NBCOT Practice Test 3

An OTR who works in an inpatient rehabilitation unit is completing an evaluation of a patient who had bilateral total knee arthroplasties 3 days ago. The patient is in generally good health, plans to live independently at home, and wants to resume volunteer work in the community. The patient currently requires OT services to increase independence in bathing, dressing, and toileting. What MUST the OTR consider when scheduling the patient for OT?

A. Availability of caregivers to participate in daily sessions for education and training

B. Patient's endurance for completing activities according to a clinical pathway

C. Understand documentation requirements for reimbursement by the third-party payer

C. Understand documentation requirements for reimbursement by the third-party payer

*The OTR has the responsibility of understanding policies and procedures related to reimbursement when establishing the intervention plan.

An OTR is establishing a pediatric private practice to provide comprehensive in-home services. According to Part C of the Individuals with Disabilities Education Improvement Act of 2004, what MUST the OTR include as part of each child's intervention?

A. Evidence of family-centered treatment sessions in the child's natural environment

B. Individualized family service plan based on the child's special education goals

C. Child-focused goals emphasizing curricular standards for successful transition to school

A. Evidence of family-centered treatment sessions in the child's natural environment

*The Individualized Education Program plan must contain several pieces of information, including the location of OT services and the beginning and end dates.

An OTR who is working in an acute psychiatric setting observes that an occupational therapy aide, who was recently hired, has violated departmental policy by leaving a transfer belt attached to a walker in the hallway. What is the FIRST action the OTR should take after observing this?

A. Inform the rehabilitation supervisor and document the incident

B. Remove the walker and transfer belt from the hallway, and remind the aide of the policy

C. Locate the aide and explain that leaving the walker and transfer belt in the hall is a safety hazard

B. Remove the walker and transfer belt from the hallway, and remind the aide of the policy

*The FIRST action the OTR should take is to eliminate the potential safety risk of having the walker and transfer belt in the hallway.

An entry-level OTR accepts a new job that includes providing services at two skilled nursing facilities and supervising an experienced COTA. Prior to starting the new position, the OTR wants to know the supervision requirements for occupational therapy assistants. Where must the OTR locate the regulations for COTA supervision?

A. National Board for Certification in Occupational Therapy (NBCOT)

B. American Occupational Therapy Association (AOTA)

C. Occupational Therapy Practice Act of the state licensure board

C. Occupational Therapy Practice Act of the state licensure board

*Supervision requirements are located in the Occupational Therapy Practice Act of each state's licensure board.

An inpatient who has COPD is participating in a dressing session while seated at the bedside. While putting on a pair of pants, the patient begins to have dyspnea. Pulse oximetry indicates the patient's oxygen saturation level is 93%. After stopping the activity, what should the OTR have the patient do NEXT?

A. Take several short, shallow breaths through the mouth

B. Breathe in deeply through the nose and slowly exhale through pursed lips

C. Inhale through pursed lips and quickly exhale through the nose

D. Breathe through a nasal canula using supplemental oxygen

B. Breathe in deeply through the nose and slowly exhale through pursed lips

*Pursed lip breathing is an intervention technique that assists in mitigating the effects of dyspnea.

An OTR working in a skilled nursing facility frequently teaches residents how to use adaptive devices during BADL. The OTR wants to evaluate if the instruction methods and devices are effective in helping to improve the residents' functional performance. Which method would be MOST EFFECTIVE to use for gathering this information?

A. Note the number of times the residents bring the devices to BADL sessions

B. Ask the residents how often during the week they use the devices for BADL

C. Have the residents demonstrate the use of the devices during a session

D. Track how many times the residents spontaneously use the devices during BADL

D. Track how many times the residents spontaneously use the devices during BADL

*Tracking spontaneous use of the devices during BADL provides the best indication of transfer of learning and the impact of the devices on residents' functional performance.

To promote professional development and maintain certification, an OTR is developing a continuing competency plan. What action should the OTR take FIRST?

A. Determine specific requirements of the state OT regulatory board

B. Identify professional development activities needed for recertification

C. Review current professional goals with an OT supervisor

D. Prioritize professional needs based on a self-assessment

D. Prioritize professional needs based on a self-assessment

*An effective component of maintaining continuing competence is to systematically perform a self-assessment of current skills and abilities, followed by developing a learning plan that prioritizes professional needs.

An OTR is providing supervision to a rehabilitation health aide, who assists a client with bathing. During the initial OT evaluation, the patient identified independence in bathing as a priority goal and was assessed to require 25% assistance. However, the aide tells the OTR that the patient wants total assistance during bathing sessions and frequently asks the aide to complete tasks that the patient can perform. What is the FIRST action the OTR should take to support progress toward the patient's bathing goal?

A. Document the discrepancy in the patient's performance level between the OTR and the aide

B. Plan to re-evaluate the client's level of assistance for bathing during the next scheduled session

C. Conduct a joint session with the client and the aide to review goals for bathing

C. Conduct a joint session with the client and the aide to review goals for bathing

*It is the responsibility of the supervising OTR to provide adequate supervision and training to ensure the effectiveness of the intervention.

An OTR working in an industrial setting is documenting the success of a wellness program. One of the program goals is to reduce the number of job-related injuries among workers in a warehouse shipping and receiving department. The initial assessment cited risks related to poor worker fitness, improper lifting techniques, and inadequate work routines. What information about the program should be documented in the program reports to management to provide the MOST BENEFICIAL information about the effectiveness of the program?

A. Evidence of improved body mechanics among workers during lifting tasks

B. Number of new or recurring injuries during the reporting period

C. Pre- and post-test results from a work questionnaire about job-related ergonomics

B. Number of new or recurring injuries during the reporting period

*Tracking the number of new or recurring injuries during the reporting period is a quantitative metric to evaluate the effectiveness of the program.

A client is in the early stages of a slow, progressive upper motor neuron disease. Mild intention tremors and fatigue interfere with the completion of typical daily tasks and the ability to work a full day as an accountant. Currently, the client ambulates with a cane in the home and uses a wheelchair for community mobility. The client's goal is to remain working as long as possible. Which work accommodation meets the employer's obligation for this client as required by the Americans with Disabilities Act?

A. Consideration for modifying the client's current work schedule

B. Employee review to change the essential elements of the job description

C. Modification of doorways throughout the workplace for maximal accessibility

A. Consideration for modifying the client's current work schedule

*Modifying the client's current work schedule is a reasonable accommodation as outlined by the Americans with Disabilities Act.

An OTR has been leading discussions about evidence-based practice during monthly rehabilitation team meetings. The discussion at the next meeting will focus on reviewing the final step associated with this systematic process of searching and appraising literature. What information should the OTR include in the presentation when summarizing the final step in the evidence-based practice process?

A. Appraising and synthesizing the evidence

B. Evaluating the effectiveness of each step in the process

C. Applying best evidence to guide practice decisions

B. Evaluating the effectiveness of each step in the process

*The final step in the evidence-based practice process is to evaluate the effectiveness of each step in the process.

An OTR working in a pediatric outpatient setting is teaching an 8-year-old child with osteogenesis imperfecta to transfer from the floor to a standing position. At the start of the transfer, the child slips and falls, hitting the left shoulder on the floor. As the OTR attends to the child, they observe that the child is wiping away tears, despite stating that the shoulder is fine. After comforting the child and completing an incident report, what action should the OTR take NEXT in this situation?

A. Complete a functional evaluation of the affected upper extremity

B. End the session until the incident is discussed with the referring physician

C. Continue the session while monitoring the child's functional movement patterns

B. End the session until the incident is discussed with the referring physician

*A child with osteogenesis imperfecta, a condition associated with bones that fracture easily, is at risk for having a broken bone from a minor injury or fall.

Using the levels of evidence hierarchy, which type of research methodology is considered the strongest type of evidence to inform practice decisions?

A. Meta-analysis

B. Randomized Control Trial

C. Single-subject case study

A. Meta-analysis

*Evidence from a meta-analysis is considered Level I evidence and is the strongest type of evidence to inform practice decisions.

An OTR is providing consultative services to develop a wellness program at a community senior center. A needs assessment survey indicates center participants have a fear of falling, feel they are at risk for falls, and want to age in place for as long as possible. In addition to including fall prevention education, which topic should the OTR recommend as part of the educational programming offered at the center?

A. Benefits of participating in socially stimulating activities

B. Value of identifying effective home modifications

C. Influence of aging on immediate and delayed memory

B. Value of identifying effective home modifications

*An effective person-environment fit promotes safe aging-in-place. By incorporating the value of identifying effective home modifications into the educational program, the client will be able to determine whether changes will be beneficial in their home.

A client who sustained a Colles' fracture of the dominant extremity is in OT. The client is able to touch their fingertips to their palms, but stiffness and swelling limit their ability to grip. Pain interferes with ability to complete typical work tasks using the affected hand, and the client compensates for most tasks, except writing, by using the non-dominant hand. Which is BEST to include in the assessment section of the client's weekly progress note?

A. "Improvements are noted in ROM and strength, but persistent stiffness, swelling, and pain interfere with full functional use of the affected hand for completion of daily tasks."

B. "ROM and strength of the affected hand and wrist are improved slightly compared to the previous evaluation."

C. "Client is able to complete work tasks by using the non-dominant extremity. Recommend continuation of OT for pain management and to improve ROM in the dominant hand."

A. "Improvements are noted in ROM and strength, but persistent stiffness, swelling, and pain interfere with full functional use of the affected hand for completion of daily tasks."

*This statement accurately states the assessment of the client's progress in relation to meaningful daily occupations.

An inpatient who has secondary-progressive multiple sclerosis had surgery 3 days ago for placement of an intrathecal baclofen pump to influence severe spasticity in both lower extremities. When the OTR arrives for the next scheduled session, the patient is in respiratory distress with decreased mental status. What is the FIRST action the OTR should take based on this observation?

A. Activate the emergency response system and start chest compressions

B. Immediately alert the primary care nurse assigned to the patient

C. Place the patient in a reverse Trendelenburg position and administer oxygen

B. Immediately alert the primary care nurse assigned to the patient

*When a patient has a change in medical status, the OTR must evaluate the level of urgency of the situation and determine the best plan of action. In this situation, the OTR considers the type and severity of the patient's symptoms, as well as the context of the hospital setting, which provides immediate access to nursing staff.

Which data collection set is part of a comprehensive assessment completed by a home health agency to support payment from Medicare for home health services?

A. Minimum Data Set (MDS)

B. Outcome and Assessment Information Set (OASIS)

C. Functional Independence Measure (FIM)

B. Outcome and Assessment Information Set (OASIS)

*The Outcome and Assessment Information Set (OASIS) is a standardized assessment used by home health agencies for establishing a plan of care, measuring outcomes, and supporting reimbursement from Medicare.

An OTR who works in a hospital setting is working with a patient who has the herpes zoster virus and is on contact and airborne precautions. Which of the following options represent the MOST EFFECTIVE sequence for putting on personal protective equipment at the start of the session?

A. Gown, Mask, Gloves

B. Gloves, Mask, Gown

C. Mask, Gloves, Gown

A. Gown, Mask, Gloves

*The proper sequence for putting on personal protective equipment is as follows: gown, mask, gloves.

Which federal law in the United States regulates the provision of reasonable accommodations for a student with a disability to have equal access to academic programs and to fully participate in sports, after-school care, and extracurricular activities?

A. Individuals with Disabilities Education Act (IDEA) Part C

B. Section 504 of the Vocational Rehabilitation Act

C. Individuals with Disabilities Education Act (IDEA) Part B

B. Section 504 of the Vocational Rehabilitation Act

*Section 504 of the Vocational Rehabilitation Act is the federal law in the United States that regulates the provision of reasonable accommodations for a student with a disability to have equal access to academic programs and to fully participate in sports, after-school care, and extracurricular activities.

A client who had a CVA one month ago now has moderate-severe flexor spasticity and scapular immobility of the involved upper extremity. Which technique is CONTRAINDICATED to use for minimizing the impact of spasticity on passive mobility for dressing and hygiene?

A. Self-ROM exercises in supine several times per day

B. Reciprocal overhead pulley exercises using wall-mounted pulleys

C. Upper extremity weight-bearing during functional tasks

D. Long-arm air splinting prior to completing a self-care task

B. Reciprocal overhead pulley exercises using wall-mounted pulleys

*Reciprocal overhead pulley exercises that use wall-mounted pulleys are contraindicated for this client due to the risk of causing impingement syndrome and increasing the client's pain.

An OTR is employed at a skilled nursing facility on an hourly basis and is typically scheduled to work 2 shifts each month. The facility-specific clinical protocol directs the OTR to use a standardized assessment tool that is unfamiliar to the OTR. What is the FIRST action the OTR should take in this situation?

A. Alert the therapy supervisor that additional training is needed

B. Follow the step-by-step procedural instructions on the test form

C. Request a colleague to administer the assessment tool when needed

A. Alert the therapy supervisor that additional training is needed

*It is the responsibility of the OTR to be adequately qualified and prepared to complete all components of the job.

An OTR wants to measure the effectiveness of a leisure education program for clients who attend an outpatient chemical dependency unit. What method should the OTR use to obtain a valid measure of the program's effectiveness?

A. Track the number of clients referred to the program with the number of clients who complete the program

B. Compare a measurement of client leisure involvement at the start of the program with leisure involvement upon completion of the program

C. Administer a questionnaire about the perceived importance of leisure activities to clients who complete the program

D. Monitor the frequency of client attendance and level of participation during each session of the program

B. Compare a measurement of client leisure involvement at the start of the program with leisure involvement upon completion of the program

*This method provides measurable performance-based information for evaluating program effectiveness.

An OTR attended a continuing education class on cognitive strategies for children with attention deficit hyperactivity disorder. During the class, the instructor discussed anecdotal evidence for the use of oculovestibular treatment to improve learning ability. In researching the topic, the OTR reads a peer-reviewed article that indicates a correlation of 0.01 (r = 0.01) between the use of oculovestibular techniques and process skills. What do the research findings from the peer-reviewed article indicate for the level of correlation?

A. Weak correlation

B. Negligible correlation

C. Moderate correlation

D. High correlation

B. Negligible correlation

*When calculating correlation, the symbol representing correlation = r. The interpretation of the correlation coefficient is the strength of the relationship. An r-value less than 0.70 indicates that the correlation is unacceptable or inadequate.

An inpatient has been participating in ADL, social skills, and prevocational groups as part of a multidisciplinary program for the treatment of anorexia. What information about the patient's participation should be documented in the "A" section of the SOAP note to provide the MOST BENEFICIAL information about the patient's progress?

A. Patient reports compliance with caloric intake requirements

B. Evidence of specific decision-making skills the patient uses during assigned group tasks

C. Examples of patients' conformity with strict limits set on personal behavior

D. Impressions about the patient's ability to use appropriate judgement related to own skills and assets

D. Impressions about the patient's ability to use appropriate judgement related to own skills and assets

*The 'A' section of the note includes professional impressions that the OTR forms about the client's status or progress based on clinical data.

An OTR is teaching compensatory strategies to an older adult client who lives alone and receives weekly visits from a family member. One of the client's priorities is to be independent with IADL, including medication management. However, when filling the pill box, the client made 8 medication errors in the past month. To respect the client's stated priorities and to maintain client safety, which statement represents the BEST ethical action for the OTR to take?

A. Encourage the client's family member to organize the medication in the pill box once per week

B. Have the client fill the pill box with the family member present to monitor for possible mistakes

C. Ask for medications to be pre-packaged at the pharmacy according to prescription instructions

C. Ask for medications to be pre-packaged at the pharmacy according to prescription instructions

*It is the ethical responsibility of the OTR to select an intervention strategy that will ensure the client's safety (principle of beneficence) and respect the client's wishes (principle of autonomy).

A hospital-wide interprofessional continuous quality improvement (CQI) committee has identified a reduction in pressure sores related to hospitalizations as an opportunity for improvement. After discussing the initiative with the rehabilitation manager, what should the OTR do NEXT to contribute to this process?

A. Explain to all rehabilitation staff the Department of Health and Human Services (DHHS) initiative to decrease the incidence of pressure sores related to hospitalizations

B. Develop a survey for the rehabilitation staff to determine the frequency of assessment and provision of interventions related to wound management and care

C. Develop an in-service education program for all rehabilitation staff, including information about pressure sores being preventable and a major concern of health care

B. Develop a survey for the rehabilitation staff to determine the frequency of assessment and provision of interventions related to wound management and care

*This step in the continuous quality improvement (CQI) process allows for data collection that can help assess the current situation prior to developing solutions.

What type of precautions MUST an OTR who works in a hospital setting take if an inpatient has been diagnosed with vancomycin-resistant enterococci (VRE)?

A. Standard

B. Airborne

C. Contact

C. Contact

*In the hospital setting, a patient with VRE is placed on contact precautions, often in a private room, to prevent the spread of the organism to other patients.

A rheumatologist has prescribed bilateral nighttime resting hand orthotics for a child who has early-stage juvenile rheumatoid arthritis. The parents ask the OTR who works at the child's school to fabricate the orthotics. Despite having this condition, the child is functioning at grade level and is not on the OT caseload. What action should the OTR take in response to the parents' request?

A. Schedule a time after school hours to fabricate the orthotics for the child

B. Initiate an IEP indicating the child's needs for school-based OT

C. Inform the parents to schedule an appointment at an outpatient OT clinic

D. Provide the parents with a catalog of information for ordering pre-fabricated orthotics

C. Inform the parents to schedule an appointment at an outpatient OT clinic

*School-based OT must relate to curriculum-based activities. These orthotics are typically used for preventive positioning during nighttime use. Since this intervention is not directly related to curriculum-based activities and the orthotics will not be worn during the school day, the OTR should refer the child to an outpatient OT clinic for the orthotics.

An OTR has been providing home health services for 2 weeks to a patient who has had cardiac bypass surgery. The OTR determines that the patient could benefit from an outpatient cardiac rehabilitation program. The OTR informs the supervisor of these conclusions, but the supervisor recommends that the patient continue with home health services to maintain Medicare reimbursement. What action should the OTR take in this situation?

A. Ask the patient and family about their service preference

B. Continue to provide services based on the initial plan

C. Contact the patient's physician to discuss a referral to the program

D. Provide justification for the referral in a discharge summary

D. Provide justification for the referral in a discharge summary

*For home health services to be covered under Medicare, the interventions provided must be medically necessary with the expectation of achieving performance outcomes.

A child with developmental delay has mastered the ability to cut simple figure shapes with scissors. Which scissor activity is best for the OT to introduce to the child during their next intervention session?

A. Cutting simple geometric figures

B. Cutting complex figure shapes

C. Cutting multiple circles

B. Cutting complex figure shapes

A person blinded in an accident begins an OT program for persons with vision loss. The OT collaborates with the individual to develop an intervention plan. Which should be included in the plan as an initial focus of intervention?

A. Developing the client's computer skills

B. Adapting meal preparation techniques

C. Exploring potential vocational opportunities

D. Organizing the client's morning routine

D. Organizing the client's morning routine

*Organizing the morning routine is the most relevant initial goal. Being organized can help the individual effectively and independently complete their personal ADL without vision.

A person is five days post-coronary artery bypass graft (CABG). The patient expresses anxiety about performing any type of activity and reports chest pain during ambulation. The cardiologist has approved activities at a metabolic equivalent (MET) level of 2 to 3. Which activity is best for the OT to use when initiating intervention with this person?

A. Grooming while standing at the sink

B. Keyboarding while sitting

C. Performing light housework

A. Grooming while standing at the sink

*Grooming while standing at the sink is at a MET level 2-3. Keyboarding while sitting is at a 1.0 MET level. Light housework is at the 3-4 MET level.

The OT wishes to compare the results of an evaluation of lateral pinch to the norms. Which is the best positioning for the therapist to place the individual in when using the pinch meter?

A. Forearm in neutral, and the pinch meter placed on the DIP joint

B. Forearm in neutral, and the pinch meter placed on the middle phalanx

C. Forearm in pronation, and the pinch meter placed on the DIP joint

D. Forearm in pronation, and the pinch meter placed on the middle plalnax

B. Forearm in neutral, and the pinch meter placed on the middle phalanx

*Norms for lateral pinch have been established with the forearm in neutral and the pinch meter placed on the middle phalanx. The other described positions do not match the normed position.

An OT evaluates a client using the Allen Cognitive Level (ACL) Screen. The client successfully completes three running stitches. What should the therapist do next?

A. Demonstrate the whip stitch and ask the client to imitate this and complete three stitches

B. Demonstrate the single cordovan stitch and ask the client to imitate this and complete three stitches

C. Demonstrate that the person demonstrates a cognitive level consistent with Level 3 of the Cognitive Disabilities model

A. Demonstrate the whip stitch and ask the client to imitate this and complete three stitches

*According to the Allen Cognitive Level (ACL) Screen, after the completion of three running stitches, the person should move on to the next step in the screening process, which is the completion of three whip stitches. After completing three whip stitches, the therapist then points to the single cordovan stitch and asks the client if they can do that stitch.

An individual recovering from flexor tendon repair surgery is two days post-operation. The surgeon refers the client to OT with a prescription to use the Kleinart protocol to guide intervention. The client is now seven weeks postoperation. What are the most appropriate intervention activities for the OT to use with this client?

A. Home management activities, such as doing laundry

B. Light ADL such as grooming

C. Strengthening exercises using high-resistance TheraBand

D. Passive exercises using a dynamic splint

B. Light ADL such as grooming

*According to the Kleinert protocol, light ADL are introduced 6-8 weeks postoperation. Strengthening activities are heavier work activities (such as laundry) and are introduced 8-12 weeks postoperatively. The use of a dynamic splint is indicated immediately and up to 4 weeks postoperation.

A client with a history of heart failure was instructed by their primary care physician to maintain a MET level of 6 or lower. Which of the following activities would NOT be appropriate for therapeutic intervention?

A. Gardening

B. Water aerobics

C. Walking very briskly

D. Making a bed

C. Walking very briskly

*Walking briskly (at about 4.5 mph) is a MET level 6.3. Water aerobics is MET level 5.3. Gardening is a level 3.5-5, and making a bed is level 3.3.

An individual diagnosed with schizophrenia is referred to a partial hospitalization program. During the initial evaluation interview, the OT observes that the client consistently returns to the focus of the first question when answering each subsequent question. Each time the therapist introduces a new topic to discuss in the interview, the client ignores it and returns to the original topic of focus. When documenting the client's behavior, which of the following is most accurate for the therapist to report the client is demonstrating?

A. Thought blocking

B. Perseveration

C. Obsessive thinking

D. Poverty of speech

B. Perseveration

*Perseveration is a persistent focus on a previous topic or behavior after a new topic or behavior is introduced. Thought blocking is the interruption of a thought process before it is fully completed. Obsessive thinking involves the persistence of an illogical thought. Poverty of speech is speech that is limited in amount and content.

An OT works with the new foster parent of a 2-year-old child diagnosed with major developmental delays and severe hypotonia. The therapist advises the foster parent to position the head in midline during feeding. What additional positioning recommendations for feeding are most suitable for this child?

A. Sitting with hips and knees at 90-degree flexion, neck in neutral

B. Sitting with hips and knees at 90-degree flexion, neck in extension

C. Semi-reclined with neck in neutral

D. Semi-reclined with neck in extension

C. Semi-reclined with neck in neutral

*This semi-reclined position can be easily maintained with the use of a commercially available child seat, and it allows for correct postural alignment during the feeding activity.

Several adolescents with behavior problems attend

an after-school program in a mental health

outpatient program. They work at an

egocentric-cooperative level in a group dealing

with issues related to peer pressure. Which of the following would the OT most likely observe the participants doing in the group?

A. Actively taking on roles such as energizer, coordinator, or opinion giver

B. Focusing on the group tasks rather than the feelings of the participants

C. Making decisions with minimal to no supervision from the group leader

B. Focusing on the group tasks rather than the feelings of the participants

*The egocentric-cooperative group tends to focus on the tasks to be completed with little attention devoted to the feelings of the participants. At this level, members do not actively assume diverse group roles or make independent decisions.

An individual with rheumatoid arthritis (RA) has developed several boutonniere deformities. Which of the following is the most accurate description for the OT to include in documentation of the individual's presenting signs?

A. Hyperextension of the PIP joint and flexion of the DIP joint

B. Ulnar deviation and subluxation of the MCP joint

C. Flexion of the PIP and hyperextension of the DIP

D. Herberden's nodes at the DIP joints and Bouchard's nodes at the PIP joints

C. Flexion of the PIP and hyperextension of the DIP

*A boutonniere deformity occurs when there is flexion of the PIP and hyperextension of the DIP.

- A swan neck deformity occurs when there is hyperextension of the PIP and flexion of DIP

-Ulnar deviation and subluxation of the MCP joints are additional deformities that can result from RA.

- Herberden's nodes and Bouchard's nodes are types of bone spurs that can result from osteoarthritis

An OT is determining a mobility device for a 3-year-old child with spastic diplegia and hamstring tightness that will allow participation in play activities and exploration of the surroundings. Which mobility device will be most beneficial for encouraging participation in play activities?

A. Caster cart with a triangular-shaped wedge under the knees

B. Power chair with an adjustable posterior tilt feature

C. Lightweight hand-held walker with all swivel casters

A. Caster cart with a triangular-shaped wedge under the knees

An OT is determining appropriate assistive technology to enhance a sixth grader's participation in history class. The student has good listening comprehension skills, but delays in fluency directly impact engagement in classroom presentations. What accommodation is the most appropriate to support the student's completion of presentations?

A. Voice recognition software

B. Text-to-speech feature

C. Abbreviated expansion

B. Text-to-speech feature

A 14-month-old child has moderate hypotonia resulting in poor oral motor control. Which position is recommended for promoting oral motor function during feeding?

A. Torso supported in a slight recline with head and neck at midline

B. Posterior pelvic tilt with trunk in forward flexion and neck flexed

C. Seated upright in a standard high chair with head extended

A. Torso supported in a slight recline with head and neck at midline

A 4-year-old child has hypotonia secondary to spastic cerebral palsy. The initial evaluation indicates difficulty maintaining an upright posture requiring postural supports. During a self-feeding session focused on drinking from a cup, the child demonstrates poor lip closure and insufficient suction. Which adaptation is most beneficial in order to promote progress toward independence during self-feeding?

A. Introduce a shorter, smaller straw

B. Use a specialized one-way valve cup

C. Trial a cup with a non-spill valve

D. Provide a U-shaped clear cut-out cup

B. Use a specialized one-way valve cup

A 7-year-old with complete spina bifida at the T10 level attends outpatient OT weekly. The child's parent reports that the child is losing bladder control. Upon re-evaluating the child, the OT notes that the child shows a minimal decrease in strength in both bilateral lower and upper extremities, as well as an increase in the equinovarus position of the feet. The therapist contacts the physician to report that the child's change in status may indicate which of the following?

A. Shunt malformation

B. A recent growth spurt

C. Arnold-Chiari formation

D. Thetherd cord

D. Thetherd cord

*Tethered cord is noted by all of the symptoms listed. The spinal cord of the child with spina bifida is sometimes attached to the spinal column and becomes taut as the child grows. The child requires surgical release of the tethered cord.

An individual hospitalized for the first time due to a brief psychotic episode attends an OT group. During task performance, the OT notices that the person is restless with hand tremors and shaking legs. Which of the following should the therapist document that the person seems to be exhibiting?

A. Akinesia

B. Pseudo-parkinsonism

C. Akathisia

D. Tardive dyskinesia

C. Akathisia

*Akathisia is a movement disorder characterized by distressing inner restlessness and an inability to stay still, causing a compulsion to move.

Two weeks after beginning kindergarten, a five-year-old with myelomeningocele develops a sudden onset of headaches, vomiting, irritability, and "sunken" appearance of eyes without signs of a fever. Which action is best for the OT to take in response to the child's presenting symptoms?

A. Bring the child to the school nurse to determine if the child's presenting symptoms are indicative of the flu

B. Inform the parents that they should immediately have the physician examine the child for a tethered cord

C. Refer the child to the school psychologist for an assessment of school anxiety

D. Inform the parents that they should immediately have the physician examine the child for shunt malfunction

D. Inform the parents that they should immediately have the physician examine the child for shunt malfunction

*These identified symptoms, along with seizures, are all symptoms of shunt malfunction. Shunt malfunction is a medical emergency.

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

A. The wrist

B. The Guyon's Canal

C. The elbow

D. The forearm

D. The forearm

*The presenting signs described in this case scenario indicate pronator teres syndrome. A positive Tinel's sign at the forearm is consistent with this syndrome, which is a medial nerve compression between the two heads of the pronator teres. Symptoms are similar to carpal tunnel syndrome (CTS) except there is aching pain in the forearm and no night symptoms.

A patient is recovering from a right CVA resulting in severe left hemiplegia and visuospatial deficits. Their left lower extremity has pitting edema. Which wheelchair would be best for the OT to recommend for this patient?

A. A powered wheelchair with a joystick control and dual elevating leg rests

B. A lightweight active duty wheelchair with dual elevating leg rests

C. A one-arm drive chair with an elevating leg rest on the left

D. A hemiplegic chair with an elevating leg rest on the left

D. A hemiplegic chair with an elevating leg rest on the left

*A hemiplegic chair has a low seat height and is the best choice for this patient.

An OT evaluates a person who complains of persistent wrist pain after painting a house three weeks ago. The patient demonstrates signs and symptoms consistent with de Quervain's tenosynovitis. Which assessment measure should the therapist use to confirm the diagnosis?

A. Finkelstein's test

B. Phalen's test

C. Froment's sign

D. Craig's test

A. Finkelstein's test

*Finkelstein's test is specific for reproducing the pain associated with de Quervain's tenosynovitis of the abductor pollicis longus and extensor pollicis brevis. Finkelstein's test is performed by having the patient make a fist with the thumb inside the fingers and then perform ulnar deviation. Sharp pain along the distal radius, close to the wrist, is a positive result.

-Froment's sign is used to identify ulnar nerve dysfunction

-Phalen's test identifies median nerve compression in the carpal tunnel