Occupational Therapy Best Practices: Case Studies and Intervention Strategies, Exams of Medicine

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NBCOT COTA.

An OTR® is writing treatment goals for a client receiving occupational therapy services in a work conditioning program after a right shoulder sprain. The client is employed as a surgical technician in an outpatient surgery center. Which option is the BEST example of a long-term goal? A. Client will return to full duty as a surgical technician in a full-time capacity within 4 weeks. B. Client's employer will implement reasonable accommodations to promote the client's ability to complete full-time physical demands as a surgical technician within 4 weeks. C. Client will return to full duty as a surgical technician with the ability to carry over proper body mechanics to reduce risk for reinjury. D. Client will use proper body mechanics 100% of the time while completing the job of a surgical technician within 4 weeks. - \Client will return to full duty as a surgical technician in a full-time capacity within 4 weeks. The goal is client centered, objectively focused on the goal of full-duty and full- time employment in the role of surgical technician within a specified timeline. What is an effective strategy to facilitate maximal independence in self-feeding with a client who has middle- to late-stage dementia? A. Change the client's diet to foods that are palatable and easy to chew. B. Change the consistency of foods to allow for easier chewing and swallowing. C. Provide hand-over-hand guidance for food retrieval and utensil-to-mouth motions. D. Provide constant verbal cues throughout feeding to improve attention to the self- feeding task. - \Provide hand-over-hand guidance for food retrieval and utensil-to-mouth motions. Hand-over-hand guidance is an effective strategy to encourage maximal independence through participation in daily living tasks, including self-feeding. During the initial evaluation for a client with Parkinson's disease, the OTR® asks the client to "pretend you are brushing your teeth," that is, show the movement of brushing teeth without using the supplies needed for brushing teeth. The client is unable to initiate movement of the dominant arm toward the mouth to demonstrate oral hygiene. Which step should the OTR take NEXT in the evaluation of this client? A. Try a wrist weight to stabilize the arm during teeth brushing B. Ask whether the caregiver can provide arm support to bring the hand to the mouth C. Observe as the client brushes teeth with toothbrush and toothpaste at the bathroom sink D. Provide a mobile arm support to compensate for arm movement when brushing teeth

\Observe as the client brushes teeth with toothbrush and toothpaste at the bathroom sink. The client may not have understood the verbal instructions, and performing the task in the actual context may allow for more accurate demonstration of the client's abilities. An OTR® is adapting the environment to reduce the incidence of repetitive strain injuries among office workers. To maximize the effectiveness of the ergonomic program, what would the OTR® be MOST likely to include? A. Visual reinforcement with signs posted around the office and workstations B. Empowerment of the workers and creation of a positive group-safety culture C. A series of lectures and videos showing bad versus good workstation ergonomics D. Education of supervisors in how to identify noncompliant workers - \Empowerment of the workers and creation of a positive group-safety culture. Motivation is a big factor for change to occur. Creating a sense of teamwork allows for mutual support to accomplish goals together. An extremely agitated patient is admitted to an inpatient psychiatric hospital late on a Friday afternoon. Because nursing is short staffed, the nurse on the unit requests that the patient attend an occupational therapy group being led by a COTA® that evening. The COTA® calls the OTR®, who is working at a location far from the unit, for guidance. The OTR® is unable to return to the unit in time to evaluate the client before the session. What is the BEST course of action the OTR® should direct the COTA® to take? A. Allow the patient to attend the group B. Do not allow the patient to attend the group C. Cancel the group and evaluate the client D. Allow the patient to attend the group with the understanding that the OTR® will complete the evaluation on returning to the unit - \Do not allow the patient to attend the group. The COTA® is not permitted to initiate treatment of a client; the OTR® must do the initial assessment of the client. Allowing the patient to attend a group session would be an ethics violation and liability risk. A client with a unilateral transradial amputation is undergoing pre-positioning training for a myoelectric arm. Which of the following is the MOST appropriate goal? A. Within three sessions, the client will independently don the prosthesis and obtain good electrical contacts with the electrode sites 100% of the time. B. Within three sessions, the client will be able to open and close the myoelectric terminal device 100% of the time. C. Within 1 week, the client will be able to accurately identify how to arrange the wrist of the myoelectric terminal device to be able to optimally grasp different objects. D. Within 1 month, the client will be able to use the myoelectric terminal device as a functional assist and stabilizer in 100% of daily activities. - \Within 1 week, the client will be able to accurately identify how to arrange the wrist of the myoelectric terminal device to be able to optimally grasp different objects. The pre- positioning phase focuses on teaching the client with an amputation to position the terminal device for optimal grasp.

An OTR® is evaluating a patient who underwent an open reduction and internal fixation (ORIF) of the hip and is non-weight bearing. The patient wants to return home but will require a temporary wheelchair to do so. What would be the MOST important concern for this patient in relation to chosing a wheelchair? A. Overall cost-effectiveness B. Durability of the product C. Individualism of the parts D. Adjustability of the wheelchair - \Overall cost-effectiveness. Whether a medical condition is temporary, stable, or progressive will influence a client's wheelchair selection. Someone with a temporary condition will most likely be more concerned with the cost of a temporary wheelchair than with individualism of the parts, the product's durability, or adjustability. A client has central vision loss secondary to macular degeneration. The OTR® plans to teach the client eccentric viewing techniques to compensate for the client's visual loss. What should the OTR® teach the client as the FIRST step of this process? A. Head positioning for optimal viewing B. Methods for using a magnification device C. Scanning exercises across the full field of vision D. Strategies for increasing blind spot awareness - \Strategies for increasing blind spot awareness. The first step in eccentric viewing techniques is increasing the client's awareness of the central scotoma, or blind spot. An OTR® is working with an infant who is recovering from a brachial plexus injury. What type of sling should the OTR® fabricate? A. A sling that fits proximally around the humerus B. A sling that fits proximally around the radius C. A sling that fits proximally around the ulna D. A sling that fits proximally around the clavicle - \A sling that fits proximally around the humerus. A sling that fits proximally around the humerus will prevent the child from sustaining further injury to the brachial plexus during ADLs. The Safe, Accountable, Flexible, Efficient Transportation Equity Act (Pub. L. 109-59) was signed into law in 2005. What is the basic premise of this law? A. This law includes providing transportation benefits to optimize access to the workplace and assumes that lack of transportation is a major barrier and challenge in sustainable employment. B. That people who can access fixed-route public transportation may travel more successfully compared with those who do not have such access. C. That state and local transportation decision makers play a role in bringing attention to safety concerns related to individual users of different transportation modes D. That people who can access public transportation in a sustainable fashion, are more likely to be successful in welfare-to-work initiatives. -

\That state and local transportation decision makers play a role in bringing attention to safety concerns related to individual users of different transportation modes. This option describes the premise of the Safe, Accountable, Flexible, Efficient Transportation Equity Act. An OTR® is using the Ayres Sensory Integration Intervention program for a 6-year-old child with attention deficit hyperactivity disorder and sensory-seeking behaviors. Which principle should the OTR® keep in mind when selecting activities for this intervention program? A. The sensory environment is completely structured to allow for optimum integration of sensory information. B. Sensory experiences are limited to one sensory factor at a time to ensure mastery. C. Passive participation on the part of the child is encouraged. D. Appropriate activities are done individually and not in a small group. - \Appropriate activities are done individually and not in a small group. The Ayres Sensory Integration Intervention program is applied individually rather than in groups. An OTR® is working with a client with Alzheimer's disease (AD) in a skilled nursing facility. The client's adult child, who is the client's primary caregiver, appears to be stressed and fatigued and has asked the OTR® for advice about how to best manage the parent's progressive decline in function. What would be the BEST approach the OTR® could use? A. Refer the caregiver to a physician for treatment. B. Refer the caregiver to the social worker for community resources. C. Provide the caregiver with education about the progression of AD. D. Suggest that the caregiver use the massage services at the facility. - \Provide the caregiver with education about the progression of AD. The most appropriate approach for an OTR® when dealing with caregivers of clients with AD is to provide education about the progression of AD along with strategies to improve the caregiver's self-efficacy in caring for the client. An OTR® receives orders to evaluate and treat a client in the acute phase of spinal cord injury. What is the OTR®'s INITIAL role during this phase? A. Evaluation of the client's ADL ability B. Evaluation of the client's strength C. Evaluation of total body positioning D. Evaluation of possible discharge location - \Evaluation of total body positioning. During the acute, immobilized phase of spinal cord injury, the OTR® initiates total body positioning to prevent problems associated with body functions (ROM) or body structures (skin). Which activity is an important part of the process of deciding whether a professional dilemma might in fact involve a violation of the Occupational Therapy Code of Ethics (2015)? A. Taking quick action to reduce the potential for the dilemma to become greater

B. Clearly stating the dilemma in a way that focuses on the most important issue to be resolved C. Seeking justification for the actions of those involved D. Determining the best way to protect one's self-interest - \Seeking justification for the actions of those involved. Not all professional dilemmas involve a violation of the Code of Ethics. Before taking action, reflecting on one's own beliefs and values and examining the facts are important. Being able to articulate what the dilemma is usually leads to a better determination of whether a violation is involved. Once the dilemma is clearly framed, it is important to look carefully at the language in the Code to see if it addresses the situation. An OTR®; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The OTR writes the following goal for one group member using the COAST method: "The client will cook a meal before being discharged." How should the timeline (or T) part of this goal be modified to be made MORE measurable? A. It should specifically reference the anticipated discharge date. B. It should list the number of weeks in which the goal should be accomplished. C. It should list the number of sessions that are sufficient to address the goal. D. It does not need to be modified. - \It should specifically reference the anticipated discharge date. It is appropriate to have a long-term goal reference discharge for the timeline; however, the specific discharge date needs to be included. The private automobile is the dominant form of transportation for most adults in the United States and is closely tied to occupational routines. Older adults who can no longer drive need viable options for other types of transportation to remain engaged in valued occupations. How do the majority of older adult nondrivers in the United States travel in the community? A. As riders on public transportation vehicles B. As passengers in private automobiles driven by someone else C. As operators of nonmotorized or small-scale vehicles such as bicycles and golf carts D. As pedestrians during daylight hours and not at all at night - \As passengers in private automobiles driven by someone else. Multiple sources confirm that an overwhelming majority of older adults nondrivers travel in cars driven by someone else once they can no longer drive. An OTR® is working with a child who has a sensory processing disorder. The therapist would like to assess the child's motor planning using a standardized assessment tool. Which tool would be appropriate for the therapist to use? A. Sensory Integration and Praxis Test (SIPT) B. Sensory integration clinical observations C. Sensory Profile D. Bruininks-Oseretsky Test of Motor Performance (BOT-2) - \Bruininks-Oseretsky Test of Motor Performance (BOT-2). The BOT-2 can be used to assess aspects of fine and gross motor functioning that may be difficult as a result of dyspraxia.

An OTR® is working with a young adult experiencing acute lower back pain. What INITIAL activity is most appropriate in mediation? A. Education in basic body mechanics B. Long-duration, low-intensity back exercises C. Short-duration, high-intensity back exercises D. Vocational counseling and planning - \Education in basic body mechanics. Management of clients with lower back pain should initially include education in body mechanics and application to engaged occupations to prevent further injury. A client who has undergone electroconvulsive therapy (ECT) in the early morning arrives for an evening occupational therapy task group in an inpatient psychiatric unit. What is the OTR®'s BEST choice for working with the client at this time? A. Contact the nursing staff to escort the client back to the client's room. B. Remind the client of the need for 24 hours of bed rest after ECT. C. Invite the client to participate in a different group that focuses on reminiscence. D. Encourage the client to choose one of the available tasks to work on during the group. - \Encourage the client to choose one of the available tasks to work on during the group. ECT is immediately followed by a short, required bed rest, especially if residual symptoms include headache, nausea, and dizziness; regular activities can then be resumed. The parent of a 7-year-old child with attention deficit hyperactivity disorder informs the OTR® that the child recently started taking dexmethylfenidate (Focalin). Which side effect of this drug must the OTR® watch for? A. Moodiness and agitation B. Euphoria C. Blurred vision D. Mydriasis and hyperthermia - \Moodiness and agitation. Of the options, only A is a possible side effect of central nervous system stimulants. An OTR® has determined that a visually impaired client can no longer drive. What should the therapist include in the occupational therapy intervention to help this client be independent in the use of community mobility? A. Familiarize the client with the procedures for using paratransit. B. Obtain a bus schedule and start training the client to use the bus for fixed-route travel. C. Select, test, adopt, and train the client and the client's family or support system in the use of the most appropriate transportation options. D. Educate the client on the need for driving cessation and the importance of maintaining independence in the community mobility. -

\Select, test, adopt, and train the client and the client's family or support system in the use of the most appropriate transportation options. This is a comprehensive approach to follow after determining a client cannot drive. Which behavioral symptom might a client with early-stage dementia have? A. Pacing B. Difficulty choosing appropriate clothing C. Vulgar or rude language D. Suspicion - \Suspicion. A client with early-stage dementia might become suspicious; it is common for clients to think misplaced items have been stolen or that their spouse may be unfaithful. What is the most important safety recommendation for clients with middle-stage Alzheimer's disease (AD)? A. Do not allow this client to complete ADLs independently because the client might not dress appropriately for the weather. B. Do not leave this client alone because the client might get lost, even in a familiar environment. C. Provide this client with activity to engage the client throughout the day to minimize behavioral disturbances. D. Provide this client with redirection to minimize behavioral outbursts and prevent self- injurious behaviors. - \Do not leave this client alone because the client might get lost, even in a familiar environment. The most important safety issue would be leaving a client with AD alone, because the client might become lost or confused, even in familiar environments. A COTA® is working toward service competency for adaptive feeding equipment instruction. How would the OTR® BEST establish service competency? A. Review the COTA®'s documentation of multiple patients whose feeding impairments warranted adaptive equipment, then discuss the outcomes with the COTA®. B. Observe the COTA® educate clients on how to use adaptive feeding equipment to ensure the COTA® instructs clients in the same manner as would the OTR®. C. Compare outcomes by rating the same client's performance with the adaptive feeding equipment at the same level of independence. D. Collect information from various sources, including other therapists, the COTA®'s documentation, and feedback from clients, to determine competency. - \Compare outcomes by rating the same client's performance with the adaptive feeding equipment at the same level of independence. Service competency is defined as "the process of teaching, training, and evaluating in which the OTR® determines that the COTA® performs tasks in the same way that the OTR® would and achieves the same outcomes" (Youngstrom, 2009, p. 943). In this example, both the COTA® and OTR® observe the same client performing a task and rate that performance in a similar manner. Comparing outcomes helps to ensure clients receive care of equal quality.

An OTR® is working with a child who has scoliosis with a curve of 70°. The child would like to engage in sports activities. On the basis of this medical condition, which factor would most likely limit the child's ability to participate in sports? - \Cardiopulmonary function. Children with a scoliosis curve between 65° and 80° may have reduced cardiopulmonary function. An OTR® is instructing a client post-hip surgery on after-toileting cleansing while adhering to appropriate hip precautions. What method is the BEST to prevent further injury? A. Advise the client to wipe between the legs in a standing position over the commode. B. Instruct the client to wipe between the legs in a sitting position on an elevated toilet seat. C. Advise the client to wipe from behind the legs in a standing position over the commode. D. Instruct the client to wipe from behind the legs in a sitting position on an elevated toilet seat. - \Instruct the client to wipe between the legs in a sitting position on an elevated toilet seat. All hip replacement clients should wipe between their legs in a sitting position. An OTR is working with a client with a flexor tendon injury. One week after repair surgery, the OTR removes the cast made postsurgery and fabricates a splint. Which splint is appropriate for this client? A. Active wrist extension splint B. Active wrist, finger, and thumb extension splint C. Resting hand splint D. Dorsal blocking splint - \Dorsal blocking splint. The dorsal blocking splint protects the surgery and guards against flexor tendon rupture. A school-based OTR® has evaluated a 4-year-old child who has cerebral palsy. Results of the Peabody Developmental Motor Scales Second Edition (PDMS-2) indicate the child is functioning at a 2-year-old developmental level. Which environment is MOST CONDUCIVE for conducting the initial play assessment based on this information? A. In the classroom with peers and familiar developmental toys B. In an isolated room with access to age-appropriate computer games C. At the community playground with sliding, swinging, and climbing opportunities D. In a therapy room with the OTR® providing the child with a selection of toys - \In the classroom with peers and familiar developmental toys. Play is most meaningful when it occurs in context; therefore, the classroom with peers and familiar toys is most appropriate for an initial play assessment. A child's activities cannot be accurately observed unless they occur within the environment where the child plays. Which occupation-based intervention activity is MOST appropriate to develop the bilateral hand skills of a 3-year-old child with autism? A. Holding a cup while pouring water from a large pitcher B. Donning a dress and buttoning the five 2-inch buttons on the dress

C. Writing the child's own name while stabilizing the paper D. Holding the handle of a small bucket while filling it with water from a faucet - \Holding the handle of a small bucket while filling it with water from a faucet. Of the options, holding the handle of a small bucket while filling it with water from a faucet is the most appropriate play-based activity for the child's age. When measuring a client for a wheelchair, what are the four basic measurements the OTR® MUST take? A. Seat width, seat depth, seat height, seat-back height B. Seat width, seat depth, seat height, footrest length C. Seat width, seat depth, seat-back height, footrest length D. Seat width, seat depth, footrest length, seat-to-back angle - \Seat width, seat depth, seat height, seat-back height. These measurements must be provided when ordering a wheelchair. Other measurements are helpful for comfort (e.g., armrest height). A client with a nondisplaced shaft fracture of the right fifth metacarpal has a physician's order for full-time splinting. Which orthosis would the OTR® be MOST likely to fabricate? A. Dorsal hood splint with the wrist in approximately 20° flexion, all metacarpophalangeal (MCP) joints of the affected hand in 70°-90° flexion, and interphalangeal (IP) joints of the affected hand in 0° extension B. Volar-based ulnar gutter with MCP and IP joints of the ring and fifth fingers in 0° extension and the wrist in neutral C. Dorsal-based wrist cockup splint with MCP and IP joints free and the wrist in approximately 20° extension D. Volar-based ulnar gutter with MCP joints of the ring and fifth fingers in 70°-90° flexion, fourth and fifth IP joints in 0° extension, and the wrist in approximately 20° extension - \Volar-based ulnar gutter with MCP joints of the ring and fifth fingers in 70°-90° flexion, fourth and fifth IP joints in 0° extension, and the wrist in approximately 20° extension. Holding the MCP joints in flexion helps prevent contracture of the collateral ligaments. An OTR® is preparing a job demand analysis report for a furniture manufacturing company. The report includes several recommendations to decrease risk factors for musculoskeletal cumulative trauma disorders at work. For administrative controls, the OTR® recommends the implementation of task rotation every 4 hours of work. What recommendation will MOST likely be included under the engineering controls? A. Job rotation through different workstations B. Raising the table height of the assembly line by 3 inches C. Implementing factorywide stretching exercises during breaks D. Introducing high-speed, high-vibration power tools for speedy assembly - \Raising the table height of the assembly line by 3 inches. The goals of engineering controls are to provide proper design of the work environment, tools, and processes. Adjusting the height of the workstation is one example of engineering controls.

A client with dementia quits bathing routines before completing them and has difficulty measuring shampoo and lotion. The areas of the body that are usually washed are more distal (hands, arms). The client might attempt to wash the back, but not consistently. At what stage is this client, according to the Allen Cognitive Level Screen? A. 4. B. 3. C. 3. D. 3.4 - \3.6. At Level 3.6, the client will be able to wash most distal portions of the body and those that are easily seen but will not always follow the sequence thoroughly. The client may quit before completion and may have difficulty with measuring soaps, lotions, and deodorant. An OTR® is preparing to discharge a client to home after hip replacement. The client reports having a high-step tub with a shower door and no money to buy additional equipment. Which recommendation is MOST appropriate for bathing? A. Recommend the client substitute a plastic lawn chair for a shower chair. B. Recommend the client place nonskid strips on the floor of the stall. C. Recommend the client sponge-bathe at the sink until equipment can be purchased. D. Recommend the client stay at the facility until equipment can be purchased. - \Recommend the client sponge-bathe at the sink until equipment can be purchased. Sponge-bathing at the sink is an alternative activity if hip precautions cannot otherwise be met. An OTR® is assessing a client who is in an active state of mania. The client has difficulty concentrating on the assessment procedure and displays disruptive behavior, telling the OTR that the OTR is "stupid" and "asking dumb questions." The OTR tells the client, "I would like to help you, but I will not tolerate this behavior. You are not being nice to me right now, and I deserve to be treated better than this." Which interpersonal strategy does the OTR's statement exemplify? A. Validation B. Limit setting C. Confrontation D. Reframing - \Confrontation. Confrontation, in which the practitioner identifies the client's behavior in an effort to help the client self-manage it, is an appropriate interpersonal strategy when dealing with clients with mental illness. Confrontation may include limit setting. A physician has referred a client to an outpatient setting for an occupational therapy evaluation and intervention. The client has late effects from a stroke that occurred approximately 10 years ago. The OTR® is performing a screening before initiating the evaluation. Which is the MOST likely reason for completing the screening? A. To complete the occupational profile and become acquainted with the client B. To meet the client and conduct a standardized interview before the evaluation C. To complete the assessments to save time during the evaluation process D. To identify whether the client may benefit from occupational therapy services -

\To identify whether the client may benefit from occupational therapy services. The purpose of a screening is to determine whether a client would benefit from an occupational therapy evaluation or services. The caregiver of a client with middle-stage dementia requests assistance from the OTR®. The caregiver wants to ease the client's morning personal care routine. What is the BEST recommendation related to the bathroom environment that the OTR® can provide to the caregiver? A. Paint the bathroom a bright yellow. B. Use labels for hot and cold on the faucets in the bathroom. C. Use low levels of light to reduce eyestrain. D. Keep all bathroom items clearly visible to the client. - \Use labels for hot and cold on the faucets in the bathroom. Labeling physical structures with symbols, such as arrows for direction, is helpful to people with dementia. A client with low vision was prescribed a handheld magnifier to promote reading. The client reports to the OTR® that the handheld magnifier does not make text clear enough to read. Which recommendation is BEST for the OTR to make? A. The handheld magnifier should be held at a predetermined distance from what is being read. B. The handheld magnifier should be held up to the eye to see objects in the distance. C. With stronger magnification, the field of view is larger and the magnifier is held closer. D. With weaker magnification, the field of view is smaller and the magnifier is held farther away. - \The handheld magnifier should be held at a predetermined distance from what is being read. Handheld magnifiers, which are prescribed by an optometrist or ophthalmologist, must be held at a predetermined distance from what is being read. An OTR® in home health care is seeing a client who has Stage III Alzheimer's disease. The client lives with an adult daughter and likes to wander around the house and has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no step at the front entrance. The client's daughter is determined to have the client remain at home with her as long as possible. To provide a defined, safe environment for the client to wander in the house, what will the OTR® MOST likely recommend? A. A deadbolt at the front door B. A side bolt high on the front door C. A gated area in the living room, using child safety gates D. A walk with the client several times a day - \A side bolt high on the front door. A side bolt that is not within reach of the client is one strategy to prevent the client from opening the front door and wandering away from the house without the daughter's awareness.

An OTR® is working with a client with hemiplegia on laundry tasks. Folding the laundry proves too difficult because of the weaker extremity, and the client becomes increasingly frustrated. How should the OTR® BEST modify the activity? A. Stop the task and move on to the next planned activity. B. Instruct the client to sort the laundry by darks, colors, and whites using both hands. C. Use appropriate therapeutic use of self to address the client's frustration. D. Allow the client to practice hanging up clothes in the closet. - \Instruct the client to sort the laundry by darks, colors, and whites using both hands. The activity analysis skill here is grading; the OTR® recognizes the difficulty of performing this bilateral upper-extremity activity and appropriately downgrades the task to reduce the need for both hands. A client sustained a nondisplaced humeral neck fracture after a fall. Which course of occupational therapy would be BEST? A. Instruct the client in use of a sling with no ROM for 3 weeks B. Instruct the client in use of a sling with supervised ROM C. Provide no occupational therapy intervention because the client will have a surgical reduction D. Fabricate a removable orthosis - \Instruct the client in use of a sling with supervised ROM. With a nondisplaced fracture of the humeral neck, support from a sling and supervised exercise lead to the most desirable outcome. A client with middle-stage dementia has been wandering outside the house in the middle of the night. The client's caregivers have been using monitoring devices and recently added door alarms, but by the time someone can attend to the client's wandering, the client is usually at the neighbor's driveway. The weather has become colder, and the family is concerned that the client will get frostbite if the client wanders outside again. What would be the OTR®'s next appropriate recommendation? A. Install bed rails to keep the client from climbing out of bed. B. Place the client in a nursing home C. Conceal the doorknobs so that the client cannot open the doors. D. Move the client's bed into one of the caregiver's rooms. - \Conceal the doorknobs so that the client cannot open the doors. Visual barriers, such as concealing the doorknobs, have been found to be effective with people with dementia. The client might not attend to the doorknob because it is unseen or the client will find it difficult to open the doors and get out of the house. The concealed doorknobs might also give the family time to wake up and redirect the client. Performing a functional transfer with a client with CVA, the OTR® blocks the client's affected knee and instructs the client to reach for the desired surface and move toward the stronger side. What transfer technique does this BEST describe? A. Assisted stand pivot B. Bent pivot transfer C. Maximum assist transfer D. Dependent lift transfer -

\Assisted stand pivot. An assisted stand pivot is used to move a client from one surface to another. What has the AOTA Ethics Commission recommended that occupational therapy authors do to avoid plagiarism in the electronic age? A. Cite only sources that are no more than 10 years old B. Use electronic tools to check content for possible plagiarism C. Provide source citations for all statements in written and oral content D. Provide source citations for the work of other authors in written documents but not in oral presentations - \Use electronic tools to check content for possible plagiarism. Because it is challenging to ensure that authors have appropriately cited all sources, use of electronic tools is recommended to ensure that papers and presentations are not plagiarized. An OTR®; is providing dressing skills training for a client with traumatic brain injury (TBI). The client has a sequencing deficit and continually places underwear over pants and socks over shoes. What strategy is appropriate for the OTR to use with this client? A. Use picture cards of dressing and have the client put the steps of dressing in order B. Have the client write out the steps in dressing using paper and pencil C. Hand the client each item of clothing and provide assistance in donning the item D. Ask the client which clothing item should be selected next - \Hand the client each item of clothing and provide assistance in donning the item. Minimizing environmental distractions and decreasing the complexity of the task will allow the client to experience success in completing one step of the task at a time. Which type of pressure do occupational therapy practitioners most commonly identify as leading to moral distress and organizational ethics violations? A. Deciding whether an intervention is within the scope of occupational therapy practice B. Describing progress by recipients of service when little change has occurred C. Providing interventions based on the likelihood of best reimbursement D. Extending work hours to treat more clients - \Describing progress by recipients of service when little change has occurred. Slater and Brandt (2011) described a study conducted in 2008 that identified reimbursement constraints as one of the top ethical concerns leading to moral distress in occupational therapy practitioners. Practitioners reported that being pressured to provide therapeutic service primarily for financial benefit rather than for the health and well-being of clients was highly distressing. A client has visual acuity of 20/200 in the right eye and 20/400 in the left eye. With what technology will the client MOST likely be able to operate a microwave with a flat panel? A. A prescribed magnifier B. Color-coded buttons C. Raised dots on the panel D. Task light over the microwave - \Raised dots on the panel. The client's visual impairment is such that the remaining vision is not adequate as a sensory input, which means using an alternative sensory

pathway. Tactile or auditory substitution is common. Putting raised dots on the microwave panel is an example of tactile substitution. An OTR® supervises a COTA® who works with a group of adults who are continuing their recovery from alcohol and drug addiction by living in a halfway house. The OTR® suggests that the COTA® become familiar with a particular group intervention in working with these clients. What type of intervention would the OTR® MOST likely suggest? A. An occupational deprivation group B. ProjectMAINSTREAM C. A heavy work activity group D. A 12-step self-help group - \A 12-step self-help group. Most substance abuse programs include one or more self- help groups that use a classic 12-step process. Most substance abusers seek help through self-help groups. Occupational therapists working with this population are likely to become involved in facilitating or supporting these groups. An OTR® wishes to prioritize the focus of intervention for a client with Guillain-Barré syndrome in the acute inflammatory phase. Which factors should the OTR evaluate? A. Sensory loss, pain, cognitive impairment B. Pain, fatigue, cognitive impairment C. Pain, fatigue, swallowing problems D. Rigidity, pain, swallowing problems - \Pain, fatigue, swallowing problems. Because ascending paralysis is typical of Guillain- Barré syndrome, evaluation consistently addresses pain, fatigue, and swallowing problems. This constellation of symptoms best fits the clinical reasoning for prioritizing issues to be evaluated. While performing PROM for a client with stroke, the OTR®; notes that the client's shoulder is resistant to flexion beyond 90°, although the client reports being pain free. What does this finding suggest? A. Shoulder subluxation is inhibiting movement. B. The scapula is not gliding to produce full flexion. C. The humerus is locked in against the acromion. D. Spasticity is preventing the shoulder from reaching full range. - \The scapula is not gliding to produce full flexion. The muscles supporting the scapula have likely shortened from disuse and are limiting the full range of shoulder motion. Both the humerus and the scapula must move to support full shoulder motion. An OTR® is using an adaptive approach with a client returning to work after bilateral carpal tunnel release surgery 6 weeks ago. The client works as a supermarket checker. Which job task modification incorporates an adaptive approach? A. Handheld barcode scanner B. Strengthening exercise using 2-pound weight C. Adjustable-height stool at the cash register D. Upper body stretching breaks every hour -

\Handheld barcode scanner. An adaptive approach supports functional performance through use of compensatory techniques such as changes in activity demand. An OTR® is working with a client who has ventricular tachycardia. The client's vital signs include a heart rate greater than 100 beats per minute. What is the appropriate therapeutic response to this client's situation? A. Allow the client to rest 10 minutes, then begin an occupational task that focuses on upper-extremity movement. B. Work with the client in a supported sitting position with the client's legs elevated. C. Instruct the client in adapting performance of grooming and feeding tasks. D. Defer the client's participation in occupational therapy until later, because the client is medically unstable. - \Defer the client's participation in occupational therapy until later, because the client is medically unstable. Ventricular tachycardia of more than 100 beats per minute can cause sudden cardiac death. Therapy should be deferred until the client is medically stable. An OTR® is working with a driver who is experiencing visual neglect poststroke. What is the MOST APPROPRIATE compensatory approach the OTR® can use to help the driver improve on-road performance? A. Teach the person to look at a reference point in the vehicle, such as the center of the hood, to improve lane maintenance. B. Avoid night driving to limit exposure to the bright lights from other vehicles C. Avoid driving in peak traffic hours and in inclement weather. D. Awareness training pending the client's insight. - \Awareness training pending the client's insight. Clients with neglect or visual attention deficits are usually anosognostic and do not gain insight into their impairment, or the effect of the impairment, on driving performance. An OTR® is working with a client who has difficulties with visual skills as a result of damage to the central nervous system (CNS). Which visual skill is related to CNS damage? A. Visual memory B. Stereopsis C. Figure-ground D. Kinesthesia - \Stereopsis. Stereopsis, or binocular depth perception, is a visual skill that would be affected by CNS damage. An OTR® is concerned that a worker participating in a back-neck school program may be magnifying symptoms. On assessment measures, the worker inconsistently reports pain throughout body mechanics training activities. The worker often refuses to complete tasks, citing pain as the reason. Which reason is the MOST likely for the worker to magnify symptoms? A. The worker is satisfied in the worker role and lacks motivation to complete tasks. B. The worker fears increased pain from task completion.

C. The employer is supportive and is encouraging the return to work. D. The worker values work and perceives work as a source of motivation. - \The worker fears increased pain from task completion. Workers may increase their pain reports in an attempt to avoid an increase in pain after task completion. A person with Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome) is having difficulty in the transition to a new adult foster care home, and an OTR® is contracted to make four home visits to assess the client and provide appropriate intervention. When the OTR® arrives for the first visit and attempts to interview the client, the client angrily refuses to speak with the OTR®. Which option is BEST in response? A. Stay long enough to convince the client to cooperate so that the placement can be successful B. Engage the client in a favorite game and convince the client to work together C. Leave the home, allowing the client to refuse occupational therapy services D. Tell the client that the OTR® will stop hassling the client after four visits - \Leave the home, allowing the client to refuse occupational therapy services. Recipients of occupational therapy services have the right to refuse services. As noted in Principle 3 of the Occupational Therapy Code of Ethics and Ethics Standards, "Occupational therapy personnel shall respect the right of the individual to self-determination" (p. S20). Because the client's foster family is also a client, it would be acceptable to ask the client for permission to meet with the foster family to gather information and provide indirect recommendations. A client with recent hip replacement surgery is concerned about how to shampoo hair while not able to use the shower at home. What recommendation from the OTR® will most appropriately address the client's concern? A. The client may shampoo the hair while standing in the shower, covering the hip with a plastic bag. B. The client may shampoo the hair while sitting on a stool or standing at the kitchen sink. C. The client may shampoo the hair while in a wheelchair at the bathroom sink. D. The client may shampoo the hair while standing at the bathroom sink. - \The client may shampoo the hair while sitting on a stool or standing at the kitchen sink. Bending forward at the kitchen sink does not require as much hip flexion as bending forward at a typical bathroom sink; many clients are able to wash hair at the kitchen sink without compromising hip precautions. A worker participating in back-neck rehabilitation is receiving education on proper standing workstations. The worker is required to move 10-lb discs onto a dowel. Which design element should be considered for the client's workstation? A. Workstation height should allow some elbow extension during the task. B. The workstation should enable the worker to sit or stand during the task. C. The workstation should enable the worker to reach overhead during the task. D. Workstation tools should be placed beyond arm's reach during the task. -

\Workstation height should allow some elbow extension during the task. A standing workstation is ideal for tasks requiring downward force; heavier tasks should be done with some elbow extension to minimize forces applied to the elbow musculature. The director of rehabilitation asks a newly hired OTR® to provide occlusion to a client who is experiencing diplopia to enable the client to more fully participate in rehabilitation. Which action should the OTR take FIRST in response to this request? A. Provide occlusion to the client and notify the director that the task has been completed B. Refuse the director's request, because occlusion is inappropriate for an OTR to provide C. Explain to the director that occlusion can be provided only under the direction of a physician D. Refer the request to another OTR with more experience in oculomotor function - \Explain to the director that occlusion can be provided only under the direction of a physician. Diplopia causes perceptual distortion that creates confusion for the client and limits participation. Diplopia can be eliminated using occlusion, usually by covering part or all of one eye. OTRs can apply occlusion only under the direction of a physician. The caregiver of a client with middle-stage dementia requests assistance from the OTR®. The caregiver wants to ease the client's morning personal care routine. What is the BEST recommendation related to the bathroom environment that the OTR® can provide to the caregiver? A. Paint the bathroom a bright yellow. B. Use labels for hot and cold on the faucets in the bathroom. C. Use low levels of light to reduce eyestrain. D. Keep all bathroom items clearly visible to the client. - \Use labels for hot and cold on the faucets in the bathroom. Labeling physical structures with symbols, such as arrows for direction, is helpful to people with dementia. A 30-year-old construction worker has developed work-related right biceps tendonitis. In the past 2 weeks, the client has primarily been working on the drainage system, which requires sawing a lot of metal pipes. What risk factor should be closely assessed during a worksite evaluation? A. Handle size of the hand saw B. Sawing repetitions per minute C. Length of the saw blade D. Diameter of the metal pipes - \Diameter of the metal pipes. Tendonitis is a musculoskeletal injury resulting from repetition. A high-risk repetition rate for the elbow is more than 10 repetitions per minute. An assembly-line worker is returning to work after being treated for cubital tunnel compression at the left elbow from prolonged pressure on surfaces. What is the MOST appropriate height for this client's workstation? A. Above elbow height

B. Just below elbow height C. 4 inches below elbow height D. 8 inches below elbow height - \Just below elbow height. The ideal position for precision assembly is to position the workstation above elbow height, but for a worker with recent nerve compression at the elbow, it is important to set up the work environment so as to not induce further prolonged pressure at the elbow. Therefore, the workstation should be just below elbow height, eliminating all pressure at the elbow. In this case, use of a magnifying device will allow for precision in assembly, compensating for the lack of close proximity. An OTR® in an inpatient facility is conducting a cooking activity to teach effective coping skills to a small group of adolescents. A group member becomes frustrated with a teammate and is angry and verbally threatening. What is the BEST response in this situation? A. "I see that you're becoming upset by your teammate. Let's calm down and breathe for 10 seconds." B. "You seem to be getting upset by your teammate. Verbally threatening is not a good behavior to show others." C. "I need you to stop, pause for a while, and calm down." D. "You seem really upset right now. Would you want to take a minute to calm down or just go back to your room for now?" - "You seem really upset right now. Would you want to take a minute to calm down or just go back to your room for now?" When a potentially dangerous situation commences, such as a threat of assault, the OTR® should offer the adolescent choices for effective coping strategies to deal with emotional outbursts. An OTR®; has recently had a conflict with a physical therapist who works at the same treatment facility. During a team meeting that includes the client, the OTR says that the physical therapist is using outdated approaches that are ineffective. One of the other team members feels that the OTR has violated an ethical principle and wants to discuss the matter with the OTR after the meeting concludes. Which principle will the team member discuss with the OTR in relation to the OTR's comment? A. Beneficence B. Autonomy C. Justice D. Fidelity - \Fidelity. The principle of fidelity requires that an OTR treat other professionals with respect, discretion, and integrity. By allowing the interpersonal conflict to affect comments during a team meeting, the OTR has not been respectful of the physical therapist's practice choices and has not used appropriate conflict resolution strategies. Principle 6I of the Occupational Therapy Code of Ethics (2015) states that occupational therapy practitioners "shall respect the practices, competencies, roles, and responsibilities of their own and other professions to promote a collaborative environment reflective of interprofessional teams."

An OTR® is treating a client with a proximal interphalangeal (PIP) flexion contracture secondary to a sports injury. To improve extension of the PIP for functional use of the hand, what is the BEST use of limited therapy time? A. Apply paraffin followed by joint mobilization techniques B. Fit the client with a prefabricated dynamic PIP extension assist splint C. Instruct the client in flexion blocking exercises D. Fabricate a customized dynamic PIP extension assist splint - \Fit the client with a prefabricated dynamic PIP extension assist splint. A prefabricated dynamic PIP extension assist splint will improve PIP extension and takes less therapy time to fit than to custom make this splint. An OTR® is providing early intervention services to a 24-month-old child who has a pervasive developmental disorder. The parents' goal is for the child to be able to participate in age-appropriate activities with peers. Which of the following contexts is BEST for promoting progress toward this goal? A. Organized play group in a community playground B. Backyard of the child's home with siblings C. Group session in the occupational therapy clinic with other children D. Tumbling group for preschoolers in a community gymnasium - \Organized play group in a community playground. The environment is important for supporting a child's play actions; the child perceives the interactions within various environments, then learns to act on those interactions. A play group that is organized will allow the child to be in a natural play environment while learning to adapt to or accommodate peers in interactions. An OTR® is adapting the environment to reduce the incidence of repetitive strain injuries among office workers. To maximize the effectiveness of the ergonomic program, what would the OTR® be MOST likely to include? A. Visual reinforcement with signs posted around the office and workstations B. Empowerment of the workers and creation of a positive group-safety culture C. A series of lectures and videos showing bad versus good workstation ergonomics D. Education of supervisors in how to identify noncompliant workers - \Empowerment of the workers and creation of a positive group-safety culture. Motivation is a big factor for change to occur. Creating a sense of teamwork allows for mutual support to accomplish goals together. An OTR® has just instructed a hip replacement client on a proper sit-to-stand technique from the chair. What is the BEST method to record the client's adherence to hip precautions? A. Ask the client to demonstrate the activity in the clinic. B. Ask the client to demonstrate the activity in the client's room. C. Observe the client in the dining room performing the activity. D. Ask the client's caregiver to demonstrate how they are performing transfers. - \Observe the client in the dining room performing the activity. By observing the client, a true level of occupational performance can be recorded.

An OTR® recognizes that a client with an incomplete spinal cord injury will be ready for discharge to home in the next few weeks. What is the BEST method to determine the client's occupational performance? A. A safety checklist B. A performance review C. A caregiver interview D. A home evaluation - \A home evaluation. When the discharge location is determined, a home evaluation should be performed to be sure that the therapists, client, and caregivers can perform activities in the home and ensure safe and equitable discharge. The director of occupational therapy services for a large metropolitan home health agency is conducting a supervisory visit and notices that the OTR® is writing progress notes on a personal electronic tablet. The OTR® is excited about using this new technology and shares with the director that it saves a great deal of time. Which response by the director is MOST appropriate? A. Applaud the OTR® for using technology efficiently B. Develop a policy prohibiting the use of personal electronic tablets for note writing C. Ask the OTR® to describe the use of electronic recording to the other OTR®s at the agency D. Ask home health clients for their opinions regarding electronic record keeping - \Develop a policy prohibiting the use of personal electronic tablets for note writing. The information contained in an OTR®'s notes is considered confidential information protected under the Health Insurance Portability and Accountability Act and must be kept secure. In addition, confidentiality is covered in the Occupational Therapy Code of Ethics and Ethics Standards, so recording notes on a personal electronic device might be interpreted as unethical behavior, particularly if it resulted in a breach of client confidentiality. Occupational therapy workplaces must develop a policy prohibiting the recording of client information on personal devices. A student in the first grade has illegible handwriting. Results of a standardized assessment indicate the student scored 0.5 standard deviations from the mean on a gross motor subtest and 2.0 standard deviations from the mean on a fine motor subtest. What do these results indicate? A. Activities to improve handwriting should be included as part of the intervention. B. Ninety-eight percent of the student's peers would score better on the fine motor test. C. Fine and gross motor skills are within an acceptable range from the norm. D. Fine motor and gross motor skills are moderately delayed compared to the norm. - \Activities to improve handwriting should be included as part of the intervention. Standard deviations less than 1.5 suggest a need for occupational therapy services; in this case, the gross motor standard deviation does not suggest a delay, whereas the fine motor standard deviation should be addressed through an intervention plan that addresses the student's handwriting. While assessing muscle tone in an inpatient who has multiple sclerosis, the OTR® moves the patient's upper extremity rapidly through its full range while the patient

relaxes the limb. The OTR® notes a slight catch of the upper extremity in the midrange of motion. Which of the following occurred during the assessment of this movement? A. Hypertonicity B. Flaccidity C. Spasticity D. Weakness - \Spasticity. Spasticity is indicated when a sudden catch or resistance occurs within a quick movement throughout the range of motion for the extremity Results from a manual muscle test indicate that a client who is in Stage II of amyotrophic lateral sclerosis has Good Minus (4/5) strength of the intrinsic muscles. The client reports that by the end of a meal, it becomes extremely difficult to hold and manipulate eating utensils. Which assistive device will be MOST EFFECTIVE for the client to use during self-feeding at this stage of the disease process? A. Foam tubing to build up handles of eating utensils B. Standard universal cuff with elasticized strap C. Lightweight plastic eating utensils with contoured grip D. Wrist support with palmar pocket for inserting utensils - \Foam tubing to build up handles of eating utensils. Built-up utensils will allow the client to use less grasp strength throughout the meal and will be effective in compensating for the decreased intrinsic muscle strength. For which condition is a custom wheelchair seating system MOST appropriate? A. Multiple sclerosis (MS) B. Recent total hip replacement C. Guillain-Barré syndrome D. Acute traumatic brain injury (TBI) - \Multiple sclerosis (MS). A custom seating system is indicated for a client who will likely be a long-time wheelchair user (e.g., a person with MS) to prevent deformity and skin breakdown. An OTR is evaluating a client for an injury to the right middle finger. On assessment, the OTR notices that the client is unable to extend the distal interphalangeal (DIP) joint but can move it into extension passively (mallet finger). What treatment plan would the OTR recommend for this injury? A. Electrical stimulation and ultrasound to facilitate extensor tendon gliding B. A hand strengthening program C. Resting of the joint D. A static orthosis holding the DIP joint in slight hyperextension - \A static orthosis holding the DIP joint in slight hyperextension. An orthosis holding the DIP joint in slight hyperextension places the tendon on slack for optimum healing of the extensor tendon injury. An OTR® is performing caregiver training for a client with Stage 3 Parkinson's disease (PD) and family members because of the client's emerging need for increased

assistance with ADLs and mobility. Which instruction would MOST appropriately help family members deal with a freezing episode? A. Educate the family to have the client silently count each step while walking. B. Recommend that the family use a rhythmic beat to each step as they walk with the client. C. Advise the family to place vertical strips on the floor where freezing episodes are likely to occur at home. D. Encourage the family to give the client tactile cues to promote weight shifting to resume walking. - \Recommend that the family use a rhythmic beat to each step as they walk with the client. External cueing and feedback from caregivers is an important strategy to improve safety and in this case reduce freezing episodes. The rhythmic nature of counting out loud or using a beat helps promote smoother movements that are more coordinated. An OTR® is providing back-neck training to workers at a food production service as a primary injury prevention program. The OTR® can expect the target population to consist primarily of which type of worker? A. Workers with mild back or neck pain B. Workers with no back or neck symptoms C. Workers, human resource staff, employers, and family members D. Workers who need medical treatment for back or neck injuries - \Workers with no back or neck symptoms. Primary injury prevention is aimed at workers who have not experienced symptoms of a work-related injury. An OTR® is working with a client in the active phase of C8 spinal cord injury. What is the BEST method of preventing heterotopic ossification in the client? A. Low-load prolonged stretch B. Maintenance of joint ROM C. High-low limited stretch D. Application of leg wraps - \Maintenance of joint ROM. Heterotopic ossification refers to the growth of bone in abnormal anatomic locations and is best prevented with joint ROM and medication routine. A client is being treated for an extensor tendon repair in Zone VI of the middle finger proximal to the juncturae tendinum. Which orthosis would be MOST appropriate? A. Hand based, including only the middle finger B. Forearm based, including only the middle finger C. Hand based, including the middle, ring, and index fingers D. Forearm based, including the middle, ring, and index fingers - \Forearm based, including the middle, ring, and index fingers. It is important to consider adjacent digits when applying an orthosis. In this example, the injury falls proximal to the juncturae tendinum, which can apply force to the repaired site if the adjacent digits were to flex, thus compromising the repair.

An OTR® is preparing a client with T1 spinal cord injury for discharge to home alone. What is the BEST recommendation for required home assistance? A. Homemaking assistance for a few hours a daily B. Attendant care 24 hours a day C. Attendant care 12 hours a day D. Homemaking assistance for several hours daily - \Homemaking assistance for a few hours a daily. A client with low-level (T1) SCI should be independent in personal care and only require a few hours of homemaking assistance each day upon discharge. A newly certified OTR® wants to provide occupational therapy coverage on an "as- needed basis" at a medical center burn unit. What should the OTR® expect the facility to provide in order to promote continuity of care for these services based on best practice standards? A. Funds to attend professional development classes to learn about evidence-based burn care B. Availability of burn-care protocols currently used for patients with thermal injuries C. Options for establishing service competence for completing clinically based processes and procedures on the unit D. Written communication from the primary therapist in advance of the coverage date outlining patient care routines - \Options for establishing service competence for completing clinically based processes and procedures on the unit. Service competency will support that the newly certified OTR® and existing practitioners in the burn unit are performing functions similarly and achieving the same outcome. An OTR® has completed an evaluation of an inpatient who has acute Guillain-Barré syndrome. The patient scored a "3" on all subtests of the Functional Independence Measure. Based on this information, which outcome would be realistic for this patient to achieve prior to transitioning to a skilled nursing facility? A. Uses energy conservation techniques during daily self-care tasks B. Completes three sets of a progressive resistive upper-extremity exercise program C. Independently completes wheelchair transfers using proper body mechanics D. Demonstrates controlled dynamic trunk movements during IADL activities - \Uses energy conservation techniques during daily self-care tasks. According to the FIM score, the patient requires moderate assistance for performing activities. In the acute phase of Guillain-Barré syndrome, the patient may be experiencing muscle belly tenderness and overall fatigue; energy conservation techniques will allow the patient to engage more productively in daily self-care tasks. An OTR® is working with a child who has a sensory processing disorder. The therapist would like to assess the child's motor planning using a standardized assessment tool. Which tool would be appropriate for the therapist to use? A. Sensory Integration and Praxis Test (SIPT) B. Sensory integration clinical observations C. Sensory Profile

D. Bruininks-Oseretsky Test of Motor Performance (BOT-2) - \Bruininks-Oseretsky Test of Motor Performance (BOT-2). The BOT-2 can be used to assess aspects of fine and gross motor functioning that may be difficult as a result of dyspraxia. An OTR®; is conducting a cooking group for people with schizophrenia who are nearing discharge from the hospital. The OTR writes the following goal for one group member using the COAST method: "The client will cook a meal before being discharged." What conclusion can you draw about the specific conditions (or S) under which this client is supposed to complete the occupation? A. The client will complete the occupation in the hospital's kitchen with adaptive equipment. B. The client will complete the occupation at home with no adaptive equipment. C. The client will complete the occupation at a community transitional facility using modified techniques. D. The client will complete the occupation in the hospital's kitchen using no adaptive equipment or modified techniques. - \The client will complete the occupation in the hospital's kitchen using no adaptive equipment or modified techniques. Because no specifications are given for adaptive equipment or modified techniques and the client is attending a predischarge hospital cooking group, it is appropriate to assume that the client will not require special conditions for the completion of this goal and that the occupation will be completed in the hospital's kitchen. An OTR® is planning a feeding session with a client with a C5 spinal cord injury (SCI). Which feeding utensil or adaptive equipment would be MOST APPROPRIATE to introduce during the session? A. An electric self-feeder B. Utensils with built-up grips C. Mobile arm support D. Tenodesis orthosis - \Mobile arm support. A mobile arm support is best for a client with a C5 injury because the client would most likely show shoulder muscle activity along with biceps and upper trapezius. When evaluating a client in a skilled nursing facility, the OTR® notes that the client's skin has a yellowish cast, the fingernail beds are bluish in color, and the client has noticeable edema in both lower extremities. What condition would MOST likely cause these symptoms? A. Right-sided congestive heart failure B. Left-sided congestive heart failure C. Aortic stenosis D. Aortic insufficiency - \Right-sided congestive heart failure. When the right side of the heart fails, blood flows back into the venous system. Symptoms of right-sided heart failure include cyanotic nail beds, jaundice, and lower-extremity edema.

A client with Huntington's disease presents with decreased motor planning. What is the most effective intervention for an OTR® to implement with this cognitive impairment? A. Provide alternative suggestions for safe mobility, including use of a wheelchair for community mobility. B. Provide the client with strategies to self-assess performance on tasks. C. Suggest that the client reduce participation in tasks that are difficult. D. Have the client imagine performing the task in a smooth, coordinated manner. - \Have the client imagine performing the task in a smooth, coordinated manner. Mental imagery is an effective strategy to improve motor abilities for clients with decreased motor planning. An OTR® is working with a client with C5 spinal cord injury. What is the BEST splinting strategy to use to encourage sensory feedback? A. Use of padded splints B. Use of dorsal splints C. Use of hand-based splints D. Use of dynamic splints - \Use of dorsal splints. A dorsally based splint will allow for maximal sensory feedback while worn. An OTR® is working in a clubhouse with a group of clients who have mental health issues. Which leadership style would be MOST effective? A. Director B. Authority figure C. Facilitator D. Advisor - \Advisor. The clubhouse model puts the locus of control on the members. When designing groups, the members formulate the goals, and the OTR® acts as an advisor. An OTR® is using cognitive-behavioral therapy strategies to help an adolescent client with attention deficit hyperactivity disorder regulate behavior so the client is able to get to work on time. Which strategy is related to cognitive-behavioral therapy? IncorrectA. Encouraging the client to take a movement break when the client begins to feel off task while getting ready for work. B. Encouraging the client to set an alarm clock so that the client is able to get up for work on time. C. Encouraging the client to visualize completing the prework routine without getting distracted and arriving to work on time. D. Encouraging the client to call the boss when the client is running late instead of sneaking in through the back door. - \Encouraging the client to visualize completing the prework routine without getting distracted and arriving to work on time. Cognitive-behavioral therapy techniques include challenging automatic thoughts, reducing cognitive distortions, challenging underlying beliefs and assumptions, visualization, controlling recurrent thoughts, and self- monitoring (or controlling) behavior.