OTD741 - Final Exam

The ____________ is the quality measure used by inpatient rehab facilities and the _____________ is used to assess a patient's status and determine the GG codes that are part of the quality measure.

- IRF-PAI; AM-PAC

- IRF-PAI; Quality Indicators (QI)

- OASIS; AM-PAC

- MDS; Quality Indicators (QI)

IRF-PAI; Quality Indicators (QI)

You see a patient for a 60-min treatment session. You complete 32 mins of neuromuscular reeducation (97112), 15 mins of therapeutic exercise (97110) and 13 mins of therapeutic activity (97530). How many total unites will you be billing?

- 3 units

- 4 units

- 2 units

- 5 units

4 units

You are working with an OT client during his morning routine. Once you retrieve all of his clothes from the closet and set them next to him, he is able to put them on independently. He required steadying when standing to pull up his pants. What is his GG score for lower body dressing?

- 5

- 4

- 3

- 2

4

You are an OT working in an acute care setting. The hospital social worker is asking for your discharge recommendation for the following scenario:

Client is a 78 y/o single male with limited community support. Currently, he only tolerates 15-20 mins of OT. UB dressing MinA, LB dressing ModA, toileting ModA, toilet transfers ModA, bathtub transfers Dependent. IADLs were not assessed, however you predict he will be Dependent.

Given this scenario, what is the best recommendation?

- Discharge to home and referral to home health OT

- Discharge to IRF to increase independence before returning home

- Discharge to SNF to increase independence before returning home

- Client not be discharged from acute care until they're able to complete basic self-care skills

Discharge to SNF to increase independence before returning home

What is the typical Medicare reimbursement source for OP rehab?

- Medicare B

- Medicare A

- Medicare C

Medicare B

Following a recent CVA, George is being transferred from an acute care hospital floor to a SNF for therapy. Which of the following will cover the cost of his stay at the SNF?

- Medicare A

- Medicare B

- Medicare D

- Medi-gap

Medicare A

If a service is not covered by Medicare, the treatment facility is responsible for notifying the patient and having them sign a __________, which indicates they understand the service is not covered and they will be responsible for the cost.

- RUG level

- Advanced Beneficiary Notice (ABN)

- Local Coverage Determination (LCD)

- Medicare Administrative Contract

Advanced Beneficiary Notice (ABN)

Which of the folloiwng is an acceptable reason for a home health client to leave their home?

- Hair cut

- Family birthday party

- Church

- All of the above

All of the above

Which of the following diagnoses would NOT qualify for an IRF stay?

- RLE amputation

- CVA

- Right total knee arthroplasty (TKA)

- None of the above

Right total knee arthroplasty (TKA)

Which of the following is an AOTA initiative for older adults?

- Driving and community mobility

- Fall prevention

- Community-based health and wellness programs

- All of the above

All of the above

You have just received orders for a new client who was just admitted to a SNF. The primary diagnosis is pneumonia and diagnosis of COPD. Additional diagnoses include glaucoma and depression. Also noted from the medical record is complicating conditions of orthostatic hypotension, and decreased attention and memory. Which of the following according to the CDC are considered fall risks?

- Cognitive impairment

- Low vision

- Depression

- All of the above

All of the above

You have just received orders to work with a client that has sustained an acute hemorrhagic stroke. Intracranial pressure is being monitored. What is the first thing that you need to do?

- Contact physician and request ICP parameters

- Ask nursing to assist with the positioning of the transducer to allow for accurate readings

- ICP pressure is < 20 mmHG begin assessment at bed level

Ask nursing to assist with the positioning of the transducer to allow for accurate readings

Larry is a 79 y/o male who slipped and fell in the Meijer parking lot on an icy winter morning. This scenario would be classified as which of the following.

- An unaccounted for fall

- A fall due to intrinsic factors

- A fall due to extrinsic factors

- She did not fall

A fall due to extrinsic factors

True or false: An incident report does not need to be completed for falls that do not result in injury.

False

You have just landed your first job in a regional medical center that receives Trauma I clients. OT and PT do not receive orders until the patient is out of the ICU. You are concerned that valuable time is being lost and want to advocate for early intervention. What supporting evidence do you have to promote early mobilization?

- Early mobilization results in decr. incidence of nosocomial infections

- Early mobilization results in fewer secondary medical complications

- Early mobilization results in more discharges to home rather than rehab

- All of the above

All of the above

Laura was seen in the ER and diagnosed with an ischemic stroke. She was taken to surgery for a thrombectomy. Which of the following individuals would most likely be performing the surgery?

- Neurologist

- Neurosurgeon

- Neurointerventionalist

- Neurointensivist

Neurointerventionalist

You enter a client's room to being an OT intervention consisting of oral facial hygiene and bathing while sitting on the edge of the bed. While the client is supine, you notice a sand bag placed over the groin (femoral vein). The client stated that they went for cardiac catheterization earlier in the day. What is your best response?

- Defer treatment until client is 4-8 hours following the procedure that involved the femoral vein

- Continue with treatment plan monitoring respiratory status

- Cover groin area with a plastic sheeting material to protect the procedure site and continue with the Tx plan

Defer treatment until client is 4-8 hours following the procedure that involved the femoral vein

While screening a client in the ICU, you note all the lines and medical devices. You notice a line that wraps around the thumb and inserts in the radial side of the forearm. What precautions do you need to take?

- Do not get the line wet during morning self-care routine

- No ROM to the wrist

- No ROM to the fingers and thumb

- Both A and B

Both A and B

Which of the following interventions is appropriate for a client that received a permanent pacemaker 2 days ago?

- Adapted dressing keeping shoulder motions below 90 degrees

- Full AROM to the shoulders bilaterally to prevent contractures

- UE strengthening exercises that do not exceed 20 lbs of resistance

Adapted dressing keeping shoulder motions below 90 degrees

Which of the following is an increased risk factor for falls in older adults?

- Forward head posture

- Achilles tendon tightness

- Increased medication use

- All of the above

All of the above

Which of the following is an appropriate intervention one day post-op rotator cuff repair?

- ROM distal to the surgical site

- Shoulder AROM and isometric strengthening

- Shoulder PROM and AROM

ROM distal to the surgical site

Precautions for a client s/p posterior hip replacement consists of: no hip flexion beyond 90 degrees, no hip adduction past neutral and ___________.

- No hip internal rotation

- No hip external rotation

- No knee flexion past 90 degrees

No hip internal rotation

You are an OT working with an 88 y/o patient who recently fell at home and broke his left leg. The patient underwent an ORIF and was given weight-bearing restrictions post-operatively. The surgeon placed orders allowing the patient to perform toe-touch weight-bearing on his left leg. This means that the patient can place how much weight through this limb?

- 30% of their body weight

- 0% of their body weight

- 10-15% of their body weight

- 75% of their body weight

10-15% of their body weight

You are working with a 78 y/o male who just underwent a total hip replacement due to severe osteoarthritis in his left hip. When you review the chart you do not see any information about the type of procedure completed (anterior vs. posterior, total arthroplasty vs. hemiarthroplasty) or precautions. What is the best education to provide to the patient?

- No hip flexion past 90 degrees

- No hip adduction

- No hip rotation

- The patient should be educated on all of the above precautions

The patient should be educated on all of the above precautions

Which of the following is a likely treatment for a patient with a BKA in an OP setting once they've received their prosthesis?

- Residual limb hygiene

- Self-care training

- Prosthetic training

- All of the above

All of the above

Which of the following is a likely treatment in the acute care setting for a person with an AKA?

- Bed mobility and transfer training

- Laterality discrimination and mirror therapy

- Prosthetic training

- Both A and B

Both A and B

Your patient is 1 day post-op RTKA. You review the post-op report and see he had a standard TKA procedure without complications. When you enter the room, the patient very fearful about moving his right leg and questions his precautions. Which of the following precautions should you educate him on?

- Patient should only put partial weight through his right leg

- Patient should not bend his right knee beyond 90 degrees of flexion

- Both A and B

- Assure him that he has no precautions and that he should be moving as much as possible while avoiding strenuous movement of the knees

Assure him that he has no precautions and that he should be moving as much as possible while avoiding strenuous movement of the knees

True or false: A client that has a thoracic compression fracture has orders to wear a TLSO when up. It is appropriate to don the orthotic after the patient has moved from supine to EOB assuming you can maintain bending/twisting precautions.

True

You received an OP referral for a 68 y/o female with the diagnosis of osteoarthritis of the CMC. The client works part-time in a law office as a legal assistant. She uses paper clips and three ring binders to organize documents. She complains of pain at home in the evenings. She misses playing card games with friends. Which of the following would be best recommendation for this client?

- Neoprene thumb spica splint

- Figure-eight splint

- Resting hand splint

Neoprene thumb spica splint

A client presents with swollen, red, hot joints. They report that they are having a "flare-up". Which of the following do you recommend?

- Gentle AROM

- Aggressive stretching of the involved joints

- Avoid ROM and stretching

Gentle AROM

OT received orders to treat a client one day post CABG x4. They have not been out of bed since the surgery. Which of the following describes the beset way to complete bed mobility?

- Overhead trapeze bar to assist with roll and then sitting EOB followed by a SP transfer

- Log-roll to sitting EOB followed by standing transfer using a walker or rollator without putting too much weight through walker

- Sequential or segmental rolling, using bed rail to pull self to sidelying position then a sliding board transfer to the w/c

Log-roll to sitting EOB followed by standing transfer using a walker or rollator without putting too much weight through walker

While reviewing the electronic medical record (EMR), the results of an excuse stress test was 65%. What precautions do you need to take with this client?

- Client is on bed rest - activities need to be at bed level

- Client is allowed out of bed with METs levels 3 or below

- None, this is within normal range

Client is allowed out of bed with METs levels 3 or below

Which of the following would be a beneficial treatment session for a patient with CHF?

- Using a rollator in the kitchen and lifting items into the cabinets with 1-2 lb weights on wrist to increase strength

- Education and training on activity modification and adaptive equipment for ADL/IADL tasks to reduce SOB and fatigue

- A rigorous HEP that increases repetitions and resistance on a weekly basis

- All of the above

Education and training on activity modification and adaptive equipment for ADL/IADL tasks to reduce SOB and fatigue

You are working in an acute care hospital with a patient who had a CABGx2 three days ago. You have been instructed to keep the MET level at a 2-2.5 range. Which of the following activities would likely be in this range?

- Bedrest

- Using a bedpan in bed

- Washing UB sitting EOB

- Walking around the room to obtain hygiene items for a shower

Washing UB sitting EOB

Which of the following is a good technique to teach a patient with dyspnea?

- Elevate head of bed 10-20 degrees

- Limit prolonged forward flexion when engaging in LE dressing tasks

- Incorporate controlled breathing into ADL tasks

- All of the above

All of the above

Which of the following would be an appropriate recommendation for a patient with COPD who reports fatigue and SOB when showering and bending forward in his tub/shower combo?

- Use a tub transfer bench

- Use of long-handled sponge due

- Stand in the shower to improved endurance

- Both A and B

Both A and B

Which of the following need to be considered when working with a patient who has been diagnosed with a DVT?

- If patient has an inferior vena cava filter placed

- Number of days since anticoagulation medications were started

- Ensure patient has been cleared by physician prior to getting out of bed

- All of the answers

All of the answers

Self-awareness of one's endurance level is important in many disease processes. Which of the following is a self-assessment to assist with increasing one's awareness?

- BORG

- BERG

- TUG

BORG

Which non-invasive test would commonly be used to monitor a patient with peripheral vascular disease?

- Holter Monitor

- Arterial Blood Gas

- Doppler Study

- Cardiac Catheterization

Doppler Study

Which of the following would be used to treat cardiac dysrhythmia?

- Cardioversion

- Ablation

- Pacemaker

- All of the above

All of the above

Assessing muscle strength by completing an MMT may be difficult with someone diagnosed with Parkinson's Disease. Why?

- Muscle rigidity

- Limited or decreased ROM

- Decreased cognition

Muscle rigidity

When assessing a client with a diagnosis of MS, you will want to observe or evaluate which of the following?

- Cognition

- Sensation

- Vision

- All of the above

All of the above

A client with a diagnosis of MS is complaining of fatigue after completing an 8-hr day at work. UE strength was difficult to test but was at least a 3/5. Client ambulates for short distances using a Rollator. For longer distances, they use a w/c. During assessment, you noticed client had difficulty sitting unsupported. They required at least one hand support to maintain an upright position. They reported that their office chair did not have a back or side supports. Which of the following is best practice?

- Request ergonomic work station assessment to address secondary fatigue

- Begin basic instruction in work implications and energy conservation to increase function at home

- Evaluate for a power w/c that provides lateral and back support

- Carry on with session, work on strengthening and rehab

Request ergonomic work station assessment to address secondary fatigue

When you observe your 91-y/o patient at mealtime, you notice he has a gurgling voice after eating and drinking. Which is the best course of action?

- Nothing needs to be done since he's not coughing after swallowing liquids

- Request a referral for a MBSS to rule out aspiration

- Recommend patient be NPO

Request a referral for a MBSS to rule out aspiration

OT received orders to assess a client's ability to feed themselves. Client is able to follow one to two-step commands. However, they are unable to stay awake. You frequently need to wake her up to answer questions. Which of the following is the best way to move forward with this client?

- Defer evaluation until client arousal level is sufficient for feeding/eating

- Initiate and complete a feeding eval as per physician order

- Assign client to an OTA to monitor cognitive status

Defer evaluation until client arousal level is sufficient for feeding/eating

Which of the following would most likely result in coughing (aspiration) after the swallow?

- Pooling of fluid in the valleculae

- Opening of the cricoid muscle

- Nasoreflux

Pooling of fluid in the valleculae

True or false: A client with CNS damage and impaired sensation may have difficulty with pureed food because it does not stay together as a bolus.

True

An OT client with rapidly advancing ALS has lost functional use of his UE (shoulder, elbow, wrist, and hand strength is 2/5 or below). He fatigues rapidly when attempting to use his hands. He has moderate dysarthria. In the past, he was able to communicate with his grandchildren using an iPad. This has become more difficult to the point that he is becoming withdrawn. Which of the following is best practice regarding augmentative communication?

- Collab with SLP on a device that utilizes visual scanning to communicate

- Collab with SLP on a device that utilizes speech to text feature on his iPad

- Work with the client on strengthening hand and finger muscles to increase ability to use his iPad

Collab with SLP on a device that utilizes visual scanning to communicate

True or false: Fatigue is a major complaint with someone diagnosed with MS.

True

An OT client requested coffee when they came to the clinic. They start coughing before the swallow. What phase of the swallow is impaired?

- Anticipatory

- Oral

- Pharyngeal

- Esophageal

Oral

Upon chart review, you find that your patient was diagnosed with a left MCA ischemic stroke. You see that he has right hemiplegia. Which assessment would be appropriate to complete with this patient?

- Motor Assessment Scale (MAS)

- Fugl Meyer

- Modified Ashworth

- All of the above

All of the above

You just received orders to eval and treat a client that has a diagnosis of R MCA stroke. In general, what problem would you anticipate?

- Aphasia

- Left-sided neglect

- Right visual field deficit

- Ataxia

Left-sided neglect

You hand your patient a toothbrush and she combs her hair with it. What is she displaying?

- Ideomotor apraxia

- Ideational apraxia

- Constructional apraxia

- Perseveration

Ideational apraxia

Your patient is diagnosed with a R PCA stroke. Which of the following deficits would you anticipate?

- Aphasia

- Homonymous hemianopsia

- Ataxia

- Dysphagia

Homonymous hemianopsia

What part of the brain regulates attention and damage can result in decreased consciousness?

- Occipital lobe

- Reticular activating system

- Prefrontal cortex

- Wernicke's Area

Reticular activating system

Your patient was diagnosed with a thalamic stroke. Which of the following symptoms could they possibly experience?

- Impaired proprioception and severe pain in one side of the body

- Vertigo

- Apraxia

- Ataxia

Impaired proprioception and severe pain in one side of the body

Which of the following cognitive strategies would not be appropriate for a client presenting at Rancho level 5-6?

- Erroerless learning

- Goal-Plan-Do-Review

- Memory notebook

- Both B and C

Both B and C

Your patient was diagnosed with a brainstem stroke. Which of the following symptoms would you possibly see?

- Diplopia

- Dysarthria

- Hemiplegia

- All of the above

All of the above

You are an OT working in the IRF setting. You are setting the plan of care for your patient that is admitted due to a recent CVA. The patient will be receiving OT, PT, and ST. Which of the following is a likely plan of care in this setting?

- 1 hour of OT per day, 5 days per week for 3 weeks

- 1.5 hours of OT per day, 5 days per week for 3 weeks

- 1.5 hours per day 2-3 days per week for 3 weeks

- 1 hour per day 2-3 days per week for 3 weeks

1 hour of OT per day, 5 days per week for 3 weeks

What impairments would you expect to see if you had a patient diagnosed with a R MCA occlusion?

- Left hemiplegia and left hemi-sensory impairment

- Spatial-perceptual impairments

- Aphasia

- Both A and B

Both A and B

An OT is working with a client with moderate dementia in a SNF. The OT is attempting to have the client was their face at the sink. The client is easily distracted and is becoming agitated, even after repeated cues from the OT. What would be the best course of action for the OT to take?

- Continue to provide tactile and verbal cues to facilitate task completion

- Take a break from the task. Have a conversation with the client about the weekend activities and the weather for five mins before resuming the task

- Take client back to their room for a nap and try the activity later

- Sternly tell the client to focus on the task

Take a break from the task. Have a conversation with the client about the weekend activities and the weather for five mins before resuming the task

A client with an ACLS Performance Test score of three (manual actions/activities). Which of the following would be the best treatment activity to have a client with a cognitive-functional level of three complete during therapy?

- Facilitate cooking a six-ingredient, two-course meal with standby assist

- Facilitate social interaction in the caf in a large group setting. Encourage client to engage in conversation. Movie and popcorn is available for client to enjoy

- Transport client to a chair in their room to watch his favorite TV show, a part of his daily routine

- Demonstrate brushing hair. Present the hair brush to client and have them brush their hair

Demonstrate brushing hair. Present the hair brush to client and have them brush their hair

The tradition on the rehab unit is for clients who are leaving to have them plan their "moving on" party. An OT client who is tested at an ACL level 4 will be discharged next week. The OTA who is assigned to them is having difficulty facilitating from the client. Which of the following recommendations are the most appropriate?

- At a Level 4, they will not be able to plan the party. Ask the caregivers what they'd like and don't involve the client

- At a Level 4, they should be able to participate in goal-directed activities that are familiar to them. Try providing them with incentives (candy) to participate in planning the party

- At a Level 4, they will not be able to plan the party. Engage them by showing them a limited number (less than 3) of pics from previous parties and ask them to choose

At a Level 4, they will not be able to plan the party. Engage them by showing them a limited number (less than 3) of pics from previous parties and ask them to choose

Linda is an 81 y/o with diagnosis of dementia. When you are working with her during her morning self-care routine, she's able to carry out basic tasks with verbal cues. She can navigate in her home and neighborhood independently, but gets lost at the store or any new environment. Based on her performance, what's her ACL?

- Level 2

- Level 5

- Level 3

Level 3

A new client was admitted to memory care unit of a long-term care institution. Orders are for OT to establish engagement in memory unit programming based on cognitive level. The client scores a 3.0 on ACL. Which of the following would be appropriate recommendations for activities?

- Establish and maintain a structured schedule

- Place objects needed for the activity in front of them, may need to split up as to not overwhelm them

- Incorporate as much fine motor activity as possible

- Both A and B

Both A and B

True or false: It is highly recommended to evaluate cognition not only using linguistic (paper pencil/tabletop) tools, but functional cognitive assessment tools as well.

True

During a team meeting with the client and their family, the OT reports that client scored a 4.6 on ACLS-5. They stated the client would be able to live alone with daily assist to monitor personal safety. The family asks how the OT came about this score. What's the most appropriate response?

- We administered the ACLS-5, which is a screening tool and we verified the score by observing the client in multiple different situations.

- We observed the client completing their morning routine, then compared their abilities using the Routine Task Inventory.

- The ACLS-5 is an evidence-based assessment that predicts ADLs and IADLs.

We administered the ACLS-5, which is a screening tool and we verified the score by observing the client in multiple different situations.

Phyllis was admitted to the hospital for a UTI and had also recently received a round of chemotherapy. You evaluated her on Monday, and she was Alert & Orientedx4 and was following prompts well. On Wednesday, you went in for treatment and she was extremely agitated, and the nurse reported she has had inappropriate speech. What do you think has happened?

- Phyllis is experiencing delirium

- Phyllis is starting to develop chemotherapy-induced cognitive impairment

- Phyllis is showing early signs of dementia

Phyllis is experiencing delirium

You are leading a small group consisting of caregivers of individuals with dementia. One participant said she "lives in fear" of her husband wandering off and getting lost. Which of the following is the best recommendation?

- Recruit neighbors who can assist with the search

- Disguise doors with window treatments and nail windows shut

- Allow them to wander and follow them--they usually follow the same path in the future

- Both A and C

Both A and C

True or false: The best way to work with a client that has a problem with orientation is to use errorless learning.

True

An OT client presents with motor function below the neurologic level, and most key muscles below the neurologic level have a muscle grade less than 3, would receive an ASIA rating of?

- A

- B

- C

- D

C

Which of the following adaptive devices would facilitate self-feeding with a person who has a complete C5 lesion?

- Universal cuff with wrist support splint

- Short opponens splint

- Large handle spoon

Universal cuff with wrist support splint

Which of the following is a realistic long-term goal for an individuals with a C6 SCI in IRF?

- Eating -- QI level 5-6

- Lower body dressing -- QI level 5-6

- Toileting -- QI level 4-5

- Sliding board transfer -- QI level 3

Eating -- QI level 5-6

Which of the following would cause the need for increased assist for an individual who is aging with an SCI?

- Shoulder pain

- Fatigue and weakness

- Weight gain

- All of the above

All of the above

You are working on morning BADLs with a client who is status post complete SCI at the T5-6 level. Client uses a TLSO to stabilize the spine and has orders to remove the TLSO while in supine. When you arrive for treatment, client is in a seated position with the TLSO located on the bedside table. You place the TLSO and report the incident. Your next step is...

- Reinforce donning TLSO while in bed with client completing a log roll to don/doff TLSO

- Reinforce donning TLSO while in bed with client completing a segment roll to don/doff TLSO

- Work with client on UB dressing while in seated position, then place TLSO over their clothing for easy removal during day

- Carry on with session as normal

Reinforce donning TLSO while in bed with client completing a log roll to don/doff TLSO

Functionally, someone at the C7-8 level should, after therapy, be able to...

- Independently complete BADL with aide of assistive devices

- Independently transfer bed to w/c with or without assistive devices

- Independent with IADL with aide of assistive devices

- Independent with all ADLs without assistive devices

Independently complete BADL with aide of assistive devices

Your patient was diagnosed with an S3 SCI. Due to level of injury, patient will experience which of the following bladder issues?

- Reflexive (Spastic) bladder

- Areflexive (Flaccid) bladder

- Both answers

- Neither answer

Areflexive (Flaccid) bladder

The diagnosis of the OT referral states that client is a complete C5 SCI with Brown-Sequards Syndrome. What sensory loss would you anticipate?

- Loss of pain and temperature bilaterally with proprioception and light touch preserved

- Loss of sensation distal to forearm bilaterally

- Greater loss of function in the UE than the LE

- Loss of proprioception on one side and loss of pain and temperature on the other extremity

Loss of proprioception on one side and loss of pain and temperature on the other extremity

Your patient who has a T2 SCI presents in OP clinic in w/c with a pounding headache, bradycardia, sweating, and has goosebumps above the level of injury. Which of the following do you suspect and what is the best course of action?

- Orthostatic hypotension, move patient to supine

- Orthostatic hypotension, keep patient upright in w/c

- Autonomic dysreflexia, keep patient upright in w/c, look for noxious stimuli, and contact 911

- Autonomic dysreflexia, transfer patient to supine, look for noxious stimuli, and contact 911

Autonomic dysreflexia, keep patient upright in w/c, look for noxious stimuli, and contact 911

Your new eval has a diagnosis of central cord syndrome. How would you expect him to present?

- Greater function in LE than UE

- Greater function in UE than LE

- Greater function on one side of body than the other (hemiplegia)

- He will only have autonomic dysfunction

Greater function in LE than UE