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

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 client is very protectiv ...

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 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 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? A. Parents' occupation and roles B. Inclusion of siblings in programming C. Family routines and habits D. Availability of resources and supports Asking families about routines and habits is the most important thing to consider when providing a home program. Compliance and carryover with a home program increases when therapy activities are well-defined, demonstrated, and embedded into the flow of the family's already established routines and habits. Closely examining a typical week of a family enables the OTR and parents to embed reasonable goals and activities in interactive routines, making the program process more therapeutic for the family. A child with cognitive delays is working on toilet training in various settings with the OTR. The child is using adaptive equipment that is portable and provides a familiar seat to encourage comfort during toileting experiences outside the home. Generalization of toileting skills has improved with the use of this device. Which toilet device is BEST described above? A. Special tomato potty seat B. Bath chair C. Raised toilet seat D. Plastic reducer ring Special tomato seats are intended to provide a comfortable and familiar toilet seat in various environments for clients. They are easy to transport and use in a variety of settings. For a child working on toileting in new settings, this portable potty chair provides a familiar tool in a new setting. This promotes success in toilet training in new settings outside the home. Answer B: A bath chair does not support toileting needs in various environments. A bath chair is used in the bath to support an individual with decreased motor control. Answer C: A raised toilet seat is helpful for those needing additional supports in the lower extremity. The information above does not indicate the client has lower extremity needs. Answer D: A plastic reducer ring is used to prevent splashes during toileting routines and provides a small seating option for small children to increase stability. During evaluation, the OTR observes that the client is not responding to visual stimuli on the left side. Based on this observation, which visual deficit is the MOST APPROPRIATE for the OTR to document? A. Visual acuity loss B. Visual memory loss C. Oculomotor loss D. Visual field loss An OTR is working with a 2-year-old child with Down syndrome who is receiving early intervention services. The family and therapy team are working on ways to further develop the child's social play skills. What intervention is MOST BENEFICIAL to increase social play skills? You answered this question incorrectly. A. Support play using adapted toys for engagement B. Encourage parents to demonstrate turn taking for the child C. Help parents create a play group for the child D. Praise engagement in imaginative play in therapy - Helping parents create a play group for their child is the most beneficial intervention because it includes a family-centered approach or coaching parents and providing services in the community and natural environment. This type of intervention is also beneficial because the play group includes other children in the family's neighborhood or community which will encourage social interaction with peers. Answer A: Adapted toys are more appropriate for children with low postural stability and limited extremity movement. Adapted toys do not support the goal to develop social play skills. A 30-year-old student suffered burns to her upper body after a car accident. The client underwent skin grafting and was referred to occupational therapy for compression and scar management. Which of the following statements BEST describes compression therapy? A. Clients should be fitted with compression garments at least 3 weeks after wound healing B. Compression is applied to donor sites that take more than 2 weeks to spontaneously heal C. Garments are worn 8 to 12 hours during the day but can be removed at night for comfort D. Pressure must be greater on the creases of the burned area, such as the knees and elbows Appropriate compression after burn injuries prevents or treats hypertrophic scars and scar contractures.Compression assists in skin desensitization, edema control, and scar compression. It is used to reduce edema and prevent the formation of hypertrophic scars after burns. The OTR should measure the amount of edema to determine the effectiveness of the garment. Answer A: Clients should be fitted no more than 3 weeks after wound healing. If this is not possible, they should be provided with interim garments. Answer C: Compression garments are worn throughout the day but can be removed for about 1 hour for activities of daily living (ADLs) such as bathing. Answer D: Garments must exert equal pressure over the entire area of the burn. Pressure inserts such as gel pads can equalize pressure over the creases. Uneven pressure causes discomfort and constricts circulation. A client is admitted to an intensive residential program to address substance dependence and recovery. Which interventions would be MOST appropriate to use in this residential program with this client? You answered this question correctly. A. Develop coping skills to handle occupational challenges B. Avoid engagement in occupations and meaningful activities C. Reduce self-expression in order to reduce likelihood of relapse D. Promote rigid lifestyle patterns to promote sustained sobriety During an OTR activity group at a mental health facility, a client with depression, who is receiving electroconvulsive therapy (ECT) treatment, complains about short-term memory loss. What is the MOST BENEFICIAL approach to use in this situation A. Reassure the client that short-term memory loss is a typical response to electroconvulsive therapy (ECT) B. Immediately contact the psychiatrist to inform him of this symptom development C. Provide cues during activities to compensate for short-term memory loss D. Tell the person to inform his psychiatrist of this symptom development Reassuring the client that short-term memory loss is a typical response to electroconvulsive therapy (ECT) is the correct answer. Studies show an immediate loss of memory shortly after ECT. Luckily, clients are back to their baseline memory in 6 months. When working with a client with depression, it is essential to relate with understanding and empathy. Responses of validation of the client's feelings or thoughts are the most beneficial approach and provides the client information about the ECT process. Answer B: Immediately contacting the psychiatrist to inform him of this symptom development is not necessary as a side effect of electroconvulsive therapy (ECT) is often short-term memory loss and it is temporary, resolving itself back to baseline after 6 months. Answer C: While it is an OTR's instinct to encourage independence by providing supports or modifications, such as providing cues during activities to compensate for short-term memory loss, an OTR should provide the opposite when working with a client with depression. Providing understanding and empathetic responses such as reassuring the client is the most beneficial approach to use in this scenario. Answer D: When working with a client with depression, it is counterproductive to treat the client in an authoritarian manner by telling the client what do to in order to help himself or herself. Clients with depression often subject themselves to mental punishment because they are depressed and unable to change their condition. Providing information about the ECT side effects and depressive process is a better approach and will reassure them of the symptoms they are experiencing. An OTR works with 4-year-old child and asks him to hold on to the swing with both hands and pump his legs. The OTR stops the swing and changes the direction of the swing to elicit a different type of balance response. When the child shows an adaptive response, the OTR changes the speed of the swing to elicit a higher-level balance response. What is the BEST description for this example? A. Providing an appropriate context B. Engaging in purposeful activity C. Using a just-right challenge D. Reinforcing practice of balance An OTR plans an intervention for a client with nerve injury in the dominant hand. The client lacks protective sensation. Which intervention approach is MOST effective to promote safety and increase function? A. Discriminative sensory re-education B. Cortical reorganization strategies C. Compensatory sensory strategies D. Graded motor imagery re-education ompensatory strategies are essential for clients without protective sensation in order to avoid injury, as, clients are unable to feel items that are hot or cause pain. Clients must learn to utilize adaptive strategies including the use of another portion of the body that does have improved protective sensation to determine temperature and assess safety. Often clients will utilize an elbow under running water to determine temperature. Clients are also encouraged to utilize vision with tasks and are encouraged to look prior to touching in order to avoid harmful or painful situations. For example, with cooking tasks, the client is required to look for a hot burner before placing objects or a hand on the burner. Answer A: Discriminative sensory re-education requires protective sensation and promotes the identification and manipulation of objects with vision occluded. Without protective sensation, clients are unable to discriminate objects and may not feel harmful or possibly dangerous objects, resulting in injury. Answer B: Cortical reorganization relies on graded motor imagery re-education and is utilized when pain or sensory disturbances occur based on a disconnection between motor intention and proprioceptive feedback. In this case, the client has experienced a nerve injury in the dominant hand and is not experiencing cortical involvement with hand dysfunction. Answer D: Graded motor imagery re-education is a treatment technique that promotes cortical reorganization utilized when pain or sensory disturbances occur based on a disconnection between motor intention and proprioceptive feedback. In this case, the client has experienced a nerve injury in the dominant hand and is not experiencing cortical involvement with hand dysfunction. A client is 5 days status post cerebrovascular accident (CVA). During evaluation, the OTR observes the client seated in a chair during breakfast. The client demonstrates difficulty reaching items on the table and requires the support of the chair to remain upright while seated. Which BEST describes what the OTR has observed? A. Dysfunction of limb control B. Deficits of trunk control C. Visual task dysfunctions D. Symptoms of dysphagia A child is being evaluated for a manual wheelchair to improve mobility throughout the community and home. There are several physical characteristics that the OTR must consider when determining the best fit. What must the child be able to do to use a manual wheelchair? You answered this question correctly. A. Be able to functionally and efficiently propel the chair B. Be able to complete sports in the chair C. Be able to independently navigate the chair D. Be able to use front tires to propel the chair A client post-cerebrovascular accident (CVA) demonstrates difficulty finding items in the refrigerator and pantry. Which intervention is MOST appropriate for the OTR to initiate? A. Broaden visual scanning B. Utilize a vertical line strategy C. Occlude or patch the right eye D. Provide Brock string exercises An individual with depression is collaborating with his OTR to help the practitioner identify goals for treatment, however, he is only able to describe vague and general goal areas. What action is MOST IMPORTANT for the OTR to do NEXT in order to complete the goal development process with this individual? A. Create objective and measurable statements B. Describe the client's reasons for the goals C. Obtain specific measurements of the individual's skills D. Identification of the intervention approach to be used The next most important action for the OTR to take is to describe the reasons for the goal areas he has expressed. In client collaboration, it is essential to be client-centered and to follow the client's lead to facilitate the goal development process. Describing the reasons for the goals may further clarify the goal areas and create more specific goals in the process. In addition, having a reason for a goal provides intrinsic motivation to follow through with treatment in order to meet the goal. People with depression often lack interest and can be indecisive, therefore, it is important for the OTR to guide the client to understand the reasons for the goals and why the OTR and client are working on the goals. Answer A: Creating objective, measurable statements of goals can occur after the OTR collaborates with the client and understands the reasons for the goals because this will create buy-in and motivation to work on those goals. Answer C: There is currently no occupational therapy assessment specific to depression, so obtaining specific measurements of the individual's skills is not the correct answer. Instead, the occupational therapist should evaluate a person's behavior and statements to determine the stage of function and treatment approach. Answer D: Identification of the intervention approach to be used is not the most important action to take next. This step usually takes place after goals are established. The OTR is providing sensory reeducation interventions to a client following nerve injury to the hand. The OTR asks the client to close the eyes and determine where the stimulus is located in the hand. Which BEST describes this intervention? A. Discriminative sensory re-education B. Compensatory sensation re-education C. Cortical motor imagery re-organization D. Desensitization and habituation tasks An OTR is working in the second-grade classroom with a boy on a handwriting task. The OTR notices that the boy holds his pencil very tight and has difficulty placing words on his paper. He also tends to lose his place when copying from the board. What is the BEST sensorimotor approach or intervention to use to address these problems. You answered this question correctly. A. Use a rubber band sling for a slanted, relaxed pencil position B. Decrease written work assignments for the child in class C. Enlarge print for better viewing of words on the board D. Use colored lines or raised lines for improved placement An OTR is working with at-risk adolescents with a history of depression and suicide attempts on an in-patient acute psychiatric unit. What OT intervention is MOST BENEFICIAL for this population? You answered this question correctly. A. Planning a menu for a healthy cooking group B. Exploring new leisure interests and activities in a coping skills group C. Developing a school in-service for suicide prevention The occupational therapist is working with a 67-year-old retired cook who presents with perceptual deficits following a stroke. The client would like to maintain her ability to make meals for herself and her husband. She wants to keep challenging her perceptual skills in an attempt to overcome her deficits. Which of the following is the MOST appropriate activity given the client's goals? A. Have her locate the necessary utensils in a cluttered drawer B. Instruct her to place the ingredients on the right side of the stove when cooking C. Show her some examples of utensils with built-up handles D. Suggest that she wears shirts with front pockets or design to help orient clothing The restorative and remedial approach is most appropriate given the client's goal to improve her perceptual component skills. Locating the necessary utensils in a cluttered drawer is an example of environmental manipulation in order to challenge perceptual skills during a meal preparation activity. This activity challenges the client's figure-ground perception.The other activities are examples of compensatory strategies. Answer B: Moving objects to the right side is a compensatory strategy for clients with left spatial neglect. Answer C: The use of built-up handles is an example of a compensatory strategy for clients with impaired grasp and grip strength. Answer D: The use of visual cues to identify the front of the shirt is a compensatory strategy appropriate for clients with deficits affecting dressing skills. The client goal is to focus on meal preparation skills. An OTR is customizing a thermoplastic splint to decrease a client's swan neck deformity. Which splint should the OTR create to BEST promote hand function for this client? A. Proximal interphalangeal (PIP) hyperextension block B. Metacarpophalangeal (MCP) ulnar deviation blocks C. Prefabricated resting splint D. Dynamic / serial static splint A swan neck splint is also known as a proximal interphalangeal (PIP) hyperextension block and is used to restrict unwanted PIP hyperextension motion that occurs with swan neck deformity. Answer B: Metacarpophalangeal (MCP) ulnar deviation blocks are utilized when MCP joints are painful and misaligned. With a swan neck deformity, the MCP is not misaligned or deviated. Answer C: Prefabricated resting splint are utilized to provide localized rest to the wrist and hand that is painful; however, this does not correct swan neck deformities. Answer D: Dynamic or serial static splints are utilized to regain range of motion (ROM) and do not provide the correction for a swan neck deformity. A client presented with stiffness in her fingers after metacarpophalangeal (MCP) joint replacement. The OTR noted that the proximal interphalangeal joint can be passively flexed if the MCP is extended. Limited range and tightness are noted if the MCP is flexed. What should the OTR conclude is the PRIMARY cause for this loss of range of motion? A. Extrinsic flexor tightness B. Intrinsic flexor tightness C. Extrinsic extensor tightness D. Intrinsic extensor tightness The extensor digitorum communis and extensor digiti minimi extend the metacarpophalangeal (MCP) and flex the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints. Flexion of the MCP joint lengthens the extrinsic extensors. If the extensor tendons are adherent, the person will not be able to flex the PIP and DIP joint. This is the cause for the loss of range of motion as observed by the OTR. Answer A: Complete extension of the fingers will not be possible if there is extrinsic flexor tightness. Proximal interphalangeal (PIP) and distal interphalangeal (DIP) will be positioned in flexion when the metacarpophalangeal (MCP) is in extension. Interphalangeal (IP) joint extension will be possible if the wrist is positioned in flexion.Answer B: Tightness in the intrinsic muscles of the hand can be tested by passively extending the MCP joint and moving the PIP joint into extension, then flexion. Increased resistance to PIP joint movement is noted when the MCP joint is extended if there is tightness in the intrinsic muscles. Answer D: Increased resistance to PIP joint movement is noted when the MCP joint is extended if there is tightness in the intrinsic muscles. Bottom Line: The extensor digitorum communis and extensor digiti minimi extend the metacarpophalangeal (MCP) and flex the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints. Flexion of the MCP joint lengthens the extrinsic extensors. If the extensor tendons are adherent, the person will not be able to flex the PIP and DIP joint. An OTR is asked to evaluate a 7-year-old girl who is having difficulty in her first-grade classroom. Her teacher reports that she fidgets a lot in class and has difficulty paying attention. In addition, she tends to be aggressive with the other children, bumps into the furniture, and chews on her pencil. Which assessment tool should the OTR use INITIALLY? A. Sensory Profile B. School Function Assessment C. Developmental Test of Visual Perception D. Peabody Developmental Motor Scales Electrical modalities are CONTRAINDICATED in which of the following treatment goals? A. Promote muscle lengthening after tenolysis B. Stimulate recovery after nerve injury repair C. Increase strength after pacemaker placement D. Control pain in complex regional pain syndrome - Electrical modalities should not be used if a client has a pacemaker since this may inhibit the pacing of the device.Electrical modalities such as transcutaneous electrical nerve stimulation (TENS) and neuromuscular electrical stimulation (NMES) are used to decreased pain, reduce edema, and increase muscle function to increase the client's functional abilities. Answer A: TENS and NMES can be used to improve movement after tenolysis and capsulotomy surgery. Answer B: NMES can be used to stimulate and strengthen newly innervated muscles during the reinnervation phase after nerve injury repair. Answer D: TENS and NMES are used to reduce pain in clients with complex regional pain syndrome. An OTR is working with a child with oral hypersensitivity. The child has difficulty with food tastes and gags frequently. The child refuses food at mealtimes and only has three preferred foods. What approach or intervention is MOST beneficial for the OTR to use to reduce oral hypersensitivity and decrease food selectivity? A. Jaw strengthening and repetitive chewing activities to build oral motor skill B. Gradual oral sensory exploration allowing the child to explore new foods using play C. Adaptive positioning to provide a firm base of support to the trunk and feet during feeding D. High-dose vitamin supplements to address concern for nutritional deficiencies A client is receiving phase 2 of cardiac rehabilitation and demonstrates limited progression in the program. Which would be MOST beneficial for the client at this point in rehabilitation? A. Reduce the social and vocational interactions to reduce stress B. Therapists help identify possible modifications for risk factors C. Recommend avoidance of the vocational, leisure, and social activities A client with a 3-year history of back pain presents to occupational therapy for intervention. Which strategy is MOST effective for the OTR to recommend the client to use during occupational engagement? . Bend forward at hips when reaching in drawers B. Bend forward while donning and doffing socks C. Squat with knees apart to pick items off floor The OTR is working with an adolescent, 16-year-old girl, diagnosed with depression. Her primary area of concern is socialization with her peers. Her strength is in the area of task skills. What is the BEST therapy goal to address INITIALLY for this client? You answered this question incorrectly. A. Client will increase socialization with peers by participating in task groups B. Client will select and teach two peers a craft activity which she enjoys C. Client will be provided with the opportunity to interact with peers while she demonstrates a familiar craft activity D. Client will select and teach a craft activity to the OTR and state two positive comments about her instruction A client is admitted to the acute-care stroke unit. He has made progress in his tolerance to complete self-care activities while in bed. The client is able to wash his face with a washcloth while in bed in an upright position. The OTR has been monitoring his vital signs during the activities and determined that the client may be able to try to participate in more complex self-care tasks. Which of the following is the MOST appropriate self-care activity? You answered this question correctly. A. Brushing the teeth while he is sitting in bed B. Rolling toward both sides using a bed rail C. Washing the upper body at the edge of the bed D. Pulling up pants while standing by the bed A client is recovering from metacarpophalangeal (MCP) joint repair. Her hand had been immobilized to promote healing. This period of immobilization resulted in limited active and passive range of motion. The OTR noted that the client tends to avoid moving the joint. The OTR recommended exercises to isolate the MCP flexion and extension. Which of the following orthosis can BEST be incorporated in the exercise? You answered this question incorrectly A. Soft 4-finger buddy strap B. Blocking splint C. Resting-hand splint D. Metacarpophalangeal ulnar deviation splint Blocking exercises promote isolation motion of a joint and will benefit clients with limited active or passive range of motion. The client is instructed to hold the position at a comfortable end-range for 3 to 5 seconds. A digital proximal interphalangeal (PIP) block can help isolate metacarpophalangeal (MCP) flexion and extension. An OTR is working with a client who depends on her wheelchair for mobility. She just started to work at the front desk of a doctor's office. The client can manage to transfer herself and her wheelchair out of her car. She states that she often feels very tired when she returns home from work and struggles to propel the wheelchair over the threshold into her home. Which of the following recommended work simplification examples is MOST appropriate for the client to enable her to complete her activities of daily living (ADLs) and instrumental ADLs (IADLs) after work? A. Advise her to take the bus to and from work B. Install a ramp at the entrance of the home C. Rearrange the furniture to accommodate the wheelchair D. Add safety grab bars around the toilet and bathtub A client presents to occupational therapy with a diagnosis of shoulder pain. During evaluation the OTR determines that the client's pain is not only within the shoulder area, but also radiates into the neck and down the arm. Functionally, the client demonstrates reduced strength in the affected arm and decreased grip strength in the affected hand. The OTR suspects nerve dysfunction. Which is the MOST APPROPRIATE clinical test for the OTR to complete with this client? You answered this question incorrectly, A. Tinel's sign B. Froment's sign C. Phalen's test D. Adson test The Adson test is utilized to determine thoracic outlet syndrome. Based on this client's pattern of impairment, including radiating pain from the shoulder and weakness in the affected upper extremity and hand, the OTR suspects nerve dysfunction in the shoulder area consistent with thoracic outlet syndrome. The Adson test is completed where the OTR palpates the radial pulse on the affected upper extremity. The client then rotates the head toward the upper extremity, then extends the head as the upper extremity is laterally tolerated and extended. Disappearance or slowing of the radial pulse indicates a positive response. Answer A: Tinel's sign is utilized to determine carpal tunnel syndrome. Often with carpal tunnel syndrome, the client experiences pain and numbness in the thumb, index, and middle fingers. Answer B: Froment's sign is utilized to determine ulnar nerve paralysis of the adductor pollicis muscle which is responsible for thumb movement. Answer C: Phalen's test is for suspected carpal tunnel syndrome. Often with carpal tunnel syndrome, the client experiences pain and numbness in the thumb, index, and middle fingers. A 4-year-old child with decreased trunk and head control attends a 2-day-a-week mom's day out day care group. The mom mentioned that during the time the child is there, the staff does not move the child from her wheelchair onto seating options. The preschool stated to mom that they are not comfortable with the seating options they have in the classroom and would like recommendations on possible options for the child. The child is most engaged during circle and calendar time, so the staff would like an option that would support sitting on the floor or at the same level with peers and provide support, as she tends to fall sideways. What would be the BEST option for the OTR to recommend in this situation? You answered this question incorrectly. A. Corner chair B. Infant sitter C. Cube chair D. Howda Hug chair 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. The child would not tip and would remain upright when in this chair. Answer B: Infant sitters are generally designed for a smaller frame and would not meet the needs of this age group. The child is too old for this chair. Answer C: A cube chair could be an option if the child did not need neck support. This device would not fully support the child's needs. Answer D: The Howda Hug chair provides proprioceptive feedback to those needing extra sensory input. It would not provide trunk and neck support. A 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 visual field. Which of the following behaviors can the OTR expect to observe while working with this client? You answered this question incorrectly. A. The client will randomly search for objects on the meal tray B. The client will not attempt to scan towards the left side C. The client looks for items on the tray quickly and without order D. The client is unaware of the missing items on the tray Clients with left hemisphere injury experience right visual field deficit. With visual field deficits, the client does not fully see the environment and is unable to take in all the information provided, including all of the objects on the meal tray. Clients with visual field deficit following stroke experience perceptual completion, where the client is not immediately aware of the absence of vision or missing information. With visual field loss, the brain fills in the information, without fully receiving all of the information available. For client's with left hemisphere injury, the client will demonstrate a systematic scanning pattern; however, will be unaware of how far to extend the scanning pattern to the right visual field in order to fully see what is on the meal tray. Clients with visual field deficit attempt to compensate for the deficit in visual field by engaging visual attention and using an organized search and scanning pattern. Clients learn to turn the head towards the blind field, in this case, the right field and rescan the area to check for accuracy. Which of the following activities incorporate supported reach for the hemiplegic upper extremity? A. Opening or closing a drawer B. Pushing up from side lying to sitting C. Using a wheeled walker D. Writing a check to pay bills A client with age-related macular degeneration lives alone and has been referred for home OT health services in order to increase safety with instrumental activities of daily living (IADLs), specifically meal preparation tasks. Which intervention would be MOST beneficial for the OTR to utilize with this client? You answered this question correctly. A. Avoid meal prep secondary to safety B. Use of tactile markers on appliances C. Decrease lighting and contrast in kitchen D. Open all blinds in the kitchen area An OTR working in early intervention is preparing for an evaluation of a 2-year old child recently referred by a local pediatrician. The pediatrician notes the child is experiencing sensory challenges and social participation delays. Which is the MOST appropriate step for the OTR to take to address this referral? A. Determine the skill sets that may be delayed and require intervention based on the parent report B. Determine eligibility for early childhood intervention services through observation, assessment, and team information C. Provide a transition plan for day care and school that supports sensory challenges and promotes social engagement D. Write therapist-based goals and objectives including focus on sensory processing and social engagement challenges n elderly client sustained a fall and fractured the shoulder. The client is admitted to an inpatient rehabilitation unit. Extreme pain occurs with any movement of the shoulder. Which intervention is MOST appropriate to help this client resume shoulder movement without increasing pain? A. Provide passive range of motion (ROM) to the end range B. Provide resistive functional activities C. Provide passive stretching of the arm D. Provide passive ROM within range An OTR is working at the community mental health complex with a person with schizophrenia who is experiencing several negative symptoms. What are the MOST BENEFICIAL types of interventions to use with this population? A. Activities that bolster the sense of personal achievement and mastery B. Unstructured activities with abstract expectations and goals C. Highly structured activities with concrete expectations and goals D. Activities that divert attention and help with self-coping strategies An OTR implements an intervention with a client with hemiparesis following a cerebrovascular accident (CVA) who demonstrates reaching. Which is an effective strategy for the OTR to implement? A. dominance retraining B. Reach and manipulate C. Shoulder protection D. Postural support Upper extremity motor control consists of two components of function during reaching activities. The first is the reaching component where the arm moves from the body toward the object. The second is the manipulation component where the hand must open in order to grasp the object correctly. Following a CVA, clients must re-learn motor control and reaching / manipulation are essential in order to promote functional use of the affected upper extremity. An OTR is conducting a group for clients with early-stage Alzheimer disease. Which is MOST important for the OTR to consider during group activities? A. Importance of sensory stimulation and opportunities for engagement B. Importance of reality testing, body image, self-identity, and self-esteem C. Importance of adapting both task demand and contextual factors D. Importance of resuming normal thinking and cognitive processes During evaluation, a client with an ulnar nerve laceration determines meal preparation to be a goal of rehabilitation. Which is the MOST effective strategy to promote safety during meal preparation for this client? You answered this question incorrectly. A. Avoid the use of the hand during activity B. Substitute pinch to ring and small finger C. Hold heavy pots and pans close to body D. Visual protection of the affected hand When a nerve has been lacerated, sensory loss is extensive. The client no longer can feel if something is hot and does not have the automatic protections to move away from something dangerous. Sensory loss of the ulnar nerve results in injury, specifically burns. Clients must be taught to use vision in order to protect against burns where they are constantly asked to watch where they place their hands during activities. An OTR is working with a woman at a domestic violence shelter. During the initial intake interview, the OTR observes that she exhibits poor eye contact, barely speaks, and is tearful during their discussion. At the end of the interview, she tells the OTR she has no need to develop life management skills because her life has no value. What is the MOST APPROPRIATE response for the OTR to make to this woman she is interviewing? A. Ask her if she is feeling suicidal and wants to harm herself B. Reassure her that she is now safe, and things will get better C. Reassure her that she is not to blame for the violence inflicted on her D. Provide support and tell her she can begin the program when she is ready Asking the woman in the scenario if she is suicidal and wants to harm herself is the most appropriate response for the OTR to make. Based on the observations, the woman is showing possible signs of depression (e.g., poor eye contact, quiet or withdrawn, tearful). Suicidal thoughts are experienced by some people who suffer from depression. The most dangerous periods are often in the beginning, when the person is most anxious, and help is not present. All statements should be immediately reported to the primary therapist and team. A client is receiving occupational therapy services during an inpatient stay. The client has experienced prolonged time spent in bed and demonstrates extensive slouching with lumbar flexion. Prior to transferring the patient, which action is MOST appropriate for the therapist to take? A. Providing cues for trunk alignment B. Assist client into anterior pelvic tilt C. Stabilize feet and ankles on the floor D. Shift weight forward, raising buttocks Generally after prolonged time in bed, clients demonstrate a posterior pelvic tilt along with lumbar flexion, which moves the mass of the body backward. In order to promote safe transferring, the client will need to move the mass of the body forward, assuming an anterior pelvic tilt and a neutral spine in preparation for the transfer. With the mass of the body moved anteriorly, the center of the client's body moves over the feet, encouraging clients to participate in the transfer. Many clients are unaware of the correct positioning; therefore, assisting the client into the anterior pelvic tilt is essential. A client in the acute stage of Guillain-Barre syndrome is referred to OT. The OTR sees the client on the inpatient unit and completes an evaluation. Which is MOST appropriate for the OTR to recommend for this client? A. Modifications and positioning to provide the most comfort B. Complete home assessment and environmental modifications C. Introduce energy conservation techniques and modifications D. Provide splinting options to reduce pain symptoms Which of the following is encouraged during the INITIAL phase of occupational therapy intervention for clients with Guillain-Barre syndrome? A. Passive activities B. AROM exercise C. Resistive exercise D. Early ambulation A client recently lost significant function in the dominant hand following extensor tendon injury and presents with boutonniere deformity. Which is the BEST immediate course of action for the OTR to take in response to this client's hand function and impairment? A. Dorsal blocking hand splint B. Splint PIP joint in full extension C. Splint PIP in full palm flexion D. Resting position hand splint An OTR is working with a 43-year-old woman with fibromyalgia. Over the past 6 months, she has experienced chronic pain and fatigue and has missed several days of work. What is the MOST BENEFICIAL intervention approach to address this woman's condition? A. Relaxation and mindfulness sessions to override the physiological pain response B. Contextual and work modifications to simplify tasks and conserve energy C. An integrative, graded activity program for chronic pain including physical, intrapersonal, and interpersonal components D. Communication and assertiveness training so she feels comfortable asking for assistance and delegating activities as needed An integrative, graded activity program to address chronic pain is the most beneficial approach to use in this scenario. It is comprehensive and includes a physical component that consists of relaxation training, adaptive equipment, environmental modification, teaching on body mechanics and energy conservation, and a gradual increase in time spent in the productive activity. Then it moves into the next phase, the intrapersonal component, that addresses examining one's lifestyle, environment, roles, values, and leisure development.Lastly, interpersonal skills are addressed with focuses on communication and assertiveness training to achieve self-esteem and control in life. A client with visual field loss presents to OT wearing a prism on glasses. Which BEST reflects the purpose behind the use of the prism? A. Reduce double vision B. Improve visual field C. Enhancing contrast D. Improve visual clarity A prism is a type of lens that is thicker on one side than on the other. The purpose of the prism is to move the image from the non-seeing area to the seeing area. A client with visual field loss experiences reduced peripheral vision. A prism can be utilized in order to expand the remaining visual field and promote visual awareness in the non-seeing area. An OTR is working in the intensive care unit with an adult client who recently sustained a traumatic brain injury from a car accident. The client is at a level 2 Allen Cognitive Level. The client can feed himself and requires 24-hour nursing care. What type of activity is MOST EFFECTIVE for a client at this level? A. Doing a woodworking project B. Assembling multiple place settings C. Making a mosaic tile trivet D. Tossing a large, soft ball . ACL level 4 B. ACL Level 3 CCT Level 4 or 5 An 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 A client demonstrates a discrepancy between active range of motion (AROM) and passive range of motion (PROM) of the shoulder girdle. Specifically, the OTR notes that the client's PROM for shoulder flexion is 180 degrees compared to 80 degrees of AROM. What is the MOST LIKELY cause of this discrepancy? A. Weakness B. Pain C. Neuropathy D. Paralysis An OTR just started working in a community-based setting and would like to conduct a needs assessment at the agency in order to set clear goals and objectives for the clients she will be serving via group protocols. Which of these steps occurs after the needs-assessment process is completed A. Gather background data B. ID participants for the survey, focus group, interview C. Analyze data to create group intervention protocols D. Plan individual intervention session . Plan individual intervention sessions Planning individual intervention sessions is not part of the needs-assessment process. This step occurs last in the process of writing a group protocol for a client population which is very different from the needs-assessment process A client is diagnosed with stage 3 amyotrophic lateral sclerosis (ALS). The client and family establish a goal of maintaining engagement in leisure activities. Which is the BEST for the therapist to recommend? A. Provide smart technology B. Implement caregiver training C. Encourage AROM D. continue with normal activity . ALS or amyotrophic lateral sclerosis is a group of progressive, degenerative neuromuscular diseases, affecting both upper motor neuron and lower motor neuron function. In stage 3 of ALS, the client remains ambulatory but has severe weakness in certain muscles and difficulty with fatigue and completing activities of daily living (ADLs).Smart technology would provide adaptations to compensate for the weaknesses in the hands and wrists and would promote continued engagement in activities including use of voice command for access to Internet, research items, contact friends, and send communications. Stages of ALS- Stage 1 - Mild weakness, clumsy, independent Stage 2 of ALS - Moderate selectiveness weakness, slight decreased in independence, difficulty with functional mobility Stage 3 of ALS - Severe, selective weakness in ankles, wrists, hands. Moderate dependence for ADLs, easily fatigues, increased respiratory effort Stage 4 of ALS - w/c dependent for functional mobility, severe lower extremity weakness, able to perform some ADLs; however fatigues easily Stage 5 of ALS - Severe LE weakness, moderate to severe UE weakness, w/c dependent, dependence in ADLs Stage 6 of ALS ependence in all ADLs, bed position, w/c mobility A client with stage 2 amyotrophic lateral sclerosis (ALS) is seen for OT intervention. Which is the MOST appropriate goal for the OTR to provide to this client? A. Maintain function with adaptive devices B. Environmental modification for caregiver C. Maintain function without adaptive devices D. Obtain a hospital bed and power w/c . A client in stage 2 of amyotrophic lateral sclerosis (ALS) experiences moderate selective weakness and slight dependence in activities of daily living (ADLs) secondary to reduced fine motor skills. Clients in this stage may experience difficulty with buttoning or fastening clothing and may have difficulty getting dressed due to reduced active range of motion. In this stage, the use of adaptive devices promotes continued engagement and maintains function for clients with ALS. 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. Which is the MOST appropriate way for the OTR to respond? A. Complete assessments to address driving safety B. Offer caregiver support to address driving safety C. Continue with current plan of care, avoid driving D. Notify the client that driving is not safe at this time ssessments can determine a client's driving safety, cognitive function, and ability to problem solve in a dynamic, complex and often novel context. The results of driving assessments often provide valuable information to be conveyed to the client, caregiver, and referring physician regarding the client's safety A client is diagnosed with amyotrophic lateral sclerosis. He used to work in his company's head office but had to start working from home due to severe weakness in his arms and legs. During the evaluation, the OTR finds that the client has 2+/5 muscle grade in the wrists and hands. The client also states that although he can complete most of his self-care, he needs more time since he is easily fatigued. He lives with his wife and children in a 2-story home and has difficulty going up and down the stairs. The client states, "I feel like I am catching my breath every time I go up the stairs. It is hard, you know. Our bedroom and the kids' rooms are on the second floor. I still try to do some work in my office upstairs." Which intervention activity would be MOST important for this client? A. Energy conservation B. Home modifications C. Endurance training D. Strengthening program - 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? A. Performance patterns B. Sensorimotor skills C. Cognitive-perceptual skills D. Psychological issues . 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 environements An individual with multiple sclerosis is seeing an OTR for intervention. The client has difficulty managing fatigue and spasticity during daily occupations. Which recommendation is the BEST for the OTR to make? A. cognitive compensation B. pain tolerance program C. exercise programs D. Employment changes . A structured exercise program can reduce fatigue and increase endurance. A comprehensive stretching exercise program can manage spasticity. Through the use of exercise programs and stretching programs, clients experience improved quality of life, reduced fatigue, and improved ambulation. Clients who engage in these activities demonstrate improved engagement in daily occupations 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? D. Utilize auditory, kinesthetic, and visual input to increase accuracy - A client receiving OT services in an inpatient rehabilitation unit demonstrates difficulty with feeding and is often spilling food, with food frequently falling off utensils. Which is the BEST action for the OTR to take in response to this client's activity of daily living (ADL) performance? A. address trunk control, specifically anterior weight shirt B. Address lateral weight shifting during basic activity C. Address trunk extension during all eating and feeding tasks D. Address symptoms of dysphagia and positioning during ADL . Address trunk control, specifically anterior weight shit A client with multiple sclerosis and cognitive deficits is being discharged from occupational therapy. During a family/caregiver education session, the OTR instructs family members in ways to promote independence for the client based on cognitive skills. Which method is BEST for the therapist to teach the family? A. Reduce time allotted for completing daily activities B. Increase distractions to encourage the client to focus C. Use emotion-focused strategies for decision-making D. Doing one task at a time and avoid multi-tasking . A client with multiple sclerosis and cognitive deficits is being discharged from occupational therapy. During a family/caregiver education session, the OTR instructs family members in ways to promote independence for the client based on cognitive skills. Which method is BEST for the therapist to teach the family? A OTR is working with an 85-year-old client who sustained a hip fracture after a fall. The client previously fractured her back as she was bending to pick up an item off the floor. The OTR recommended that the client use a long, handheld assistive device to minimize bending forward during activities. The OTR was demonstrating how to use a long-handled shoe horn and reacher. The client did not seem willing to use the assistive device, saying, "See, I have always put my shoes on in a certain way all these years." How should the OTR INITIALLY respond? A. "Well, at least give it a try." B. "This is the best way to do it?" C. "Can you show me how?" D. "Ok, do what you want to do." . "Can you show me how?"Older clients have developed habits and certain ways to perform activities. The client, in this case, has had several injuries in the past and may have developed adaptive techniques for dressing. Even if the client has her own way of donning and doffing her shoes, the OTR should assess whether the technique is functional and safe An OTR is addressing bed mobility with a client following hip replacement surgery. In order to promote bed mobility, which skill should be addressed FIRST? A. Scooting to the EOB B. Rolling to the unaffected side C. Prop on elbows and move legs D. Possible mechanical lift transfer . Following hip replacement surgery, clients are placed on hip precautions that reduce the movement allowed with the operated hip. Depending on the approach of the surgery, clients are often prevented from hip flexion and adduction. In order to adhere to the hip precautions established following surgery, bed mobility must be adapted to observe precautions. The best procedure for clients to move in and out of bed is to prop up on elbows and slide legs toward the side of the bed, followed by the trunk and upper extremities An OTR plans interventions for a client in the recovery phase of Guillain-Barre syndrome. Which intervention approach is MOST effective to promote re-engagement in occupations? A. Activity tolerance training B. Strength-training program C. Communication devices D. Role and task modification . Guillain-Barre syndrome is an acute inflammatory disorder in which the body's immune system attacks the peripheral nervous system resulting in destruction of the myelin sheath. Functionally, clients with this disorder experience weakness and sensory changes beginning in the distal portions of the extremities. The progression of the disorder occurs in three stages A 75-year-old male diagnosed with Parkinson disease receives a referral for occupational therapy services. The OTR begins the session with an interview with the client and his wife to complete an occupational profile. The wife shares that it takes longer for the client to eat. She says, "This morning, he sat there with the spoon in his hand. It seems like for a moment he forgot how to use the spoon! Then just like that he started to finally use it to eat his oatmeal." What should the OTR conclude is the PRIMARY cause for this observation? A. Bradykinesia B. Freezing C. Tremors D. Akinesia . Akinesia Akinesiaisturbance in voluntary movement Bradykinesia- slow movement Freezing- person stops the movement after the movement was already initiatied Resting tremoristurbance in involuntary movement Classic Triad of PD Symptoms - 1. Disturbance in voluntary movement 2. tremor 3. rigidity A client post cerebrovascular accident (CVA) demonstrates difficulties during morning activities of daily living (ADLs), and cannot correctly manipulate a toothbrush. Which should the OTR document in regards to the client's ADL performance? A. Spatial Neglect B. Figure Ground C. Visual Agnosiaifficulty using vision to ID objects and rely on use of touch D. Motor apraxia . The client demonstrates difficulty with motor apraxia resulting in difficulty with manipulation of the tools required to complete the task. Motor apraxia results in difficulty with planning and executing motor movements. The client may experience difficulty with manipulation of an object during task performance. In this case, the client demonstrated difficulty manipulating the toothbrush correctly in order to complete activities of daily living (ADLs) A client is seeing an OTR following a burn injury to the dominant upper extremity and missed one therapy session. At the following session, the client noted significant increase in pain, decreased range of motion, and swelling at the elbow. Which is the MOST appropriate response for the OTR to make? A. Provide PROM B. Continue POC C. Address psychological adjustment to the burn D. Alert the Team for alternative tx . The client presents with symptoms consistent with heterotopic ossification; therefore, alerting the team of the changes including increased pain, decreased range of motion, and swelling is essential to determine if medication or surgery is necessary.Heterotopic ossification is the formation of bone in locations that normally do not contain bone tissue. This complication typically develops either in the soft tissue surrounding a joint or in the joint capsule and can significantly limit range of motion. Pain around the joint is severe and loss of active range of motion occurs quickly. Alerting the team to address alternative treatment strategies is necessary in order to reduce pain and maintain range of motion An older adult with a diagnosis of Alzheimer's disease lives with family members. Over the course of therapy, the client demonstrates increased need for supervision and increased dependence in instrumental activities of daily living (IADLs), including medication management, financial management, and grocery shopping. Which is the MOST appropriate intervention for the OTR to provide? A. adapt the activities by simplifying complex tasks B. Encourage the client to remain independent in tasks C. Continue ADLs and avoid IADLs D. Provide environment adaptations to simplify tasks . At this stage, clients and family are encouraged to avoid tasks that require new learning. In order to remain engaged in current familiar tasks, the tasks must be adapted and simplified in order to promote continued independence and role maintenance in these IADLs.As an example,in order to promote safe engagement with medication management: medications may be left where they can be seen pill boxes may be utilized timers can be programmed in order to remember when to take medications checklists can be created in order to verify that medications were taken appropriately This client may also benefit from set up with these tasks, including having a caregiver or family prepare a pill-box for the client, providing pre-written checks for certain activities, using auto pay, and providing a pre-printed grocery list that allows the client to check boxes for desired groceries A client with stage III Parkinson disease was referred to home health occupational therapy. The client presented with festinating gait but the OTR also observed that the client is still ambulatory. The client's wife expressed concern that the client refuses to use a walker and may fall at home when she is not around. Which of the following environmental modifications is MOST BENEFICIAL for the client? A. Install a raised toilet seat B. remove throw rugs in hallway C. Place signs to remind him to use his waler D. Use dining room chairs with armrests An OTR is working with a child with arthrogryposis in a school setting. What type of intervention approach is MOST BENEFICIAL for a child with this type of congenital condition? A. Constraint-induced movement B. Activity adaptation approach C. Neurodevelopmental therapy approach D. Motor learning approach Children with arthrogryposis have significant limitations in hand function beginning at birth with limited increase in function as they age. Because they experience a loss of range of motion from birth, they often learn adapted methods to accomplish tasks and are good problem solvers - therefore, the activity adaptation approach is the most beneficial for this type of condition as it adapts the task or environment to fit the child's capabilities. A client with rheumatoid arthritis is seeing an OTR for intervention. The client has been completing range-of-motion and dynamic exercises daily and reports decreased stiffness. Which is the BEST response for the therapist to make in response to this report? A. Continue exercises daily, with each major joint moving through full range of motion (ROM) B. Stop exercises if flare occurs, focusing on rest and pain relief during flare up C. Continue exercises daily until each major joint feels fatigued, but avoid pain D. Maintain 10 to 15 repetitions with full ROM regardless of fatigue or pain An OTR is planning interventions for a client with chronic inflammatory disease in bilateral hands who demonstrates minimal inflammation and low endurance during tasks. Which interventions would be MOST appropriate for this client? A. Resting hand splints B. Restrictive splinting C. Range of motion (ROM) to point of pain D. Stretch to end range A client recently sustained a C4 spinal cord injury which resulted in paralysis of the upper extremities, trunk, and lower extremities. The client complains of shoulder pain since he has been bed bound. The OTR is recommending bed positioning and incorporated an alternative position for the painful upper extremity. How should the upper extremity be intermittently positioned to relieve pain? A. Scapular elevation, 80 degrees of shoulder abduction, shoulder internal rotation, elbow slight flexion B. Scapular depression, 80 degrees of shoulder abduction, shoulder external rotation, elbow extension C. Scapular retraction, 90 degrees of shoulder abduction, shoulder external rotation, elbow extension D. Scapular protraction, 90 degrees of shoulder abduction, shoulder internal rotation, elbow flexion Clients tend to position the upper extremity in scapular elevation and elbow flexion, which contributes to pain. The position should be scapular depression, 80 degrees of shoulder abduction, shoulder external rotation, and elbow extension. Answers A & C & D: These choices do not place the upper extremity in a position to alleviate the pain during the acute phase of rehabilitation when the client is immobilized. Bottom Line: Evaluation of total body positioning is important during the acute phase when the client is immobilized to prevent pain and further loss of motion. When positioning a bed bound patient with shoulder pain, consider the positioning of scapular depression, 80 degrees of shoulder abduction, shoulder external rotation, and elbow extension. A OTR is planning a life-skills group with individuals in an outpatient community mental health agency. Many of the clients have identified areas of life which are difficult and problematic specifically related to employment. Which is the MOST appropriate intervention for the OTR to utilize during this group? A. Meal preparation B. Resume building C. Leisure exploration D. Financial management A client is receiving OT services to address visual scanning training following a cerebrovascular accident (CVA) and subsequent visual field loss. The client presents to the clinic with glasses that have a prism recommended by an optometrist. The client is unsure why the prism was recommended and why it is used to help with vision. How should the OTR address the client's hesitation regarding the prism? A. Provide education that the prism is used to expand visual field and help the client learn to compensate for visual field loss B. Remove the prism from the glasses and contact the prescribing optometrist to report that the prism was not beneficial C. Provide education that the prism increases the binocular fusion of the two eyes and can assist with near distance or reading tasks D. Recommend the client return to the prescribing optometrist in order to have the required education provided regarding the prism An adolescent with a 3-year history of anorexia nervosa is being discharged home in 2 days. The OTR will conduct a family meeting prior to discharge in order to provide essential information to assist the client in transitioning to home and in recovery. Which is the MOST relevant information for the OTR to provide? ]A. Encourage family to select and prepare food initially B. Encourage independent meal planning, selection, and preparation C. Blame the client for lack of healthy eating habits and choices D. Suggest healthy eating options and identify maladaptive behavior Initial treatment necessitates the responsibility for selecting and preparing the food be shifted away from the client, with gradual transition of the responsibility back to the client over time.Essentially, anorexia nervosa is an eating disorder and a maladaptive coping mechanism. In order to promote health and prevent relapse, the client must return home in a more controlled environment. A major lifestyle change is necessary to overcome this and the client must first be able to address coping mechanisms while food is managed by the family. A client with a burn to the hand is receiving intervention from an OTR. Which method is MOST effective for the therapist to use when addressing scar management from a burn? A. No management B. Pressure garment C. Retrograde massage D. Desensitization An OTR is working in a juvenile detention center with inner-city teenagers who have experienced emotional and physical trauma. What trauma-informed sensory approach is MOST EFFECTIVE for the therapist to use to promote safety and support for recognizing and regulating sensory experiences? A. A crisis plan that helps teens identify what upsets them, how it feels in their body, and what activities help calm them down B. Parachute games to illustrate movements to facilitate calm and alerting responses in their bodies C. Bioenergetics exercises focusing on breathing and movement exercises to heighten emotional awareness and expression D. Expressive therapy group where teens explore and uncover memories through creative writing, poetry, or art An OTR is conducting an expressive therapy group for Vietnam veterans who exhibited symptoms of substance abuse and post-traumatic stress syndrome. The group goals are to develop self-identity, self-esteem, and coping strategies. What is the MOST BENEFICIAL approach to use when designing activities for this group? A. Sensorimotor approach B. Cognitive behavioral approach C. Developmental approach D. Psychodynamic approach An OTR is seeing a client with diagnosed anxiety disorder for evaluation. Which assessment tool would be MOST beneficial for the OTR to utilize with this client? A. Life events inventory or family interview B. Standardized tools for daily living activities C. Interviews, surveys, and role checklists D. Trait-based or diagnostic specific measures A client with age-related macular degeneration is participating in outpatient rehabilitation. The OTR provides a task in which the patient is required to read instructions and complete the task. The client is observed to hold the instructions very close and is frustrated by the task. How should the OTR adapt this task in order to promote successful engagement for the client? A. Reduce overhead lighting in the room B. Utilize relative-size magnification C. Reduce contrast with the text provided D. Utilize relative-distance magnification Age-related macular degeneration results in a loss of central vision causing decreased visual acuity. Use of relative-size magnification would allow for the client to read/access instructions. Relative-size magnification increases the size of the object or the print in order to make the information accessible to the client. An OTR is working with a group of 4 to 6-year-old children in an out-patient pediatric clinic to create a wall mural by tearing small pieces of tissue paper and pasting them to a large piece of paper. Which preparation activity is BEST to promote the hand skills needed to create the mural? A. Stringing small beads B. Pushing heavy objects C. Playing finger games D. Rolling clay into a ball Stringing small beads is the best preparation activity to create a tissue paper mural. Stringing beads requires a precision grasp, hand strength, and bimanual hand skills to participate in the task effectively. These are the same skills needed in making a tissue-paper mural. A single parent of two school-aged children is employed as a truck driver. He was hospitalized for severe depression following the sudden death of his wife a year ago. His wife's primary role had been homemaker. He was hospitalized a second time this past weekend for an exacerbation of depression. What performance skills are MOST IMPORTANT for the OTR to address INITIALLY? A. Interpersonal skills B. Self-management skills C. Cognitive skills D. Leisure skills Leisure skills are the most important performance skills for an OTR to address initially when working with a client with severe depression because in this stage of depression, the OTR's focus is on creating an external structure for the client. Leisure activities such as crafts and exercises in short segments can be useful at this stage. They are concrete, engaging activities with clear expectations. A client with diminished sensation in bilateral hands has difficulty with instrumental activities of daily living (IADL) tasks, specifically cooking. Which is the MOST appropriate for the OTR to test in order to promote safety during IADL? A. Protective sensation B. Receptor density map C. Light touch sensation D. Stereognosis and touch - Protective sensation, including pain and temperature awareness, are essential to promote safety with instrumental activities of daily living (IADL). Protective sensation includes pain sensation and temperature awareness. An OTR is working with an educational team on universal design models to make an elementary classroom more universally accessible for all students. The team would like to first work on incorporating more opportunities to improve literacy exposure and accessibility in the classroom. Which type of assistive technology is the BEST option to improve accessibility and increase literacy exposure for students in the classroom? A. Talking calculator B. Word prediction software C. Keyboard and mouse D. Adapted books The client is a 30-year-old nurse's aid who sustained a glenoid labrum tear while transferring a resident out of bed. She was referred to occupational therapy after undergoing shoulder surgery. The goal of her therapy program is to prepare her to return to work at the nursing home. In order to address her shoulder range of motion and strength, the OTR asked her to practice transferring a person using a mechanical lift since this will be one of the activities involved in her job when she returns to work. The OTR is providing what type of rehabilitation program? A. Work conditioning B. On-site prevention program C. Work hardening D. Functional capacity evaluation Work-hardening programs are highly structured programs that are specific to the client's job and designed to maximize her ability to return to work. They involve real or simulated work activities combined with conditioning activities. The client, in this case, is being prepared to return to her previous job as a nurse's aide. The use of the mechanical lift is job specific. Answer A: Work conditioning emphasizes conditioning activities with limited work task simulation. Work hardening, on the other hand, focuses on maximizing the client's ability to resume participation in activities specific to the job. Answer B: On-site prevention programs aim to educate employees to avoid work-related injuries. It can include stretching and fitness programs, ergonomic assessment, and hazard assessment. Answer D: Functional capacity evaluations determine the client's skills or limitations that will affect her ability to perform job-related tasks. A child in fourth grade is struggling academically and his teacher cannot read his handwriting. The teacher asks the OTR at the school to evaluate his handwriting abilities. What is the FIRST step when evaluating a child's handwriting? A. Conducting a standardized handwriting test B. Examining the child's visual and motor functions through clinical observations C. Gathering data on a child's writing compared with classroom standards D. Reviewing the child's medical records A client with age-related macular degeneration was referred to occupational therapy for low vision rehabilitation. Which is MOST ACCURATE for the OTR to document as the plan of care? A. Field enhancement techniques B. Compensatory techniques C. Use of prism for reading D. Use of patching for reading A OTR is developing intervention goals for a client who had a stroke affecting the posterior cerebral artery. He has demonstrated deficits indicative of homonymous hemianopsia, and was transferred to a skilled nursing facility to continue his therapy. The OTR observed that his visual field deficit has a severe impact on his mobility, activities of daily living (ADLs), and instrumental ADLs (IADLs). Which statement reflects an appropriate goal for the client to achieve in 4 weeks? A. "The client will locate three words in 5 minutes given word search activity without verbal cues" B. "The client will demonstrate improved score in static and kinetic confrontation tests" C. "The client will initiate wide head turn toward the blind field without verbal cues in three of five trials" D. "The client will be able to see stimulus in four quadrants of the visual field without verbal cues" The return of visual field function is unlikely, especially given the time frame of the client's therapy. Occupational therapy should focus on compensatory strategies to regain independence despite the presence of homonymous hemianopsia. The OTR should focus on improving the client's awareness of the location and extent of the visual field deficit. The client will need to accept the presence of the deficit in order to adopt the compensatory strategies in his daily activities.The other choices are incorrect as these goals attempt to remediate the visual field loss due to homonymous hemianopsia. An OTR is applying the procedures of the constraint-induced movement therapy with a client. The client is attempting to scoop food from a bowl with her right hand, which was affected by a stroke. The OTR has been providing her with verbal cues during the activity. At the end of the activity, the OTR engaged the client in a discussion regarding the task performance. The OTR is using which component of motor learning? A. Repetition B. Intrinsic feedback C. Shaping D. Extrinsic feedback Extrinsic feedback is the external information from the environment received by the client while she is performing the task or after she has performed the task.Feedback can either be intrinsic or extrinsic. In this case, extrinsic feedback was in the form of the OTR's verbal cues while the client is performing the task. The OTR also provided extrinsic feedback at the end of the session during the discussion. The client is provided with the knowledge about her performance so that she can assess if she was able to perform it correctly or how the task can be better performed. Answer A: Motor learning involves repetition. In the case, repetition is applied in the protocol of constraint-induced movement therapy. Answer B: Intrinsic feedback is the sensory experience felt by the client. The client may experience a sensation that the movement feels different or awkward. The client combines intrinsic feedback with extrinsic feedback to assess the performance of a motor task. Answer C: In shaping, the desired behavior or motor action is performed in small, successive increments. The client is provided with explicit feedback to identify the improvement in motor performance. This reinforces the performance as the client continues to learn the movement. A OTR re-evaluates a child who is participating in an early intervention program using a norm-referenced assessment. The assessment results indicate a drop in overall scores on the assessment over the course of the intervention period or six months. What is the BEST explanation for this change in performance? A. The child has regressed in his overall task performance B. The child has developed more slowly than typically aged peers C. The OTR administered the assessment incorrectly D. The caregivers did not follow through with a home program Answer D: Norm-referenced assessments only provide objective data based on the child's overall subtest or area score, and cannot assess follow-through with a home program. An OTR is working in an acute, psychiatric unit at the community hospital. The OTR receives a referral for an adolescent with a history of self-mutilation. The mother reports that she discovered her daughter's condition after washing her bloody bed sheets. She also mentions that her daughter is under extreme stress at school as she is in the running to become valedictorian of her high school. What is the MOST BENEFICIAL interest for the client to explore upon discharge? A. Joining the debate team to improve college applications B. Meal preparation to make quick easy meals and save time C. Going to movies and hanging out with friends on weekends D. Yoga and mindfulness groups that meet at high school An OTR is assigned to work with a client with a traumatic below-the-knee amputation following a car crash. The client experiences extreme pain in the residual limb. Which is the MOST important for the OTR to address? A. Phantom limb pain and adjustment B. Prosthetic limb preparation programs C. Selection of a specific prosthetic limb D. Limb dominance change and function The loss of a limb can profoundly effect a person's body scheme and self-efficacy and phantom limb pain can impact rehabilitation significantly. In order to promote rehabilitation outcomes, adjustment to loss of limb, and reduce pain, the phantom limb pain and psychological adjustment are critical to address early in rehabilitation.Below-the-knee amputations preserve the knee and thus eliminate the need for a prosthetic knee joint. Traumatic amputation occurs due to trauma secondary to environmental hazards or accidents, including car crashes. The preprosthetic phase begins immediately after training and is focused on addressing pain and psychological adjustment. In order to address pain, the therapist must understand phantom limb pain as well as the psychological factors that have been identified as triggers of phantom limb pain.Phantom limb pain can vary greatly and results from changes in the central nervous system and peripheral nerve damage. Phantom limb pain can be debilitating and occurs when the client feels the distal portion of the limb, although the limb is no longer present. The pain my vary over time and may eventually dissipate; however, in the rehabilitation process, the phantom limb pain must be addressed and normalized in order for the client to progress. The psychological adjustment process requires the client to grieve the loss of the limb and may contribute to the associated pain. Reactions after amputations are complex and unique to each individual. Answer B: Prosthetic limb preparation programs are essential during the early stages of amputation and begin immediately after amputation; however, the client must first address the pain in order to tolerate early fittings of a prosthesis. Answer C: Selection of a specific prosthetic limb begins with education and occurs in the second phase of rehabilitation. With pain this severe, prosthetic limb preparation and selecting a specific limb is not appropriate and rehabilitation should begin with preprosthetic training, specifically focused on addressing pain and psychological adjustment. Answer D: Limb dominance and function is not addressed with this question. With lower extremity amputation, limb dominance is less critical in rehabilitation. A client participates in cardiac rehabilitation twice a week. The client is hoping to return to work in a busy and dynamic warehouse setting. Which is the MOST appropriate for the OTR to address? A. Home care demands B. Workplace demands C. Muscle endurance tasks D. Static endurance tasks An OTR is administering a criterion-referenced standardized assessment developmental checklist to a 4-year-old child who has a moderate developmental delay. The child did not meet the standard for cutting on a line or drawing a circle. For what purpose would these results be MOST useful? A. Comparing the child's performance to the sample of same-aged peers B. Identifying functional tasks that would be most difficult for the child C. Determining developmentally appropriate activities in therapy sessions D. Linking outcomes measures to other typically developing children An individual who is acutely manic has been admitted to the hospital for stabilization. The individual is referred for occupational therapy intervention. Which intervention would be MOST appropriate for this individual? A. Monitor values and enjoyment while completing various types of activities B. Assist client to return to goal-directed actions, including goal setting C. Engage in cognitive therapy to recognize, evaluate, and change thoughts D. Perform reality testing and question unrealistic beliefs and thought processes The OTR is leading a stress management group, which includes a woman who has schizophrenia and is actively hallucinating. Which stress management activity is LEAST APPROPRIATE for this individual? A. Aerobic exercise B. Social skills training C. Mental imagery D. Deep breathing A OTR is developing a treatment plan to help the client with post-polio syndrome to manage chronic pain. The intervention includes promoting lifestyle changes, modifying roles and habits, and altering beliefs and attitudes in order to adapt to the condition and lead a satisfying life using his remaining functional skills. Which of the following intervention techniques is the OTR applying in this scenario? A. Energy conservation B. CBT C. Task-oriented approach D. Client-centered approach . An OTR is planning a group for adolescent children with fetal alcohol spectrum disorder. The children are experiencing social withdrawal, teasing and bullying at school, and difficulty maintaining peer relationships. Which interventions are MOST BENEFICIAL for the OTR to utilize with this group of children? A. Negotiate with friends and reduce interfering behaviors B. Create a social story on good manners and giving compliments C. Participate and cooperate in parallel projects D. Verbalize understanding of intentions of others An OTR is planning a group for adolescent children with fetal alcohol spectrum disorder. The children are experiencing social withdrawal, teasing and bullying at school, and difficulty maintaining peer relationships. Which interventions are MOST BENEFICIAL for the OTR to utilize with this group of children? A. Rolling out model clay and making shapes with cookie cutters B. Providing HOH A during writing C. Painting on an easel using a wide-barrel paint brush D. Cutting out various shapes an designs using spring-loaded scissors Painting on an easel using a wide-barrel paintbrush is the initial and most effective intervention to include when using a sensorimotor approach to improve handwriting skills. The upright orientation that an easel offers promotes wrist extension and an efficient pencil grasp. The wide-barrel paint brush can reduce hand muscle tension and fatigue. A 5-year-old child with cerebral palsy exhibits a digital pronate grasp pattern during writing activities. The child's individual education program (IEP) goal is to use a static tripod grasp while writing her first name in a legible manner on primer paper upon request 80% of the time. What are the MOST APPROPRIATE methods to promote the desired grasp pattern? A. Activities to increase hand tone and stability B. Activities to facilitate the palmar-raking grasp C. Activities to promote supination and radial-ulnar dissociation D. Activities to increase proximal control and shoulder strength . Activities to promote supination and radial-ulnar dissociation are the most appropriate methods to promote a static tripod grasp because they involve the developmental hand patterns necessary for the desired grasp. To use a static tripod grasp, the child must have fully developed separation of the sides of the hand and the ability to isolate fingers to grasp a writing implement. The wrist is in an efficient, neutral position and movement is usually initiated from the wrist. A OTR is providing interventions to a client with reduced trunk and postural control following a stroke. Which of the following activities BEST promotes dynamic weight shifting designed to improve trunk control for activities of daily living (ADLs)? A. Therapist provides verbal cues to "sit tall" B. The therapist positions the client sitting in front of the sink to brush teeth to facilitate anterior weight shift C. Provide trunk support sitting in w/c with pillows D. Complete laundry to facilitate posterior weight shift 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? A. A token economy system to reinforce cooperation and task completion B. A therapy ball to sit on in the classroom so he can move while working C. Movement breaks D. Referral to social work or school counselor A 21-year-old collegiate volleyball player presents to an outpatient clinic status post shoulder tendonitis. During exam, the client reports she plays a position that requires her to perform an overhead swing for hitting frequently during her games and practices, which are daily during the season. The client has already rested for an extended time after initial injury and, per her doctor, is ready to proceed with active therapy to regain strength in order for her to return to volleyball full-time. At this time, the client reports little to no pain with basic movements during routine functional tasks. What are the MOST appropriate strengthening exercises for this collegiate volleyball player hoping to return to full-time play? A. Pendulum exercises and ROM without weights of resistance B. Progressive resistive concentric ROM exercises with med-heavy weights C. Stretching and Progressive resistive eccentric exercises with Theraband D. Aggressive stretching A OTR is evaluating problem-solving and sequencing skills of a client with a long-standing history of mental illness while making brownies from a mix. The client is hesitant to engage in the task and requires multiple cues in order to initiate the task. In order to promote engagement of the client during evaluation, which is the most appropriate INITIAL action for the OTR to take based on this observation? A. Evaluate the client's cognitive function to make a simple meal B. Determine the client's interest in meal preparation as a goal C. Schedule the client for meal prep group D. Determine the client's home environment and need for meal prep - 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? A. Osteopenia B. Osteosarcoma C. Osteoporosis D. OA An OTR is working with a family who has a child with reactive attachment disorder. The child has been stealing, hoarding food, and does not comply with directions to complete chores around the house. The child is detached and unaffectionate with his parents, but very nice to his teacher and soccer coach. What is the MOST APPROPRIATE intervention to do INITIALLY to address this child's behavior? A. Prepare and only eat meals in the kitchen and keep locks on the kitchen cabinets B. Family education about reactive attachment d/o and setting realistic goals C. A family meeting to discuss progress on goals and bring about positive therapeutic outcomes D. A family chore list with rewards An OTR is working with a child with quadriparesis spastic cerebral palsy in the classroom. What intervention is the MOST EFFECTIVE to promote play skills and long-term engagement in learning at school? A. Switch-activated toys or adapted computer B. East-to-grasp handle extensions on toys C. Velcro straps to hold most classroom tools D. Non-slip material to stabilize toys An OTR is working with a teenage youth with a spinal cord injury (SCI) at the C5 level. The client would like to transition to more independent feeding as he is currently being assisted by his family when eating. What is the BEST device that can support independent feeding for this client? A. Tenodesis splint B. cock-up splint C. Resting hand splint D. long opponent splint . The opponens splint (also called the wrist support with universal cuff) is used to support the wrist due to weak wrist muscles. An injury at C5 would need additional wrist supports. A patient with a C5 injury can use a crude type of tenodesis grip. They may experience paralysis of the wrist extensor muscles, but they may be able to supinate to manipulate the position of the wrist. This movement allows the user to wear a splint with a utensil adapter and move food to the mouth. Answer A: The tenodesis splint is ideal for those with injury at the C6 level with wrist extension strength but no finger strength. Answer B: The cock-up splint is used to immobilize and protect the wrist following injury, often carpal tunnel. Answer C: The resting hand splint treats moderate flexion contractures of the wrist/hand/thumb; one could not eat with this splint in place. An OTR is developing a group for women with early stage Alzheimer disease. The therapist utilizes the Allen Cognitive Disabilities Model to develop this group program. Which activity is BEST for the therapist to do in order for this group to be successful? A. Painting and building a doll house B. Zumba and dance exercise classes C. Parachute games with loud music D. Address transitions in adulthood . B & C- sensorimotor approach good for relearning skills **Study ACL Levels** An OTR is designing a splint for a client in the acute stage of rheumatoid arthritis. Which splint would be MOST appropriate for the client? A. Splints to increase ROM and prevent atrophy B. Night splints for protection and positioning C. Heavy weighted splints for strengthening D. Resting splints to reduce inflammation . Rheumatoid arthritis is a chronic, systemic inflammatory condition characterized by pain, swelling, stiffness of hand joints. In the acute stage of rheumatoid arthritis, clients are recommended to utilize resting splints to reduce acute inflammation, decrease pain, maintain range of motion (ROM), and protect joints. Answer A: Splints to increase ROM and prevent atrophy are utilized in later stages of rheumatoid arthritis where the disease becomes more chronic and ROM can be increased. Answer B: Night splints for protection and positioning are utilized in later stages of rheumatoid arthritis where the client needs to maintain positioning throughout the night to promote functional use of the hand and reduce pain. Answer C: Heavy splints are contraindicated as these may increase pain and fatigue. In the acute stages of rheumatoid arthritis, clients benefit from lightweight splints that do not weigh down the hand and upper extremity. 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? A. Work hardening B. Improving cognition C. Work conditioning D. Improve strength Work hardening refers to formal, multidisciplinary programs for rehabilitating an injured worker. Work hardening programs have the end goal of returning the client to work, and often include: a job site evaluation graded activities during interventions work simulation strengthening cardiovascular conditioning education program modification Work hardening includes all aspects required for the client to return to work including multiple contexts and settings, and is designed to meet the specifications and requirements needed for the job. Answer B: Improving cognition is a component of a work hardening program. Programs are designed to meet the needs of the client and provide a holistic approach to return to work. Cognition is one component required for successful return to work for an injured worker; therefore, in order to provide the most comprehensive program, a work hardening program is recommended. Answer C: Work conditioning focuses on the underlying physical skills required to return to work and is addressed in acute stages or earlier in the plan of care. Work conditioning is often limited to physical conditioning only; therefore, in order to provide the most comprehensive program, a work hardening program is recommended. Answer D: Improving strength is a component of a work hardening program. Programs are designed to meet the needs of the client and provide a holistic approach to return to work. Strength is one component required for successful return to work for an injured worker; therefore, in order to provide the most comprehensive program, a work hardening program is recommended. A OTR is trying to justify to the client's insurance company the purpose of the orthosis that is recommended for the client with ulnar deviation deformity from arthritis. Which of the following reasons BEST explains the purpose of the orthosis? A. The orthosis will prevent the progression of deformity B. The orthosis will immobilize the hand and facilitate healing C. The orthosis will help correct the deformity of the joints D. The orthosis will provide stability to the affected joints An OTR is working with an infant in the neonatal intensive care unit who was born at 25 weeks' gestation. The infant is the first child of young parents without high school diplomas who live about 2 hours from the hospital. Both parents appear unsettled and afraid to touch and hold their child for fear they will hurt the infant. What INITAL action should the OTR take when providing developmental care to the infant and family? A. Provide family education on kangaroo care and explain the benefit of this care for relaxation and caregiver closeness B. Consider using supportive measures such as containment to promote self-regulation and attachment C. Explore ways of creating a home-like environment at the infant's bedspace to provide family privacy and comfort D. Provide written home program activities and training to the parents before discharge to ensure carry-over into the home Following hip surgery, a client is performing grooming while standing at the sink. The client begins to feel weak and short of breath and requests to sit down. What type of decrease is MOST appropriate for the OTR to document regarding this individual? A. Muscle endurance B. Motivation for rehab C. Cardiac functioning D. Level of participation A OTR is preparing to complete an initial evaluation on an individual diagnosed with obsessive-compulsive disorder. Which strategy is MOST EFFECTIVE while interviewing this individual? A. Limit the time available to answer each question B. Instruct the individual to take his time and not rush C. Utilize open-ended questions D. Minimize environmental distractions An OTR evaluates and develops an intervention plan for an adult male with a work-related back injury. The OTR is collaborating with an occupational therapy assistant (OTA) to implement evidence-based interventions to facilitate an outpatient client's return to work, which involves frequent lifting and carrying. Which intervention would be BEST APPROACH to improve the capacity for frequent lifting and carrying? A. Stretching and strengthening of the thoracolumbar spine B. Graded lifting and carrying simulation with proper body mechanics instruction C. Pain management including journaling and deep breathing D. Ergonomic assessment of the work side A middle-aged client has a long-standing diagnosis of lumbar spondylosis. The client also recently suffered an acute myocardial infarction and has been convalescing in the hospital. The OTR in acute care conducted an evaluation revealing weakness, fatigue and shortness and breath, limited spinal mobility with chronic pain, and unsteady gait. The OTR is meeting with the health care team and family in a case conference. The team is discussing home discharge priorities for the client. Which of the following recommendation is the MOST IMPORTANT contribution the OTR can make to the discharge planning process? A. Recommend social services including meals-on-wheels B. Recommend exercises for the lumbar muscles to increase strength and flexibility C. Recommend mobility devices such as a rolling walker or scooter for the home D. Recommend a home evaluation for safety and function in the home environment 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? A. The client will not be able to understand verbal instructions to don a shirt B. The client will have difficulty monitoring the quality of performance C. The client will not know what to do with the shirt when it is presented D. The client will not be able to put the L arm in the sleeve of the shirt . An OTR is working in early intervention services with a family with an infant born with a cleft lip and palate. The infant appears to have feeding difficulties including problems latching on to the bottle or breast, prolonged feeding times, and poor weight gain. What intervention is MOST effective for the OTR to recommend to the family to promote successful feeding experiences? A. Use regular bottles or nipples during feeding times B. Refer the infant for surgical repair of the cleft lip C. Suggest NG tube D. Provide check and/or lip support with gentle closure of the lip during feeding . A OTR is assessing the reflexes of a 3-month-old infant. The OTR places the infant supine and encourages the infant to turn her neck/head toward the side where an object is making noise. Which of the following responses to this neck/head movement indicates the presence of the asymmetrical tonic neck reflex? A. Flexion in both UE and LE B. Extension in both UE and LE C. Flexion in the UE and LE on the same side the head is turned and extension in the opposite UE and LE D. Extension in the UE and LE on the side the head is turned and flexion in the opposite UE and LE . A OTR is assessing the reflexes of a 3-month-old infant. The OTR places the infant supine and encourages the infant to turn her neck/head toward the side where an object is making noise. Which of the following responses to this neck/head movement indicates the presence of the asymmetrical tonic neck reflex? A. The child has experience drinking from a straw only B. The child struggles with achieving mouth and lip closure C. the child has poor bolus control . A OTR is assessing the reflexes of a 3-month-old infant. The OTR places the infant supine and encourages the infant to turn her neck/head toward the side where an object is making noise. Which of the following responses to this neck/head movement indicates the presence of the asymmetrical tonic neck reflex? A. Light touch during medical procedures and nursing care B. More exposure to a variety of sensory experiences C. Firm, graded handling and support in extremities D. Perform all medical procedures at one . An OTR is working with a 1 year, 8-month-old child who was diagnosed with developmental delay. The child receives early intervention services because of delays in motor, self-care, adaptive, and social emotional domains. Findings from the initial evaluation also suggest that the child has self-regulatory difficulties and has difficulty falling asleep and staying asleep. Which intervention is MOST EFFECTIVE to address INITIALLY to assist the family with their sleeping concerns? A. Limit nighttime sounds and lights to promote better sleep habits and routine B. Use a weighted blanket during naps and nighttime sleeping C. Create a plan for reinforcing the child's independence in falling asleep D. Establish a consistent quiet nap and nighttime routine with the family . 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? A. Playdoh activities B. Teaching the child to hold the paper more firmly with non-dominant hand C. Using a slant board during writing D. prone activities on the scooter board to build core strength . The OTR is consulting with a teacher about strategies to use during handwriting instruction for a school-age child who has decreased proprioceptive awareness in his hand and wrist. What is the MOST EFFECTIVE strategy for the OTR to suggest for the teacher to explore? A. Writing with pen instead of pencil B. Providing an angled desktop. surface C. Writing with a triangle grip on the pencil D. Using a pediatric-weighted pencil holder . Suggesting a pediatric-weighted pencil holder is the most effective strategy for addressing decreased proprioceptive awareness in his hand and wrist. The weighted pencil holder will make the pencil heavier in the child's hand, providing increased awareness of the pencil, and increased stability of wrist as the child writes in class A OTR is working with a child with autism spectrum disorder on improving engagement and interaction. Which intervention strategy is the MOST BENEFICIAL to improve these skills with this child? A. Provide opportunities for deep pressure. and proprioception through active play B. Provide clear boundaries regarding the intervention space C. Promoting imagination in the OT session D. Create fun problems to be solved . An OTR is working with a student in kindergarten who has moderate hypotonia and poor oral control. The student wants to eat the same foods as her peers in the cafeteria, however, the student currently eats a soft diet and requires moderate assistance when eating. What INITIAL intervention should the OTR use to progress toward the student's goal? A. Implement AD during. feeding B. Determine foods with correct textures C. ID proper positioning devices for the student in the cafeteria D. Ask the student their favorite food preferences on the menu . An OTR is working with a student in kindergarten who has moderate hypotonia and poor oral control. The student wants to eat the same foods as her peers in the cafeteria, however, the student currently eats a soft diet and requires moderate assistance when eating. What INITIAL intervention should the OTR use to progress toward the student's goal? A. Writing in shaving cream B. shining in prone C. playing with a feather boa D. Log-rolling to snuggly wrap the body in a blanket An OTR is working in early intervention with a 15-month-old with sensory processing problems who is at risk for autism spectrum disorder. The early intervention team is working with the child and family on the goal of increasing caregiver-child interaction. Which intervention is MOST EFFECTIVE in addressing this goal? A. Limit nighttime sounds and lights to promote better sleep routine B. Teach caregivers massage for caring and increase self-regulation C. Coach parents on how to read child's cues for greater responsiveness D. Play computer or table activities with the child in the home . An OTR is working with a child with autism spectrum disorder on improving behavior and task completion during a therapy session. Which intervention strategy is the MOST BENEFICIAL to improve these skills with this child? A. Use objects or visual schedules to predict next steps in the task B. Alternate preferred motor tasks with more challenging motor tasks C. Discuss ways to use certain objects based on their properties D. Carefully grade the introduction of novelty into a. session . An OTR is providing services for a 7-month-old infant who was born preterm and has low oral muscle tone and jaw instability. The family would like the child to swallow food more efficiently, so the child can start gaining weight. Which intervention is MOST EFFECTIVE in addressing this eating goal? A. Adapt. an infant seat for stability, teach jaw support techniques, use small flat spoons for improved suck-swallow B. Encourage self-feeding for the child and face-face interaction with caregiver C. Coach the caregiver on sensory properties of food D. Consider the families cultures and belief for feeding patterns . An OTR is providing services for a 7-month-old infant who was born preterm and has low oral muscle tone and jaw instability. The family would like the child to swallow food more efficiently, so the child can start gaining weight. Which intervention is MOST EFFECTIVE in addressing this eating goal? A. The child will enter the play session without disrupting play with his peers at least 2 times during a 20-minutes play session B. During a therapist-supported play group, the child will play with peers as demonstrated by two exchanges of tows with peers during a 20-min play session . An OTR is working with a 6-year-old child to develop the skill of complex rotation to promote better hand function for handwriting tasks. Which activity is BEST to promote complex rotation? A. shrining small beads B. picking up bingo chips C. playing pick-up sticks D. Constructing twisted shapes with pipe cleaners . An OTR is using a developmental frame of reference to promote righting/equilibrium reactions in a 4-year-old who has developmental delays. The child has integrated an anterior protective extension reaction in a sitting position. What protective extension reaction should the OTR work on developing NEXT? A. posterior B. Supine C. Prone D. Lateral . A lateral or sideways protective extension reaction is the next reaction to illicit with the child in order to develop that skill. The developmental sequence of protective extension reactions is as follows: first anteriorly, then laterally, and lastly, posteriorly. An OTR is working with a 2-year-old child with feeding difficulties. The child is experiencing delays in self-feeding due to hand weakness and oral tactile hypersensitivity. What interventions are MOST BENEFICIAL to address these feeding concerns and improve self-feeding? A. Universal cuff with small, smooth spoon B. Dycem mat and textured food the child likes C. Mobile arm support and cold/sour foods D. straw for dining and assist from therapist A teacher notices a child having difficulty copying shapes and letters from the board. In addition, the teacher mentions that the same child enjoys coloring and can stay in the lines and doing puzzles is her favorite activity. The teacher would like to refer her for an occupational therapy evaluation. What skill should the OTR evaluate FIRST? A. Visual perception B. Visual motor integration C. FMS D. Sensory Processing . Visual motor integration refers to the interaction of visual skills, visual-perceptual skills, and motor skills which encompasses all the teacher's concerns of difficulty copying shapes and letters from the board, thus addressing all of the teacher's concerns and the motor skills needed for copying shapes and handwriting. Visual motor integration refers to the interaction of visual skills, visual-perceptual skills, and motor skills which encompasses all the teacher's concerns of difficulty copying shapes and letters from the board, thus addressing all of the teacher's concerns and the motor skills needed for copying shapes and handwriting. A. Provide sensory integration in each session to enhance the child's ability to filter sensations and recognize the optimal level of arousal B. Encourage the child to make his or her own choice in social situations C. Apply newly developed social skills in small, less intimidating peer context D. Use a goal chart as a visual reminder of positive behaviors to encourage and perform with more confidence . An OTR is working with a 3-year-old boy with developmental delays. He appears to have hypotonia and difficulty manipulating small objects during play. Which activity is MOST EFFECTIVE to increase fine motor and object manipulation performance in this child? A. Picking up beans repetitively and dripping them in a cup B. build an airport with blocks and roads and planes with legos C. Wheelbarrow across the room . Wheelbarrow addresses hypotonia but not FMS An OTR receives an acute care occupational therapy order for a client who is known to be positive for the human immunodeficiency virus (HIV). What is the INITIAL precaution he/she should take to assess the client? A. Wear gloves B. Wipe down patient-care equipment to prevent the spread of microorganisms C. Wash hands and skin surfaces thoroughly D. Report infected lesions to supervisor . An OTR is working in an outpatient pediatric clinic and would like to begin using a newly developed therapeutic listening program with children diagnosed with autism spectrum disorder. What information is MOST important for the OTR to know prior to using this program with this population? A. How to monitor the effectiveness of the new program B. The standard program protocol to use with each child C. The clinical guidelines and evidence about the program D. The reimbursement rate of the program for the clinic An OTR and OTA work together for a home health company. The state in which they work requires OTRs and OTAs to obtain a physical agent modality (PAMs) certification to use and apply PAMs to clients. The OTR has received PAMs certification but the OTA has not. For the OTR to properly manage her caseload and supervise the OTA, which of the following would be the BEST supervisory strategy? A. OTR should provide close supervision when the OTA is using the PAMS with clients. B. OTR should provide supervision and instruction to the OTA for the proper use of PAMs C. OTR should review precautions and C/I for the use of PAMs with OTA D. OTR should be responsible for the selection and direct application of PAMs A OTR is selecting an intervention for a client with hemiparesis after a stroke. The OTR has considered constraint-induced movement therapy and would like to learn more about the effectiveness of the intervention compared with other traditional therapy interventions. What type of research studies would BEST provide the evidence the OTR is looking for? A. Qualitative studies B. Cross-sectional studies C. Quasi-experimental studies D. Case-control studies . Quasi-experimental studies and randomized clinical trials are examples of experimental research. The OTR, in this case, is looking for evidence about the relative effectiveness of constraint-induced movement therapy compared with traditional therapy interventions for individuals with hemiparesis due to cerebrovascular accident (CVA). Experimental research is the most relevant research design given the task of finding evidence to aid in the selection of an effective treatment. An OTR just recently changed work settings from the acute care hospital setting to the school system. The OTR's caseload is mostly children with cerebral palsy and she desires to learn more about the research relevant to the area of practice but is very overwhelmed by the large volume of evidence available. What is the MOST beneficial method for the OTR to use to implement evidence in practice-based decisions? A. Search scholarly databases for articles using levels of evidence B. Test a variety of approaches in practice and analyze their effectiveness C. Utilize systematic reviews and resources that synthesize study results D. Subscribe to clinical blogs and LISTERVs to stay up to date on current trends . A 30-year-old client presents with paralysis of both legs following spinal cord injury. The client has not been able to regain movement in the legs after extensive therapy; however, has regained independence in activities of daily living (ADLs) and activities in the home. The client expresses interest in return to driving in order to return to work and be active in the community. The OTR explained that a driving evaluation may be necessary to ensure the client's safety. The client agreed to this recommendation. What should the OTR do FIRST to prepare the client for a comprehensive driver evaluation? A. Recommend a being the wheel evaluation B. Refer the client to an OT driving specialist C. complete a driving safety screen to determine risk D. Measure the client for w/c that will fir her car A client with loss of protective sensation in bilateral hands is receiving occupational therapy services. Which should the OTR utilize during intervention? A. Increase the amount of force required to maintain grip B. Visually occlude client during intervention to promote discrimination C. Persist in activities for prolonged time periods, promoting sensation D. Protect exposure to sharp items or extreme temps . Which of the following is TRUE regarding the Workers' Compensation Laws? A. Employees with work injuries are encouraged to remain engaged in work tasks with the company B. Most require the employer to pay for medical expenses related to a workplace injury C. Workers' compensation is automatic D. Workers' compensation benefits are managed through the federal government 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? A. Inpatient rehab prior to d/c home B. Outpatient therapy for PT C. Client remain in SNF with ongoing therapy D. Home health services with a live-in caregiver until the client is deemed safe to be alone . Ensuring that clients are safe to return home is an important role for OT. When a client is being discharged to a home environment, the OTR must determine the needs of the client, the family support available, and the context in which the client will return. In this case, the client has limited family support and will return to the home living alone. The home is multi-story; therefore the client is anticipated to experience different and more complex needs based on the context. To promote safety and independence for this client when returning home, home health services are recommended The Director of Rehabilitation is performing an environmental analysis as part of the strategic planning process for the OT department. She documents that the department has established a reputation for being very adept at processing physician orders, initiating OT evaluations, and completing documentation in a timely manner. This type of information MOST CLOSELY represents what about the department's functioning? A. Efficiency B. Strategy C. Threat D. Opportunities . 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? A. Distribute load over smaller joints B. Modify daily schedule to alternate heavy and light tasks throughout the day C. Remain in one position for extended periods of time D. Reduce muscle strength and ROM An occupational therapist working at a skilled nursing facility enters a patient's room to see if they are ready to go to the OT room. The patient is not there, but the OT sees a scrapbook on the patient's bed. the OT pages through the scrapbook. Is this a violation of an ethical principal? If it is, which principle? A. Fidelity B. Nonmaleficence C. Veracity D. Autonomy **Study Code of Ethics** Pat, an OT for a home health provider, has violated the ethical principle of nonmaleficence by injuring a patient during treatment. Which of the following bodies who oversee ethical practice in occupational therapy can revoke Pat's OT license? A. State regulatory Board B. AOTA C. NBCOT D. ACOTe According to the OTPF, advocacy and self-advocacy are considered: - Types of OT intervention aimed toward empowering clients AOTA's Scope of Practice paper states that occupational therapists and occupational therapy assistants must graduate from an accredited education program. The organization responsible for ensuring that this occurs is: A. ACOTE B. NBCOT C. Licensure examination D. State Board of Medicine . ACOTE The organization responsible for ensuring that registered occupational therapists and certified occupational therapy assistants meet standards of knowledge necessary to practice is: A. NBCOT B. AOTA C. AOTPAC D. ACOTe . NBCOT The non-profit, non-partisan organization whose sole purpose is to further legislative actions in support of the occupational therapy profession is called: A. IDEA B. PDPM C. AOTA D. AOTPAC - Liam was born at 30 weeks gestation with a birth weight of 1200 grams. He earned an APGAR score of 4 immediately after birth and presented with a yellow-hue to his skin. He is currently residing in the Neonatal Intensive Care Unit with a nasal cannula and a G-tube. What are Liam's birth classifications? A. Extremely LBW, Pre-term B. Very LBW, pre-term C. Average BW, Full-term . Very LBW 1000-1500 grams below 36 weeks When is a baby considered pre-mature orn before 36 weeks Study birth weight classifications - Liam's date of birth was September 29th, 2019. You are scheduled to evaluate him in the Neonatal Intensive Care Unit on March 10th, 2020. What is his adjusted age? - 5 month, 11 days As a skilled occupational therapist, when entering the room you begin to observe Liam. He is currently under Bilirubin lights secondary to jaundice, with trunk arching, and a facial grimace. He even appears to be sitting on air. You speak with the nurse and ask him how Liam has been responding in the neonatal intensive care environment. He reports that Liam is always fussy, does not sleep for long periods of time, and is having a difficult time maintaining his weight. He is being evaluated for a nasogastric (NG) tube tomorrow due to the limited weight gain with the G-tube. What infant behaviors are you observing? A. Stress reactions as he is unable to obtain physical touch from the medical team due to his treatment. B. Approach behaviors as he appears ready to play. C. Stress reactions as he is experiencing occupational deprivation. D. Self-regulation behaviors as he is trying to adjust to the demands of the Bilirubin lights. . The correct answer is stress reactions due to occupational deprivation. He is unable to participate in his two primary occupations of sleep and feeding at this time. There is nothing in the case that indicates that he responds well to physical touch. You evaluate Liam's _______ and _______ secondary to the nurse's report of decreased success during feeding routines. You notice the gastroenterologist (GI) coming into the treatment room and stop to chat. You discuss your concerns with his absent reflexes and support the transition to an NG tube to aid growth and development. A. Suck & Swallow, Galant Reflect B. Rooting Reflex, Suck & Swallow C. Palmar Reflex, Plantar Reflex D. ATNR, rooting Reflect Study Reflexes**- look for reflex quizlets - After a review of Liam's case, you recommend Liam for daily occupational therapy services to address his delays. Which of the following goals is MOST appropriate? A. Liam will tolerate cheek/lip support in a 60 degree upright position without any behavioral stress responses observed during feeding routines within 2 weeks. B. Liam will grasp a toy presented at midline in a supported seated position with self-initiation of motor movement 75% of trials to increase his functional play skills. C. Liam will sustain appropriate oxygen saturation during positional changes with the return to homeostatic balance as observed by stable vitals within 10 seconds, within 4 weeks. D. Caregivers will demonstrate proper swaddling and positioning techniques during therapy sessions with less than 2 verbal cues to increase safety during mobility within 2 weeks . You are working in an outpatient pediatric clinic and see that your next client has arrived on March 10th, 2020. His name is Enzo. The referral includes his date of birth (February 10th, 2018) and developmental delay. You decide to sit at the front desk for a moment to observe Enzo's interactions with his caregiver in the lobby. He is running all around the lobby, placing all items in his mouth, and is unresponsive to the caregiver's verbal cues. What assessments would be MOST appropriate to select for his evaluation? A. The Child Sensory Profile and The Peabody B. The BOT-2 and the Infant/Toddler Sensory Profile C. The Denver and The Child Sensory Profile D. The Infant/Toddler Sensory Profile and The Peabody . As the caregiver completed the selected sensory profile, she stated how Enzo appears to have difficulties in almost all domains. She noted that Enzo is always on the go, has a difficult time paying attention, refuses to touch textures, does not like wearing a variety of clothing, and is very picky during mealtimes. She reported that he does not have any formal diagnoses but she thinks he may have Autism Spectrum Disorder. What MOST likely is the way Enzo's brain is perceiving his vestibular sensory environment? A. Hyper-responsive, low threshold B. Hypo-responsive, high threshold C. Passive participant in vestibular activities The correct answer is hypo-responsive, he responds too little to input meaning that he seeks more input to regulate. He has a high threshold as he must obtain a lot or high level of input before his needs will be met. You decide to educate the caregiver regarding a potential intervention strategy to assist with Enzo's sensory processing and self-regulation skills. You select the Zones of Regulation program. Which of the following interventions would be MOST appropriate? A. Creating a Fortune Teller with Enzo B. Providing Enzo with pictures of faces that fall within each Zone C. Describing the emotions to the caregiver to label in the everyday environment as Enzo does not yet have the attention to participate in the formal Zones Program D. Providing Enzo with a paper copy of the written emotions . At the end of the evaluation, you recommend occupational therapy services twice/week for six months for Enzo. You also begin education regarding a sensory diet. Which of the following sensory diet activities would BEST assist Enzo's attention? A. Providing Enzo with the opportunity to touch different textures B. Integrating heavy work C. Providing Enzo with an adapted toothbrush D. Integrating chewing jewelry into Enzo's daily routine . Heavy work is the only choice that integrates vestibular, proprioceptive and tactile input Ken is a 10-year-old boy presenting with spastic, diplegic cerebral palsy. He experienced a traumatic birth but has not previously received occupational therapy services. Ken's caregiver reports that he would like his son to be more coordinated and better at performing his everyday activities. Ken is left-hand dominant. You begin your evaluation by examining Ken's range of motion as you remember that you must always assess the range of motion before strength. He demonstrates decreased range of motion of his right forearm supinators, right wrist extensors, and right elbow extensors. What can you do to inhibit his tone? A. Tapping of Muscles B. Vibration C. Positions Against Gravity D. Joint Compression During your first treatment session with Ken, you decide to try a variety of positions. You notice that he rarely utilizes the right side of his body when performing tasks and will often hold stable surfaces or refuse to participate when a task appears too difficult. You decide to be creative and try a variety of positions to increase the utilization of the right side of his body. Which of the following positions would BEST reach this goal? A. Side-lying B. Ring Sitting C. Prone D. Quadruped . Side-lying will provide him with options and allow the therapist to grade to the just-right challenge. Quad will be too challenging as it will require constant utilization of the affected side of his body. Ring Sitting will not force movement of one side. Prone does not require weight-bearing. On the BOT-2, Ken demonstrates scores well below average for his bilateral coordination skills. Considering his age, what goal would be MOST appropriate to address his bilateral coordination deficits? A. Ken will participate in contralateral coordination movements with self-correction of errors, independently at least 75% of trials. B. Ken will sustain upper-extremity weight-bearing positions for at least 8 consecutive minutes, 2/3x. C. Ken will perform palm to finger translation of small objects independently with less than 3 errors within 5 minute time-frame. D. Ken will replicate complex shapes (overlapping pencils, star) independently with less than 2 edge control errors observed 2/3x. To further increase Ken's utilization of his right upper extremity, you decide to examine modality-based treatment interventions. Which of the following interventions focuses on limiting movement of the unaffected limb to promote movement of the affected limb? A. Kinesiotaping B. Constraint Induced Movement Therapy C. Interactive Metronome D. Integrated Listening Systems - Annabelle begins receiving school-based occupational therapy services. When collaborating with the teacher, she states that Annabelle's class is experiencing difficulties with emotional regulation skills. You notice that you are currently working with 3 different children in Annabelle's classroom. Under the response to intervention (RtI) 3-tiered model, conducting a classroom-wide intervention falls under which tier? Tier 4 Tier 2 Tier 1 Tier 3 Study Tiers of Therapy - One of Annabelle's goals on her Individualized Education Plan (IEP) is related to handwriting. It states, "Annabelle will demonstrate more legible handwriting." You read this and become frustrated as there are assessments that can better target specific handwriting deficits. Which of the following interventions would BEST promote her orientation errors? A. Provide Annabelle with a worksheet and have her copy each letter she is reversing repeatedly B. Provide Annabelle with a variety of worksheets and have her circle each of the letters she is reversing with a different color. C. Educate the IEP team that we cannot assist Annabelle with her reversal challenges at her age D. Provide Annabelle with a Wet-Dry-Try board with a smiley face cue for starting point . During your 1:1 treatment session, Annabelle reports that she has to go to the bathroom. She informs you that she is unable to manipulate the fasteners on her clothes. Is a pediatric occupational therapist working in school-based practice able to assist Annabelle with this skill? A. True B. False . True A patient with poor visual acuity is being discharged home with a flight of stairs in order to access his bedroom and full bathroom. The most appropriate environmental adaptation to ensure the individual can access his living quarters safely would be: A. Instruct the patient to sleep in his recliner B. Mark the end of each step with high contrast tape C. Install a stair glide D. Install handrails . Your outpatient client, diagnosed with MS three years ago, is complaining of an increase in diplopia. This is new and concerning her. Your best course of action in this situation would be? A. Discuss the effect of MS on vision and trial the use of an eye patch, alternating eyes B. Discuss the impact of MS on the visual system and suggest the consult a neuro-ophthalmologist C. Tell her she is experiencing exacerbation and bring her to the ER D.Nothing let her know this is the normal disease process . During a dressing session your patient is unable to locate his white socks on the white bed sheets. This behavior most likely indicates a deficit in the area of: A. Unilateral spatial neglect B. Cog processing C. Contextual Memory D. figure-ground discrimination . You are working with an individual with constructional apraxia, body scheme disturbances, and unilateral spatial neglect. These deficits become evident during the ADL portion of your evaluation. These deficits may result in: A. Figure-ground discrimination B. Dressing Apraxia C. None of the above D. Working memory deficits In a task-orientated approach the aim is to focus on the activity, rather then underlying impairments A. true B. false . true An insufficiency in convergence might present barriers to occupational performance. This might include: A.Safety while ascending/descending a flight of stairs B. Difficulty with depth perception C. All of the responses are correct D. Wheelchair mobility As a home health OT, you have been assigned a new client with amyotrophic lateral sclerosis (ALS). He lives alone. He currently requires total assistance with all aspects of ADL's, requires an electric w/c for all aspects of mobility, directs his care independently, and relies on an environmental control unit (ECU) for access to technology throughout his home. What would be the most appropriate area of focus in this situation? A. Discuss additional resources, including assistive technology in order to facilitate independence in the home setting BDiscuss the need to engage in leisure activities outside of the home, you want him to avoid depression C. Begin education and training on the ECU charging and back-up instructions D. Discharge, he has all appropriate physical assistance and assistive technology to remain in the home setting . While working with your client on meal preparation skills, she is able to organize her items, tools, and the environment. However, once she initiated the task she is unable to sequence the steps. In your assessment you would document that such behaviors indicate a sign of which dysfunction? A. Ideational Apraxia B. Encoding C. Executive Dysfunction D. Short-term memory Your patient has a diagnosis of Parkinson's and a STG was to increase BADL's (UB & LB bathing & dressing) to min A. During your session you notice he is unable to weight shift forward and or reach for objects on either side of the sink. The best preparatory tasks to address these missing components of movements in your session would include? A. While standing practice reaching for items B. All aspects of bed mobility C. Practice STS with emphasis on the anterior weight shift D. While seated practice reaching for items forward, laterally, and inferior . Older adults with premorbid cervical spondylosis may be at risk for which clinical syndrome of SCI? A. Central Cord Syndrome B. Cauda Equina C. Anterior Cord Syndrome D. Brown-Sequard Syndrome . During your treatment session a patient with confusion is having difficulty placing both feet into his pants legs. Which is the most appropriate preparatory method to use to prepare the individual to progress to actual dressing training? A. Having him place his feet through loops of thera-band B. Wearing two different color socks C. Practicing pulling his pants up and down during toileting D. Using a dressing stick to pull his pants up over his knees . At which level would a client with a SCI be able to independently (or at modified independence level) complete an effective bowel & bladder program and skin inspections? A. C&-8 B. C6 C. C4-5 D. C5 An adult diagnosed with multiple sclerosis (MS) over 10 years ago recently experienced an exacerbation. She requires use of lofstand crutches in the home and a manual wheelchair in the community. Which energy conservation technique(s) would best be suited to address participation in IADL's? A. Alternating sitting and standing B. Leaning against the countertop while standing C. Sitting at the kitchen table D. Sitting on a perched still while at the countertop The best method to implement to evaluate the presence of unilateral spatial neglect during your initial evaluation would be: A. Line Bisection Test B. Reading a pargraph C. Jebson Hand Test D. Six-Block Assesmbly Test Your are working in the outpatient clinic. You have begun treating a mother who suffered a C7 SCI. She is 3 months post injury and wants to begin playing and interacting more with her young children. In the participation phase of treatment, what tasks would you trial in order to promote goal attainment? A.Computer tasks that integrate use of a typing stick B. All of the tasks are appropriate for a C7 SCI C. Tasks that address practice of application of her tenodesis grasp D. Tasks that trial use of a universal cuff to hold craft tools (i.e: a paint brush) You are working with your patient with a neurological deficit and you notice she is able to apply the toothpaste and brush her teeth for 15 minutes. You document in your assessment that you suspect which deficit? A. Judgement B. Problem solving C. Sequencing D. Termination of an activity You are covering for a therapist on maternity leave. The objective of the session is to address alternating attention during a cooking task. However, once the client reads the directions she turns and asks you to repeat the directions. This might indicate an impairment in which cognitive process? A. Orientation B. Perceptual Memory C. Short Term Memory D. Arousal . You are participating in a community outing with your CI. One of the patients has suffered a ASIA A C5 SCI. While waiting in line for lunch she comments that she has a pounding headache. As you are talking you notice she is sweating. What is the next best step to take? A. Check the patient's urinary catheter bag and level of collection B. Offer her some water. She is dehydrated due to the heat in the building. C. Ask if she applied sunblock, lack of sensation in her legs has resulted in a sunburn on her legs D. You should not be assisting in a patient's care in a community setting During a home health visit to your client with ALS, you notice some coughing after he sips his water. What would be the best course of action? A. Discuss the need to seek a videofluoroscopy due to the progressive nature of his disease B. Ignore the coughing, he was positioned incorrectly in his electric chair C. Nothing, he has a terminal disease and he should be able to enjoy what he wants D. Discuss the progress of his disease and secondary effects of pneumonia Jim, who is recovering from Guillain-Barre Syndrome (GBS) is now demonstrating fair minus (3-) strength in both of his upper extremities (UE's). He is determined to make gains in his UE strength so that he can transfer and hold his 1 year old son. In order to achieve this goal, what should you include in the preparatory phase of treatment? A. Complete active ROM (AROM) gravity eliminated B. AROM against gravity C.Complete tricep dips. This address concentric and eccentric tricep activation D. AROM with resistance The spinal cord injury syndrome which tends to involve the upper extremities to a greater degree than the lower extremities is: A. Central Cord B. Anterior Cord C. Brown-Sequard D. Cauda-Equina . Which of the following is NOT thought to be a potential cause of cancer: A. Environment carcinogens B. Correct! Medications C. Genetics D. Lifestyle choices . During your second week of treatment, your client who was recently diagnosed with Parkinson's, demonstrates increased lethargy and social withdrawal compared to the last week. This might be an indication of which potential secondary complication/factor? A. Cognitive decline B. Poor fluid and nutritional intake C. Loss of sleep D. Urinary tract infection The stage of cancer is considered the one with the most advanced cancer and poorer prognosis: A. Stage 2 B. Stage 3 C. Stage 0 D. Stage 4 Which of the following is a form of physiological blindness? A. Homonymous Hemianopsia B. Inattention C. Neglect D. All of the above . During your oculomotor screening for tracking you notice your patient is unable to maintain neutral head control in order to following the moving target. This might indicate an issue with: A. Visual memory B. Saccadic eye movement C. Pattern recognition D. Spatial apraxia . Your Parkinson's patient continues to present with deficits in anterior weight shifts in order to complete any gross transitional movement patterns. The wife is unable to provide any sort of physical assistance. Over the next week it was determined that use of one tactile and one verbal cue facilitates initiation of motor planning skills required to complete various transitional movements. You explain to the wife that this is due to: A. The sound of her voice activates his recall of dancing at their wedding B. All of the responses are correct C. Use of external cues provide input to the vestibular and sensorimotor systems, facilitating initiation of movement D. Application of auditory cues minimizing the cognitive demand of the movement "A + O x 4" indicates that the client is Alert, and Oriented to Person, Place, Date, & Situation A. True B. False Micrographia is a symptom of: A. Napoleon Syndrome B. ALS C. PD D. MS