity of daily living (ADL) assessment at the skilled nursing facility? - The client will not know what the shirt is for when presented An OTR provides direct services at the local homeless shelter. The OTR wanted to apply the situated learning approach during one of the group sessions. Which activity is an example of the application of didactic learning with modeling and practice in a person-specific context? onduct a group session on money management then visit a local bank An 80-year-old was admitted to a skilled nursing facility after surgery to repair a fractured hip. The client was transferred to the facility from the hospital to regain independence in activities of daily living and mobility. The client was working in the garden and lost balance; however, did not sustain a fall to the ground. Although the client did not fall, the sudden movement led to a broken hip. During the evaluation, the client was unsure why the hip broke since a fall did not occur. Which of the following conditions is MOST LIKELY the largest contributor to the injury? - Osteoporosis A OTR is completing an evaluation with a client and assessed the client's muscle tone with a score of 2 on the Ashworth Scale. Which performance assessment would be MOST affected by the Ashworth Scale score? - Manual muscle test This is the result of radial nerve injury at the wrist, which does not allow for the wrist or hand muscles to move. - Wrist drop deformity An OTR is helping a client set up for breakfast. The client was assisted to the bedside chair. The tray table was positioned after making sure that the client is seated with the head, neck, trunk, and lower body in alignment. The OTR observed the client's ability to use the utensils to self-feed. The client was served a plate of scrambled eggs and pancakes with syrup along with a cup of fresh pineapples. The client is on a dysphagia diet level 3. What should the OTR do NEXT? - Remove the cup of pineapples from the tray An OTR is assisting the client during an activity of daily living (ADL) session. The client is a 67-year-old grandmother who sustained a recent brain injury but has significantly recovered since her hospital admission. The OTR asked the client which self-care activity she would like to do first. After a few minutes, she responds and seemed to hesitate. Finally, the client said, "I need to go to the bedroom. No! Go to the bathroom." The OTR assisted the client to the bathroom. The client stood in front of the sink and proceeded to wash her face. "I need a dish," she asked the OTR. The OTR paused and said, "Tell me again what you need." The client said, "The one that you dry a dish with," while making a gesture as if to wipe her face. "Do you mean a towel?" the OTR asked. The client nodded. What should the OTR conclude regarding the client communication disorder based on the observed behavior during the session? - The client has anomic aphasia, which is difficulty with word retrieval What is the BEST preventive measure an OTR can recommend for a client with deep vein thrombosis (DVT) following stroke? - Use of graduated compression stocks An OTR uses a neurodevelopmental therapy approach and inhibition techniques in preparation for a dressing activity with an individual who has a traumatic brain injury with resulting hypertonicity. Which choice BEST illustrates inhibition techniques for hypertonia using a neurodevelopmental therapy approach? - Weight-bearing or light joint compression An OTR is evaluating a client who has visual impairment from glaucoma. During which task would this impairment be MOST evident? - Walking in the park Which of the following assesses protective sensation? - Monofilament A client presents for occupational therapy intervention with age-related macular degeneration. Which strategy is MOST BENEFICIAL to promote successful engagement in the intervention during therapy sessions? - Increase contrast An OTR is fabricating a splint for a client who sustained radial nerve damage from a motor vehicle crash. Based on the nerve injury, which is the BEST position for the splint to place the wrist and hand during the healing phase? - the splint should support the wrist, metacarpophalanges, and thumb in extension, placing the hand in functional position During a home care session, a client with Alzheimer disease describes to the OTR an event where the client drove to the grocery store and had difficulty finding the way home. What is the MOST APPROPRIATE way for the OTR to respond? - perform an assessment to determine a client's driving safety D. Follow test protocol for giving additional directions n OTR is administering a standardized assessment to a child who appears to be demonstrating difficulty initiating one of the subtests. In order to obtain accurate results, what action is required by the OTR to take? A. Adapt instructions to meet the child's needs B. Stop testing because child seems fatigued C. Provide verbal and tactile cues as needed D. Follow test protocol for giving additional directions B. Twenty-six percent of children in the sample group scored higher than this child n OTR is interpreting a developmental test that was administered to a five year old child. The child scored in the 74th percentile for the child's age and gender group. What can the OTR conclude based on this score? A. The child displays below-average developmental skills compared to similar children B. Twenty-six percent of children in the sample group scored higher than this child C. The child has major delays compared to the normative sample group D. These scores are reliable for measuring changes and guiding treatment planning D. Engage the caregivers in conversation about the child and the progress made since the last therapy visit n OTR is making an early intervention home visit to a family in a rural community. The grandmother, mother, and mother's sister are present during the session, and the grandmother bottle-feeding the 8-month-old infant when the OTR arrives. The OTR's goal for the child is to work with the family on further developing the child's motor skills. What INITIAL action should the OTR take in the session with this family? A. Wait until the child finishes eating for the mother to begin therapy with the child in order to work on motor skill development B. Re-schedule the child's therapy session due to concern that motor activities are contraindicated after bottle-feeding C. Focus the treatment session on feeding skills to incorporate the natural routine and habits of the family D. Engage the caregivers in conversation about the child and the progress made since the last therapy visit C. Remove physical guidance quickly to decrease dependence on the technique n OTR is working with a child with cerebral palsy. The OTR facilitates the child's performance by physically or manually guiding movement. Although this manual guidance approach can guide selective attention and help the child organize and plan the movement, what principle is MOST IMPORTANT for the OTR to implement when using manual guidance this child? A. Use verbal instructions while physically guiding the child's movement B. Provide light touch rather than deep pressure throughout the session C. Remove physical guidance quickly to decrease dependence on the technique D. Never use manual guidance, it is not appropriate for a child with cerebral palsy A. Bruininks-Oseretsky Test of Motor Proficiency and Test of Handwriting Skills n OTR is working in a school system and is about to evaluate a student in fourth grade who has a learning disability and ADHD. Which standardized assessments would be MOST APPROPRIATE for the OTR to use in the evaluation process? A. Bruininks-Oseretsky Test of Motor Proficiency and Test of Handwriting Skills B. Peabody Developmental Motor Scales and the Vineland Adaptive Behavior Scales C. Hawaii Early Learning Profile and Clinical Observations D. Wee-FIM and the Denver II Developmental Screening B. Collaborate with the parents and identify mutually acceptable treatment goals for the child n OTR completed a developmental assessment of a 5 year old child with Down syndrome. Results indicated the child is dependent with most self-care activities. The parents do not place a high importance or priority on feeding or dressing independence, but the OTR does. What action is MOST IMPORTANT for the OTR to take as part of the intervention planning process? A. Talk to the parents about establishing independence in self-care skills as a primary goal for the child B. Collaborate with the parents and identify mutually acceptable treatment goals for the child C. Ask for consent from the parents to begin working on feeding and dressing skills with the child D. Inform parents of the importance of self-care independence for school-aged children D. Develop and run groups to foster resiliency and social engagement and participation n OTR is working with a child in elementary school who is experiencing extreme poverty and homelessness. The child requires Tier 2 services or targeted intervention because the child is at risk of mental health challenges. Which intervention strategy BEST describes a Tier 2 intervention for this population? A. Analyze the child's specific needs and collaborate with mental health team to coordinate care for those intensive needs B. Provide a school-wide in-service training on adverse childhood events and its effects on learning C. Provide tips for promoting mental health and successful functioning in school D. Develop and run groups to foster resiliency and social engagement and participation A. Provide cues for backward chaining techniques second-grade student in a school-based setting was recently diagnosed with dyspraxia following an OT evaluation. While working on shoe tying during an OT session, the student states, "I'm never going to learn to tie my shoes. I do not know how to make a knot with the laces." What is the BEST method of instruction the OTR should take in response to the student's concern? A. Provide cues for backward chaining techniques B. Implement a picture schedule for the task C. Validate the child's feelings An OTR is working with a pediatric client that demonstrates delays in hand skills when engaged in various play-based and community tasks. The OTR observes that the child is unable to hold a cup in his hand with grasp control during a feeding task. Which one BEST describes the grasping pattern that may be delayed? A. Disk grasp B. Pincer grasp C. Cylindrical grasp D. Spherical grasp The cylindrical grasping pattern is used to hold a glass or cup Answer A: The disk grasp is used to hold a disk shape like a lid. Answer B: The pincer grasp used to hold and manipulate small objects. Answer D: The spherical grasp is used to hold a ball. An OTR is transferring a client to a wheelchair. In order to prepare the equipment required for the transfer, which is the BEST action for the OTR to take? A. Lock armrests in place on the wheelchair B. Unlock brakes on the wheelchair and bed C. Place wheelchair at an appropriate angle ]D. Install the lumbar supports prior to transfer When transferring a client to a wheelchair, the wheelchair is placed at approximately a 0° to 30° angle to the surface the client is transferring from. The specific angle of the wheelchair is based on the type of transfer and the ability of the client to assist in the transfer. A client with rheumatoid arthritis is practicing meal preparation in an outpatient OT clinic. The client complains of pain in the hands with meal preparation. Which action is MOST appropriate for the OT to address? A. Use of built-up handles for stirring B. Use of heavy bowls to prevent sliding C. Use of thin-handled knives for chopping D. Use of large jars with more quantities An older adult with age-related macular degeneration has been admitted to inpatient rehabilitation following total hip replacement. The OTR completes an evaluation and determines that the client has reduced contrast sensitivity. Which action is BEST for the therapist to take? A. Add high-contrast markers to adaptive equipment for dressing B. Utilize low, calm lighting to decrease stress while learning dressing C. Ensure all adaptive equipment is white to promote cleanliness An OTR provided home-based services to a client in the recovery phase of Guillain-Barre syndrome. The OTR encourages the client to sit during grooming tasks and also encourages the client to maintain needed items on the counter in order to avoid bending and reaching. Which intervention BEST describes what the therapist is using? A. Range-of-motion and strengthening programming[ 0.0%]B. Introduction of strategies that decrease anxiety[100.0%]C. Energy conservation and fatigue management[ 0.0%]D. Positioning trunk and head strategies for comfort An OTR has been working with a 7-year-old child with high-functioning autism spectrum disorder in an outpatient clinic setting for 3 months. The child continues to have a difficult time transitioning into the therapy gym from the waiting room. He would rather play with the toys in the waiting room and disregards the therapist and mother's requests to transition. What intervention is MOST effective for the therapist to use to promote successful transitions? A. Re-arrange seating in the waiting areas B. Use a timer to allow the child to play with the toys for a certain amount of time and then transition after the timer goes off C. Work with SLP to ID and implement effective communication strategies D. Manage the stimuli present in the clinic to prevent "flight, flight or fright" response Timers are the most effective intervention for the therapist to use to promote successful transitions because they provide an objective signal that something is about to occur. Timers also operate independently of an adult once set and the occupational therapist shows it to the child and informs him about what will happen and what will need to occur after the timer sounds in order to make the transition happen An OTR is working with a child in the foster system who was born prematurely. The OTR observes that the child easily over reacts to touch, sounds, odors, and tastes. The child also has emotional outbursts of anxiety when climbing on the playground equipment or unpredictable surfaces. Which sensory integration problems BEST describe what this child appears to be experiencing? A. Under-responsiveness and poor visual perception B. over-responsiveness and dyspraxia C. Over-responsiveness and gravitational insecurity D. Under-responsiveness and vestibular-bilateral problems After a few months of OT services in the schools, Michael can finally flip his pencil to erase his misspelled words without dropping his pencil while writing, allowing him to finish his work in a timely manner. What hand manipulation skill pattern does this BEST represent? A. Complex rotation B. Simple rotations C. Shifting D. Palm-to-finger translation . Complex rotation The hand manipulation skill of complex rotation involves rotating an object 180 to 360 degrees while the thumb and fingers alternate positions; therefore, turning the pencil over to use the eraser is an example of complex rotation. Answer B: Simple rotation involves rotating or turning an object held in the fingertips 90 degrees or less while the thumb is in opposition (e.g., orienting a puzzle piece in space). Answer C: Shift is a linear movement of the object on the finger surface; the thumb remains on the radial side of the hand, and involves moving objects across the pads of the finger tips (e.g., spreading cards out in the hands or separating two pieces of paper). Answer D: Palm-to-finger translation involves moving an object from the palm to the finger tips (e.g., putting coins in a soda machine or piggy bank). The OTR works with a 19-month-old child with significant visual and motor impairments in an early intervention playgroup. Which activity is MOST BENEFICIAL to increase the child's participation in the playgroup? A. Learning to Play an instrument B. Playing in a sand/water table C. Listening to stories at circle time D. Participation in a puppet theater . Playing in a sand/water table is the most beneficial activity to increase the child's participation in the early intervention playgroup. Children with visual and motor impairments benefit from a variety of movement experiences to develop body awareness and directionality (e.g., playing with peers at the sand/water table feeling toys). Activities involving tactile (touch) discrimination will also help children with visual and motor impairments learn about the properties of objects needed to manipulate toys and tools. Feeling real-life objects like sand or water also builds perceptual knowledge needed for later communication A OTR is working with a child with autism spectrum disorder on improving play and ideational praxis. Which intervention is the LEAST APPROPRIATE to use with this child? A. Have the child help the OTR build an obstacle course B. Take turns b/t imitating the child and child imitating you C. Use movie characters and stories to begin to introduce pretend play D. Provide choice boards to aid in understanding what is to be don. . Providing choice cards to aid in understanding of what is to be done is the least appropriate intervention to use to improve play skills and ideational praxis for children with autism spectrum disorder. This intervention will decrease a child's ability to play and use ideation because it provides the answers already so that the child does not have to generate or initiate a new response or play in a different or creative way. An OTR is working with a 12-year-old boy who will not play on the swings or slides at school. He also has difficulty climbing up the second-floor staircase at school and cannot sit in the bleachers. Which choice BEST depicts this child's area of concern? A. Tactile defensiveness B. Gravitational insecurity C. Dyspraxia (clumsy, difficulty sequencing complex movements) D. Auditory processing problems . An OTR is working in an outpatient therapy clinic with a 6-year-old child with a short attention span who has difficulty sitting still and following directions to complete tasks in a timely manner at home and at school. Which activity is MOST BENEFICIAL to promote attention and task completion? A. Picking up beans and receptively and dropping them a cap B. Building an airport with towers, roads and planes from legos and blocks C. Doing the wheelbarrow and walking from one room to another D. jumping on a trampoline in a circular pattern with a peer Wheelbarrow walking is a beneficial activity where children walk on their hands while an adult, therapist, or peer holds their legs. This type of activity involves heavy work and joint compression strategies through the upper extremity that can combat inattention and provides calming sensation through the body so that a child can lower his high arousal level to pay better attention, sit still, and follow directions more effectively after the input is provided to the body. The other activity choices do not include this type of strategy An OTR is working with a school-aged child with autism spectrum disorder in his second-grade classroom. The teacher reports that the child is continually off task, not finishing his assignments in a timely manner, and roams the classroom frequently not knowing what task to do next. What intervention is MOST BENEFICIAL to use to improve behavior and task completion in this child with autism spectrum disorder? A. Provide choices and visual schedules to ai din knowing classroom expectations B. provide movement breaks in the classroom during the off-task behavior times C. Alter the lighting, noise, and smells in the classroom D. Discuss ways to use objects based on their properties . Providing choices and visual schedules to aid in knowing the classroom expectations is the most beneficial intervention to use to improve behavior and task completion in the classroom for this child with autism spectrum disorder. Choices and visual schedules provide structure and predictability which foster independence with communication and an understanding of the classroom routine.Answer B: Providing movement breaks in the classroom during the off-task behavior times is most beneficial to improve motor skills and may or may not improve attention span. It could create more of a distraction in the classroom if not well thought out and orchestrated effectively A OTR observes two children at preschool playing with a pile of blocks. They are sitting next to each other. One child is stacking blocks to make a tower. The other child is sorting all the blue blocks into a container. Which BEST describes this type of play? A. Symbolic play B. Associative play C. Parallel play D. Onlooker play . Parallel play occurs when children play separately from others but close to them, mimicking their actions.Answer A: Symbolic play is play with language and supports the development of children's abilities to express ideas, feelings, and experiences, for example, playing dress up or house.Answer B: Associative play is a more mature form of play that reflects social connections. It occurs when children enjoy the company of other children but have little organization of their activity, for example, borrowing toys or demonstrating toys but not being interested in the activity they are doing.Answer D: Onlooker play occurs when individuals engage in forms of social interaction, such as conversation about play, without joining in the activity, for example, a child talking to a group of children about their construction of a sand castle A 9-year-old girl is referred to an outpatient pediatric clinic for a screening for occupational therapy services. Her mother reports to the OTR that her daughter constantly breaks her pencils while doing her math homework, frequently falls out of her chair at home, and hugs her family and friends at inappropriate times. Based on the other's observations, in which area does the girl require the MOST intervention? A. Praxis B. Sensory defensiveness C. Sequencing D. Proprioceptive awareness An OTR receives a feeding referral for a 3-year-old child with oral hypersensitivity. Which pattern of behaviors BEST represents oral hypersensitivity? A. Gags frequently, limited variety of foods, refuses tooth brushing B. coughing when swalling C. Difficulty chewing foods, weak jaw strength, poor tongue mobility. D. mouths objects regularly, pica, excessive drooling . Gags frequently, limited variety of foods, and refuses tooth-brushing are oral hypersensitivity behaviors of children who have oral feeding difficulties. Once recognized, an OTR can create opportunities for gradual oral sensory exploration through play and positive experiences to reduce oral hypersensitivity.Answer B: Coughing when swallowing, eating a large variety of foods, enjoying self-feeding is a pattern of behaviors ideal and typical for a 3-year-old to exhibit. It is desired that a child cough when swallowing, indicating the presence of a gag reflex. By 3 years, children should eat a large variety of table foods, feed themselves, and tolerate a variety of different textures in the mouth.Answer C: Difficulty chewing textured foods, decreased jaw strength, poor tongue mobility are indicators of oral motor impairments, specifically decreased tone or oral motor weakness and coordination difficulties, the opposite of hypersensitivity.Answer D: Mouths objects regularly, history of pica, and drooling are all indicators of low sensory registration (mouthing, eating everything/anything—even non-food items or pica), poor oral motor awareness/weakness, and poor discrimination of textures. Even though these are oral motor impairments, they are not characteristics of hypersensitivity An OTR is working with an infant in the neonatal intensive care unit born at 28 weeks' gestation who appears to have difficulty developing grasping patterns due to his indwelling thumbs. What is the MOST EFFECTIVE intervention to use to facilitate grasping development? A. Splinting to encourage thumb abduction needed for grasping B. Placing a towel roll in the hand C. Positioning the infant in supine flexion to encourage hands to midline D. Positioning the infant prone extension to encourage opening of hand Splinting to encourage thumb abduction needed for grasping is the most effective intervention to facilitate grasp development in an infant with indwelling thumbs. Splinting the thumb in abduction will create a more functional hand position for the infant to explore his or her environment and begin to grasp for toys or body parts for self-regulation and soothing. Answer B: A towel roll is not strong enough to counteract the indwelling thumb position to promote grasping. Splinting material is strong and sturdy to maintain the desired hand position so the infant can manipulate objects more efficiently to develop grasping patterns. Answer C: Positioning the infant in supine flexion addresses the needed positioning, but does not address appropriate grasping. Answer D: This child is too young to be placed in the prone position. This activity would be a good one to teach the family upon discharge. An OTR is working with a 1-year-old with spastic quadriplegic cerebral palsy on the development of sensorimotor play skills. Which family-centered intervention is MOST EFFECTIVE to address this goal? A. Coaching families to use switch-operated toys with child B. Guide the child through movements in an obstacle course C. Play computer or tablet activities D. Teach caregiver massage to promote engagement in play . Coaching families to use switch-operated toys with the child with spastic quadriplegic is the most effective, family-centered intervention to address the goal of development of sensorimotor play skills. This intervention involves training caregivers in assistive devices that allow engagement in play for children with limited extremity movement, like a child with spastic quadriplegic cerebral palsy.Answer B: Guiding a child through movements in an obstacle course has some value in fostering motor development, but it is not the most effective because of the movement limitations of children with spastic quadriplegic cerebral palsy, such as hypertonia and postural instability. Answer C: Computer or tablet activities promote engagement in play, but they are somewhat limited in the sensory realm, especially the tactile/touch sense that you can effectively get from switch-activated toys as well as object manipulation, which is limited on a tablet. Therefore, this is not the most effective intervention. Answer D: Massage is best used to calm children who have difficulty with self-regulation or tactile sensitivities. Therefore, this is not the most effective intervention for developing sensorimotor play skills. An OTR is working in the school system with children with autism. The OTR organizes programs that use activities in a group setting to promote social participation and social skill development. What principles are MOST IMPORTANT to consider when planning social skills groups for children with autism spectrum disorder? A. The group needs to be fun and competitive B. Provide a safe and supportive environment that includes emotional regulation strategies C. Peers invited to the group are of different ages and have a variety of interest D. Members are asked to role-play perform and demonstrate learned skills An OTR is working with a family of a 3-year-old child with autism spectrum disorder who has ongoing sleeping problems. The child has difficulty settling down to fall asleep and stay asleep and occasionally is seen night walking. What intervention is MOST EFFECTIVE for the family and child to promote sleep? A. Create a consistent bedtime B. Check on the child when the child cries C. Pain the bedroom bright yellow D. Use light-weight sheets on the child's bed . Create a consistent bedtime routine An OTR has completed an evaluation of a child in second grade who has handwriting difficulties. The OTR would like to use a biomechanical approach to intervention to improve handwriting and written production. What strategy BEST represents a biomechanical approach to handwriting intervention? A. Slant board to promote wrist extension and an efficient pencil grasp B. Line paper with diagrams C. Raised writing lines D. Handwriting instruction and receptive task practice A OTR is conducting a feeding intervention group in an out-patient therapy clinic for children with sensory processing disorders. These children seek oral sensory stimulation by mouthing their shirt sleeves, drooling when they eat, and over stuffing their mouths when eating. Which intervention strategy is MOST EFFECTIVE for children with poor oral sensory awareness? A. Providing foods with lumpy textures/sweet flavors B. Providing foods with strong flavors and cold temps C. Providing pureed food D. Providing bland foods/warm temps . Providing foods with strong flavors and at cold temperatures is the most effective intervention strategy for children with poor oral sensory awareness. During the intervention group, the OTR may start with activities involving a rubber massage brush, cold washcloth, or vibrating device to provide oral sensory stimulation and wake up the muscles in and around the mouth. During mealtimes, the OTR would recommend foods with strong flavors with cold temperatures (e.g., cold orange slices, pieces of flavored cold cuts, spicy chips) to help children take appropriate sized bites of foods. Children who consistently overstuff their mouths when eating may require foods that are cut into pieces and close supervision for safety An OTR plans to use a sensorimotor approach to improve the handwriting skills of a 6-year-old student who has a mild learning disability. The student maintains a very tight grip on a pencil when writing, consistently uses a palmar grasp when holding the pencil, and has directional confusion when forming letters. Which activity would be MOST EFFECTIVE to include as part of the INITIAL intervention when using this approach? A. Painting letters using a wide-barrel brush on paper attached to an upright easel B. Rolling out colored modeling dough and making-cookie cutter shapes on a tabletop C. Using spring-opening scissors to cut out geometric paper shapes D. providing HOH Assistance . Painting letters using a wide-barrel brush on paper attached to an upright easel is the most effective initial intervention because it addresses the tight grip by using a wide-barrel brush to loosen the grip. The activity also has the student using an upright easel which places the wrist in an optimal position for writing and can help facilitate a different, more mature grasp pattern. Painting letters is also an activity that uses the sensorimotor approach which will provide the student with another sensory experience while learning to form letters correctly for improved handwriting. Answer B: Rolling out colored modeling dough and making cookie-cutter shapes on a tabletop does use a sensorimotor approach, but it does not address tight grip, grasp, or directionality An OTR working in the school system is implementing a transition plan for a group of developmentally disabled 17-year old students. The long-term goals for the students are gainful employment and supervised independent living in a group home. What activity BEST addresses the long-term goals related to transition for these students? A. Asking for Assistance when ordering food in the classroom B. Going out to lunch in a fast-food restaurant C. Ordering a take-out lunch by phone D. ID lunch items from a picture menu in the classroom Going out for lunch in a fast-food restaurant is the best activity to address the suggested goals related to transition because it addresses community participation and inclusion which are two major principles of transition. This activity also develops the appropriate life skills needed for independent living such as social skills, problem solving, self-determination, and community mobility An OTR is working in an inpatient rehabilitation hospital with an individual who survived a gunshot wound to his head and sustained a traumatic brain injury. After several weeks of therapies, the patient is consistently oriented to person, place, and time and requires no assistance once new tasks or activities are learned. Which Rancho Los Amigos intervention approach BEST describes the appropriate treatment for this patient? A. Talk to him about his feelings and encourage note-taking as a way to help with memory problems B. He may need help initiating and continuing activities C. Keep comments and questions short and simple D. Keep the room quiet and calm . Talk to him about his feelings and encourage note-taking as a way to help with memory problems A client with hemiparesis of the dominant upper extremity is referred to OT. The OTR recommends the use of constraint-induced movement therapy in order to promote use of the upper extremity. Which BEST represents the OTR recommendations? A. Strengthening and exercise of the affected UE B. Restraint of the unaffected limb; focused use of affected limb C.Repetitive-task practice/task-specific practice for unaffected limbs D. Mental practice and cognitive rehearsal of a physical skill . Restraint of the unaffected limb; focused use of affected limn A client is referred for OT services with a diagnosis of ataxia. When the OTR is preparing for the evaluation, which of the following should the OTR prepare to assess? A. Spasticity B. Coordination C. Hypertonicity D. Hypersensitivity . Coordination A client with motor apraxia is receiving outpatient OT services. The client is participating in a meal preparation activity with the OTR. Which should the OTR provide in order to promote the carryover of skills learned during the treatment session into the home? A. Avoid variations of the tasks B. Vary treatment environments C. Avoid all meal preparation tasks D. Vary teaching strategies regularly . Vary treatment environment An OTR is working in an acute care rehabilitation hospital with an individual who survived a car accident and sustained a traumatic brain injury. The patient can demonstrate a generalized reflex response and his responses to external stimuli are significantly delayed. Which Rancho Los Amigos intervention approach BEST describes the appropriate treatment for this patient? A. Envourage the individual to participate in all therapies; client may not understand the extent of injury B. Keep comments and questions short and simple C. Allow as much safe movement (sitting, reaching, walking) as possible D. Tell the person who you are, where he is, why he is, in the hospital and what day it is. . An interdisciplinary educational team at a local public high school recently reassessed a 17-year-old student who sustained traumatic brain injury at the age of 6 years. After several years of intervention in the schools, the reassessment results revealed significant limitations in completing written classroom assignments and homework. What is the NEXT logical step for the educational team to consider? A. Develop discipline-specific goal B.Introduce the student to a computer C. Excuse the student from written work D. Identify appropriate transition goals . An OTR uses a neurodevelopmental therapy approach and inhibition techniques in preparation for a dressing activity with an individual who has a traumatic brain injury with resulting hypertonicity. Which choice BEST illustrates inhibition techniques for hypertonia using a neurodevelopmental therapy approach? A. light stroking of the hypertonic muscle and heavy joint compression B. Fast brushing over the involved muscle bellies C. WB or light going compression of the affected extremity D. Tapping the tendons or the muscle bellies of the hypertonic muscles - The therapist used the Rancho Los Amigos Scale of Cognitive Functioning during the evaluation of a client who sustained traumatic brain injury following a boating accident and determined the client was at a level VI in cognitive functioning. The client was observed to show goal-directed behavior when cued by the staff. She was able to recognize her family members and some of the nurses. The nurses observed that the client can stay focused while she brushed her teeth and washed her face. What activity is MOST appropriate during occupational therapy evaluation? A. OTR administers set of paper and pencil tasks to assess cog skills B. The client's perceptual skills are assessed first prior to a cognitive assessment C. OTR completes a comprehensive evaluation of the client's vision D. Client's ability in all ADLs is assessed along with some instrumental ADLs . Assessing the ability in basic activities of daily living (ADLs) and instrumental ADLs provides the OTR an opportunity to observe the client's cognition, perceptual skills, and behavioral appropriateness. She presents with behaviors consistent with Rancho Los Amigos level VI of cognitive functioning. Clients at this level are alert, but often confused and agitated. They can follow simple two- to three-step commands but are easily distracted. It is necessary for the OTR to determine the client's ability to complete basic ADLs, instrumental ADLs, and ability to reintegrate into the community as well as the number of cues needed to support performance RLA Level I - No Response The patient shows no reaction and appears to be in a deep sleep RLA Level II - Generalized response Inconsistent and non-purposeful reaction, such as gross body movements or physiological change RLA Level III - Generalized response Inconsistent response to stimulus. May be biased to certain stimuli and familiar voices. Withdraws limb in response to painful stimulus. RLA Level IV onfused-agitated Heightened level of response—may be agitated. Behavior is mostly bizarre and non-purposeful. Unable to cooperate with treatment RLA Level V onfused-inappropraite Able to respond to simple commands. Shows inappropriate behavior given complex instructions or when in an unstructured activity. Easily distracted and can still be agitated by certain stimuli in the environment RLA Level VI onfused-appropriate Shows goal-directed behavior but still requires structure. Able to tolerate unpleasant stimuli with assistance. Difficulty learning new information but can perform familiar activities with supervision. Selective attention to tasks can be observed but can perform common daily activities Level VII utomatic-appropriate Able to perform daily routine. Has superficial insight but lacks realistic problem solving and ability to plan. Impaired judgment, which may make it unsafe for the person to participate in social activities and driving Level VII - Purposeful-Appropriate Social, emotional, and intellectual capacities enable the person to participate in society. Capable of home and community independence A client with ataxia is receiving OT services to improve coordination and promote use of upper extremities during activity of daily living (ADL) tasks. Which of the following should the OTR recommend to promote engagement in ADLs? A. Stabilize joints proximal to distal B. Promote movements farther from body C. Request assistance for difficult activity of daily tasks D. Joint stabilization at the distal portion of task . Stabilizing the joints proximally (closer to the body) reduces ataxia and allows for distal (farther from the body) movements in the hands and fingers to be more accurate. In order to stabilize proximally, clients may be seated and supported using a high back chair. The support of the chair offers trunk and shoulder stabilization required for reaching tasks. Clients may also benefit from stabilizing elbows on arm rests or on a table in order to complete activity of daily living (ADL) tasks that require mobility of the hands and fingers. A client with mild cognitive impairment is referred for OT evaluation. The client continues to be engaged socially and plays card games with friends each week. The client reports that friends are bothered by mistakes made when playing cards. Which intervention is MOST appropriate for the OTR to utilize to improve the client's accuracy and engagement when playing cards? A. Avoiding playing card games to decrease fustration B. Provide pictures of how to play game and C. Reduce socialization activities and avoid structures activities D. Utilize auditory, kinesthetic, and visual input to increase accuracy . Clients with mild cognitive impairment often appear socially and physically intact, but begin to experience a decline in some areas of performance that are often noted first by close family and friends. In order to improve function and engagement, clients are encouraged to endorse a multi-sensory approach that includes visual, auditory, tactile, and kinesthetic input. Using a multi-sensory approach provides positive feedback and allows for multiple sensory systems to engage, increasing accurate processing of information An OTR is working with a 2-year-old child with arthrogryposis, a congenital orthopedic disorder, who has significant limitations in hand function. What is the BEST intervention to promote play skills in this child? A. HOH manipulation of a variety of toys B. Button switch to operate a toy care to move C. Mother playing peekaboo D. Finger painting Children with arthrogryposis have multiple contractures in small and large joints. The shoulders may be internally rotated and drawn inward (adducted), the elbows are usually extended, and the wrists are usually flexed. In most affected individuals, the fingers are flexed and stiff. These contractures impair range of motion which can impact how a child performs everyday occupations such as play. Adapted equipment and assistive devices (such as a button switch to operate a toy car) are often used in therapy to promote occupational performance for this population An OTR is working on increasing social participation and engagement with a teenager with a recent diagnosis of a C5 complete spinal cord injury. The teenager previously used her phone to connect with others via social media and texting. She is ready to experiment with an adapted app to access her smart phone. Which of the following would BEST suit the client's needs? A. Tech Speak B. iClick C. Universal remote control D. Housemate Pro with joystick . A teenager with a recent traumatic injury may be interested in re-engaging in previous social tasks with peers. Technologies are available to support teenagers with physical challenges to engage and participate in desired tasks, including smart phone access. The Housemate Pro with joystick control would allow the youth to engage in desired social engagement again.In addition to controlling household items via an app, this system allows the user to integrate phone use with adaptation. The app allows the individual to use the wheelchair joystick to control the phone. The teenager would be able to access desired social media applications using the joystick and adapted application. Answer A: Tech Speak is an augmentative communication device that can also integrate environmental home controls. A client with a C5 spinal cord injury likely has the ability to speak, as a C5 spinal cord injury does not impact the ability to speak independently. This device provides augmentative speaking options for those that have speaking challenges. Answer B: iClick allows the user to control appliances with a switch or iPad. This tool could be handy when the client is ready to independently manipulate appliances in the home. Answer C: Universal remote control is used to control several media items including TV, DVD, satellite receivers, etc. The client is seeking to control the phone, not TV, DVD, or satellite An OTR has an elementary aged student transitioning to a new manual chair. The OTR has determined the appropriate chair type and is now determining the appropriate wheelchair features for the client. The OTR has assessed the child's functional mobility skills, the frame size of the manual chair, and the desirable seat-to-floor height. What the BEST wheelchair feature selection that can be ordered based on these measurements? A. Backrest cushion B. seat cushion C. tilt in space D. Armrest style . Seat cushion An elementary aged child has recently been discharged to home after open heart surgery. Following the surgery, the child now requires oxygen to maintain appropriate oxygen saturations. The child was provided a large tank of oxygen for the home with a long tube to allow movement about in his bedroom but he cannot quite get into the bathroom. The child is not able to access the dining room or living room. The family states that they are able to order smaller tanks but didn't know why they might need them. What might the OTR recommended during a home visit to promote increased accessibility to the home environment? A. Oxygen cylider cart for smaller tanks B. Longer tubing C. Oxygen backpack carrier for smaller tanks D. Remove oxygen during family time . When evaluating the needs of individuals, the OTR must weigh all options and determine what best would meet the needs of the family, environment, and individual. In this case, the child needs an option that best supports independence and safety. Although several possibilities were proposed, only one would best suit the child's size, needs, and environment.There are many options for children to improve mobility and accessibility while on oxygen support. In this case, an oxygen backpack allows the child to increase independence and access to his environment. The large tank can be used when the child does not need to be mobile. The OTR might recommend this option to allow the child to choose a design that matches the child's personality while also supporting independence in the home and community A family is looking for additional seating options in the home for their 6-year-old daughter with a genetic disorder that impacts muscle control and use. The child uses a wheelchair for mobility and several adaptive seating options. The family would like to explore a supportive option for the children's playroom during movie times or family game time. What would be the BEST option for the OTR to recommend? A. Corner chair B. Therapy bench C. Rifton Modular Wooden Chair with Pommel d. Rock'er Pediatric Chill Out Chair . Seating options vary depending on the child's needs. In this case, a cozy seating alternative can be recommended to the family. The child's mobility and positioning needs are individually attended to by using this custom relaxation chair.The Rock'er Pediatric Chill Out Chair is designed to provide an alternative chair option for individuals who are not in their wheelchair or adaptive seating. The chair includes a soothing rocking motion that helps calm the individual. The chair is custom designed for the needs of the user. Answer A: A corner chair provides external support for children with inadequate postural control of the neck, head, and trunk and who are inclined to fall sideways or back if they overstretch. Answer B: A therapy bench is the best choice for children working on transitioning from one level to another. It provides the best option for complete use of upper extremity for play and table-top tasks. Using the therapy bench requires a certain level of lower extremity and trunk control for use. Answer C: A modular chair provides supports and can be adapted to meet the needs of the individual. This may be a good option for the family; however, it would not be the best choice given the current needs for the family. An OTR is working with a family to determine an appropriate chair for a 6-year-old child with spastic diplegia cerebral palsy. The child has indicated a desire to begin independent toileting. Presently the child is able to walk with a reverse walker and can don and doff elastic pants and underpants. Which is the BEST support to help this child with independent toileting? A. Special tomato Seat (comfort) B. Bath Chair C. Raised toilet seat D. Plastic Reducer ring . Careful consideration of a client's motor control should be weighed when evaluating self-care needs. In this case, the client is able to move his lower body using a walker and is able to independently don and doff lower body clothing items. However, the client may need support at the trunk when toileting to prevent tipping. The raised toilet seat would facilitate trunk support during the toileting task.A raised toilet seat is helpful for those needing additional supports in the lower extremity. The information above suggests the client has the ability to move his lower body, but may need increased support (walker). In this case, the client would benefit from the stability of the raised seat to lower and raise himself from the toilet independently. An elementary aged boy with spastic quadriplegia cerebral palsy would like to expand his leisure activities. He wants to be able to play video games on his tablet. The OTR is able to position the tablet to an accessible position, but realizes the boy would benefit from having more assistance with engaging the tablet's screen due to decreased motor control and precision. What might the OTR recommend? A. Tech Speak B. Hook and Switch Interface C. Big Mack D. Housemate Pro Tech Speak - Tech Speak is an augmentative communication device that can also integrate environmental home controls. Tech Speak does not attach to tablets, so this is not an appropriate choice. Hook + Switch Interface Hook + Switch Interface is designed to provide wired connections to a tablet and is intended for use linked to motor challenges. Once the hook is connected, the switch is able to engage applications on the tablet. Switches are attached to the hook and allow the child to engage in tablet features. Using a switch allows individuals with decreased motor control to engage the switch to interact with the tablet Big Mack Hook + Switch Interface is designed to provide wired connections to a tablet and is intended for use linked to motor challenges. Once the hook is connected, the switch is able to engage applications on the tablet. Switches are attached to the hook and allow the child to engage in tablet features. Using a switch allows individuals with decreased motor control to engage the switch to interact with the tablet HouseMate Pro - The HouseMate Pro allows the user to control household items via an app and allows the user to integrate phone use with adaptation. This tool does not improve engagement with a tablet An OTR is working with a speech-language pathologist (SLP) to create an augmentative communication system for a 7-year-old client with limited mobility or motor control in the upper and lower extremities. She is seated in a wheelchair and is able to use her head to turn from side to side. What is the OTR's FIRST role in this case? A. Recommend the type of device B. Recommend the positioning of the device C. Collaborate with the SPL to determine the type of device D. Create a visual schedule to promote . A young child with decreased trunk stability is working on toileting training with the OTR. The OTR observes the child needs a smaller toilet seat size to improve sitting support. Which is the BEST option for the OTR to try with the small child? A. Special tomato seat B. Bath chair- for bathing not toileting C. raised toilet seta D. Plastic seat reducer ring . A plastic reducer ring is used to prevent splashes during toileting routines and provides a small seating option for small children to increase stability. The plastic reducer ring snaps into the toilet bowl and reduces the size of the seat area to provide secure seating An OTR has a teenaged client with decreased mobility and oral communication skills who would like to increase his independence at home. In particular, the teenager wants to use the telephone without the assistance of others including answering the phone. He feels this would increase his ability to function more independently in his home setting. What is the BEST recommendation the OTR can make for this teenager? A. Tech Speak B. iClick C. Infrared phone D. Housemate Pro . The infrared phone allows individuals with disabilities to use a land line telephone service in their home. In some cases, the infrared phone has capabilities to record nearly a hundred voice responses or common phrases. An individual who would benefit from supports for physical and communication needs can use this infrared phone to increase participation with social communication A client is referred for an OT evaluation. The referral states that the client is experiencing ideational apraxia. Which is MOST appropriate for the OTR to observe during evaluation with this client? A. Initiation of task B. Appropriate use of toothbrush C. Manipulation of the toothbrush in hand D. Visual search for the toothbrush on the sink . Ideational apraxia is the inability to plan and execute motor activities while interacting with objects in daily life. Ideational apraxia occurs when clients have difficulty using objects appropriately and often experience difficulty understanding how objects are used. In this case, the client would be expected to have difficulty using the toothbrush appropriately. A client is referred for OT services with a diagnosis of ataxia. When the OTR is preparing for the evaluation, which of the following should the OTR prepare to assess? A. Spasticity B. Coordination C. Hypertonicity D. Hypersensitivity . Coordination An OTR is preparing to evaluate a client diagnosed with multiple sclerosis. In addition to an occupational profile, the OTR would like to use an occupation-focused assessment to gather information regarding the client's life history, how he copes with life changes, and the client's perspective on the impact of the disability. Which of the following assessment tools would be MOST beneficial for the OTR to use? A. Tinetti Assessment Tool B. Occupational Performance History Interview C. FIM D. Occupational Self-Assessment . Occupational Performance History Interview Occupational Performance History Interview (OPHI) Age: Areas addressed: Method: dolescent to adult activity/occuaptional choices, critical life events, daily routine, occupational roles Interview Tinetti Assessment Tool Age Areas addressed: Method dults measures risk for falls, gait/balance observation Functional Independence Measure (FIM) Age Areas addressed Method dults Measures functional status, self-care, cognition, communication Observation Occupational Self-Assessment Age Areas addressed Method - 14+ volition, habituation, performance, values, personal causation, interest, roles, habits, routines self-report The therapist used the Rancho Los Amigos Scale of Cognitive Functioning during the evaluation of a client who sustained traumatic brain injury following a boating accident and determined the client was at a level VI in cognitive functioning. The client was observed to show goal-directed behavior when cued by the staff. She was able to recognize her family members and some of the nurses. The nurses observed that the client can stay focused while she brushed her teeth and washed her face. What activity is MOST appropriate during occupational therapy evaluation? A. OTR administers a set of paper and pencil tasks to assess cog skills B. perceptual skills are assessed first prior to cog assessment C. OTR completes comprehensive eval of client's vision D. The client's ability in all ADLs and IADLs A client who sustained a right elbow and wrist fracture was referred for an occupational therapy evaluation. She expressed that she has difficulty feeling objects in her hand. What is the FIRST action the OTR should take during the initial evaluation? A. A complete sensory screen and ID appropriate tests B. Assess pain and protective sensation C. Complete a pinprick test to rule out digital nerve laceration D. Obtain history through client interview A OTR is completing an initial evaluation of a client who was diagnosed with Guillain-Barre syndrome (GBS). The OTR gathers information regarding problems and concerns that the client experienced since the onset of GBS, performance strategies that the client found successful or unsuccessful, the impact of the client's environment, activity demands, and the client's priorities. The OTR is completing which component of a comprehensive evaluation? A. Performance skills assessment B. Analysis of performance patterns C. Assessment of client factors D. Completing an occupational profile . A OTR in the acute care unit of a hospital would like to use a standardized assessment for a client who was referred for occupational therapy after a hemorrhagic stroke to evaluate the client's functional status and cognition. The OTR knows that the client may not be able to tolerate a lengthy evaluation session at this time. Which of the following is the MOST appropriate standardized assessment? A. Barthel Index B. National Institutes of Health Stroke Scale C. Mini FIM D. Glasgow Coma Scale . The Mini Functional Independence Measure (FIM) will provide a structured evaluation of the client's functional skills in self-care, mobility, and transfers. It will also evaluate the client's cognition. The total time to administer the Mini FIM is approximately 30 minutes Mini FIM Assessment Type Total time to administer Description - standardized outcome measure 30 mins evaluates functional tasks, including self-care, transfers, mobility and cognition Barthel Index Assessment Type: Total time to administer: Description: - Standardized outcome measure 30 minutes functional tasks eating, grooming, bathing, bowel/bladder mgt, toileting, dressing, mobility, transfers and stairs National Institutes of Health (NIH) Stroke Scale Assessment Type: Total time to administer: Description: - Standardized prognostic scale 10 mins evaluations Level of consciousness, language, neglect, visual field, eye movement, motor strength, ataxia, dysarthria, sensation NOT FUNCTIONAL TASKS Glasgow Coma Scale Assessment Type: Time to administer: Description: - Standardized prognostic scale 10 mins Evaluates responses- eye opening, verbal and motor response to stimuli. NOT FUNCTIONAL TASKS A OTR is completing an evaluation of a client with myasthenia gravis. The client presents with severe drooping of her eyelids. The client stated that she experiences difficulty speaking especially in the afternoon when she feels more tired. The OTR completed an occupational profile. What is the NEXT step the OTR should complete? A. Perform MMT B. Discuss psychological issues C. Fall risk assessment D. Proceed with sensory testing . Clients with myasthenia gravis experience changes in facial appearance, including diplopia (double vision), drooping of the eyelids, and/or the inability to move the eyes in certain directions, since the disease leads to oculomotor dysfunction. They may also experience weakness of the oropharyngeal muscles, which leads to difficulty speaking, difficulty swallowing, and fear of choking.Clients are often treated with steroids and may experience steroid-related physical changes. These physical changes may have psychosocial effects. The therapists should convey empathy and encourage a discussion of these issues. It may be necessary to refer the client to a support group or psychologist 10% only experience limb weakness fall risk more likely if they experience diplopia-double vision MG affects skeletal muscles and probably not have sensory deficits A client with multiple sclerosis is being seen for outpatient occupational therapy services. The OTR begins the evaluation by determining the client's goals for therapy, perceived performance of tasks identified, and satisfaction of performance for these tasks. Which assessment tool BEST represents what the OTR is using? A. COPM B. Home Safety and Accessibility Assessment Tool C. Six minute walk test and timed up and go test D. Multiple Sclerosis Walking and balance scale OPM OTR is completing an assessment with a client who recently had a cerebrovascular accident (CVA). The OTR assessed the client's muscle tone and recorded a score of 2 on the Ashworth Scale. Which of the following performance skills would this observation have the MOST impact on its accuracy when assessed? A. ROM B. MMT C. Static 2-point discrimination D. Pinprick Test . MMT Ashworth Scale 0 1 2 3 4 - 0- Normal muscle tone 1- Normal muscle tone 2- slight increase in muscle tone; "catch" when limb moved 3onsiderable increase in muscle tone 4- limb rigid flexion or extension A child has been referred for an occupational therapy screening in your clinic. What is the PRIMARY purpose of an occupational therapy screening? A. Determine if a comprehensive evaluation is needed B. Obtain a comprehensive assessment of performance C. Obtain data from which a treatment plan D. Measure therapeutic progress of the therapy goals . Determine if a comprehensive evaluation is needed An OTR is treating a client with complex regional pain syndrome (CRPS) in the dominant hand. The client is very protective of the hand secondary to pain and edema and becomes nauseated when the hand is touched. What is the therapist's BEST response to this situation? A. Avoid touching the hand and promote use of the non-dominant hand B. Provide a structured exercise program that includes the shoulder C. Do not initiate therapy until the pain and edema has resolved D. Avoid movement of shoulder and focus specifically on the hand function A continuous, severe burning pain that is often out of proportion to the severity of the injury characterizes complex regional pain syndrome (CRPS). Although the hand is the affected area, CRPS often triggers shoulder pain and stiffness; therefore, the shoulder must be incorporated into an exercise program in order to maintain or prevent shoulder dysfunction.CRPS is treated by reducing sympathetic stimulation and is most responsive in the early stages with the first goal of intervention to reduce pain and hypersensitivity. An OTR is working with a client with hemiparesis of the dominant upper extremity following a cerebrovascular accident (CVA). The client has significantly low tone in the upper extremity and no functional use. Which is BEST for the OTR to address when working with this client? A. Risk of joint and soft tissue injury during activities of daily living (ADLs) and bed mobility B. Constraint-induced movement therapy to decrease learned non-use C. Weight-bearing through the upper extremity and use for support D. Using supported reach tasks and moving objects across a table During the low tone stage, joints are at an increased risk for injury due to instability and are more likely to become misaligned. With low tone, the muscles do not provide the typical or normal stabilization around the joints, increasing the opportunity for misalignment to occur. In order to protect the unstable joints, the OTR must address the risk, maintenance, and protection of the joints and soft tissues during activities of daily living (ADLs) and bed mobility. An OTR is planning group intervention utilizing a cognitive-behavioral frame of reference. Which intervention is MOST appropriate to utilize during group activities? A. Use open-ended questions to obtain understanding B. Provide feedback for members to help one another C. Explore client feelings through movement activities D. Practice and rehearse techniques learned in group The cognitive-behavioral frame of reference promotes that the best strategy for change is reinforcements. Change occurs when behavior is reinforced in some way. Practice and rehearsal of technique learned, or role-playing, allows clients to practice newly learned behaviors in a safe, therapeutic, and supportive environment. A 14-year-old client is working with a OTR to expand his social engagement and participation with peers. He presents with challenges connecting with peers and making friends. The client has indicated a personal goal to increase social engagement and friendships. What is the BEST way for the OTR to gain a perspective on the client's needs? A. Use a parent report to determine targeted areas to improve social engagement B. Use a client report to determine the youth's feelings and experiences in context C. Use parent report to determine cognitive and social engagement skills D. Use standardized testing to determine targeted areas to improve cognitive skills and work preferences During a chart review, an OTR notes the client has experienced extensor tendon injury in zone I of the hand. Which BEST describes what the client is experiencing? A. Mallet deformity B. Clawhand deformity C. Complex regional pain D. Finger contractures Mallet deformity is the result of a disruption of the terminal extensor tendon and manifests itself as distal interphalangeal (DIP) extensor lag, specifically in zone 1 of the hand. A mallet finger is characterized by flexion of the DIP joint resulting in the finger losing the ability to extend the distal phalanx. Clawhand deformity is the result of high level ulnar nerve involvement resulting in the hyperextension of the metacarpophalangeal (MCP) joints of the ring and small fingers. The hyperextension is the result of the overaction of the extensor digitorum communis that results in a clawing appearance of the hand. Answer C: Complex regional pain syndrome is not unique to this injury and is a group of disorders that involve pain and dysfunction with the severity out of proportion to the initiating event. Complex regional pain syndrome can develop with any injuries and is not specific to hand injuries. Answer D: Contractures result in tissue shortening due to lack of passive motion and are not unique to this zone of the hand. A client presents with severe rheumatoid arthritis of both shoulders and hips and is limited in his ability to perform self-care activities. He lives at home with his wife. He expressed that he has not been able to help his wife with homemaking tasks and would like to avoid being a burden to his wife. He would like to be able to dress himself and complete his own bathing and grooming. Which of the following assistive devices is MOST appropriate for the client? A. Button hook B. Long-handled sponge C. Built-up handle toothbrush D. Mounted nail clipper An OTR is making an early intervention home visit to a family in a rural community. The grandmother, mother, and mother's sister are present during the session, and the grandmother is bottle-feeding the 8-month-old infant when the OTR arrives. The OTR's goal for the child is to work with the family on further developing the child's motor skills. What INITIAL action should the OTR take in the session with this family? A. Wait until the child finishes eating for the mother to begin therapy with the child in order to work on motor skill development B. Re-schedule the child's therapy session due to concern that motor activities are contraindicated after bottle-feeding C. Focus the treatment session on feeding skills to incorporate the natural routine and habits of the family D. Engage the caregivers in conversation about the child and the progress made since the last therapy visit33.8% of Users Answered Correctly A client is beginning phase 2 of cardiac rehabilitation in an outpatient setting. After assessing the client's risk factors and cardiovascular response to exercise, the OTR develops the intervention plan to incorporate discontinuous exercise. Which is the BEST benefit for this recommendation? A. Multiple muscle groups are utilized B. Completion of 40 minutes of exercise C. Specific muscle groups are targeted D. Mimics home exercise programs Discontinuous exercise allows the patient to stay on one piece of equipment for one-half or one-third of the allotted time and provides an opportunity for multiple muscle groups to be utilized, boredom to be minimized, and exposure to a variety of equipment. Discontinuous exercise provides a broader rehabilitation program secondary to focusing on multiple muscle groups. An OTR is working with a patient who had a cerebrovascular accident on increasing his/her functional hand use. What is the MOST BENEFICIAL activity to develop radial-ulnar dissociation needed to increase in-hand manipulation skills? A. Watering a plant using a spray bottle B. Wearing a serpentine splint at night C. Playing a card game of Go-Fish D. Completing a 100-piece puzzle Watering a plant using a spray bottle deliberately separates the radial side of the hand (the thumb, second, and third digits) from the ulnar side (fourth and fifth digit) of the hand to practice working on the dissociation of the hand to improve hand use. Working in an acute care setting, an order is received for acute post-operative repair of boxer's fracture of the right dominant upper extremity. The patient has been immobilized post-operatively with gauze and ace wrapping. The surgeon has ordered an occupational therapy evaluation and treatment including splinting. What is the MOST appropriate plan of treatment, including the most appropriate splint fabrication and the most appropriate approach to post-operative edema control for this patient. A. Forearm-based resting hand splint with wrist extension at 20 degrees, begin active and passive tendon glides to promote wrist and digit mobility, positioning, and/or light massage to promote edema control B. Forearm-based ulnar gutter splint with 4th and 5th metacarpophalangeal joint flexed to 60 degrees, begin active and passive tendon glides for wrist and digit mobility, positioning, and/or light massage to promote edema control C. Forearm-based wrist cock-up splint with wrist extension at 30 degrees to allow for metacarpophalangeal joint flexion, begin passive tendon glides and active-assisted range-of-motion exercises for wrist and digital mobility and light massage to promote edema control D. Volar hand-based ulnar gutter splint with 5th metacarpophalangeal joint flexed to 45 degrees, begin tendon glides for wrist and digit mobility and positioning to promote edema control According to current research and evidence-based practice, ulnar gutter splints with mild wrist extension and metacarpophalangeal joint flexion to 60 degrees, if possible, is recommended. Early mobilization through tendon gliding and range of motion is indicated to promote early return to active sports in athletes with boxer's fracture. An OTR is working with a kindergarten classroom teacher in developing seating options for all students in her classroom. The teacher shared that her students are seated on the floor during several academic instruction times. They are positioned in a circle and often students struggle with keeping their hands to themselves and their bodies in their own space. What type of chair might the OTR recommend to the teacher? A corner chair B Infant sitter C cube chair D Howda Hug Chair A cube chair is a common chair used in preschool and kindergarten classrooms. It provides support as well as cues on personal space. A cube chair can provide an organized workspace for children and may help with sensory needs. Answer A: A corner chair provides external support for children with inadequate postural control of the neck, head, and trunk and who are inclined to fall sideways or back if they overstretch. This type of chair would likely be too adapted for the general population. Answer B: Infant sitters are generally designed for a smaller frame and would not meet the needs of this age group. Answer D: The Howda Hug chair provides proprioceptive feedback to those needing extra sensory input. Not all students in the classroom may benefit from this type of seating option. A client with low vision lives with a spouse and has difficulty navigating the home environment safely. The spouse often leaves cabinet doors open, the dishwasher open, and moves furniture regularly. Which strategy would be BEST for the OTR to implement with this client and spouse in order to improve safety in the home? A. Task lighting B. Organization C. Use of contrast D. Mobility training A client is participating in occupational therapy following a cerebrovascular accident (CVA) with hemiparesis of the dominant upper extremity. The therapist provides assistive devices in order to promote occupational engagement. Which of the following interventions are BEST for the therapist to introduce? A. Rocker knife and elastic shoe laces B. WBing on the UE C. Splinting and positioning programs D. Supported reach tasks with BADLs A client works in a factory warehouse, stacking boxes on shelves. The client is recovering from a shoulder injury and was referred to occupational therapy to facilitate return to work. Which of the following is the BEST method when measuring range of motion? A. The OTR only measures joint range of motion below shoulder level if he or she suspects an unhealed fracture B. The OTR should hold the goniometer in place while moving the shoulder through range of motion C. The OTR observes the client's posture and compensatory motions when measuring the range of motion D. The OTR measures the scapular movement only with functional reaching tasks using the goniometer An OTR is working with a group of clients at level 5 Allen Cognitive Level in a community mental health center. They are concrete thinkers and can imitate new procedures and remember several steps at a time. What type of group intervention is MOST EFFECTIVE for clients at this level? A. Prepare and cook a simple meal B. Collate forms and stuff envelopes C. Practice medication management D. Perform basic daily grooming tasks B- level 3 C- Practicing medication management is a major problem because clients at Level 5 have a lack of abstract thinking which prevents them from understanding the nature of their illness or the effects of medication D- level 3 A client was recently diagnosed with a hemorrhagic stroke that affected the upper trunk of the middle cerebral artery. He demonstrated abnormal muscle tone in the right arm. Which of the following behaviors will MOST LIKELY be observed based on the pattern of impairment and cortical involvement? A. The client does not dress the left side of the body B. The client has slow, labored, and telegraphic speech C. The client is unable to locate items on the left of the table D. The client has double vision and a drooping eyelid Clients who experience a stroke of the upper trunk of the middle cerebral artery in the left hemisphere present with Broca aphasia and contralateral hemiplegia. The client, in this case, presented with hemiplegia of the right arm, which is contralateral to the affected left hemisphere. An OTR is working in an outpatient clinic and is seeing a client with borderline personality disorder. Which of the following would the therapist do when using a client-centered approach? A. Provide strong limit setting during group settings that focus on self-help and relationships with and among peers B. Focus on the here and now; provide calmness and consistency without being drawn into power struggles C. Provide opportunities for spontaneity, productiveness, and focus on feelings and emotions rather than routines and habits D. Provide courtesy, honesty, and respect in order to gain the confidence of the client while allowing slow attempts to engage An OTR working in an outpatient rehabilitation clinic receives a referral for a client with a high-level radial nerve laceration from a car accident. Upon evaluation, the OTR determines that the client would benefit from a splint. Which is the MOST effective splint for the OTR to create? A. Dynamic extension splint B. Long dorsal blocking splint C. Strong Velcro "buddy" splint D. Multi-dynamic flexion splint The radial nerve innervates the extensor-supinator group of muscles of the forearm, including: brachioradialis extensor carpi radialis longus extensor carpi radialis brevis supinator digiti minimi abductor pollicis longus extensor pollicis brevis extensor pollicis longus extensor indicis proprius Due to the innervation of the extensor muscles, a high-level radial nerve injury would result in the inability for the hand to extend. A dynamic extension splint provides wrist extension, metacarpophalangeal (MP) extension, and thumb extension, positioning the hand into a functional position. Answer B: A long dorsal blocking splint limits the full extension of the hand and is used to immobilize the joints of the hand in order to promote healing. This is often utilized following flexor tendon repair. A splint that promotes extension would be needed for a complete radial nerve injury. Answer C: A strong Velcro "buddy" splint is used to protect a finger after a fracture or to encourage movement of a stiff finger. A buddy splint would not be beneficial for a high-level radial nerve injury, as, none of the fingers have extension with this injury. Answer D: Dynamic flexion splints are utilized with median nerve injuries to promote flexion of the hand. The flexors remain intact with a radial nerve injury, making a splint that promotes flexion inappropriate. A client has developed edema in the right hand after it was immobilized in a cast. She is right-hand dominant and has difficulty using her left hand for tasks that require dexterity. She lives alone and needs to use both hands for instrumental activities of daily living (IADLs) such as meal preparation and cleaning. The OTR wants to recommend a temporary method to provide compression. Which of the following compression materials is MOST appropriate for the client? A. Low-stretch bandage B. Coban wraps C. Compression glove D. Custom-made garment A client is referred for inpatient occupational therapy following hip surgery. What is the FIRST thing the OTR must do prior to evaluating a client's activities of daily living (ADLs) and functional ambulation? A. Confer with the client's physical therapist regarding the client's ambulatory status B. Review the client's medical record for demographics, current status, and precautions C. Review the client's most recent vital signs with the attending nurse D. Ask the client about the prior level of function, ambulation, and community mobility The OTR applies metal cylinders that vary in temperature to a client with a hand injury. The client demonstrates no response to all cylinders applied to the hand. Which BEST describes this client's impairment? A. Decreased pain and touch awareness B. Decreased temperature sensation C. Decreased stereognosis awareness D. Decreased proprioception sensation An entry level OTR implements a group program for clients with rheumatoid arthritis. During a session focused on meal preparation, one client demonstrates significant pain when opening a jar. How should the OTR advise the client? A. Use two hands to open B. Utilize a jar opener C. Rest between attempts D. Ask for help from others An OTR is seeing a client post-surgery with range-of-motion (ROM) limitations due to edema. Which is MOST appropriate for the OTR to recommend in order to reduce the effects of edema on ROM? A. Elevate the injured extremity B. Apply heat to the extremity C. Massage from proximal to distal A 2-month-old client is struggling with food refusal and the parents are worried of failure to thrive. An OTR has been placed on consultative services to determine possible concerns related to feeding challenges. The OTR observes several clinical presentations of feeding refusal behaviors. Which of the following is the BEST example of a feeding refusal behavior in an infant? A. Refusing the nipple/spoon by closing mouth B. Coughing when food is swallowed C. Intolerance to cow's milk and vomiting D. Eye redness or watery eyes during feedings A client recently diagnosed with multiple sclerosis is referred for occupational therapy. During the initial evaluation, the client does not have many significant limitations or concerns; however, the client is concerned about the future with this diagnosis. Which is the BEST method for the OTR to take when developing a plan of care with this client? A. Encourage the client to identify a caregiver for future decision-making B. Address self-management skills, modifications, and techniques C. Encourage the client to continue to work only with physicians at this time Thermal modalities are CONTRAINDICATED for clients who have which of the following diagnoses? A. Subacute inflammation B. Bone fracture C. Raynaud phenomenon D. Complex regional pain syndrome hermal modalities are contraindicated in clients with impaired vascular structures, such as in Raynaud phenomenon. Clients with Raynaud phenomenon experience vasospasm of the blood vessels in the distal extremities, usually the fingers and toes, in response to cold temperature and stress. This leads to reduced blood supply to the fingers and toes. The fingers and toes may feel numb, cold, or painful as the blood vessels constrict. They may also experience throbbing, redness, or pain as blood flow returns.Thermal modalities are also contraindicated in clients with impaired temperature sensation, decreased circulation, cold hypersensitivity. An OTR is working on the acute-care unit at a mental health complex and wants to start a sensorimotor group for adults with schizophrenia. The OTR notices the clients are under reactive, fatigued, walk in slow motion, and appear to have a flat affect. What group intervention is the MOST BENEFICIAL to address these performance issues and promote engagement? A. Mindfulness B. Parachute games C. Baking cookies D. Writing a poem - An OTR is treating a client with chronic obstructive pulmonary disease who has low activity tolerance for basic activities of daily living. Which of the following energy conservation techniques would be MOST effective to teach the client to implement when bathing? A. Use a long-handled sponge to reach lower legs and feet B. Use pursed-lip breathing to manage shortness of breath during the shower C. Take a shower at the end of the day D. Sit on a shower chair to complete bathing tasks An OTR has completed an evaluation of client with demonstrated weakness of the distal upper extremity muscles secondary to radial nerve compression. The OTR notes that the client's strength for wrist and finger extension is returning, but at a slow pace. To facilitate wrist and finger extension, what physical agent modality would the MOST EFFECTIVE? A. Neuromuscular electrical nerve stimulation B. Transcutaneous electrical nerve stimulation C. Therapeutic ultrasound D. Paraffin An OTR is working with a group of clients with borderline personality disorder at a mental health facility in the community. Each group member is working on goals to improve self-regulation of emotions, interpersonal relationships, and a sense of self-efficacy. What type of approach is the MOST EFFECTIVE to address these goals? A. Behavioral cognitive approach B. Psychodynamic approach C. Developmental approach D. Model of Human Occupation The behavioral cognitive approach is the most effective approach to address self-regulation of emotions, interpersonal relationships, and a sense of self-efficacy for individuals with borderline personality disorder. The cognitive behavioral approach involves addressing the need for learning or changing client performance patterns/behaviors. This approach is mostly used when self-control and self-management are primary concerns. Answer B: The psychodynamic approach involves providing a context in which ego skills can be evaluated and worked on through the symbolic meaning of activities or encourage self-identity/expression through art, poetry, dance/movement, or creative writing. Answer C: The developmental approach focuses on the changes in performance patterns that occur with developmental progression. Illness and disability can interrupt the normal developmental progression and change a person's habits, routines, and roles. Therefore, this approach addresses those changes and what tasks or redesigning of the tasks necessary to master to progress developmentally to the next stage. Answer D: The Model of Human Occupation is an overarching theory that looks at occupation and the person holistically and universally across ages, cultures, and disabilities. An OTR using this theory evaluates the person and facilitates adaptive reorganization so that order can be restored. This approach is mostly used when self-organization and motivation are primary concerns. A OTR is new to working with neonates and families in the neonatal intensive care unit. What is the MOST EFFECTIVE method for providing occupational therapy services in today's neonatal intensive care unit? You answered this question correctly. A. Decrease stimulation to the infants' immature nervous system B. Provide sensory stimulation to compensate for perceived deprivation C. Provide individualized, family-centered developmental care D. Modify the environment for neonates so they can tolerate more stimuli Providing individualized, family-centered developmental care to the family and neonate is the most effective method for providing occupational therapy services in today's neonatal intensive care unit. Each family and neonate are unique and requires an individualized developmental care plan. Developmental care is an evidence-based philosophy and comprehensive approach to care giving intended to improve neurodevelopmental outcomes in neonates, so they can cope with life in the neonatal intensive care unit. The Developmental Care Model includes the following seven core measures: healing environment, partnering with families, positioning and handling, safeguarding sleep, minimizing stress and pain, protecting skin, and optimizing nutrition. The other methods are single approaches within the more comprehensive developmental care model that occupational therapists and other team members use in neonatal intensive care units to modify the environment for optimal response and healing to occur. A client presents to a hand clinic for intervention following nerve laceration to the non-dominant arm. The client experiences extreme pain, demonstrates significant overprotection of the arm, and does not utilize the arm during functional tasks. Which desensitization technique is MOST appropriate for the OTR to utilize? A. Use built-up handles to evenly distribute gripping pressure over surface area B. Use graded stimulation starting with modalities that are slightly aversive C. Use buttoning and fastening tasks without the use of vision to guide movement D. Use identification of items from a box of rice without vision to guide movement For example, the use of vibration is aversive to a client who experiences an overwhelming change in sensation following nerve laceration. Vibration has been found to focus the client's attention toward the stimuli instead of the arm allowing for sensory receptors to be desensitized, while impacting and reorganizing the higher level cortical response to the stimulus. Following vibration, movement and touch sensation can be incorporated in order to develop functional use of the arm. Using graded modalities, including the use of vibration, movement, and touch increases the client's tolerance over time to sensation by promoting habituation. A firefighter sustained a hip fracture after falling from a window. The client is now participating in a work-hardening program in a multi-disciplinary setting. Which would be the MOST appropriate activity for the OTR to provide during a therapy session? A. Donning/doffing fire gear B. Strength and flexibility tasks C. Social interactions with others A client is an executive secretary and performs extensive typing throughout the day. The client is experiencing wrist pain at night and tingling in the thumb, index, and middle fingers. The client presents to an OTR for intervention. Which intervention is MOST appropriate for the OTR to utilize with this client? You answered this question incorrectly. A. Avoiding work-related tasks, splinting, transcutaneous electrical nerve stimulation (TENS) B. Desensitization tasks, splinting, edema control C. Isotoner gloves, contrast baths, and splinting D. Avoid all typing tasks, edema control, splinting Carpal tunnel syndrome is caused by pressure on the median nerve and is associated with increased pressure in the carpal canal because of trauma, edema, or retention of fluids. Carpal tunnel syndrome is often related to repetitive wrist movements as experienced by this client and the extensive typing completed each day as well as pain and tingling in the thumb, index, and middle fingers that are innervated by the median nerve.In order to reduce this client's pain, conservative intervention is first utilized. Conservative treatment of carpal tunnel syndrome including orthotics for the wrist in no more than 20 degrees extension, contrast baths to reduce edema, and wearing Isotoner gloves at night to reduce swelling. An adult with bulimia nervosa is seeing an OTR for intervention. Which intervention is MOST appropriate for the OTR to provide? A. Examine values and independent-living skills B. Social-skills training and repetitive daily practice C. Rewards for participation in daily occupations D. Guided imagery to reduce stress and distraction An individual with fibromyalgia continues to experience extreme pain that limits occupational engagement. The individual remains compliant with medications and exercise protocols. Which action should the OTR take to BEST help this client reduce pain symptoms? A. Reduce exercise to reduce pain symptoms B. Avoid strength training to stabilize symptoms C. Implement cognitive behavioral therapy D. Utilize forms of dialectical behavioral therapy Fibromyalgia is widespread musculoskeletal pain in the muscles, ligaments, and tendons. Fibromyalgia is difficult to address secondary to how widespread the pain is throughout the body.Pharmacologic therapies, cardiovascular exercises, and cognitive behavioral therapy have been found to be successful in the treatment of fibromyalgia. Cognitive behavioral therapy specifically addresses stress, pain, fatigue, sleep patterns, coping strategies, and self-management in order to promote occupational engagement. Cognitive behavioral therapy focuses on challenging and changing unhelpful cognitive thoughts, including pain symptoms, and developing positive coping strategies. The use of this method allows clients to explore their pain symptoms and develop positive coping strategies. A OTR is working with a 69-year-old male. When he was younger, he participated in several sporting and outdoor activities. Since retiring he has become more sedentary. Currently, he prefers watching sports on TV, as he has experienced significant mobility loss and balance problems. Which factor contributes MOST to his decline in functional movement? A. Changes in diet B. Chronological age C. Inactivity D. Social isolation A client is seen for general deconditioning in an inpatient rehabilitation unit. The OTR is transferring the client from the wheelchair to the mat. Which is the BEST transfer technique for the OTR to utilize? You answered this question correctly. A. Stand pivot transfer B. Sliding board transfer C. Two person transfe D. Mechanical lift transfer An intelligent individual with a diagnosis of paranoid schizophrenia has been hospitalized in an acute care psychiatric setting and has just been assigned to attend the OT program. Which INITIAL activity would BEST engage this client? A. Completing a detailed wooden model with written instructions B. Playing a competitive game of chess C. Finishing and painting a preassembled wooden box D. Engaging in reminiscence activities Finishing and painting a preassembled wooden box is the best initial activity to engage a client with paranoid schizophrenia. Concrete craft and art projects provide structured ways of utilizing one's strengths, resources, and talents while providing an engaging context to explore values and interests without being too overwhelming. Answer A: Using written directions to complete a detailed wooden model is not concrete enough and may be the next activity to try with the client after he masters the initial activity. Answer B: Playing a competitive game of chess may overwhelm a person with paranoid schizophrenia. Competitive activities tend to exacerbate symptoms of paranoid schizophrenia (e.g., suspicion, mistrust, hypersensitivity). Answer D: Engaging in reminiscence is not the best activity for people with paranoid schizophrenia because they tend to not like discussing past events. It can induce emotional detachment or dysregulation, anxiety, and paranoia. Reminiscence is a common technique used when working with people with dementia. An OTR is assisting a client transfer into a bathtub following hip joint replacement using the posterolateral approach. Which would be MOST beneficial to assist this client? You answered this question correctly. A. Position operated leg into hip flexion to move over the edge of the tub B. Position operated leg into hip extension to move over edge of tub C. Position operated leg into adduction to move over edge of the tub D. Position operated leg with internal rotation to move over edge of tub48.0% of Users Answered Correctly Following hip joint replacement, the muscles that surround the hip are unable to support the hip fully, resulting in instability. The posterolateral approach results in instability with hip flexion; therefore, the client must avoid tasks that require hip flexion. Following surgery, the client will be placed on hip precautions. For this client, and based on the posterolateral approach utilized during surgery, the client is not allowed to flex hip greater than 90 degrees, no internal rotation, and no adduction or crossing of the knees or feet. Noncompliance with these precautions during muscle and soft tissue healing may result in hip dislocation.In order to promote the transfer into the bathtub, the operated leg needs to be positioned in hip extension and then hip abducted to allow for the leg to go over the edge of the tub. THR Posterolateral Approach Precautions - 1. No hip flexion greater than 90 degrees 2. No internation rotation 3. No adductions (crossing legs or feet) THR Anterolateral Approach Precautions - 1. No external rotations 2. No adductions 3. No extension An OTR is preparing for an evaluation with a client diagnosed with carpal tunnel syndrome. Which area is MOST likely to be impacted with this diagnosis A. Weakness of the ulnar intrinsic muscles of the hand B. Hyperextension of the metacarpophalangeal joints C. Weakness of brachioradialis and all distal muscles D. Weakness of medial intrinsic muscles of the hand Answer A: The ulnar nerve is not involved in carpal tunnel syndrome; therefore, the ulnar intrinsic muscles will not be affected. The median nerve is involved with carpal tunnel syndrome. Answer B: Hyperextension of the metacarpophalangeal joints is the result of ulnar nerve injury. The ulnar nerve is not involved with carpal tunnel syndrome. Answer C: Brachioradialis is a muscle in the forearm that is innervated by the radial nerve. The radial nerve is not impacted with carpal tunnel syndrome. A client recently had a stroke and received occupational therapy services while in the intensive care unit (ICU). He was transferred to a skilled nursing facility after 1 week to continue therapy. A OTR is reviewing the client's therapy notes from the ICU, which stated that the client has a tone of 3 on the Ashworth Scale. What can the OTR conclude based on this score? A. First tone or resistance occurs when the muscle is in a shortened range during slow, passive movement B. A considerable increase in muscle tone C. Stretch reflex (palpable catch) occurs when the muscle is in a shortened range D. Normal muscle tone Ashworth Scale 0- 1- 2- 3- 4- - 0- Normal muscle tone 1- slight increase in muscle tone; "catch" when limb moved 2- More marked increase in muscle tone, but limb easily flexed 3onsiderable increase in muscle tone 4- limb riding in flexion or extension Mild-Moderate-Severe Spasticity Scale Mild- Moderate- Severe- - Mild- stretch reflex (palpable catch) occurs at the muscle's end range Moderate- stretch reflex (palpable catch) occurs at the muscle's mid range Severe- stretch reflex (palpable catch) occurs when the muscle is in a shortened range A 6-year-old girl is referred to school-based occupational therapy after her mother expressed concern that she is having difficulty using her hands to color, getting on the swing at the playground, and her teacher reported she is having difficulty with handwriting and reading at school. What is the MOST APPROPRIATE INITIAL short-term goal for improving handwriting skills at school for this child? A. The child will write first name on the upper right-hand corner of the paper with 90% legibility B. The child will write a paragraph, without verbal prompts, in 10 minutes with 80% legibility C. The child will write one simple sentence in less than 5 minutes with 90% legibility D. The child will complete written assignments in a timely manner in the classroom with 80% legibility he most appropriate initial short-term goal for improving handwriting skills at school is starting with the easiest task to achieve within the writing sequence (e.g., writing first name). After that goal is achieved, then the next complex goal in the writing sequence of development can be addressed (e.g., writing a simple sentence, then a paragraph, and finally written assignments). A client presents for OT intervention with visual field loss following a cerebrovascular accident (CVA). Which intervention is MOST appropriate for the OTR to initiate with this client? A. Visual search B. Occluding eye C. Use of prism D. Brock string An OTR is working in the neonatal intensive care unit and just finished an initial motor evaluation of an infant born at 32 weeks' gestation. The infant's muscle tone is low and appears to have a lax head lag. At rest, the infant's lower extremities remain extended and the hips are in external rotation. What INITIAL action should the OTR take based on this assessment? You answered this question correctly. A. Train family in infant massage techniques B. Splint to promote flexion of extremities C. Tummy time activities in prone position D. Position infant in flexion with blanket support Positioning the infant in flexion with blanket support is the correct answer. The OTR's initial action is to combat the extension and position the infant in a flexion position so that the child can begin to bring hands to midline, grasp, and self-soothe/regulate. A client with myasthenia gravis was referred to occupational therapy. The entry-level OTR completed an occupational profile and found that the client experiences difficulty swallowing and complains that certain textures appear to be harder to swallow than others. The client's husband also reported that she has choked on her food several times and is concerned for his wife's safety. What should the OTR do NEXT? A. Perform instrumental procedures to assess swallowing B. Explore food consistencies that the client can tolerate C. Refer the client to a speech therapist D. Assess the client's tongue movement Refer the client to a speech therapist or an occupational therapist who has advanced training in dysphagia. Clients with severe eating and swallowing dysfunction should be evaluated and treated by an occupational therapist with advanced training in dysphagia or by a speech therapist. Answers A & B & D: Performing instrumental procedures to assess swallowing, exploring food consistencies, and assessing tongue movements require additional training that may not be covered by an entry-level OTR program. A medical transcription company has contracted with an OTR in order to reduce the severity and incidence of work-related injuries due to the extensive typing the staff completes each day. The OTR has completed a worksite evaluation and provided ergonomic education. Which is the MOST appropriate for the therapist to address next? A. Avoid management support and focus on employees only B. Provide specific activities to be completed daily by staff C. Avoid pushing information on staff, focus on management D. Improve worker fitness and obtain "buy-in" from staff Four characteristics are required for workplace prevention programs to be successful: ongoing management support supervisor participation employee buy-in ongoing support and reinforcement In order to be successful, the staff must participate, including involvement in problem-solving activities and encouraging workers to develop skills for evaluation of work areas and work methods while identifying risk factors. Worker participation encourages the workers to be instrumental in the design, development, and implementation of this injury-prevention program, including adaptations and modifications required to promote safety. Answers A & C: Both management and employees must participate to improve effectiveness and success of any injury-prevention program.Management must be committed to addressing the needs and problems identified. Management is required to develop a culture of safety and wellness and encourage workers to engage in the program as well as obtain assistance if needed.Employees must be able to evaluate work areas, work methods, and develop skills in order to prevent workplace injury specific to individual jobs. Answer B: Providing specific activities to be completed daily by staff limits the overall engagement of all staff in the process of developing workplace prevention programs. When specific tasks are provided to specific employees, obtaining the buy-in from all employees and creating ownership in the program becomes more challenging. In order to promote the buy-in from employees, all employees must participate. A 3-year-old client with a medical diagnosis of spastic quadriplegia has recently shown interest in playing with a peer. The child demonstrates mild cognitive delays. The OTR is providing interventions to support play during intervention sessions. What is the BEST intervention plan for the 3-year-old who is just learning how to socially engage with a peer? A. Plan preparatory play methods in one-on-one session B. Provide visual choices using objects of desired play items for the child to determine personal choices C. Provide adjustment to the play setting to support accessibility to play items For play to be used as a successful intervention, the client must feel that he or she is choosing the play episode. This is particularly important when working on play competency. Answer A: Planning preparatory play methods does not take into consideration the client's preferences in play. This may be implemented after desired play schemes have been determined by the therapist. Answer C: Providing adjustments to the play setting to support accessibility does not take into consideration the client's desires and appears to make an assumption regarding wants and needs in play. Bottom Line: When working with children, it is vital that play interventions support the child's interest. Focus on the child's ability to feel empowered in making the decision regarding play during interventions. A client with visual field loss has difficulty with functional mobility and has experienced multiple falls due to bumping and tripping over objects. The client has reduced participation outside of the home and demonstrates increased social isolation. Which intervention strategy is BEST for the OTR to utilize when working with this client? A. Scanning training B. White cane training C. Organizational training D. Magnification training A client following a cerebrovascular accident (CVA) reports difficulty navigating dynamic environments and often bumps into others. The client has become very self-conscious of bumping into others and currently avoids social and community outings. Which BEST reflects this client's visual impairment following CVA? A. Oculomotor changes B. Reduced visual acuity C. Reduced social skills D. Reduced visual field Visual field deficits are the most common visual disturbance associated with a cerebrovascular accident (CVA), specifically homonymous hemianopsia. With reduced visual field, the client has difficulty seeing and navigating complex environments and does not see other people in the environment. The client is more likely to bump into people or items in the area where the visual field was impacted. An occupational therapist sustained a back injury while helping a client transfer from the wheelchair to the commode. The OTR has been receiving therapy services for return to work. The OTR was allowed to continue working in the facility even while recovering; however, is only allowed to schedule clients, audit client charts, and answer the phone for 4 to 6 hours. The OTR completes an aerobic exercise and stretching program for 1-2 hours prior to work under supervision in the outpatient clinic. The OTR is receiving what type of return to work program? A. Work conditioning B. Transitional work C. Work hardening D. Volunteerism Transitional work combines acute rehabilitation and participation in some work-related activity. Acute rehabilitation involves physical conditioning programs, such as aerobic exercise, flexibility, coordination, and endurance while under supervision. A OTR in an outpatient pediatric clinic wants to ensure that her therapy efforts are carrying over into the home environment. What is MOST IMPORTANT for the OTR to consider when providing families with home programs?