Missed Practice Test Questions

An OTR working in a school system with a group of high school seniors is focusing on transitional planning and entering into the workforce following graduation. The IEP (individualized education program) goals include exploring employment options to better prepare for transitioning from high school to the community. Which BEST describes the vocational program that this OTR is providing?

A. Pre-vocational skills training program

B. Transitional employment program

C. Work readiness program

D. Vocational rehabilitation program

A. Pre-vocational skills training program (Yes, prepares high school students for success in the community for when they transition out of the educational system and into the community)

B. Transitional employment program (No, this would be an internship/apprenticeship that gives a person hands-on training for a particular job. Could be helpful once students identify area of interest)

C. Work readiness program (No, these are community-based opportunities that allow clients to obtain help with seeking employment. Such as, assistance filling out applications, creating a resume or developing interview skills. Would be helpful once students have identified interests)

D. Vocational rehabilitation program (No, this helps clients find work or helps with recent injuries to identify new areas of interest related to work/career. Appropriate for students to bridge gap from education system and community entry upon graduation. )

At the beginning of a treatment session, an occupational therapy practitioner takes a client's blood pressure and records a measurement of 128/76. The occupational therapy practitioner has the client engage in active exercise and higher intensity activities in the rehabilitation gym as part of the intervention.

The occupational therapy practitioner allows the client to rest after 15 minutes of the exercise and immediately takes the client's blood pressure again recording a measurement of 102/60. What is the BEST option for the occupational therapy practitioner to consider with these blood pressure readings?

1. Both readings would be considered normal responses to rest and exercise and the occupational therapy practitioner should proceed with the intervention

2. The second blood pressure reading would be considered an abnormal response and the intervention should be terminated

3. The occupational therapy practitioner should investigate with the medical team to understand which reading is the usual baseline for this client

4. Both readings would be considered normal responses to rest and exercise but the occupational therapy practitioner should terminate the intervention if the client reports abnormal symptoms

1. Both readings would be considered normal responses to rest and exercise and the occupational therapy practitioner should proceed with the intervention ( No, these readings are not in the hypertension range but the second reading is much lower than the resting reading )

2. The second blood pressure reading would be considered an abnormal response and the intervention should be terminated

3. The occupational therapy practitioner should investigate with the medical team to understand which reading is the usual baseline for this client (No, it is good to know the client’s typical BP at rest, variations in readings has the most clinical significant)

4. Both readings would be considered normal responses to rest and exercise but the occupational therapy practitioner should terminate the intervention if the client reports abnormal symptoms (The change in readings is not a typical response to exercise and the exercise should be terminated regardless of symptoms

A client is admitted to an inpatient unit to address alcohol use disorder. The client is referred for occupational therapy services and demonstrates a previous history of positive occupations, verbalizing motivation to improve function and engagement. The occupational therapy practitioner determines that solution-focused brief therapy (SFBT) is the most appropriate intervention to use with this client. Which BEST reflects this type of intervention approach?

1. Groups that support abstinence and promote a release from the cycles of alcohol use disorder

2. Use of the client's strengths to gather resources for goal achievement; client is the expert in change

3. Acknowledging challenges associated with abrupt change in alcohol use and encouraging harm reduction strategies

4. Identifying occupational losses, changes in roles, and promoting awareness of the impact alcohol use has on quality of life

1. Groups that support abstinence and promote a release from the cycles of alcohol use disorder (No this relates to 12-step programs, not SFBT)

2. Use of the client's strengths to gather resources for goal achievement; client is the expert in change

3. Acknowledging challenges associated with abrupt change in alcohol use and encouraging harm reduction strategies (No, this is a form of CBT)

4. Identifying occupational losses, changes in roles, and promoting awareness of the impact alcohol use has on quality of life (No, this is characteristic of evaluation and screening tools)

A client presents to occupational therapy for evaluation 6 months after experiencing a traumatic brain injury

(TBI) related to a workplace injury. The occupational therapy practitioner identifies that the client performs at an 8 (purposeful, appropriate) on the Rancho Los Amigos scale. The client's main goal for evaluation is to explore new employment options that are appropriate for current skills and abilities. Which work program would be MOST appropriate for this client?

1. Work hardening program

2. Work conditioning program

3. Work readiness program

4. Vocational rehabilitation program

1. Work hardening program (No, this is a back-to-work model for clients injured and wishing to return to the former employment)

2. Work conditioning program (No, this focuses on the improving client factors aspect (strength, endurance AROM) of the pt’s rehab process for return to work)

3. Work readiness program (No, these programs are designed to help individuals identify work options that match interests, skills, and abilities)

4. Vocational rehabilitation program (Yes, vocational rehab assists clients in identifying areas of interest with work/vocation. This client may not be able to return to former employment, needing an evaluation to identify areas of interest in relationship to work, skills, and abilities)

A client with low vision lives with a spouse and has difficulty navigating the home environment safely. The spouse often leaves cabinet doors open, the dishwasher open, and moves furniture regularly. What would be the most effective strategy for an occupational therapy practitioner to implement in order to enhance safety in the home for the client?

1. Task lighting

2. Organization

3. Use of contrast

1. Task lighting (No, this won’t be sufficient for the client to safely navigate all hazards at varying times during the day”

2. Organization (Yes, using organizational strategies in the home allows the client to be more independent and expect consistency with location of items)

3. Use of contrast (No, this promotes independence for clients with vision impairments for near tasks. This client’s inconsistent and unexpected environment is limiting independence and safety)

A client presents to occupational therapy with a diagnosis of AIDS-Dementia Complex. During evaluation, the OTR noted impairments in cognition, including visual spatial impairments, visual motor coordination, and difficulty sequencing tasks. Which intervention is MOST APPROPRIATE for the OTR to provide with this client?

1. Balloon volley and tangram puzzles

2. Scan course and narrated walks

3. Origami and theraputty exercises

4. Reading and writing task

1. Balloon volley and tangram puzzles (Yes, the balloon volley address visual motor coordination where the client has to see/find balloon and then elicit motor reaction. The tangram puzzles address visual spatial skills and sequencing)

2. Scan course and narrated walks ( No, this doesn’t address the impairments identified.)

3. Origami and theraputty exercises ( No, origami requires visual spatial and sequencing skills but theraputty only promotes hand stress and doesn’t address visual motor coordination)

4. Reading and writing task (No, eventhough reading and writing tasks require visual motor coordination, these tasks don’t fully address the visual spatial impairments and sequencing impairments)

A client with chronic amyotrophic lateral sclerosis (ALS) experiences weakness in both legs. The client lives alone and the main concern is being able to continue to stay in the home as the disease progresses. Which of the following interventions is MOST appropriate to implement with this client?

A. A home program for lower extremity exercises

B. Measurement for a manual wheelchair

C. Discuss the possible need to hire a caregiver

A. A home program for lower extremity exercises

B. Measurement for a manual wheelchair

C. Discuss the possible need to hire a caregiver (Yes, ALS is a chronic progressive condition and compensatory/adaptive strategies and environmental modifications are more appropriate d/t to ALS prognosis)

A 4-year-old child with decreased trunk and head control attends a 2-day-a-week mother's day out day preschool group. The mother mentioned that during the time the child is there, the staff does not move the child from the wheelchair onto seating options. The staff at the preschool are uncomfortable with the seating options in the classroom and feel that the seating options do not support the child's needs. The staff would like recommendations on possible seating options for the child that support sitting on the floor or at the same level with peers and provides support, as the child tends to fall sideways. What would be the BEST option for the occupational therapy practitioner to recommend in this situation?

1. Corner chair

2. Cube chair

3. Howda Hug chair

1. Corner chair (Yes, this provides external support for children with inadequate postural control of neck/head/ trunk and those who are inclined to fall sideways or back if unsupported)

2. Cube chair (No, this would be appropriate if the child didn’t require neck support)

3. Howda Hug chair (No, this chair provides proprioceptive feedback to those needing extra sensory input. It would not provide trunk/neck support)

An occupational therapy practitioner is leading a mental health and wellness group in a community-based setting. The facility's administrator requests permission for a local news crew to attend a session, aiming to promote the organization and the group to the community. The practitioner has reservations due to the sensitive nature of the topics discussed. However, the administrator points out the practitioner's reliance on grant and donor funding, suggesting that publicity is essential for job security. Ultimately, the practitioner agrees to allow the news crew to record the group session. What type of ethical dilemma BEST characterizes the practitioner's decision in this scenario?

1. Malpractice

2. Beneficence

3. Conflict of interest

4. Veracity

1. Malpractice (No, this is rendering services which result in injury, loss, or damage)

2. Beneficence (No, refers to actions done for the benefit of others)

3. Conflict of interest (Yes, the practitioner is at conflict between protecting the privacy/well-being of group members vs the pressure to secure job stability)

4. Veracity (No, this refers to telling the truth)

An occupational therapy practitioner is treatment planning for a client who underwent a coronary artery bypass graft (CABG) 8 weeks ago. The client's goals for occupational therapy include exploring options for increased independence with community integration and returning to work. The client reports frequent concerns about potentially exacerbating the heart conditions. Which lifestyle modification would be BEST for the occupational therapy practitioner to recommend as part of the client's goals?

1. Implementing sternal precautions relative to workplace requirements

2. Pursed lip breathing technique for energy conservation

3. Stress management strategies

1. Implementing sternal precautions relative to workplace requirements (No, the client is beyond the need to adhere to sternal precautions. Eight weeks after surgery, client is no longer required to implement them d/t healing.

2. Pursed lip breathing technique for energy conservation (No, this is not the most effective recommendation to help the client reach the stated goals)

3. Stress management strategies (Yes, lifestyle modification is essential to improving cardiovascular health. Coping mechanisms for stress/anxiety are required to access community and returning to work)

A client is receiving occupational therapy in an outpatient clinic for cancer rehabilitation. The client presents for an occupational therapy session and confides in the OTR that the cancer has returned and the client will need to undergo additional treatment. What is the BEST way for the OTR to handle this situation?

1. Discharge the patient and do not apply charges for the session.

2. Use open-ended questions and listen quietly to client's concerns.

3. Tell the client that he or she will be okay and continue therapy as planned.

4. Contact the referring physician to determine changes in therapy needs.

1. Discharge the patient and do not apply charges for the session. (No)

2. Use open-ended questions and listen quietly to client's concerns. (Yes, this will allow the pt to comfortably confide in the OT and promote client-directed care)

3. Tell the client that he or she will be okay and continue therapy as planned. (No)

4. Contact the referring physician to determine changes in therapy needs. (No, this isn’t necessary as the patient’s functional status has not changed.)

An OTR is working in an outpatient pediatric clinic supervising multiple COTAs. The facility has recently hired a COTA to be the clinical director. This COTA has many years of experience in both school-based and outpatient pediatric practice. What work responsibilities will the clinical director, who is a COTA, be able to complete WITHOUT supervision from the OTR?

1. All COTA work responsibilities must be supervised by an OTR, regardless of title

2. Any administrative responsibilities such as billing, scheduling, hiring, and marketing

3. All patient care can be provided by the COTA because of this COTA's level of expertise and job title

1. All COTA work responsibilities must be supervised by an OTR, regardless of title (

2. Any administrative responsibilities such as billing, scheduling, hiring, and marketing

3. All patient care can be provided by the COTA because of this COTA's level of expertise and job title

COTAs do not need OTR supervision to perform clerical, administrative, and management work responsibility (billing, scheduling, hiring, and marketing)

An occupational therapy practitioner (OTR) is treating a client 3 weeks following surgical repair of a distal biceps tendon rupture of the dominant upper extremity. The client is currently restricted from active forearm supination and demonstrates decreased strength and endurance. The client reports difficulty bringing food to the mouth during meals and expresses a desire to eat independently without violating postoperative precautions. Which of the following adaptive equipment recommendations is MOST appropriate to support safe and independent self-feeding at this time?

1. Universal cuff

2. Swivel fork or spoon

3. Mobile arm support device

1. Universal cuff (No, this would not address the need to maintain the utensil in proper orientation without supination. Client’s will have the appropriate grip strength to grasp a utensil)

2. Swivel fork or spoon (Yes, these will compensate for limited supination, allowing utensil to remain level without requiring supination)

3. Mobile arm support device ( No, this is designed to assist with proximal weakness (shoulder/elbow) by reducing effects of gravity. Client’s primary limitation is restricted forearm supination not severe weakness/poor endurance)

An OTR is evaluating a client with early-stage dementia, osteoarthritis, and depression in a home-based setting. The doctor referred the client to occupational therapy services for concerns regarding medication compliance. The doctor noted that prescriptions have been filled irregularly as the client states that refills are unnecessary since prescription bottles are still full. The OTR observes the client opening the pill bottles, which the client has some difficulty doing due to pain in hands. The OTR would like to complete a formal assessment to obtain full information for setting goals and developing a treatment plan for this IADL. Which assessment is BEST to evaluate this client?

1. 9-Hole Peg Test

2. Performance Assessment of Self-Care Skills (PASS)

3. Screening for Self-Medication Safety Post-Stroke Scale

4. Morisky Medication Adherence Scale

1. 9-Hole Peg Test ( No, this test provides insight into the client’s fine motor skills, however, this IADL requires both cognitive and motor skills and this assessment only evaluates a small portion of skills required for this task)

2. Performance Assessment of Self-Care Skills (PASS) (Yes, this is a performance-based measure that has a subtest for medication management. It considers both cognitive and physical skills required to fully engage in this occupation)

3. Screening for Self-Medication Safety Post-Stroke Scale (No, a screening does not provide enough ifo into the client’s cognitive and physical skills to complete this task)

4. Morisky Medication Adherence Scale (No, this is a self-report questionnaire and d/t to client’s potential cognitive impairments this may not be a valid test)

An OTR is providing intervention to a client with a diagnosis of fibromyalgia. The client reports difficulty completing the night time routine in a timely manner secondary to increased pain and fatigue. Which OT recommendation would be BEST for the client to incorporate at home to improve ease of the night time

routine？

1. Practice joint protection techniques for opening jars, containers, and doors

2. Apply a moist hot pack to the affected areas with 3-5 layers of towel

3. Implement energy-conservation strategies including box breathing techniques

4. Use built-up handles for grooming tools

1. Practice joint protection techniques for opening jars, containers, and doors (No, joint protection techniques are useful for clients with joint inflammation and pain.)

2. Apply a moist hot pack to the affected areas with 3-5 layers of towel (No, moist heat can be helpful however, 6-8 layers is required for safety.

3. Implement energy-conservation strategies including box breathing techniques

4. Use built-up handles for grooming tools (No, this is helpful for clients with weak grasp, decreased strength, or decreased AROM.)

After conducting a recent reassessment of a 16-year-old student who experienced a traumatic brain injury

at the age of 6, an interdisciplinary educational team at a local public high school has discovered significant difficulties in completing written classroom assignments and homework, despite several years of intervention. What should be the educational team's immediate NEXT course of action?

1. Focus therapy on the student's workload and address completion of written assignments and

2. Recommend the student to repeat a grade or enroll in a more intensive academic program.

3. Identify appropriate transition goals for the student

1. Focus therapy on the student's workload and address completion of written assignments and homework (No, this fails to acknowledge the student’s specific needs/challenges and may lead to further frustration and further academic struggles for the student)

2. Recommend the student to repeat a grade or enroll in a more intensive academic program. (No, simply repeating a grade/increasing academic demands without addressing the underlying issues related to TBI may not effectively support the student’s long-term success)

3. Identify appropriate transition goals for the student (Yes, this approach ensures that the student receive appropriate support and guidance needed to achieve success beyond high school.

An OTR is working with a client with a recent transradial amputation. The client is 7 days post-surgery and is beginning to experience extreme phantom limb pain throughout the day. Which intervention is MOST APPROPRIATE for the OTR to implement with this client?

1. Initiate isometric exercises and active movement of muscles daily

2. Provide rough textures to the residual limb for stimulation

3. Use vibration and tapping techniques over the residual limb

4. Encourage the client that the sensation will resolve in time

1. Initiate isometric exercises and active movement of muscles daily ( Yes, isometric exercises and active movement of the muscles associated with the phantom limb can be beneficial to reducing phantom limb pain)

2. Provide rough textures to the residual limb for stimulation (No, this a technique used to desensitize a hypersensitive residual limb)

3. Use vibration and tapping techniques over the residual limb (No, this is a technique used to desensitize a hypersensitive residual limb)

4. Encourage the client that the sensation will resolve in time (No, this is incorrect.)

An occupational therapy practitioner is supervising a level Il fieldwork student. When reviewing one of the student's completed evaluations, the occupational therapy practitioner notes that the fieldwork student documented the impact illness and disability has had on the client's occupational engagement, role performance, and relationships with family. Which BEST describes the level II fieldwork student's professional reasoning?

1. Narrative reasoning

2. Scientific reasoning

3. Procedural reasoning

4. Ethical reasoning

1. Narrative reasoning (Yes, this allows for a greater understanding of individual circumstances, specifically addressing the impact of illness and disability on occupational performance)

2. Scientific reasoning (No, this involves the use of applied logic and scientific methods.)

3. Procedural reasoning (No, this is reasoning based on routines for identified conditions)

4. Ethical reasoning (No, this is a systematic approach to moral conflict, addressing ethical dilemmas and generates alternative solutions to resolves the dilemmas)

An occupational therapy practitioner is working with a 15-year-old student in a school-based setting to address developmental disorder and support engagement in classroom routines. During a scheduled session, the student presents as emotionally withdrawn, reports feeling overwhelmed by classwork, and refuses to participate in the planned activity. The student remains seated but disengaged and quietly asks to return to class. What is the MOST appropriate action for the occupational therapy practitioner to take?

A. Encourage the student to explore their emotions verbally or through preferred sensory-motor tasks while gradually redirecting to therapeutic goals

B. Offer the student an alternative therapeutic activity focused on stress management and allow the session to proceed in a low-demand format

C. Validate the student's emotional state, suggest a short break, and plan to resume the session later in the day when the student may be more receptive

A. Encourage the student to explore their emotions verbally or through preferred sensory-motor tasks while gradually redirecting to therapeutic goals ( Yes, this supports the student’s mental health through validated occupation-based strategies and builds trust without compromising the therapeutic process)

B. Offer the student an alternative therapeutic activity focused on stress management and allow the session to proceed in a low-demand format (NO, this doesn’t actively engage the student in emotional processing or therapeutic rapport building.)

C. Validate the student's emotional state, suggest a short break, and plan to resume the session later in the day when the student may be more receptive (No, this delays therapeutic engagement and misses an immediate opportunity to support the student’s emotional needs in the moment)

A law firm, with more than 200 employees, is interested in developing a wellness program and an injury prevention program. The firm has determined that the addition of these programs is an added benefit to the employees, provides an incentive for hiring additional employees, and encourages retention. The law firm hires an occupational therapy practitioner to develop and implement these programs. The occupational therapy practitioner spends time understanding the structure of the organization as well as the many roles that occur within it. The occupational therapy practitioner reviews previous complaints and workers compensation claims that have been filed previously. The occupational therapy practitioner identifies many employees who report musculoskeletal injuries and return to work before the injury is fully resolved, resulting in multiple and repetitive complaints. Upon reviewing previous complaints and injuries from employees, the occupational therapy practitioner notes extensive musculoskeletal injuries specifically occurring in the mailroom and at the delivery dock of the law firm. The occupational therapy practitioner reviews the job descriptions for these positions and notes that the jobs do not state the physical requirements needed to complete the job.

Question 1 of 4 in this set

To reduce complaints and worker compensation claims, while promoting employee health and wellness, which are MOST IMPORTANT for the occupational therapy practitioner to implement?

Select the 3 best choices.

1. Ergonomic evaluations for all employees

2. Ergonomic evaluations for employees who report musculoskeletal problems

3. Worksite evaluations for all employees

4. Worksite evaluations for employees who report musculoskeletal problems

5. Work conditioning programs for all employees

6. Job demand analysis for all employees

1. Ergonomic evaluations for all employees (Yes, for all employees to improve comfort, safety, and prevent injury by matching the worker to the job/environment. Looks at workstation setup, work methods, and needed modifications.)

2. Ergonomic evaluations for employees who report musculoskeletal problems

3. Worksite evaluations for all employees (No, these are used after an injury/disability to determine if person can return to work)

4. Worksite evaluations for employees who report musculoskeletal problems (Yes, for employees with an injury/disability. Done on the job to see if they can return to work and if accommodations are needed)

5. Work conditioning programs for all employees (No, rehab program after injury to build strength, endurance, flexibility, and coordination so the employee can return to work. Includes job simulation)

6. Job demand analysis for all employees ( Yes, identifies the actual physical and cognitive demands of a job through interviews, observations, questionnaires, and measurements to ensure a good worker-job fit)

A law firm, with more than 200 employees, is interested in developing a wellness program and an injury prevention program. The firm has determined that the addition of these programs is an added benefit to the employees, provides an incentive for hiring additional employees, and encourages retention. The law firm hires an occupational therapy practitioner to develop and implement these programs. The occupational therapy practitioner spends time understanding the structure of the organization as well as the many roles that occur within it. The occupational therapy practitioner reviews previous complaints and workers compensation claims that have been filed previously. The occupational therapy practitioner identifies many employees who report musculoskeletal injuries and return to work before the injury is fully resolved, resulting in multiple and repetitive complaints. Upon reviewing previous complaints and injuries from employees, the occupational therapy practitioner notes extensive musculoskeletal injuries specifically occurring in the mailroom and at the delivery dock of the law firm. The occupational therapy practitioner reviews the job descriptions for these positions and notes that the jobs do not state the physical requirements needed to complete the job.

Question 2 of 4 in this set

The occupational therapy practitioner develops an ergonomics evaluation program to evaluate all employee workstations. Which is MOST APPROPRIATE to observe during the evaluation?

Select the 3 best choices.

1. Seating

2. Typing skills

3. Use of tools

4. Type of workstation

5. Intellectual capacity

6. Physical demands

1. Seating (Yes)

2. Typing skills (No, these are unnecessary to observe during an ergonomic evaluation; however, the positioning of arms/wrists/hand/fingers is essential to prevent typing-related musculoskeletal injuries)

3. Use of tools (Yes, this is an essential observation to promote ergonomic use and decrease likelihood of injury)

4. Type of workstation (Yes, this is critical to promote ergonomics)

5. Intellectual capacity (No, this is not a component of an ergonomics evaluation)

6. Physical demands (No, these are not a component of an ergonomics evaluation. This may be assessed during job demand analyses.)

A law firm, with more than 200 employees, is interested in developing a wellness program and an injury prevention program. The firm has determined that the addition of these programs is an added benefit to the employees, provides an incentive for hiring additional employees, and encourages retention. The law firm hires an occupational therapy practitioner to develop and implement these programs. The occupational therapy practitioner spends time understanding the structure of the organization as well as the many roles that occur within it. The occupational therapy practitioner reviews previous complaints and workers compensation claims that have been filed previously. The occupational therapy practitioner identifies many employees who report musculoskeletal injuries and return to work before the injury is fully resolved, resulting in multiple and repetitive complaints. Upon reviewing previous complaints and injuries from employees, the occupational therapy practitioner notes extensive musculoskeletal injuries specifically occurring in the mailroom and at the delivery dock of the law firm. The occupational therapy practitioner reviews the job descriptions for these positions and notes that the jobs do not state the physical requirements needed to complete the job.

Question 3 of 4 in this set

To promote better hiring practices and identify potential employees who are more appropriate for the job, which of the following are essential for the occupational therapy practitioner to implement?

1. Job demand analysis

2. Functional capacity evaluations

3. Worksite evaluations

4. Work hardening programs

5. Ergonomic evaluations

6. General vocational evaluations

1. Job demand analysis (Yes, assesses the physical demands of a job and is essential in determining requirements of the job)

2. Functional capacity evaluations (Yes, these are an objective measurement of an individual’s ability to perform work-related activities)

3. Worksite evaluations (No, these are on-the-job assessments to determine if an individual can return to work following an injury. This is for current employees after an injury not to new or potential employees)

4. Work hardening programs (No, these are meant to provide rehab to injured employees not new/potential employees)

5. Ergonomic evaluations (No, this evaluation is implemented with current employees for injury prevention and is not appropriate for new/potential employees)

6. General vocational evaluations ( Yes, these determine the potential employee’s aptitudes, abilities, and interests to find the most appropriate fit between employee and job).

A client with an extensive history of alcohol use disorder is referred for occupational therapy services. The client reports a strong desire to return to work. When interviewed regarding work and work habits, the client reports difficulty with regular attendance and was dismissed from a previous job due to intoxication. The client reports difficulty meeting the physical demands of many jobs and feels that jobs do not provide adequate challenges. Which assessment tool is MOST appropriate for the occupational therapy practitioner to implement with this client?

A. Occupational Self-Assessment

B. Canadian Occupational Performance Measure

C. Role Checklist

D. Work Environment Impact Scale

A. Occupational Self-Assessment ( No, this is a self-report measure that identifies clients’ problem areas in occupation, competence, and level of importance of varying occupations. This doesn’t address the work environment that may promote engagement for this client)

B. Canadian Occupational Performance Measure ( No, this is a semi-structured interview that addresses self-care, productivity, and leisure. Does not address the work environment that may promote engagement for client)

C. Role Checklist (No, this requires client to mark participation in varying roles they would like to participate. This does not address the client’s desire to return to work and does not address the work environment.)

D. Work Environment Impact Scale (Yes, this is a semi-structured interview which includes a rating scale to gather in on the client’s perception of the workplace environment, how the environment supports/inhibits performance, and the fit between the client’s skills and the environment.)

An occupational therapy practitioner evaluates a 62-year-old client in an outpatient therapy setting who has had a left middle cerebral artery cerebrovascular accident. The client was working a construction job when right-sided weakness and facial droop began. The client would like to regain use of the right, dominant arm to return to a favorite pastime: simple carpentry. Upon evaluation, the client presents with 2/5 strength proximally and 3/5 strength distally. Sensation is intact to light touch, deep pressure, pain, and temperature stimuli. Fine motor coordination is impaired.

The client has good minus dynamic standing balance and requires moderate to maximum assistance for basic activities of daily living.

What is the MOST APPROPRIATE exercise the occupational therapy practitioner should choose to increase strength in the right upper extremity for daily activities?

A. Active-assisted exercise with the inclined sander

B. Manipulation of tools during a carpentry project

C. Passive-assisted exercise with left upper extremity as a helper hand

D. Passive exercises performed with left upper extremity assistance

A. Active-assisted exercise with the inclined sander (Yes, this improves muscle strength and maintains ROM for individuals with trace, poor minus, and fair minus muscles)

B. Manipulation of tools during a carpentry project (No, manipulation of tools would facilitate improvements in fine motor coordination)

C. Passive-assisted exercise with left upper extremity as a helper hand (No, this can facilitate improvements in movement but wouldn’t challenge the client’s strength)

D. Passive exercises performed with left upper extremity assistance (No, passive exercise is used to preserve ROM not for strengthening)

An OTR, specializing in neurological rehabilitation, has been consulted to meet with a client to determine if the client would benefit from therapy services. Which form of documentation is MOST APPROPRIATE for the OTR to complete?

A. SOAP note

B. Initial evaluation

C. Discharge summary

D. Functional screenings

A. SOAP note (No)

B. Initial evaluation (No, these are completed to document the starting point of OT intervention and contain factual data obtained with assessments and evaluation findings interpretation. This is not used to determine if a client would benefit from OT services)

C. Discharge summary (No)

D. Functional screenings (Yes, these are utilized to determine whether or not the person would benefit from OT evaluation.)

A client is being discharged to the daughter's home after recovering from a stroke. The client still has minimal impairment in balance and will need to use a walker for mobility inside the home.

The daughter lives in a single-story home with one bathroom. The bathroom has a large walk-in shower with a seat near the back and a hand-held shower head available. The client was apprehensive about the new living arrangement, saying, "I do not want to bother my daughter and make all these changes to the house. I am sure | will be able to eventually move back to my home." The occupational therapy practitioner understands the client's concern but still thinks that some environmental modification must be in place to prevent falls, specifically in the bathroom.

What should the occupational therapy practitioner INITIALLY recommend?

A. Purchase a shower chair

B. Install grab bars in the shower

C. Place non-skid mat on the shower floor

A. Purchase a shower chair (No, a showerchair is unnecessary as the client has access to a seat in the shower")

B. Install grab bars in the shower (No, the client expressed not wanting to make permanent modifications to the home)

C. Place non-skid mat on the shower floor (Yes, this will help prevent slips and falls and doesn’t require permanent modification to the home)

An individual with chronic lower back pain has developed compensatory movement patterns in an attempt to reduce pain associated with movement. Which of the following is the MOST appropriate intervention to be utilized with this client?

A. Provide a back brace to limit abnormal movement and reduce pain

B. Teach the client proper body mechanics

C. Instruct in proper use of an adaptive device to assist with daily tasks that require bending or lifting

A. Provide a back brace to limit abnormal movement and reduce pain (No, this will provide temporary relief but doesn’t address the underlying issue of abnormal movement patterns. Relying on a brace can lead to muscle weakly with overuse)

B. Teach the client proper body mechanics (Yes, appropriate body mechanics can help decrease pain)

C. Instruct in proper use of an adaptive device to assist with daily tasks that require bending or lifting (No, this doesn’t address the root cause of the client’s pain and compensatory movement patterns)

A young, pediatric client has begun to show increased instability when walking and the parent reports frequent falls. This progressive muscle weakness is a concern to the occupational therapy practitioner. The occupational therapy practitioner observes enlarged calf muscles during clinical observations and notes that the child walks on toes frequently. The parent has requested assistance in determining a good plan of action to discuss with the pediatrician regarding the concerns.

Based on this information, what is the MOST possible diagnosis the pediatrician may consider?

A. Cerebral palsy

B. Muscular dystrophy

C. Stroke

D. Broken leg

A. Cerebral palsy (No, CP affects movement, muscle tone, balance and posture. May result in involuntary movements and impaired muscle coordination)

B. Muscular dystrophy (Yes, muscular dystrophy cause progressive muscle loss and weakness with difficulties relaxing muscles leading to increased calf muscle sizes)

C. Stroke (No)

D. Broken leg (No)

An occupational therapy practitioner treats a 36-year-old client who is 10 days post right transradial amputation. The client states that it occasionally feels like the wrist on the affected extremity is painful and feels stuck in flexion. The occupational therapy practitioner and client are able to perform active-assisted right forearm pronation and supination without pain. What should the occupational therapy practitioner do NEXT?

A. Continue probing the client about phantom pain in the affected RUE

B. Initiate RUE isometric exercises to be performed three times per day

C. Encourage active movement and functional use of the residual limb

A. Continue probing the client about phantom pain in the affected RUE (No, the client may have a negative psychological response to the term “phantom pain” as it suggest that the pain doesn’t actually exist)

B. Initiate RUE isometric exercises to be performed three times per day (No, at this stage active use, movement integration, and functional engagement should be a focus instead of residual limb rather than strengthening)

C. Encourage active movement and functional use of the residual limb (Yes, activation of the residual limb muscles may relieve discomfort caused by those sensations)

An OTR is working with a client on an inpatient rehabilitation unit.

Which is most appropriate for the OTR to document to promote communication to the other rehabilitation team members and the nursing staff regarding the client?

A. General information regarding the client's independence with basic ADL|

B. Information regarding the emotional response of the client to therapy

C. Specific details regarding how much assistance is needed for basic ADL

D. Avoid medical jargon and document using educational terms only

A. General information regarding the client's independence with basic ADL (No)

B. Information regarding the emotional response of the client to therapy (No)

C. Specific details regarding how much assistance is needed for basic ADL (Yes)

D. Avoid medical jargon and document using educational terms only (No, the use of medical info is essential and commonly used medical terminology is acceptable)

An occupational therapist completed an evaluation for a client after a cerebral vascular accident (CVA) and has recommended occupational therapy services 3 times a week for 12 weeks. The occupational therapist will transfer the plan of care to an occupational therapy assistant. The occupational therapist explains the plan of care to the client and that many of the interventions sessions will be provided by an occupational therapy assistant. The client becomes frustrated and angry, refusing to see the occupational therapy assistant for intervention. Which is MOST appropriate for the occupational therapist to implement with this client?

A. Negotiate the schedule with the client and determine concerns

B. Use active listening with the client while documenting the client's words

C. Cross arms and lean back from table while the client is talking

D. Leave the room and refuse to discuss the issues until the client is calm

A. Negotiate the schedule with the client and determine concerns (Yes, this will allow the pt to have shared decision-making in the treatment plan and interventions.)

B. Use active listening with the client while documenting the client's words (No, this may not be helpful and documenthing while listening does not provide the pt with full attention)

C. Cross arms and lean back from table while the client is talking (No)

D. Leave the room and refuse to discuss the issues until the client is calm (No)

An occupational therapy practitioner is working with an older adult with diminished hearing. Which is the MOST effective way for the occupational therapy practitioner to communicate with this client to develop rapport and trust?

A. Be consistent with word choices and avoid challenging words

B. Communicate through writing or assistive technologies

C. Position self in front of the client when speaking

A. Be consistent with word choices and avoid challenging words (No)

B. Communicate through writing or assistive technologies (No, it should not be assumed that the client is unable to communicate orally d/t hearing loss. )

C. Position self in front of the client when speaking (Yes)

An occupational therapy practitioner is working with a caregiver on facilitating feeding for a child with developmental delay. The caregiver wants to introduce soft foods to the child. Which motor movement must be integrated and demonstrated for the child to be able to eat a soft banana or avocado?

A. Lateral jaw movements and munching patterns

B. Lateral jaw movements and rooting

C. Lateral tongue movement and sucking reflex

D. Coordinated suck and swallow

A. Lateral jaw movements and munching patterns (Yes, to transition to eating soft foods, the child must demonstrate lateral jaw movement and munching patterns)

B. Lateral jaw movements and rooting (No)

C. Lateral tongue movement and sucking reflex (Yes)

D. Coordinated suck and swallow (No)

Lateral jaw movements → allow food to be transferred to center to the sides of mouth.

Munching → allow for voluntary biting on food, activating the lips and jaw during chewing

An occupational therapy practitioner is collaborating with an industrial design team to improve devices used with clients after cerebrovascular accidents. The industrial design team requests for the updated devices to be used with the occupational therapy practitioner's client population. How should the occupational therapy practitioner handle this request?

A. Allow for the devices to be used, notifying the client of the source of the devices

B. Decline for the devices to be used in clinic secondary to the source of the devices

C. Decline further collaborative efforts, as the collaboration cannot continue in clinic

D. Allow for the devices to be used with financial compensation provided if purchased

A. Allow for the devices to be used, notifying the client of the source of the devices

B. Decline for the devices to be used in clinic secondary to the source of the devices

C. Decline further collaborative efforts, as the collaboration cannot continue in clinic

D. Allow for the devices to be used with financial compensation provided if purchased

Fidelity → being faithful to one’s promises of commitments and avoiding conflicts of interest

An occupational therapy practitioner working in a large hospital system is seeing one of the physicians of the institution for upper extremity function following a fracture. The occupational therapy practitioner has worked with the physician in the past with other clients and is friendly with the physician's office staff. At lunch one day, the physician's front desk receptionist asks the occupational therapy practitioner how the physician is doing. What is the BEST response for the occupational therapy practitioner to have regarding the receptionist's question?

A. Be generic and tell the receptionist the physician is making improvements everyday.

B. Tell the receptionist that this is protected health information that cannot be disclosed.

C. Tell the receptionist that they shouldn't ask about this.

A. Be generic and tell the receptionist the physician is making improvements everyday. (No)

B. Tell the receptionist that this is protected health information that cannot be disclosed. (Yes)

C. Tell the receptionist that they shouldn't ask about this. (No)

An OTR is treatment planning a home program for a client with a diagnosis of dementia. The OTR completed the Allen Cognitive Level Screen (ACLS) and determined that the client is currently performing at an Allen Cognitive Level (ACL) of 5. When identifying goals, the client determines that accessing the community and public transportation would allow for greater independence and quality of life. Which recommendation would be MOST important to suggest to the client's immediate family to support the client in these goals?

A. Provide the client with a daily check-in with family

B. Provide a visual cue chart that allows the client to reference if confused with community and public transportation

C. Implement a dry erase checklist to be kept at home for community planning

D. Encourage the family to complete weekly check-ins with the client about community and public transportation use

A. Provide the client with a daily check-in with family (No, this is recommended for ACL 4: familiar activities)

B. Provide a visual cue chart that allows the client to reference if confused with community and public transportation (No, visual cueing is best for ACL 4.

C. Implement a dry erase checklist to be kept at home for community planning (No, visual cueing is best for ACL 4)

D. Encourage the family to complete weekly check-ins with the client about community and public transportation use

ACL Level 5 (exploratory actions) → IND with ADL/IADL with familiar routines.

During a pulmonary rehabilitation session, a client begins to exhibit signs of dyspnea. The OTR recommends the client to stop the exercise, sit down, and lean forward at the waist while supporting the upper part of the body using the forearms. What is the MOST important factor the OTR should document for this client's session?

A. Precipitating factors and circumstances

B. The client's blood pressure and heart rate

C. The level of supplemental oxygen used to resolve the dyspnea

D. The client's adherence to prescribed medications

A. Precipitating factors and circumstances (Yes, this is essential for pulmonary rehab programs, as it will determine the future activities as well as any necessary modifications)

B. The client's blood pressure and heart rate (No)

C. The level of supplemental oxygen used to resolve the dyspnea (No, there is no indication that the client required supplement oxygen and OT should never adjust the physician prescribed amount unless indicates in the therapy prescription and approved in the care plan)

D. The client's adherence to prescribed medications (No, not a priority when documenting the outcome of this session)

An occupational therapy practitioner is working with a child who was born prematurely and recognizes that the child is experiencing vision loss due to retinopathy of prematurity. Which of the following is the MOST likely expected to impact the child's occupational performance?

A. Limited visual tracking

B. Myopia (nearsightedness)

C. Double vision

A. Limited visual tracking (Yes, retinopathy typically results in disruptions to visual tracking d/t to decreased visual acuity or field losses)

B. Myopia (nearsightedness) (No)

C. Double vision (No, strabismus is a misalignment condition in infants and cwould cause double vision)

A middle-school child is creating a small model for a class project during a therapy session. The occupational therapy practitioner observes the child using very small movements to engage the tips of the thumb and index finger when creating the model. Which grasp is being used to manipulate very small items?

A. Tip pinch

B. Pincer grasp

C. Lateral pinch

D. Cylindrical grasp

A. Tip pinch ( Yes, thumb tip is meeting index finger tip)

B. Pincer grasp (No, the thumb is opposed to the index finger pad NOT tip)

C. Lateral pinch

D. Cylindrical grasp

An occupational therapy practitioner is reviewing a client's chart in preparation for evaluation. In the chart, the occupational therapy practitioner identifies that the client has been referred following transfemoral amputation with residual limb length of approximately 10 inches. Which of the following can the occupational therapy practitioner anticipate with this client?

A. Fewer functional challenges due to an above-knee amputation

B. Fewer functional challenges due to a below-knee amputation

C. More functional challenges due to the proximity of amputation

D. Fewer functional challenges due to the proximity of amputation

A. Fewer functional challenges due to an above-knee amputation (No)

B. Fewer functional challenges due to a below-knee amputation (No)

C. More functional challenges due to the proximity of amputation (Yes, the more proximal of an amputation, the greater functional challenges the person faces)

D. Fewer functional challenges due to the proximity of amputation (No)

A client with dysphagia has recently been placed on an International Dysphagia Diet Standardisation Initiative (IDDS|) Level

4 diet. During a feeding session, which type of food is MOST appropriate for the occupational therapy practitioner to provide?

A. Chewy foods

B. Pureed foods

C. Honey-thick foods

A. Chewy foods (Level 6 or 7)

B. Pureed foods

C. Honey-thick foods (Level 3)

IDDSI Level 4 → pureed or extremely thick foods

A client in an acute care setting recently experienced a traumatic brain injury and is at a Rancho Los Amigos Scale (RAS) level IV.

The client has been on bedrest for 3 weeks and is now cleared for out-of-bed activities. Which feature of a seating device is MOST IMPORTANT to support the client's functional needs and safety during initial out-of-bed activities?

A. The chair has reclining features to accommodate the client's postural stability and comfort

B. The chair has restraints for the upper and lower extremities

C. The chair has appropriate seat cushioning to prevent skin breakdown

A. The chair has reclining features to accommodate the client's postural stability and comfort (Yes, physical and physiological tolerance is low and should be monitored and planned accordingly for every session)

B. The chair has restraints for the upper and lower extremities (No, other methods to reduce harm should be prioritized rather than incorporating restraints on a clients. At this stage, may improve behaviors with changes in positioning)

C. The chair has appropriate seat cushioning to prevent skin breakdown (No, it is likely that the client can self-mobilize in the chair, even minimally, further preventing skin breakdown and therefore seat cushioning is not a priority)

After reviewing workers' needs through interviews as part of a work assessment, the occupational therapy practitioner sets a meeting with administration to discuss potential accessibility and universal design options to improve worker performance. During the meeting, the occupational therapy practitioner provides information regarding the value of supporting workers through accessibility efforts. Which BEST represents the intervention approach the occupational therapy practitioner is using?

A. Advocacy interventions

B. Virtual interventions

C. Groun interventions

D. Education and training

A. Advocacy interventions (Yes, Advocacy → empower clients to seek/obtain desired resources that promote health and well-being as part of occupational performance)

B. Virtual interventions (No)

C. Group interventions (No)

D. Education and training (No → Education = information to promote occupational engagement, health/wellness, and participation, Training = facilitates the acquisition of skill specific to meeting goals; Promotes enhanced performance)

A client is receiving occupational therapy services on an inpatient rehabilitation unit following a cerebrovascular accident (CVA).

During the evaluation, the occupational therapy practitioner observes that the client has difficulty locating all food on the left side of the tray only when eating. Which is MOST appropriate for the occupational therapy practitioner to document based on this observation?

A. Reduced visual scanning

B. Left-sided neglect

C. Oculomotor dysfunction

A. Reduced visual scanning (Yes, with Hemianopsia, a client will develop a large blind spot that increases difficulty seeing a complete picture of items)

B. Left-sided neglect (No, this occurs even when vision is fully intact. Client will ignore more than just stimuli on the left side, but the left side of their body)

C. Oculomotor dysfunction (No, this would result in double vision)

An occupational therapy practitioner completes an evaluation for a client with a hand injury. The occupational therapy practitioner tests for protective sensation. Which is the MOST APPROPRIATE way to test for protective sensation?

A. Randomly select one or two points on the hand and have the client determine one or two

B. Place smallest monofilament the client can feel on multiple areas of the client's hand

C. Apply pressure and temperatures to varying areas on the hand to determine if pain response or awareness is elicited

A. Randomly select one or two points on the hand and have the client determine one or two (No, this is two point discrimination)

B. Place smallest monofilament the client can feel on multiple areas of the client's hand (No, this addresses light touch)

C. Apply pressure and temperatures to varying areas on the hand to determine if pain response or awareness is elicited (Yes, applying pressure in varying areas to determine how much pressure is required to elicit a pain response)

An occupational therapy practitioner has been working with a family for many years. The child consistently comes to therapy at regular times every week and the therapist bills and documents accordingly. One week, the client did not attend at the normal day or time. The occupational therapy practitioner, on autopilot, billed for the routine time in error. The occupational therapy practitioner realizes the error and decides to see the client next week and not bill for that session instead of correcting the error. What BEST describes the ethical principle that is challenged?

A. Veracity

B. Justice

C. Fidelity

D. Duty

A. Veracity → Telling the truth and providing comprehensive/accurate/objecting info

B. Justice → Fair and equal distribution of goods/services; ensures impartial decision-making

C. Fidelity → Being faithful to one’s promises/commitments

D. Duty → Acting/practicing in a way that is required by law; not an ethical principles

An occupational therapy practitioner is working with a local business owner to ensure accessibility for all patrons. The occupational therapy practitioner and the local business owner meet at the business and discuss various opportunities to improve accessibility. Which BEST describes the service the occupational therapy practitioner is providing?

A. Consultation

B. Functional supervision

C. Peer supervision

D. Advocacy

A. Consultation (Yes. Consultation: collaborative process completed with stakeholders to identify and solve problems)

B. Functional supervision (No)

C. Peer supervision (No)

D. Advocacy (No. Advocacy: relies on power of persuasion to address the opinion of others. This would be applicable if the OT approached a local business owner to address accessibility issues or concerns)

An occupational therapy practitioner wants to maximize the effects of a stretching program for a client who sustained a work-related injury to the non-dominant, left upper extremity. The occupational therapy practitioner and client noticed improvements in elbow active range of motion (AROM) after stretches performed in treatment, but the client reports that stiffness and joint limitations return the next morning. Which of the following treatments is MOST APPROPRIATE to add to the existing stretching program to facilitate longer lasting gains in active range of motion (AROM)?

A. Contrast Baths

B. Ultrasound

C. Paraffin

A. Contrast Baths (No, this reduces pain and edema. Edema is not an issue with this patient)

B. Ultrasound (Yes, deep thermal modalities may enhance the outcomes of therapeutic activities that improve AROM and occupational performance)

C. Paraffin (No, this is localized heat to smaller joints to decrease stiffness, improve AROM and relieve pain. Not the best match for this patient)

Ultrasound → apply heat before prolonged stretch to promote more permanent elongation of muscle fibers.

An occupational therapy practitioner (OTR) is conducting an initial outpatient evaluation for a client who is 3 weeks post-cerebellar cerebrovascular accident. The client presents with severe truncal ataxia, dysmetria, and impaired timing of movement, resulting in dependence for all dressing tasks. During attempts at dressing, the client demonstrates excessive trunk sway and overshooting when reaching for clothing. The client reports a strong desire to regain independence but becomes unstable when attempting tasks in unsupported sitting. Which of the following is the MOST appropriate initial intervention to facilitate safe participation and progression toward dressing independence?

A. Use segmental bridging and core activation exercises prior to dressing tasks to improve proximal stability

B. Implement task-specific dressing practice in supported sitting while incorporating weighted cuffs

C. Facilitate dressing tasks in unsupported sitting while providing intermittent manual cues

A. Use segmental bridging and core activation exercises prior to dressing tasks to improve proximal stability (No, bridging exercises target strength and stability but do not directly address dysmetria or movement decomposition)

B. Implement task-specific dressing practice in supported sitting while incorporating weighted cuffs (Yes, early intervention for cerebellar ataxia should focus on task-specific training with maximal stability. Practicing meaningful occupations enhances motor learning more than isolated exercises)

C. Facilitate dressing tasks in unsupported sitting while providing intermittent manual cues (No)

An occupational therapist is completing an initial mobility evaluation for a client newly admitted to a long-term care facility following a right hemispheric CVA with left hemiplegia. Prior therapy documentation indicates poor trunk stability with trunk musculature graded at 2-/5 and delayed righting reactions. During the evaluation, the client is able to maintain brief supported sitting at the edge of the bed with verbal cueing but demonstrates inconsistent midline orientation and early fatigue. The client has not yet completed functional transfers since admission and reports feeling motivated to stand. Nursing staff report that two caregivers are typically available and that the client will require repeated daily transfers for basic care. Which transfer method is MOST appropriate at this stage of care?

A. Utilize a full-body mechanical lift with an appropriately fitted sling

B. Two-person sit-pivot transfer with gait belt

C. Lateral transfer using a sliding board

D. Powered sit-to-stand device

A. Utilize a full-body mechanical lift with an appropriately fitted sling (Yes, this offers reliable support, enhances safety, and aligns with safe handling protocols )

B. Two-person sit-pivot transfer with gait belt (No, d/t trunk strength and delayed righting reactions, this would increase risk of LOB, sudden collapse, and caregiver injury)

C. Lateral transfer using a sliding board (No, pt wouldn’t have enough trunk control, sustained sitting balance or controlled weight shifting enough for this transfer)

D. Powered sit-to-stand device (No)

An occupational therapy practitioner is working with a 42-year-old client who has chronic low back pain (LBP). The client is dependent in donning socks. Which method would be BEST for the occupational therapy practitioner to suggest to promote the client's independence in lower body dressing, specifically donning socks?

A. Encourage the client to lie supine, flexing the knee to the chest to don socks

B. Provide and instruct on the use of a sock aid

C. Encourage the client to be seated in a chair, and to bend at the waist keeping the back straight

D. Encourage wearing slippers or slide on shoes to reduce strain on the low back, avoiding socks

A. Encourage the client to lie supine, flexing the knee to the chest to don socks (Yes, this reduces the risk of twisting or curving of the spine in the process)

B. Provide and instruct on the use of a sock aid (No, this doesn’t provide stabilization for the back)

C. Encourage the client to be seated in a chair, and to bend at the waist keeping the back straight (No, this will not reduce pain or risk of further injury)

D. Encourage wearing slippers or slide on shoes to reduce strain on the low back, avoiding socks (No)

An OTR is working with a client who is unable to return to work due to chronic low back pain. The client consistently declines participation in occupational therapy and demonstrates increased anxiety, withdrawal, and fear with each activity introduced. Which is the BEST approach to encourage initial participation in occupational therapy?

A. Review prescribed medications and make any suggested changes for improved pain management

B. Apply moist heat prior to a meaningful activity using distraction techniques

C. Instruct and rehearse in proper body mechanics and postural training

D. Implement a progressive therapeutic home exercise program

A. Review prescribed medications and make any suggested changes for improved pain management (No)

B. Apply moist heat prior to a meaningful activity using distraction techniques (Yes, The OTR can first use moist heat to help decrease chronic pain and promote relaxation. Then the therapist can introduce a meaningful activity to distract the client from focusing on the pain. Adding music or another distraction can also help shift attention away from the pain.)

C. Instruct and rehearse in proper body mechanics and postural training (No, this will be included later in the rehab process when the client is willing and able to tolerate intensive activity)

D. Implement a progressive therapeutic home exercise program (No)

An occupational therapist working in the home care setting is struggling to manage the current caseload. The OTR is required to travel great distances throughout the day and has limited time to document all evaluations and intervention sessions. After completing an evaluation for a client in a very rural area, the OTR determines that the client would benefit from in-person services 3 times per week. What is the BEST option for the OTR to take to allow the client to receive the required services?

A. Treat the client as many times per week as possible when the OTR is in the area completing evaluations

B. Discharge other clients to free the OTR's schedule and allow more time to treat this client

C. Refer the client to telehealth services to maximize the client's time in therapy and decrease the travel demands on the OTR

D. Notify the supervisor that the OTR cannot provide the required services for this client due to current travel schedule

A. Treat the client as many times per week as possible when the OTR is in the area completing evaluations (No)

B. Discharge other clients to free the OTR's schedule and allow more time to treat this client (No)

C. Refer the client to telehealth services to maximize the client's time in therapy and decrease the travel demands on the OTR (No, the OT determined that the client required in-person services)

D. Notify the supervisor that the OTR cannot provide the required services for this client due to current travel schedule (Yes, OT should never accommodate a personal schedule over the needs of a client. IF the therapist is unable to provide services, they must refer the client to another therapist)

An occupational therapy practitioner is completing an evaluation with a client and assessed the client's muscle tone with a score of 2 on the Ashworth Scale. Which performance assessment would be MOST affected by the Ashworth Scale score?

A. Range of motion

B. Manual muscle test

C. Static two-point discrimination

D. Pinprick test

A. Range of motion (No, a score of 2 on the Ashworth menas the limb can be moved easily despite the marked increase in tone. PROM should be measured should still be measured)

B. Manual muscle test (Yes, a score of 2 means the client exhibited a more marked increase in muscle tone. Findings of MMT may not be be accurate in clients with increased tone. Client’s movement may not be voluntary and selective since the tone and strength of the muscles are not normal)

C. Static two-point discrimination (No, OT still needs to access the client’s sensory skills)

D. Pinprick test (No, the administration of this test is not influenced by tone)

A client sustained a below-elbow amputation and was fitted with an upper-limb body-powered prosthesis. The client has completed intermediate prosthetic training and is using the body-powered controls. As the client progresses in rehabilitation and begins advanced prosthetic training, which is MOST important for the occupational therapy practitioner to address with the client?

A. Gross motor movements using the prosthetic

B. Donning and doffing prosthesis

C. Functional goals and tasks

D. Wearing schedule

A. Gross motor movements using the prosthetic (No, this is typically addressed in intermediate prosthetic training)

B. Donning and doffing prosthesis (No, this is addressed early on in the rehab process. Prosthetic training begins after the final fitting of the prosthesis)

C. Functional goals and tasks (Yes, advanced prosthetic training addresses the functional use of the prosthesis)

D. Wearing schedule (No, this is addressed early on in the rehab process.

Prosthetic training begins after the final fitting of the prosthesis and addresses the evaluation of the prosthesis, donning/doffing, and the wearing schedule.

An occupational therapist is completing a swallow screening for a client with potential dysphagia following cerebrovascular accident

(CVA). The occupational therapy practitioner initiates the screen by asking the client to cough and clear the throat and then asks the client to swallow. Which is MOST important for the occupational therapy practitioner to observe initially during the screen?

A. Observe for extraoral and intraoral sensation and movements

B. Observe for drooling or voice change

C. Observe for uncontrolled coughing

A. Observe for extraoral and intraoral sensation and movements (No, this can be performed at bedside and is NOT a part of a swallow screen)

B. Observe for drooling or voice change (Yes, during the swallow screening the client is asked to cough or clear throat twice and then asked to swallow. The OT will observe for drooling or voice change initially and then proceed with a direct swallow text)

C. Observe for uncontrolled coughing (No, initially the OT needs to determine if the client is drooling or experiences voice change when clearing the throat. This will be done during the swallow test)

A 58-year-old client, in the early stages of Parkinson's disease, is referred to outpatient occupational therapy services. The referral states that the client experiences unilateral tremors, stooped posture, and early signs of festinating gait patterns. The client works as an attorney at a local law firm, lives with a spouse and 3 children, lives in a one-story home, and enjoys bowling with family.

Question 1 of 4 in this set

When assessing this client's needs, which assessment tools are appropriate for the occupational therapy practitioner to consider?

Select the 3 best choices.

A. Activities of daily living (ADL) assessment, including the Katz ADL

B. Cognitive screen, including Mini Mental State Examination

C. Balance assessment, including the Berg Balance Scale

D. Environmental assessment, including the Home Environmental Assessment Protocol

E. Sensory testing for bilateral hands, including

two-polnt discrimination

F. Dementia screening, including the Allen Cognitive Level Test

A. Activities of daily living (ADL) assessment, including the Katz ADL (Yes, this will evaluate the client’s ability to perform basic self-care tasks independently. Katz assesses functional status and identifies areas of difficulty)

B. Cognitive screen, including Mini Mental State Examination (No, cognition doesn’t need to be screened based on the mentioned information)

C. Balance assessment, including the Berg Balance Scale (Yes, this will assess balance and risk of falls and will be essential to promote safety)

D. Environmental assessment, including the Home Environmental Assessment Protocol (Yes, this will identify barriers at home and is critical to promote child safety)

E. Sensory testing for bilateral hands, including two-polnt discrimination (No, there is no indication that sensory function needs to be tested or addressed)

F. Dementia screening, including the Allen Cognitive Level Test (NO, cognition does not appear to be a limiting client factor)

A 58-year-old client, in the early stages of Parkinson's disease, is referred to outpatient occupational therapy services. The referral states that the client experiences unilateral tremors, stooped posture, and early signs of festinating gait patterns. The client works as an attorney at a local law firm, lives with a spouse and 3 children, lives in a one-story home, and enjoys bowling with family.

Question 2 of 4 in this set

Which interventions should an occupational therapist consider when assessing the needs of this client diagnosed with Parkinson's disease?

Select the 3 best choices.

A. Recommending medications to manage symptoms

B. Implementing home safety modifications

C. Providing education on energy conservation techniques

D. Suggesting new leisure activities that allow for sitting

E. Encouraging retirement from work due to Parkinson's diagnosis

F. Facilitating adaptive equipment use

A. Recommending medications to manage symptoms (No)

B. Implementing home safety modifications (Yes, this will allow the client to allow the client to continue to engage in roles, including spouse and parent is essential)

C. Providing education on energy conservation techniques (Yes, this is essential to occupational engagement)

D. Suggesting new leisure activities that allow for sitting (No, this is not currently necessary, possible adaptation of current leisure activities is recommended)

E. Encouraging retirement from work due to Parkinson's diagnosis (No, OT aim to support clients in maintaining meaningful roles and participation when safe and feasible)

F. Facilitating adaptive equipment use (Yes, this can improve functional activities and compensates for motor impairments associated with PD)

A 58-year-old client, in the early stages of Parkinson's disease, is referred to outpatient occupational therapy services. The referral states that the client experiences unilateral tremors, stooped posture, and early signs of festinating gait patterns. The client works as an attorney at a local law firm, lives with a spouse and 3 children, lives in a one-story home, and enjoys bowling with family.

Question 4 of 4 in this set

To address the client's leisure activities and ability to bowl with family, which interventions are most appropriate for the occupational therapy practitioner to implement?

Select the 3 best choices.

A. Using the same weight bowling ball and adjusting form

B. Aquatic therapy for joint mobility

C. Grip activities for strengthening and mobility

D. Cooking tasks that address kitchen cognitive skills

E. Mobility training using obstacle courses

F. Task-specific training for bowling techniques

A. Using the same weight bowling ball and adjusting form (Yes, this is appropriate and is likely to reduce the tremor. Adjusting form may be needed to compensator balance and gait patterns by doing a more midline throw of the ball rather than from the side of body)

B. Aquatic therapy for joint mobility (No)

C. Grip activities for strengthening and mobility (Yes, this can enhance hand-eye coordination and dexterity required for bowling)

D. Cooking tasks that address kitchen cognitive skills (No)

E. Mobility training using obstacle courses (No, this is not appropriate for the task of bowling. Often, mobility and gait training are provided by PTs)

F. Task-specific training for bowling techniques (Yes, this is recommended to promote motor movements)

An occupational therapy practitioner evaluates a 61-year-old client who is 1 day post right total knee replacement.

The client plans to discharge home with family for a couple of weeks. The client will have at least one family member to assist as needed during the day. The client would like to be able to toilet independently because it would be uncomfortable for family to help with that task. Which of the following interventions aligns BEST with the client's goal?

1. Training with adaptive equipment for lower body dressing

2. Education on home health aides that can help with toileting

3. Training the client to turn with small steps to flush the toilet

4. Raise toilet seat to decrease hip flexion with toileting

1. Training with adaptive equipment for lower body dressing (No, not priority d/t toileting goals)

2. Education on home health aides that can help with toileting (No, the patient’s goal is to toilet independently)

3. Training the client to turn with small steps to flush the toilet (Yes, d/t to unstable joint post replacement, small steps prevents ER which leads to instablity at the knee)

4. Raise toilet seat to decrease hip flexion with toileting (No, not necessary following a knee replacement)

A client sustained an injury to the ulnar nerve and complains of sensory loss along the ulnar side of the forearm, wrist, and hand.

Which of the following is the MOST important occupational therapy intervention?

A. Fabricate a splint to protect the affected area.

B. Instruct in visual protection of the anesthetic area.

C. Provide adaptive equipment to facilitate self-care

D. Use neuromuscular electrical stimulation.

A. Fabricate a splint to protect the affected area.(No, splints are to support weak muscles but must be removed ASAP to allow active muscle exercise)

B. Instruct in visual protection of the anesthetic area. (Yes, compensatory strategies are necessary to avoid injury while participating in occupations d/t sensory loss)

C. Provide adaptive equipment to facilitate self-care (No, client should continue to use vision to substitute for sensory loss to safely use AE during self-care)

D. Use neuromuscular electrical stimulation. (No, nMES provides external stimuli to strength new innervated muscles when motor function begins to return.)

An OTR is working with a large pharmaceutical company designing and implementing an ergonomic program. The OTR is initially tasked with evaluating a group of approximately 10 employees at one of the company's production lines that package pills.

Question 1 of 3 in this set

Which of the following would be the MOST IMPORTANT sources of objective data for acquiring information about a history of work-related injuries for employees?

A. Symptom surveys

B. Employee and supervisor interviews

C. Occupational Safety and Health Administration form 300: injury and illness logs (Yes, these are federally mandated recordkeeping that employees are required to maintain to document work-related injuries and illnesses)

D. Canadian Occupational Performance Measure

An OTR is supervising a level Il fieldwork student in an inpatient rehabilitation unit. The OTR notes that the student has difficulty with functional transfers and often avoids transferring clients if possible. The supervising OTR sets aside time after patient care is completed to address transfer training with the student. Which BEST reflects the type of supervision the supervising OTR is providing？

A. Clinical practice supervision

B. Functional practice supervision

C. Professional practice supervision

A. Clinical practice supervision ( Yes, the supervising OTR has identified areas of clinical weakness and determined the student would benefit from additional training to improve clinical competency)

B. Functional practice supervision (No, focuses on the performance and development of specific skills or competency like splinting by a hand therapist)

C. Professional practice supervision (No, this focuses on development of professional discipline-specific skills)

A client with chronic tendinitis is referred to occupational therapy.

The practitioner chooses to use a physical agent modality to decrease pain and promote tissue healing. Which modality would be MOST appropriate?

A. Contrast baths

B. Deep heat

C. Hot packs

A. Contrast baths (No, contrast baths promote tissue healing and may control edema but does not address chronic inflammation)

B. Deep heat (Yes, ultrasound addresses chronic inflammation, which occurs with tendinitis)

C. Hot packs (No, do not penetrate deeply enough to modify chronic tendon tissues)

An occupational therapy practitioner (OTR) is evaluating a client with a T10 spinal cord injury who uses a manual wheelchair for full-time mobility. During functional tasks, the client demonstrates posterior pelvic tilt, sacral sitting, forward sliding, and decreased trunk control when reaching outside the base of support. The therapist also notes limited passive knee extension when the client is seated. The client's feet are currently supported on standard footrests. Which intervention should the OTR implement FIRST to address the underlying cause of the client's postural dysfunction and improve occupational performance?

A. Add a pelvic positioning belt to maintain neutral pelvic alignment

B. Adjust the footrests to increase knee flexion and reduce hamstring tension

C. Provide a contoured back support to improve trunk stability during reaching

A. Add a pelvic positioning belt to maintain neutral pelvic alignment (No, this doesn’t address the hamstring tightness; using positioning devices without addressing the biomechanical issues may increase discomfort and risk of sliding)

B. Adjust the footrests to increase knee flexion and reduce hamstring tension (Yes, this addresses the posterior pelvic tilt by reducing hamstring tightness and increasing knee flexion by raising the footrests)

C. Provide a contoured back support to improve trunk stability during reaching (No, this may improve trunk support but doesn’t correct the posterior pelvic tilt and sacral sitting caused by hamstring tightness)

A client with upper extremity weakness is working with an occupational therapy practitioner to address strength. The client demonstrates full independent active range of motion (AROM) in supine. In order to gradually increase the challenge of the task, which is MOST appropriate for the occupational therapy practitioner to implement?

1. Reaching tasks using weighted objects in supine

2. Reaching tasks while seated on the edge of the mat

3. Continue with supine active range of motion activities

4. Practice reaching activities while standing at the sink

1. Reaching tasks using weighted objects in supine (Yes, increase the challenge by adding small amounts of weight in supine to allow for the client to build strength in a gravity-eliminated position)

2. Reaching tasks while seated on the edge of the mat (No, this would require work against gravity which the client may not have enough strength to do. )

3. Continue with supine active range of motion activities (No, this doesn’t increase the challenge for the pt)

4. Practice reaching activities while standing at the sink (No, this is too would be too much too son for the pt. Slightly grading up the task is best)

An occupational therapy practitioner is administering the Allen's Cognitive Level Screen on a 72-year-old client with a recent diagnosis of dementia. The occupational therapy practitioner has determined the client's score to be a 4.8. Based on this score, which intervention approach is MOST APPROPRIATE to implement with the client?

A. Perform familiar light cooking and cleaning activities, encouraging trial and error to make X improvements in performance

B. Go grocery shopping with a prepared a shopping list; with the items in order of the store set-up

C. Train a private caregiver on the appropriate cues to provide during bathing and dressing tasks

A. Perform familiar light cooking and cleaning activities, encouraging trial and error to make improvements in performance (No, Trial and Error would be more appropriate for a client at level 5)

B. Go grocery shopping with a prepared a shopping list; with the items in order of the store set-up (Yes, ACL 4.8 are expected to access familiar store/activities in the community independently when given the appropriate resources and planning)

C. Train a private caregiver on the appropriate cues to provide during bathing and dressing tasks (No, this pt doesn’t require a caregiver for bathing and dressing tasks as these tasks are familar and can be completed with mod. I)

An occupational therapy practitioner completes an evaluation of a client in a neurological outpatient rehabilitation setting.

The occupational therapy practitioner uses a Model of Human Occupation (MOHO)-based approach to evaluation. Which of the following BEST reflects the questions the occupational therapy practitioner will utilize to promote therapeutic reasoning with this client?

A. What environmental and social supports are X available to the client?

B. What is the client's response to change and desire for mastery?

C. What is the client's sense of occupational competence and identity?

A. What environmental and social supports are X available to the client?

B. What is the client's response to change and desire for mastery?

C. What is the client's sense of occupational competence and identity?

MOHO → focuses on how client participates in occupations and achieve a sense of competence and identity)

A client receives inpatient occupational therapy for wound management. The client wants to be able to independently feed themself. The client's wound is on the anterior aspect of the proximal forearm. The wound is heavily draining large amounts of serous exudate. Which dressing would the OTR recommend for this client?

A. An alginate dressing

B. Transparent film dressing

C. Hydrogel sheet

A. An alginate dressing (Yes, this dressing is soft/absorbent and is recommended for wounds with heavy exudate that require absorption)

B. Transparent film dressing (No, this is recommended for small, partial-thickness wounds with minimal drainage)

C. Hydrogel sheet (No, this dressing maintains a moist wound environment and is recommended for partial or full thickness wounds)

A toddler is working with an occupational therapist on transitioning to solid foods. Which motor motion is required for the toddler to transition to solid foods?

A. Gag reflex

B. Rooting reflex

C. Transverse tongue reflex

D. Rotary chewing

A. Gag reflex (No, not directly needed for eating solids)

B. Rooting reflex (No, not relevant for chewing solids)

C. Transverse tongue reflex (No, this helps guide the nipple and interferes with eating solids if not integrated by preventing the tongue from moving food side to side)

D. Rotary chewing (Yes, this is required to eat a large variety of textures. This develops as the toddler transitions from liquids to solids)

An occupational therapy practitioner is facilitating a community-based mealtime group for adults with visual impairments. To promote social engagement and support independent participation during meals, the occupational therapy practitioner determines that implementing organizational strategies will be most effective.

Which of the following strategies BEST reflects the use of organization to support mealtime participation?

A. Providing handheld magnifiers for reading menus and food labels

B. Increasing overhead lighting to reduce visual strain during meals

C. Assigning specific seating and consistent placement of mealtime items for each client

A. Providing handheld magnifiers for reading menus and food labels (No, this is not helpful for social engagement tasks at mealtime and would not be considered an organization strategy for visual impairments)

B. Increasing overhead lighting to reduce visual strain during meals (No, this may not allow for clients to distinguish low contrast features of a face in order to recognize the face. This would not be considered an organizational strategy for visual impairments)

C. Assigning specific seating and consistent placement of mealtime items for each client (Yes, consistent seating is essential to reduce the visual demands of clients with vision impairment)

A client with long-standing rheumatoid arthritis reports increased morning stiffness that limits independence in upper-body dressing.

During today's session, the occupational therapy practitioner plans to address this functional goal. Before initiating the dressing activity, the practitioner uses fluidotherapy followed by ultrasound to the client's hands and forearms to improve soft-tissue extensibility and joint mobility. Based on the practitioner's clinical reasoning and intent, which OTPF-4 intervention category BEST describes this approach?

1. Interventions to support occupations

2. Education and training focused on joint protection principles

3. Preparatory methods used as stand-alone interventions

1. Interventions to support occupations (Yes, PAMs like fluidotherapy and ultrasounds are considered interventions to support occupations when used to prepare clients for immediate functional tasks)

2. Education and training focused on joint protection principles (No)

3. Preparatory methods used as stand-alone interventions (No, OTPF categorizes PAMs as interventions to support occupations)

During a treatment session the rehabilitation supervisor informs the OTR that the electronic medical record (EMR) system is unavailable due to unforeseen circumstances. How BEST should the OTR respond to this situation?

1. Document treatment times, therapy treatment codes, and notes for each session on paper

2. Wait for the system to get back up and running, then document for each session

3. Take notes on the times, and therapy codes to later input into the system

D. Take notes on a computer device offline

1. Document treatment times, therapy treatment codes, and notes for each session on paper (Yes, using paper format noting essential information for each client is the best option when electronic systems are down)

2. Wait for the system to get back up and running, then document for each session (No, this leaves too much room for human error)

3. Take notes on the times, and therapy codes to later input into the system (No, you also need to take notes on assessments, observations, and interventions)

D. Take notes on a computer device offline (No, this is not protected and would violate HIPAA)

A retired golfer complained of shoulder and back pain, which limits the ability to continue to play golf. The client recently purchased a condominium with a golf course, with the intention of continuing to play the sport. The client's orthopedic surgeon did not recommend surgical intervention due to possible complications and advised the client to stop playing golf since this is contributing to the chronic pain. The client decided to consult with an occupational therapy practitioner to determine if it is possible for the client to continue playing golf. The occupational therapy practitioner decided to use the rehabilitative approach. Which of the following BEST describes this approach?

A. The occupational therapy practitioner interviews the client to identify the activity limitations caused by chronic pain.

B. The occupational therapy practitioner determines the client's ability and willingness to learn compensatory strategies.

C. The occupational therapy practitioner measures the client's range of motion to determine the effectiveness of the golf swing.

A. The occupational therapy practitioner interviews the client to identify the activity limitations caused by chronic pain. (No, the OT can obtain an understanding of the effect of impairment on ADLs to determine focus of evaluation and treatment regardless of approach)

B. The occupational therapy practitioner determines the client's ability and willingness to learn compensatory strategies. (Yes, the rehabilitative approach determines the client’s strength and remaining abilities to enable occupational performance. The biomechanical approach determines the client skills that need to be remediated)

C. The occupational therapy practitioner measures the client's range of motion to determine the effectiveness of the golf swing. (No, this best describes the biomechanical approach)

A client, who has been receiving outpatient occupational therapy services for a few months, presents to therapy visibly upset. The client's spouse recently passed away and the client is having a difficult time adjusting to the loss. The occupational therapy practitioner inquires about how the client is handling the grief associated with losing the spouse. The client states "If only I could have been there for her and not spent so much time working".

Which would best describe the client's statement?

A. Denial

B. Depression

C. Anger

D Bargaining

A. Denial (No, this is the first stage where you fail to admit the truth and unwilling to accept reality)

B. Depression (No, the client doesn’t mention sadness at this time)

C. Anger (No, the client doesn’t mention anger)

D Bargaining (Yes, this is often accompanied by guilt. Seeking ot change the situation that is causing grief)

An occupational therapy practitioner is meeting with a client for the first time. The occupational therapy practitioner reviews the documentation regarding the need for occupational therapy services, identifies loss of occupational engagement for the client, identifies client limitations through use of objective measures, completes analysis, and synthesizes the information obtained.

Which is MOST appropriate for the occupational therapy practitioner to implement next?

A. Reevaluation

B. Screenings

C. Assessments

D.Intervention planning

A. Reevaluation (No)

B. Screenings (No, this determines whether further evaluation is warranted as the OT considers the diagnosis, physical condition, referral, and chart review. Determines if a client would benefit from OT evaluation and intervention. This has already been determined)

C. Assessments (No

D.Intervention planning (Yes, this is creating objective and measurable goals, and identifying occupational therapy approaches and methods of serve delivery. )

A client diagnosed with cataracts is receiving occupational therapy services in the home environment. When treatment planning for this client, which environmental modification is MOST important to consider?

1. Reducing glare

2. Contrasting colors

3. Raised labels

4. Voice-command options for timers, and reminders

1. Reducing glare (Yes, this promotes the best use of the remaining vision to improve safety and independence by using shades/curtains, covering up shiny surfaces)

2. Contrasting colors (No, this is used for reduced visual acuity)

3. Raised labels (No, this is a task adaptation)

4. Voice-command options for timers, and reminders (No, this is an addition to the client’s routine and not environmental modification but instead a task adaptation)

An occupational therapist is working multiple PRN jobs due to challenges in the job market that have impacted caseloads, referrals, and reimbursement. In each PRN position, the occupational therapist has initiated program development and has increased referrals. With the increase in demand, the occupational therapist has difficulty maintaining commitment to all of the facilities and has difficulty managing the multiple caseloads in a timely manner, resulting in rushed documentation and limited time for client collaboration during sessions. Which ethical standard may the occupational therapist be challenging?

A. Fidelity

B. Confidentiality

C. Autonomy

D. Veracity

A. Fidelity (Yes, this means being faithful to one’s commitments/obligations. If OT accepts multiple positions but can’t meet the demands, this breaches fidelity.)

B. Confidentiality (No)

C. Autonomy (No)

D. Veracity (No, this is telling the truth.)

An occupational therapy practitioner working in a skilled nursing facility observes the seating position of a client with a complete C4 spinal cord injury. The client is dependent on a wheelchair for functional mobility. The wheelchair footrests appear to be too high.

What MOST concerns the occupational therapy practitioner when this position is observed?

A. The client may slip out of the wheelchair

B. The client is at risk for skin breakdown

C. The client is at risk for developing hypertonicity

D. The client is unable to self propel the wheelchair

A. The client may slip out of the wheelchair (No, elevated footrests elevate the knees and increase hip flexion creating a posterior pelvic tilt)

B. The client is at risk for skin breakdown (Yes, sustained sitting increases the likelihood of developing skin breakdown especially when proper alignment is not obtained)

C. The client is at risk for developing hypertonicity (No, this can only be caused by a neurological issue)

D. The client is unable to self propel the wheelchair (No, the client is dependent for functional mobility and is a quadriplegic)

A client with chronic obstructive pulmonary disease (COPD) is referred for pulmonary rehabilitation with an occupational therapist. During the evaluation, the client reports withdrawing from social activities due to shortness of breath and expresses reluctance to attend gatherings, stating, "I don't want to be a burden to my friends." The client reports feeling increasingly dependent and fatigued during daily activities. Which of the following intervention strategies should the occupational therapist do FIRST to address the client's social withdrawal and promote engagement in meaningful occupations?

A. Facilitate a group-based activity in the pulmonary rehabilitation setting to practice breathing and relaxation strategies within a supportive peer environment

B. Educate the client on pacing and energy conservation strategies to maximize endurance during essential ADLs before addressing leisure and social occupations

C.Provide instruction in pursed-lip breathing to enhance functional endurance and reduce dyspnea during outings

A. Facilitate a group-based activity in the pulmonary rehabilitation setting to practice breathing and relaxation strategies within a supportive peer environment (Yes, Group-based rehab improves social participation, symptom management, and helps patients re-engage in meaningful activities to booster self-efficacy)

B. Educate the client on pacing and energy conservation strategies to maximize endurance during essential ADLs before addressing leisure and social occupations (No, this focuses on physical performance in ADLs rather than the client’s social isolation and emotional withdrawal)

C.Provide instruction in pursed-lip breathing to enhance functional endurance and reduce dyspnea during outings (No, this doesn’t address the psychosocial withdrawal or facilitate re-engagement)

An occupational therapy practitioner is working with a pediatric client that demonstrates delays in hand skills when engaged in various play-based activities. The occupational therapy practitioner observes that the child holds and uses a toy hammer appropriately, picks up varying size balls easily, and is able to hold a cup while drinking. When provided smaller items including marbles, crayons, and feeding utensils, the client demonstrates difficulty.

With the smaller items, the client demonstrates an unar grasp or avoids the task completely. Which BEST describes the grasping patterns that may be delayed?

A. Cylindrical grasp

B. Precision grasp

C. Power grasp

D. Spherical grasp

A. Cylindrical grasp (No, this is used to hold a glass or cup. The child demonstrates use of a cylindrical grasp to hold the cup while drinking)

B. Precision grasp (Yes, the client demonstrates difficulty with tasks that require manipulation using a precision grasp)

C. Power grasp (No, this involves the use of the entire hand. The child demonstrates this grasp through the use of the toy hammer)

D. Spherical grasp (No, this is used to hold a ball and the client demonstrates this grasp by picking up varying sized balls)

An occupational therapist (OTR) is providing early intervention services to a 12-month-old child with a diagnosis of fetal alcohol syndrome (FAS) who has been placed in foster care. The caregivers report that the child demonstrates frequent waking at night, is easily startled by environmental stimuli, and requires extended soothing to return to sleep. The foster family is motivated to implement a home program that supports improved sleep while fitting within daily routines. Which is the BEST home program recommendation the OTR should make to best support the child's sleep participation?

A. Educate caregivers to gradually increase the child's tolerance to nighttime environmental stimuli to promote sensory adaptation

B. Implement a structured sleep schedule that limits daytime sleep to consolidate nighttime rest

C. Develop a predictable bedtime routine

A. Educate caregivers to gradually increase the child's tolerance to nighttime environmental stimuli to promote sensory adaptation (No, this prioritizes sensory challenge rather than regulatory support which is contraindicated at bedtime)

B. Implement a structured sleep schedule that limits daytime sleep to consolidate nighttime rest (No, this may lead to exhaustion and often worsen sleep onset and night awakenings. This fails to address the child’s sensory modulation difficulties typically seen in children with FAS)

C. Develop a predictable bedtime routine (Yes, this helps support regulation and sleep initiation. Routine and repetition are important in foster-care environments, where overall consistency may be lacking)

A 60-year-old client presents with a wound. The client's caregiver understands that there is a risk of the wound developing into a hypertrophic scar. Which of the following factors is MOST likely to contribute to hypertrophic scarring?

A. Scar beginning to form outside of the injury boundary

B. Depth of wound and limited collagen production

C. Presence of chronic inflammation and depth of wound

D. Small size of wound and acute inflammation

A. Scar beginning to form outside of the injury boundary (No, hypertrophic scars only form within the original injury boundary. Keloid scars form outside of the original injury boundary.)

B. Depth of wound and limited collagen production (No)

C. Presence of chronic inflammation and depth of wound (Yes, the presence of chronic inflammation, the location of the wound and its depth, and poor healing of the wound all contribute to hypertrophic scarring)

D. Small size of wound and acute inflammation (No)

An occupational therapy practitioner is completing an initial evaluation for a client who sustained a distal radius fracture 6 weeks ago while walking a dog. The client currently presents with decreased active range of motion (AROM), reduced grip strength, and moderate edema in the affected hand and forearm. Which of the following preparatory methods would be MOST APPROPRIATE to implement FIRST to address the client's current symptoms?

1. Provide a warm paraffin bath to the wrist and hand prior to initiating active movement.

2. Initiate functional reaching tasks to promote dynamic use of the upper extremity.

3. Position the affected extremity in a functional position during periods of rest

1. Provide a warm paraffin bath to the wrist and hand prior to initiating active movement. (No, this is contraindicated when moderate edema is present as it increases swelling and inflammation)

2. Initiate functional reaching tasks to promote dynamic use of the upper extremity. (No, this should be introduced gradually after preparatory methods to reduce edema and pain. Otherwise this will aggravate symptoms and limit progress)

3. Position the affected extremity in a functional position during periods of rest (Yes, this should be initiated early to address swelling and discomfort. Doing it during rest periods avoids over-stressing the affected area)

A 66-year-old retired carpenter experienced involuntary, jerky movements after taking a neuroleptic medication and was referred for occupational therapy. The client's spouse expressed concern that the client is starting to get depressed. The client mentioned a desire to repair an old drawer in the workshop. The occupational therapy practitioner decided to include a woodworking project in the intervention to address the client's movement disorder, provide a source of satisfaction, and facilitate engagement in a valued occupation, including repairing the old drawer. Which activity would be MOST EFFECTIVE for progressing toward this goal?

1. Cutting wood into the needed size

2. Sanding the wood with a hand sander

3. Nail the joints together with a hammer

4. Tighten the handles with a screwdriver

1. Cutting wood into the needed size (No)

2. Sanding the wood with a hand sander (Yes, promoting gross motor movements are beneficial)

3. Nail the joints together with a hammer (No)

4. Tighten the handles with a screwdriver (No, this requires fine motor skills and strength may be limited)

Which assistive device is MOST appropriate for a client being discharged home after a total knee replacement?

A. Use a leg lifter to help move the operated leg out of bed

B. Use a long-handled sponge to wash his lower body

C. Use a grab bar and shower chair when bathing

A. Use a leg lifter to help move the operated leg out of bed (No, with a knee replacement there are no restrictions during bed mobility and a leg lifter will not be necessary)

B. Use a long-handled sponge to wash his lower body (No, this would be more appropriate for hip or back precautions)

C. Use a grab bar and shower chair when bathing (Yes, this improves safety in clients with decreased standing balance and endurance)

An occupational therapy practitioner in an outpatient pediatric clinic wants to ensure that the therapy efforts are carrying over into the home environment. What is MOST IMPORTANT for the occupational therapy practitioner to consider when providing families with home programs?

1. Parents' occupation and roles

2. Inclusion of siblings in programming

3. Family routines and habits

4. Availability of resources and supports

1. Parents' occupation and roles (No, these are good to examine but not the most important when applying new skills at home)

2. Inclusion of siblings in programming (No, this is important but not most important for carryover at home)

3. Family routines and habits (Yes, this helps focus the home program and allow for goals and activities to be embedded within routines for greater carryover)

4. Availability of resources and supports (No, not the most important for home program.)

When observing a 2.5 year old child, what typical developmental manipulation skills can the occupational therapy practitioner anticipate seeing while the child plays with toys?

1. Linear movement of an object to reposition on fingers

2. Rolling an object 180° within the hand

3. Translation of object from palm to finger

1. Linear movement of an object to reposition on fingers (No, linear movement is shift which develops by 3)

2. Rolling an object 180° within the hand (No, this would be complex rotation, which develops from 3-5)

3. Translation of object from palm to finger (Yes, palm to finger translated should be developed at this age, moving an object from palm to pads of fingers)

An occupational therapy practitioner (OTR) is working with a client who presents with unilateral upper extremity hemiparesis following a recent cerebrovascular accident (CVA). The client is employed as a full-time blogger for a high-volume online publication and reports a strong desire to resume work-related tasks, including prolonged typing, editing, and digital content creation, as soon as possible. The client has intact cognition but demonstrates limited active movement and decreased coordination in the affected upper extremity. Which of the following adaptive equipment recommendations is the MOST appropriate initial intervention to support the client's return to work?

1. Recommend speech recognition software

2. Provide a standard ergonomic keyboard with wrist support

3. Introduce a one-handed keyboard layout to enable task completion

1. Recommend speech recognition software (Yes, this allows for maximum independence and efficiency)

2. Provide a standard ergonomic keyboard with wrist support (No, this isn’t sufficient compensation for the deficits)

3. Introduce a one-handed keyboard layout to enable task completion (No, this is less efficient compared to speech recognition. Also requires learning a new motor pattern)

A client recently experienced a stroke that affected the left side with consequent neglect and pusher syndrome. Sit to stand and gait activities are unsafe to attempt. What is the MOST APPROPRIATE technique for the OTR to address the pusher syndrome in order to promote safe ambulation?

1. Use an assistive device on the stronger side

2. Perform reach, grasp, and place activities with the non-paretic extremity in a sitting position

3. Initiate gait training in parallel bars

4. Perform forward bending towards the floor in order to promote anterior pelvic tilt and movement of the center of gravity forward

1. Use an assistive device on the stronger side (No, this will encourage pt to use AD to push themselves towards hemi-paretic side)

2. Perform reach, grasp, and place activities with the non-paretic extremity in a sitting position (Yes, this removes the ability for the pt to push with the non-paretic arm towards the hemi-paretic side to promote improved vertical positioning.)

3. Initiate gait training in parallel bars (No, this will allow pt to use parallel bars on non-paretic side to push themselves towards hemi-paretic side)

4. Perform forward bending towards the floor in order to promote anterior pelvic tilt and movement of the center of gravity forward (No, this is unsafe to address)

An occupational therapy practitioner is conducting a small-group intervention focused on standing tolerance and dynamic balance in an inpatient rehabilitation unit. After several minutes of standing activity, one client with a documented history of orthostatic hypotension becomes noticeably quieter, reports feeling dizzy, and reaches for nearby furniture to steady themselves. The client appears pale and fatigued but remains responsive to verbal cues. Which action should the occupational therapy practitioner take FIRST?

1. Assess the client's blood pressure and heart rate to determine whether a orthostatic episode has occurred

2. Notify nursing staff of the client's symptoms and request medical assessment of the episode

3. Guide the client into a seated or supine position while monitoring for improvement in symptoms

1. Assess the client's blood pressure and heart rate to determine whether a orthostatic episode has occurred (No, this is not the initial priority)

2. Notify nursing staff of the client's symptoms and request medical assessment of the episode

3. Guide the client into a seated or supine position while monitoring for improvement in symptoms (Yes)

A client with a memory impairment is giving directions to the occupational therapist during a therapy session. The client uses landmarks to describe how to locate various items around the client's home.

Which is MOST APPROPRIATE for the occupational therapy practitioner to document during the session?

1. Client demonstrates appropriate episodic memory for events that occurred

2. Client demonstrates adequate problem solving to identify problematic areas

3. Client demonstrate appropriate working memory, specifically visuospatial sketchpad

4. Client demonstrates adequate working memory, specifically using phonological loop

1. Client demonstrates appropriate episodic memory for events that occurred

2. Client demonstrates adequate problem solving to identify problematic areas

3. Client demonstrate appropriate working memory, specifically visuospatial sketchpad (Yes, this allows for spatial orientation and problem solving that requires visual input around locating objects. The sketchpad is used to navigate around a building/home and relies only on visual info)

4. Client demonstrates adequate working memory, specifically using phonological loop (No)

An occupational therapy practitioner evaluates a 5-year-old child with inconsistent participation in dressing. The child independently completes dressing and demonstrates age-appropriate coordination and imitation of novel motor tasks. The caregiver reports a strong preference for wearing the same fitted clothing and resistance to changes in clothing type. During the evaluation, the child uses exaggerated trunk and shoulder movements when donning shirts, intermittently withdraws from certain fabrics, and does not consistently notice when clothing is twisted or misaligned. Strength, range of motion, and task sequencing are within expected limits. Which underlying factor MOST likely explains the child's dressing performance?

1. Sensory modulation impairment characterized by tactile under-responsivity, resulting in decreased awareness of clothing contact

2. Sensory modulation impairment characterized by tactile over-responsivity, leading to selective avoidance of clothing input

3. Somatodyspraxia resulting in impaired body scheme and inconsistent motor planning during self-care tasks

1. Sensory modulation impairment characterized by tactile under-responsivity, resulting in decreased awareness of clothing contact (No, the child occasionally doesn’t notice misaligned clothing. The child is resistant to certain fabrics this shows sensitivity)

2. Sensory modulation impairment characterized by tactile over-responsivity, leading to selective avoidance of clothing input (Yes)

3. Somatodyspraxia resulting in impaired body scheme and inconsistent motor planning during self-care tasks

An occupational therapy practitioner is assessing the muscle strength of the client's shoulder flexion and recognizes that the client can only achieve less than 50% full active range of motion (AROM) against gravity. In order to determine the specific grade of the strength the client has in flexion, what is the BEST position in which the occupational therapy practitioner can place the client?

1. Sitting

2. Prone

3. Side-lying on the non-testing side

4. Side-lying on the testing side

1. Sitting (No, this would be against gravity)

2. Prone (No, this would be for shoulder extension against gravity)

3. Side-lying on the non-testing side (Yes, this puts muscles in gravity minimized position)

4. Side-lying on the testing side (No, this would restrict shoulder flexion)

Which occupational therapy recommendation would be BEST when promoting carryover ot an 8 year old with developmental delays completing lower-body dressing more independently?

A. Using a backward chaining technique, the therapist provides tactile cues for donning pants and socks, then the child slips shoes on

B Provide verbal and tactile cues during the session, have the clothing laid out in the

C Create and utilize cue cards of each step of the dressing task, the child puts the cards in order prior to completing dressing

A. Using a backward chaining technique, the therapist provides tactile cues for donning pants and socks, then the child slips shoes on (No, this fits describes an intervention run by the therapist)

B Provide verbal and tactile cues during the session, have the clothing laid out in the

C Create and utilize cue cards of each step of the dressing task, the child puts the cards in order prior to completing dressing (Yes, ‘recommendation' means homework or HEP. Cue cards fits this description)

An occupational therapy practitioner is providing interventions for a client with motor apraxia. Which would be the MOST appropriate compensatory strategy for the occupational therapy practitioner to utilize with this client?

1. Place necessary items on the unaffected side

2. Lay out clothing items in the proper orientation

3. Utilize Velcro closures on clothing items

4. Select items that require manipulation to fasten

1. Place necessary items on the unaffected side

2. Lay out clothing items in the proper orientation (No, this would address spatial dysfunction. Pt can orient to the object but can’t plan/execute the movements to complete the task)

3. Utilize Velcro closures on clothing items (Yes, motor apraxia suggests that the pt has difficulty with manipulation and would benefit from adaptive strategies like Velcro)

4. Select items that require manipulation to fasten

An occupational therapy practitioner is working with a client on an inpatient rehabilitation unit who underwent surgical repair for a right distal femur fracture and is now 50% partial weight-bearing. During a session, the client expresses feeling uncomfortable using the bedside commode and says, "I would like to use the actual bathroom. I think I can walk there." What is the INITIAL step the occupational therapy practitioner should take to address functional ambulation for toileting with this client?

1. Trial a variety of assistive devices for mobility in the room

2. Reinforce the client's weight-bearing status and other precautions

3. Wait for the physical therapist to perform a gait assessment

1. Trial a variety of assistive devices for mobility in the room

2. Reinforce the client's weight-bearing status and other precautions

3. Wait for the physical therapist to perform a gait assessment

A client has a radial nerve injury that occurred 3 months ago. Which orthosis would be BEST for the client to wear during work/daytime hours?

1. A dynamic outrigger for finger flexion

2. A static resting orthosis

3. A thumb stabilization orthosis

4. A spring coil orthosis for wrist extension

1. A dynamic outrigger for finger flexion

2. A static resting orthosis

3. A thumb stabilization orthosis (No, this is useful for repetitive strain like De Quervains)

4. A spring coil orthosis for wrist extension (Yes, radial nerve injury often presents with wrist drop, limited wrist ext. and decrease ext of fingers. This orthosis will help increase ROM and regain function)