K’s Practice Q’s for OT Boards

An OTR and a vocational rehabilitation team are using the Individual Placement and Support (IPS) model to support a client who has schizophrenia and anxiety in gaining employment. One of the intervention goals is for the client to achieve competitive employment. When using the IPS model which approach should be included in the vocational intervention to support this goal?

A. Provide education in general work behaviors, then conduct an extensive job search.

B. Secure a job placement site, then teach the client the specific job skills for that workplace.

C. Complete a detailed resume of job skills, then teach the client effective work behaviors.

B

A resident who lives in a nursing home has schizophrenia and tardive dyskinesia. The OTR is using the Abnormal Involuntary Movement scale (AIMS) to measure uncontrollable movements of the resident’s face and upper body. At what frequency should the OTR administer the AIMS for this resident?

Select the best response.

A

After a change in the resident’s medication regimen.

B

During every intervention session with the resident.

C

Prior to each of the resident’s medical appointments.

A two year-old toddler who has a developmental delay recently learned to release a 2 inch ball into a large toy box. What fine motor skills should the OTR work on next?

A. Color within the lines on a page

B. Transfer toys form hand to hand

C. Complete a 3 to 4 piece puzzle.

C

which dressing task requires the most challenging integration of performance skills, and patterns for typically developing three year-old child?

A. Finding armholes in a pullover shirt

B. Unfastening the zipper of a front opening jacket

C. Pulling down a pair of elastic waist pants

D. Taking off a pair of ankle high socks

B

A five-year-old child has a mild developmental delay. Motor impact skills are intact. Which action would be best to observe when screening emotional regulation skills?

A. Sharing toys during unstructured play

B. Responding to the feelings of others

C. Taking turns while playing a board game

B

An OTR is developing an intervention plan for an inpatient who has severe posttraumatic stress disorder. Symptoms of PTSD started several weeks after the patient was robbed in a convenient store where the patient was working. The patient’s goal is to resume work at the store, but extreme fear and distress interfere with the abilities to interact with customers. Which environment is most conducive for promoting initial progress toward a return to work goal with this patient?

A. One-on-one in the patient’s hospital room

B. During a role-play session in the therapy room

C. Discussion group with several other patients

A

A two year old child has developmental delay due to mild spastic cerebral palsy. A child has mastered four point positioning. Which movement component should the OTR plan to facilitate next?

A. Scooting on the belly

B. Unsupported upright sitting

C. Rocking on hands and knees

D. Creeping on hands and knees

C

An OTR is using a top-down approach to select interventions for a client who has unilateral neglect secondary to a CVA. Which intervention would be most beneficial to include as part of the client’s intervention when using this approach?

A. Determine compensatory options the client can use in the home environment

B. Teach drills for practicing head turning to find an object placed near the affected side

C. Place commonly used toiletry items to the client’s affected side during self-care tasks

D. Use tactile-kinesthetic guiding to the client’s involved extremity during a dressing task

A

A client in an outpatient setting sustained an acquired brain injury two months ago. Evaluation results indicate the client has functional ROM and strength, but continues to require assistance with ADL due to moderate visual and vestibular processing deficits. Which intervention represents an adaptive approach for improving the client’s performance in areas of occupation?

A. Providing the client with an exercise program for improving gaze stabilization

B. Teaching the client to use proprioceptive cues during functional activities

C. Incorporating the progressively more challenging tasks into a functional activity

D. Engaging the client in valued activities that promote postural stability and balance

B

An OTR is working with an inpatient who had a left CVA with global aphasia 5 days ago. The patient has right hemiparesis and requires moderate assistance to maintain balance while standing. What action should the OTR take when completing this assessment?

A. Introduce adaptive equipment to maximize patient’s level of performance

B. Observe as the patient performs ADL routines

C. Provide the patient with visual and tactile cues

C

An OT is evaluating an inpatient who recently had a severe TBI and is emerging from a coma. The patient is functioning at a level III (localized response) on the Rancho Los Amigos scale. Which is the first cognitive function the OTR should assess?

A. Ability to learn new information

B. Orientation to place and time

C. Level of arousal

C

The OTR working in an outpatient setting is completing an initial interview with an older adult client who has recently been diagnosed with a progressive neurological disease. What method should the OTR use during the course of the interview to communicate effective listening and client centered understanding?

A. You had gestures to indicate empathy and understanding.

B. Offer your suggestions as the client discloses concerns and problems.

C. Provide examples of how other clients have overcome similar adversity.

D. Share examples of adaptations that help to overcome adversity.

D

An OTR is providing consultative services at an assisted living facility. Facility administrators are concerned that some residence may be at risk for fall. Using a primary prevention model what initial recommendation should the OTR to the management of the facility?

A. Analysis of resident injuries that have occurred at the facility over the past five years.

B. Ongoing monitoring and observation of the residence to decrease liability.

C. Screening of all residents prior to determining needs of the facility.

C

An OTR administered a standardized assessment to a kindergarten student with developmental delay. Results indicate that the student has average fine motor skills, but test scores in the area. Visual motor skills are below average. Which of the following activities would be the most challenging for the student based on this information?

A. Drawing in a self portrait.

B. Holding a writing utensil.

C. Bouncing a basketball.

A

Explanation from ChatGPT…

Here's why:

• Visual motor skills involve the coordination of visual perception and motor control—essential for tasks that require copying, drawing, cutting along lines, etc.

• Drawing a self-portrait is a complex visual motor task that requires the child to:

  • Visually perceive facial features and spatial relationships.

  • Coordinate hand movements to reproduce them on paper.

Why not the others?

• B. Holding a writing utensil relates more to fine motor skills, which the student has average ability in.

• C. Bouncing a basketball is primarily a gross motor and visual tracking skill—not heavily reliant on fine visual-motor integration.

A high school student with autism spectrum disorder, excels academically, but has difficulty organizing assignments and homework. The OTR plans to evaluate the students relative strengths and weaknesses to guide the intervention planning. One of the students goals is to learn an organization system. Which of the following is the best assessment for this purpose?

A. Canadian occupational performance measure (COPM)

B. Executive function performance test (EFPT)

C. Behavior rating inventory of executive function (BRIEF)

C…

The BRIEF is specifically designed to assess executive functioning in children and adolescents in real-world settings. It provides insight into areas such as:

• Organization

• Planning

• Working memory

• Task initiation

• Self-monitoring

Since the student has difficulty organizing assignments and homework, the BRIEF is the best fit to evaluate their executive function strengths and weaknesses in daily functioning—directly aligning with the goal of learning an organization system.

---

Why not the others?

• A. Canadian Occupational Performance Measure (COPM):
  A great tool for identifying client-centered goals and perceived performance—but it’s not a standardized measure of executive functioning. It’s more about what the student wants to work on, not how their brain functions in those areas.

• B. Executive Function Performance Test (EFPT):
  This is a performance-based assessment designed for adults, not students in a school setting. It assesses tasks like cooking oatmeal and managing medications—not applicable to a high school student’s academic tasks.

The client in an outpatient setting sustained a frontal lobe TBI two months ago. The client has a good motor control that has residual problems with executive functioning. One of the client’s goal is to be independent with home making task tasks. During a meal preparation session, the client cooks a meal, but makes no attempt to clean the cooking utensils and dishes, or put the food items away after completing the cooking task. Which area of executive function appears to be most affected by the TBI as evidenced by this behavior?

A. Emergent awareness.

B. Selective attention.

C. Episodic memory.

D. Environmental gnosia.

A. Emergent awareness

This is the ability to monitor performance and recognize problems as they occur

An OTR working in an inpatient rehabilitation facility is scheduled to complete an initial grooming and hygiene assessment with a patient. The patient has mild hemiplegia and Neuro behavioral deficits secondary to a CVA one week ago which area of the facility should with the assessment, take place in order to obtain the most beneficial information about the impact of the symptoms on the patient’s occupational performance?

A. Bedside in the patient’s hospital room.

B. Bathroom in the patient’s hospital room.

C. Simulated environment in the OT clinic.

B

An OTR is evaluating a client who has an older nerve injury at the wrist level of the right dominant extremity. During which task with this injury be most evident?

A. Carrying a briefcase.

B. Turning a key in the car ignition.

C. Operating a desktop calculator.

D. Holding coins in the palm of the hand.

B.

An inpatient had a myocardial infarction two days ago and is beginning phase one cardiac rehab rehabilitation which activity is an essential component of the initial assessment with this patient?

A. Monitoring the patient’s orthostatic tolerance during movement.

B. Measuring the patient’s upper extremity grip and pinch strength

C. Determining the patient’s typical daily energy expenditure.

A…

An essential component of the initial assessment is ensuring the patient can tolerate upright positions and graded activity without adverse symptoms such as dizziness, hypotension, or shortness of breath. This is referred to as orthostatic tolerance.

An inpatient in a rehab rehabilitation setting sustained a C7 spinal cord injury two months ago one of the patient’s goals is to be able to prepare family meals when discharged home. What initial action should the OTR complete to support the patient success with this goal?

A. Observed current physical skills and abilities during a typical kitchen task.

B. Identify the patient’s typical meal time, routines and habits

C. Provide the patient with assistive devices to use in the kitchen.

B. Identify the patient’s typical meal time, routines and habits

An OTR assessing the reflexes of a four month old, infant places the infant in a setting position and encourages the infant to actively flex. The neck forward to look at an object held near the infant chest, which of the following responses to this movement, indicate the presence of the symmetrical tonic neck reflex?

A. Flexion of the upper extremities and extension of the lower extremities.

B. Flexion in both the upper and lower extremities.

C. Flexion of the lower extremities and extension of the upper extremities.

A. Flexion of the upper extremities and extension of the lower extremities.

An OTR who works in an elementary school is preparing to evaluate a student in fifth grade who has a learning disability and ADHD, which standardized assessments would be most effective for the OTR to include as part of the evaluation process?

A. Hawaii early learning profile (HELP) and Barthel Index of ADL

B. Bruininks-Oseretsky Test of Motor Proficiency (BOT) and Evaluation Tool of Children’s Handwriting (ETCH)

C. Wee-FIM and Rancho Los Amigos Level of Cognitive Function Revised

B. Bruininks-Oseretsky Test of Motor Proficiency (BOT) and Evaluation Tool of Children’s Handwriting (ETCH)

Which activity involves the use of a close kinetic chain movement of the upper extremity?

A. Lifting a suitcase off the floor to carry by the handle.

B. Pulling up on an overhead trap during bed mobility.

C. Hand mouth patterns used for self feeding.

B. Pulling up on an overhead trap during bed mobility.

During the administration of a standardized assessment a client demonstrates difficulty initiating a motor task. What action must the OTR take to obtain accurate results from this assessment tool?

A. Provide prompts and tactile cues as needed.

B. Follow the test protocol for giving additional directions.

C. Modify the instructions to enhance clarity.

B. Follow the test protocol for giving additional directions.

An OTR is formulating a discharge plan for an inpatient who has dementia and his functioning cognitive level four goal directed actions. The patient will be living at home with assistance from family. What type of caregiver education is most important for the OTR to provide prior to the patient’s Discharge from the inpatient facility?

A. Suggestions for modifying the environment to eliminate unnecessary household items.

B. Methods for promoting the patient’s problem-solving for independence during ADL

C. Strategies for providing visual cues that will help the patient complete daily routines.

D. Techniques for establishing and posting a written emergency plan in the home environment.

C. Strategies for providing visual cues that will help the patient complete daily routines.

A client sustained a TBI three months ago and is functioning at level VIII purposeful appropriate standby assist on the Rancho los amigos scale. The client is participating in a meal preparation task as part of the task. The client is asked to prepare vegetable soup using a five step printed recipe. The client is able to read the recipe steps aloud, but does not act on any of them when the OTR covers all but the first step of the recipe the client follows through with the step what conclusion can the OTR make about the client based on this observation?

A. Adaptive strategies compensate for attention deficits.

B. Anchoring techniques improve visual perception.

C. Ideational apraxia interferes with task initiation.

A. Adaptive strategies compensate for attention deficits.

an OTR, who works in an outpatient hand therapy clinic fabricated a forum orthosis for a client. OT is providing instructions to the client on the wearing schedule and care of the orthosis, which is the most effective method for the OTR to use in the education session to promote the clients understanding of the information presented?

A. Ask the patient and open-ended question that invites a descriptive response.

B. Provide a detailed written handout with illustration to reinforce key points.

C. Encourage the client to independently place the orthosis on and off during the session.

B. Provide a detailed written handout with illustration to reinforce key points.

in OTR is evaluating the bicep strength of a client recovering from a musculocutaneous nerve injury. The OTR asked the client to fully flex the elbow while the client is seated upright with the shoulder adducted, the elbow fully extended and the forearm in supination. The OT observes that the client’s forearm consistently moves into mid position on each attempt to flex the elbow, despite prompting the client to maintain the form and stupor nation. What conclusion can the OTR make based on this observation?

A. The brachioradialis muscle is substituting for the weaker prime mover.

B. The muscle strength of the biceps should be graded as poor 2/5.

C. The pronator teres muscle should be blocked on future testing.

D. The movement should be retested with the client positioned in prone.

A. The brachioradialis muscle is substituting for the weaker prime mover.

A private practice OTR is developing goals for a four year-old child with autism spectrum disorder who has difficulty with emotional regulation, impulse control, and problem-solving skills, The child attends preschool and academically is meeting expectations. Socially, the child wants to make friends, but has not developed friendships at school or within the neighborhood. Which task could be included as a short term goal in the intervention plan for this child?

A. Interact with periods during a structured playgroup.

B. Follow rules while playing an age-appropriate board game.

C. Plant the sand table without acquiring an injury.

A. Interact with periods during a structured playgroup.

a patient who has hemiplegia in cognitive perceptual deficits has been transferred from an acute care facility to a skilled nursing rehabilitation unit. When should discharge planning for this patient take place?

A. Throughout the rehabilitation phase of treatment.

B. When the majority of short term goals have been met.

C. After determining if the patient has potential to return home.

A. Throughout the rehabilitation phase of treatment.

An outpatient client has an acute flareup of stage I rheumatoid arthritis. Initial evaluation results indicate the client’s s MCP joints bilaterally are red and swollen. The client lacks 10° active extension of the MCP joints on the second through fifth digits bilaterally. The client works as a florist and reports pain as 9 out of 10 on a visual analog scale when completing activities requiring a grasp and prehensile patterns. The client will be participating in OT twice weekly. Which therapeutic exercise should be included as part of the intervention plan for the client to complete by the end of the first week of therapy?

A. Passive motion and stretch of the MCP joints through the full arc of motion.

B. Pinching and gripping a soft sponge and warm water within pain tolerance.

C. Isotonic and isometric exercises of both hands within pain-free ranges of motion.

D. Tending gliding exercises of the fingers against light resistance therapy putty.

C. Isotonic and isometric exercises of both hands within pain-free ranges of motion.

A young adult, client was diagnosed with axonotmesis of the ulnar nerve secondary to a crush injury of the forearm two weeks ago. After obtaining baseline assessment information, which technique would be most important for the OTR to teach to the client as part of the intervention during the initial phase of the clients rehabilitation?

A. Visual compensation.

B. Hand dominance retraining.

C. Isometric strengthening.

D. Sensory reeducation.

A. Visual compensation.

A family practice physician referred a client to outpatient OT for conservative treatment of carpal tunnel syndrome of the dominant hand. The client reports a three month history of numbness and difficulty manipulating objects. Symptoms interfere with work as a jackhammer operator for roadworks department. Evaluation results indicate loss of protective sensation, 11 mm two-point discrimination and thenar muscle atrophy. Active ROM of the affected hand is within normal limits. What initial actions should the OTR take an addition to fabricating a roller wrist orthosis?

A. Advise the client to wear the orthosis when sleeping and a padded glove went at work.

B. Arrange an appointment with an orthopedic surgeon and begin a sensory reeducation program.

C. Conduct Phalen‘s test and report findings of the overall evaluation process to the physician.

C. Conduct Phalen‘s test and report findings of the overall evaluation process to the physician.

An inpatient had a CVA with flaccid hemiplegia eight days ago. When the OTR arrives for the scheduled session, the patient reports pain in the axillary region of the affected upper extremity. The OTR notes significant edema in the arm and that the arm is warm to the touch. Which of the following is the best option for why the OTR should alert the physician about these observations?

A. Late effect of cerebral vascular disease.

B. Subluxation of the shoulder.

C. Deep vein thrombosis.

C. Deep vein thrombosis.

an OTR is working with a client who has stage 5 Alzheimer’s disease and lives with a full-time caregiver. Based on the stage of the disease process, which option would be the most beneficial recommendation for the OTR to make to the caregiver?

A. Encourage the client to participate in a new hobby.

B. Post an illustrated daily schedule for the client to follow.

C. Provide assistance for dressing and grooming activities.

C. Provide assistance for dressing and grooming activities.

ChatGPT Rationale:

At Stage 5 of Alzheimer's disease, individuals typically:

• Have moderate cognitive decline,

• Require assistance with some basic activities of daily living (ADLs) such as dressing and grooming,

• May still recognize familiar people and retain some long-term memories,

• Often become confused about time or place, and may forget important personal details.

Option A (encouraging a new hobby) may be unrealistic or frustrating at this stage due to difficulty learning new information.

Option B (posting an illustrated daily schedule) may be more appropriate at earlier stages, when the person can still interpret and follow visual cues independently.

Option C is most appropriate because it aligns with the functional deficits common in Stage 5 and addresses practical caregiver support.

An inpatient had a right CVA one week ago. Prior to the CVA, the patient was relatively healthy and worked a full-time job. During an dressing assessment, the patient puts on a pullover sweater and then realizes the need to put on a T-shirt underneath the sweater. To do this, the patient attempts to insert the T-shirt down the neck hole of the sweater, instead of removing the sweater to put on the T-shirt. Which statement, most accurately describes the reason for the patient’s action?

A. Right hemispheric damage appears to resulted in perseverative behaviors.

B. Spatial integration deficits may be affecting the ability to recognize items.

C. The central nervous system is not receiving complete visual information.

D. The patient is not able to conceptualize steps of a task due to ideational apraxia.

D. The patient is not able to conceptualize steps of a task due to ideational apraxia.

MOTR is planning an intervention session for a six-year-old child who has fetal alcohol syndrome. The child is difficulty coping when frustrated and frequently refuses to speak in social situations and during therapy. The OTR has attempted to engage the child, using play therapy and sensory-based approaches, but the child refuses to participate. How should the OTR modify the intervention approach based on the child’s responses during previous interventions?

A. Engage with the child in computer games that promote positive feedback

B. Use role-play scenarios about interacting with superheroes.

C. Include expressive media, using cartoon character puppetry.

C. Include expressive media, using cartoon character puppetry.

ChatGPT Rationale

Because the child refuses to speak and does not engage in play or sensory activities, a more indirect and non-threatening method of expression is needed.

Option C is appropriate because:

• Expressive media like puppetry allows for nonverbal communication and symbolic play.

• Cartoon characters are familiar and appealing, which can help reduce anxiety and build trust.

• Puppets can serve as a social proxy, helping the child express emotions or thoughts indirectly and more comfortably.

Why not the other options?

• A. Computer games may offer positive feedback, but they are often isolating and not relational. They don’t encourage the social-emotional expression this child needs.

• B. Role-play with superheroes could be too direct or demanding for a child who is currently refusing to speak or engage. It may feel performative and increase pressure, reducing participation.

An OTR working in a community mental health setting is using dialectical behavior therapy to guide intervention planning for a client who has a borderline personality disorder. The client works in a university setting and is at risk of losing the job due to verbal outburst and erratic mood swings. The client is aware that behavioral changes are needed and reports of willingness to work towards these changes. Which type of intervention would be most beneficial for supporting progress toward the objective when using this approach?

A. Individual sessions focus, focusing on Socratic, questioning and guided discovery for addressing problematic situations and emotions.

B. Group skills training modules on mindfulness, interpersonal effectiveness, emotion modulation, and distress tolerance.

C. Role-play sessions, using prepared scripts for practicing problem-solving and decision-making related to workplace situations.

B. Group skills training modules on mindfulness, interpersonal effectiveness, emotion modulation, and distress tolerance.

A & C list components of CBT not DBT

An OTR is using the Modified Ashworth Scale (MAS) to monitor a client’s degree of spasticity in response to a newly implemented medication regimen. At the start of the regimen, the OTR rated the client’s wrist and finger spasticity on the MAS as grade 3. Two weeks after the regimen, the rating changed to grade 1. What does this change represent?

A. Slight change and muscle tone through most of the ROM, but negligible change and active use of the wrist or hand.

B. Positive change and muscle tone resulting in increase functional use of the affected upper extremity.

C. Decrease in overall muscle tone when the affected wrist and digits are passively, moved into flexion and extension.

C. Decrease in overall muscle tone when the affected wrist and digits are passively, moved into flexion and extension.

The OTR working in a community hospital is contributing discharge recommendations for a patient who is generally deconditioned secondary to complications from a septic episode. The patient has been participating in OT for the past three weeks. Currently, the patient requires moderate assistance with transfers and tolerates up to 10 minutes of seated ADL activity prior to needing a rest break. The patient’s goal is to return home to live independently. Which discharge setting would be most beneficial for the OTR to recommend for the patient’s s next level of care?

A. Home health with skilled services.

B. Subacute rehabilitation facility.

C. Inpatient rehabilitation hospital.

B. Subacute rehabilitation facility.

An OTR is establishing therapeutic rapport with a young adult client who has a personality disorder and struggles with relationships. As a child, the client lived in several foster homes and briefly attended college before dropping out to live with a partner. Currently, the client is not working and the partner has ended the relationship. What action is most important for the OTR to take when establishing rapport with this client?

A. Established flexible, rules of conduct during intervention.

B. Focus on developing an external locus of control.

C. Support motivation to make changes to personal behaviors.

C. Support motivation to make changes to personal behaviors.

An OTR is interpreting scores of a developmental test that was administered to a three-year-old child. The child scored at the 89th percentile for the child’s age and gender group. What can the OT conclude based on this score?

A. The child has minor developmental deficits compared to the normative sample group.

B. 11% of the children in the sample group scored higher than this child.

C. This child displays above average developmental skills compared to similar children.

D. These scores are sensitive for measuring small changes in the child’s overall development.

B. 11% of the children in the sample group scored higher than this child.

Why not the other options?

• A. Incorrect – A score at the 89th percentile does not indicate deficits; it suggests strong performance.

• C. While mostly true, it is less precise than option B. It doesn’t define percentile interpretation as clearly.

• D. Incorrect – This statement refers to sensitivity, which is more applicable to criterion-referenced tests or tools designed to detect small developmental changes, not to percentile ranks from norm-referenced assessments.

An inpatient who had a left CVA one week ago is participating in a dressing session. After putting on a sock during lower body dressing, the patient repeatedly attempts to pull the sock up, even though it is already in place. What neurobehavioral deficit is most consistent with these actions?

A. Spatial inattention.

B. Somatagnosia.

C. Dressing apraxia.

D. Pre-motor perseveration.

D. Pre-motor perseveration.

Random review

Somatagnosia= inability to recognize own body parts

⚡️soma= body of cell

anosognosia= person is unaware or denies illness

⚡Do they know they have an impairment? aNOsognosia

An OTR administered to criterion reference standardized, developmental checklist to a three-year-old, who has mild developmental delay. The child did not meet the standard for snipping with scissors. For what purpose with these results be most useful?

A. Linking out outcome measures to other typically developing children.

B. Determining developmentally appropriate activities to use in therapy.

C. Identify functional task that would be most difficult for the student.

D. Comparing the child’s performance to that of an age equivalent population.

B. Determining developmentally appropriate activities to use in therapy.

A young adult client who has a substance use disorder has been referred to community based OT. Although the client has maintained sobriety for the past six months, evaluation results indicate the client has an unrealistic self concept, poor social skills and inadequate, independent living skills. Which objective would be most beneficial to include as part of the initial intervention plan for supporting the client’s participation in occupations?

A. Transition to independent living with a supportive friend.

B. Acquisition of practical skills for basic life management.

C. Engagement in leisure activities with social acquaintances.

D. Education about work stressors that contribute to relapse.

B. Acquisition of practical skills for basic life management.

An inpatient has been participating in rehabilitation since having bilateral trans femoral amputations two months ago. The patient has good balance and fair plus (3+/5) upper extremity strength, is independent with bed mobility and self-care using adaptive equipment, and requires standby assistance during wheelchair transfers and with wheelchair management. The patient is preparing for discharge to live at home with the spouse and an adult son. Modifications have been made to the main entrance of the home and the bathroom. The OTR plans to provide family education for promoting the patient safe transition to the home environment. What information would be most beneficial to include as part of this process?

A. Methods for improving the patient’s independence with transfers.

B. Techniques the patient uses to transfer to a variety of surfaces.

C. Energy conservation techniques for the patient to use during ADL.

D. Wrapping techniques for shaping and protecting the residual limb.

B. Techniques the patient uses to transfer to a variety of surfaces.

A resident of a skilled nursing facility, who has moderately severe cognitive decline, becomes increasingly agitated during meal time. What is the first action the OTR should take based on this observation?

A. Instructor resident and relaxation exercises to use that meal time.

B. Arrange for the resident to eat meals in a calm, quiet location.

C. Observe the resident a meal time to identify behavioral triggers.

C. Observe the resident a meal time to identify behavioral triggers.

A client who has moderate cognitive decline, lives in a skilled nursing facility. The client spouse visits every morning after breakfast. The spouse informed OT that the client frequency of interacting during the visit has decreased over the past few weeks, and the client now is intermittent verbal outburst that disrupt the social interaction. In addition to informing the care team, what action should the OTR take based on this observation?

A. Sit with a client and the spouse during a visit and ask the client direct questions to facilitate appropriate communication.

B. Ask the spouse, open-ended questions about the situation and identify possible triggers for the change in level of interaction.

C. Provide the spouse with information about providing immediate feedback to the client when there are signs of agitation.

B. Ask the spouse, open-ended questions about the situation and identify possible triggers for the change in level of interaction.

An OTR is leading a mindfulness group with military veterans who have PTSD. One of the goals of the group is for the participants to learn interoceptive awareness. Which activity would provide the BEST opportunity for achieving this goal?

A. Have the participants take a deep breath while feeling their chest rise with their hand and concurrently focusing on what it feels like for their lungs to expand

B. Help participants identify a preferred location, followed by asking the participants to close their eyes and visualize themselves enjoying that location

C. In a quiet space, have the participants lay down and listen to a script that provides encouraging words to feel calm and pay attention to one body part at a time

A. Have the participants take a deep breath while feeling their chest rise with their hand and concurrently focusing on what it feels like for their lungs to expand

An OTR is providing recommendations to an outpatient client who has a chronic stage 3 pressure ulcer of the coccyx. One of the client’s goals is to learn self-management strategies to promote wound healing. As part of the intervention plan, the OTR provides the client with a recommendation for a new seating system and instructions in pressure relief techniques. What additional topics should the OTR include in the client education to promote effective wound healing?

A. Pain management and desensitization

B. Nutritional intake and adequate hygiene

C. Strengthening and therapeutic exercise

B. Nutritional intake and adequate hygiene

A client has an upper extremity flexor synergy secondary to a CVA. The client has developed a severe soft-tissue contracture of the affected elbow. Which method would be MOST EFFECTIVE for increasing soft tissue length for improving elbow extension?

A. Provide submaximal stretch to the contracted soft tissue for prolonged periods of time

B. Perform passive ROM to the affected elbow with high-load stretch for brief periods of time

C. Apply a long-arm cast while the affected elbow is being stretched to the terminal end range

A. Provide submaximal stretch to the contracted soft tissue for prolonged periods of time

The student in the first grade has moderate hypotonicity resulting import oral motor control. One of the student’s goals is to be able to “eat the same food as the other kids” at lunchtime in the cafeteria at school. Currently, the student requires moderate assistance when eating and eats a soft diet. What should be the initial focus of intervention for progressing towards this goal?

A. Asking the student to identify specific food preferences from the cafeteria menu.

B. Determining which cafeteria foods have the textures the student can eat.

C. Identify seating and positioning options for the student in the cafeteria.

D. Providing the student with assistive devices to use when eating in the cafeteria.

C. Identify seating and positioning options for the student in the cafeteria.

A patient with borderline personality disorder was admitted to an inpatient facility four days ago, secondary to an exacerbation of suicidal and self mutilating behaviors. The patient’s condition is now stable, and the patient is functioning at Alan cognitive level five exploratory actions. The patient reports being overwhelmed by a new personal relationship, experiencing job dissatisfaction, and feeling a lack of control and most daily situations. Which intervention would be most beneficial for dressing, problems, and performance, skills and pattern secondary to the concurrent symptoms?

A. Coping skills group that address a variety of adaptive strategies.

B. One on one session to encourage the patient to contract for safety.

C. Daily self-care sessions that focus on structured BADL.

D. Structured one step craft activities to promote successful outcomes.

A. Coping skills group that address a variety of adaptive strategies.

In OT’s fabricating in orthotic for a client who has claw hand deformity secondary to an ulnar nerve injury several months ago. What type of orthotic is indicated for this client?

A. Dorsal based MCP joint blocking orthotic with a dynamic component to pull the fourth and fifth digit IP joints into extension.

B. Low profile dynamic orthotic that block hyper extension of the second through fifth digits and has an IP joint extension outrigger.

C. Volar-based forearm and hand static orthotic that blocks MCP joint hyper extension while allowing IP joint motion.

D. Hand based orthotic that positions the fourth and fifth digits in 30°-40° of MCP joint flexion while allowing IP joint motion.

D. Hand based orthotic that positions the fourth and fifth digits in 30°-40° of MCP joint flexion while allowing IP joint motion.

A school-based OT is selecting seating alternatives for a student who has moderate hypotonia and has just transitioned to a full-day kindergarten program. The student uses a wheelchair for mobility and does not tolerate an upright sitting position throughout the school day. What type of positioning system would be MOST BENEFICIAL for this student?

A. Lightweight chair with reclining back and reverse wheel configuration

B. Corner chair with high lateral supports that can be placed on the floor

C. Dense foam lateral supports and gel cushion for the current wheelchair

D. Modular wheelchair with tilt-in-space feature in the mobility base

C. Dense foam lateral supports and gel cushion for the current wheelchair

• Primary issue: The student has moderate hypotonia, which means decreased muscle tone and poor postural stability. The child already has a wheelchair for mobility, so improving the existing wheelchair’s support system is often the first step before switching to a different base.

• Why foam lateral supports and a gel cushion?

  • Lateral supports provide extra trunk stability and prevent the student from collapsing sideways due to low muscle tone.

  • Gel cushions help with pressure relief and pelvic stability, improving comfort for longer sitting times.

  • This modification is less restrictive than a tilt-in-space system and supports more active engagement in classroom activities (upright positioning is maintained while still providing support).

Why not D (tilt-in-space)?

• Tilt-in-space is typically indicated for students with severe postural control issues, pressure relief needs, or when upright sitting is impossible.

• In this scenario, the student does not tolerate upright sitting all day, but they might still benefit from enhanced trunk and pelvic support to increase upright tolerance, rather than changing the orientation (which could reduce participation and access in classroom activities).

• OT practice often emphasizes least restrictive and simplest modifications first, so C is considered the most appropriate starting point.

A 12 month old infant has moderate hypotonia resulting in developmental delay and poor oral motor control. Which position is recommended for this infant for promoting oral motor function during feeding?

A. Slightly reclined with trunk fully supported and the neck and head at midline

B. Fully upright in sitting with the head and neck resting in slight extension

C. Seated upright in a standard high chair with a lap tray positioned close to the chest

D. Semi-reclined in a position of comfort on a soft beanbag chair

A. Slightly reclined with trunk fully supported and the neck and head at midline

An OTR who works in a school is planning a session for a kindergarten student who has Down syndrome. The student can push down their pants during toileting but is unable to pull them up. Which technique would be most beneficial to include as part of the initial intervention for this student?

A. Use games and activities that support pinch strength

B. Train the staff on methods to support the student.

C. Assist the student with pulling up their pants

A. Use games and activities that support pinch strength

An OTR is collaborating with a client and a building contractor to have a wall mounted grab bar installed in the clients bathroom. The client lives independently in a mobile home and is at risk for fall due to cerebellar ataxia. The OTR determines the optimal placement of the grab bar is to meet the needs of the client, however, the contractor informed the OTR there are no available studs behind the wall board in the recommended location locations. Which alternative option would be most beneficial for the OTR to discuss with the contractor and the client?

A. Apply suction cup bathroom, safety bars on the wall board.

B. Install 1/2 inch plywood over existing wall board.

C. Place blocks between the wall studs under the wall board.

C. Place blocks between the wall studs under the wall board.

An OTR is collaborating with a home health client to select a new power wheelchair. The client has morbid obesity, chronic, obstructive, pulmonary disease, diabetes, and severe edema in both lower extremities. Caregivers assist the client to transfer into the chair with a mechanical lift, and the client uses the wheelchair full-time for a mobility. Based on the situation, which type of power wheelchair would be most beneficial for the OTR to recommend to this client?

A. Front wheel drive with power recline.

B. Mid wheel drive with elevating leg rests

C. Rear wheel drive with a seat elevator.

B. Mid wheel drive with elevating leg rests

Why B could be considered "most beneficial":

1. Edema is the key factor.

   • The client has severe lower-extremity edema, which requires frequent leg elevation for circulation and edema management.

   • Elevating leg rests directly address this need, while a recline feature (Answer A) does not automatically elevate the legs unless paired with elevating leg rests.

2. Mid-wheel drive maneuverability for home use.

   • The scenario states this is a home health client. Mid-wheel drive is generally preferred indoors because of its tight turning radius, making it more functional in smaller spaces (like bathrooms or narrow hallways).

3. Recline vs. Elevation.

   • Power recline is helpful for pressure relief, but exam logic prioritizes direct management of a stated medical need—in this case, leg edema.

   • Elevating leg rests not only help with edema but also assist with pressure redistribution when combined with tilt or recline.

---

Why not A or C in exam logic:

• A (Front-wheel drive with power recline): While good for stability and pressure management, it does not address edema as directly as elevating leg rests.

• C (Rear-wheel drive with seat elevator): A seat elevator is more for functional reach, not a medical priority here.

An OTR fabricated an immobilization orthosis for a 4 year old child who had a syndactyly release. The purpose of the orthosis is to protect the skin grafts, maintain the interdigital spaces, and keep the fingers properly positioned. What action should the OTR take as part of the fabrication procedure to proactively support a positive orthotic wearing experience for this child?

A. Engage the child in an activity to make a sock puppet to wear over the orthosis

B. Explain the purpose of the orthosis to the child using age-appropriate language

C. Ensure the orthosis is wrapped snuggly on the hand with a brightly colored elasticized wrap

A. Engage the child in an activity to make a sock puppet to wear over the orthosis

• 4-year-olds respond best to play and creativity, not explanations.

  • At this developmental stage (preschool), children have limited abstract reasoning. A simple explanation (option B) may not be as effective as making the orthosis feel like part of a fun activity.

  • By personalizing the orthosis (e.g., turning it into a puppet), the child is less likely to resist wearing it and more likely to view it positively.

• Engagement reduces fear.

  • Orthoses after surgery can look intimidating. Making it playful can decrease anxiety and increase emotional acceptance.

• Focus of the question:

  • The question specifically asks about "proactively supporting a positive orthotic wearing experience."

  • This is less about understanding the purpose (B) and more about ensuring compliance and comfort through engagement.

An 8 year old with severe achondroplasia has limited hand function with no isolated finger movements. The student is learning to use an adapted computer to optimize performance during classroom assignments. Which modification would BEST support student’s success to access the computer?

A. Single-switch control interface

B. Continuous joystick input device

C. Trackball mounted on a stationary base

A. Single-switch control interface

• A single-switch control interface is designed for individuals with very limited motor control. It can be programmed for scanning systems or other adaptive computer access methods that require only one reliable movement (e.g., head tap, large button press).

• This setup allows the student to make selections without the need for finger dexterity.

A student in the second grade has spastic quadriplegia secondary to cerebral palsy and uses a power wheelchair for mobility. The OTR observes the student throwing and catching a ball with peers during gym class. As the student attempts to throw the ball, the trunk shifts laterally and the student has difficulty moving back to midline to continue the game. What modification to the wheelchair would be most effective for promoting postural stability to maintain a proper base of support while the student is throwing and catching the ball?

A. Thigh and pelvic strap.

B. Lap tray attachment.

C. Chest harness.

C. Chest harness.

How would an OTR® use coaching to help improve social skills for a client with autism who is preparing for a job interview?

A.

Role-play a scenario in which the OTR is a friend and they are deciding how to spend Saturday night.

B.

Outline what will be expected of the client in the interview process and practice some interview questions.

C.

Provide explicit instructions on how to ask someone on a date.

D.

Accompany the client to a department store and help the client return a sweatshirt.

B.

Outline what will be expected of the client in the interview process and practice some interview questions.

AOTA Justification:

This approach delivers clear expectations that will help the client perform well on the job interview. Providing support by outlining expectations will help the client improve social skills in this professional setting.

A, C, D: These approaches address social skills by other means but not by coaching techniques.

The OTR® is working on a task-oriented gardening activity with a small group of adolescents in an inpatient mental health setting. One of the participants becomes self-absorbed and distractible and has bursts of energy that are affecting the other members of the group. What is the OTR’s MOSTappropriate response?

A.

“How are you doing with the pot transfer? It needs to be finished by the end of group today.”

B.

“Can I speak to you privately about your behavior during the group work?”

C.

“You are distracting the other members of the group from getting their work done.”

D.

“Please stop this behavior. It is distracting. Perhaps you want to do something else?”

Solution: The correct answer is A.

When a client starts shows symptoms of a manic episode, particularly emotional and cognitive symptoms, it is best to help the client engage in goal-directed action.

B, C, D: These responses serve to make the client aware of their behaviors but do not necessarily help the client return to meaningful task performance

A client is evaluated by an OTR® to determine ability to return to work as a dry cleaner assistant after a total hip replacement 4 months ago. The client reports having to carry loads of laundry weighing as much as 10 lbs. one-third to two-thirds of the day. Per the Dictionary of Occupational Titles (DOT), at what strength demand should the OTR design work simulation tasks?

A.

Sedentary

B.

Light

C.

Heavy

D.

Very heavy

Solution: The correct answer is B.

A light strength demand is defined by DOT as requiring a force exertion or weight carried of 20 lb occasionally as much as one-third of the day, 10 lb frequently one-third to two-thirds of the day, and negligible weight constantly over two-thirds of the day.

An entry-level COTA® begins working at a long-term care facility and needs direct continuous supervision. Which statement BEST describes this type of supervision?

A.

The COTA and supervising OTR® are in the rehabilitation gym, and the OTR observes the COTA’s performance.

B.

The COTA and OTR meet at the end of each day to discuss the COTA’s caseload and review documentation.

C.

The supervising OTR is in the facility but in another area.

D.

The COTA e-mails or texts the OTR questions throughout the day as needed, and the OTR reviews the COTA^’s documentation regularly.

Solution: The correct answer is A.

Direct supervision offers the OTR firsthand information on the COTA’s performance as a result of in-person observation. Continuous supervisionmeans the COTA is in sight of the supervising OTR.

B, D: These options involve indirect supervision.

C: This is not a type of supervision.

What strategy might an OTR® appropriately recommend to caregivers of a client with Alzheimer’s disease to assist with fall prevention?

A.

Engage the client in daily, structured activity.

B.

Provide visual reminders in the home environment.

C.

Install grab bars in the bathroom.

D.

Engage the client in an exercise program.

Solution: The correct answer is A.

Engagement in activity-based interventions, along with daily structure, has been documented to assist in fall prevention.

A patient in the early stages of amyotrophic lateral sclerosis (ALS) presents with weakness in the thenar eminence. During which ADL task would the evaluating OTR® MOST LIKELY observe the effect on function?

A.

Transferring from the bed to the bedside commode

B.

Taking a sip from a glass of water

C.

Reaching overhead to don a T-shirt

D.

Squeezing toothpaste onto a toothbrush

Solution: The correct answer is D.

Typical early signs of ALS are distal, with weakness of the small muscles of the hand being the most typical initial symptom. The muscles that make up the thenar eminence are responsible for opposition of the thumb. Squeezing toothpaste and holding a toothbrush require grasp-and-pinch patterns that involve thumb opposition.

A: Transferring from the bed to the bedside commode is not the best answer because performing a transfer puts more emphasis on the lower extremities and trunk muscles versus the distal, small muscles of the hand.

B: Although sipping water from a glass involves grasp, the thumb is more abducted in this position.

C: This approach is incorrect because it involves more proximal musculature.

An OTR® is working with a client with hemiplegia on laundry tasks. Folding the laundry proves too difficult because of the weaker extremity, and the client becomes increasingly frustrated. How should the OTR BEST modify the activity?

A.

Stop the task and move on to the next planned activity.

B.

Instruct the client to sort the laundry by type of garment using both hands.

C.

Use appropriate therapeutic use of self to address the client’s frustration.

D.

Allow the client to practice hanging up clothes in the closet.

Solution: The correct answer is B.

The activity analysis skill here is grading; the OTR recognizes the difficulty of performing this bilateral upper-extremity activity and appropriately downgrades the task to reduce the demands.

A: Changing activities is not necessary when laundry tasks can easily be modified to better meet the client’s ability; moreover, it may affect the timing of the therapeutic session.

C: Therapeutic use of self is a useful skill, but the client’s frustration can be connected to the difficulty of performing the task; therefore, simply altering the task demands would likely reduce the frustration.

D: Hanging up clothes requires bilateral upper-extremity use and would likely increase the client’s irritation because of continued difficulty.

An OTR® is working with a client with chronic obstructive pulmonary disease on therapeutic exercise and how to measure exercise tolerance. The client is performing seated bilateral shoulder flexion with 3-lb weights and rates this activity as “very, very easy.” How would the OTR® appropriately grade this activity?

A.

Change the muscle groups used by switching to shoulder abduction.

B.

Advise the client to perform the task in a standing position.

C.

Switch the client to a resistance band.

D.

Increase the number of repetitions and have the client perform the exercises while standing.

Solution: The correct answer is B.

If the client states that the current exercise is too easy, the OTR would appropriately upgrade the task. Performing these exercises in a standing position uses trunk and leg muscles, thereby increasing the physical demands.

A: Changing the muscles worked may not be an adequate challenge.

C: Switching to a resistance band may not provide a sufficient challenge and is an unnecessary modification.

D: This option increases the difficulty of the exercise too quickly; the client should first perform the exercise in a standing position with the same number of repetitions as performed while seated.

An OTR® is reviewing the chart of a client with Down syndrome. The chart indicates that the client has a history of patent ductus arteriosus (PDA). What are the risks associated with this condition?

A.

This condition can lead to increased blood pressure and rapid heart rate.

B.

This condition can lead to difficulties with feeding and shortness of breath.

C.

This condition can lead to pulmonary hypertension and heart failure.

D.

This condition can lead to vertigo and dehydration.

Solution: The correct answer is C.

PDA is a heart defect that is common in premature children and people with Down syndrome. A defect of the ductus arteriosus results in a lack of constriction, causing too much blood to flow to the lungs, eventually resulting in congestive heart failure.  

A: This response describes tachycardia, which can lead to an abnormally fast heart rate.

B: This response describes supraventricular tachycardia, which can lead to feeding difficulties.

D: These symptoms are not related to PDA defect

On an inpatient rehabilitation unit, the OTR® and the evaluating physical therapist observe a new patient with Parkinson's disease eating breakfast seated in a bedside chair. The OTR observes a fork on the floor and milk spilled on the patient's gown and tray. The patient begins coughing, spitting up pieces of pancake, and then says hello with unswallowed food in the mouth. What action would be MOST appropriate for the OTR to take while evaluating the patient?

A.

Consult with the patient to propose adaptive feeding equipment to minimize spilling and dropping food.

B.

Educate the patient on the role of occupational therapy for feeding and speech therapy for swallowing, and make an appropriate referral.

C.

Collaborate with the patient and the physical therapist to create the optimal seating and positioning of the patient to the tray for proximal stability.

D.

Discuss with the patient and the nutritionist an immediate need to switch to a mechanical soft diet.

Solution: The correct answer is B.

A speech therapist is a critical interdisciplinary team member who can evaluate for dysphagia and advise on appropriate diet changes or recommend further testing such as a video swallow. It is appropriate to discuss with the client whether the client wants increased independence with feeding via adaptive techniques or equipment, and providing education on the role of occupational therapy with feeding would help initiate this part of the intervention planning process.

A: Adaptive feeding equipment is an important consideration for developing an intervention plan for occupational therapy, but the apparent dysphagia is more urgent and requires immediate attention from the proper team members.

C: Addressing proximal stability by enhancing positioning with the bedside chair to the table and tray may help reduce tremors and improve distal stability to manipulate the utensils, but again the dysphagia is a more pressing issue at this time.

D: Changing a patient's diet is outside the scope of occupational therapy practice.

An OTR® is working on sequencing a bedtime routine with a child with autism. Which activities would be supportive of this outcome?

A.

Providing the child with pictures of the different tasks involved in the routine so that the child may perform them in order.

B.

Encouraging the child to complete the last task in a series of tasks so that the child is more inclined to want to complete the routine.

C.

Allowing the child to select which activities to eliminate from the routine.

D.

Introducing the child to adaptive equipment (e.g., an electric toothbrush) so that the routine takes less time.

Solution: The correct answer is A.

Clients with autism benefit from the use of visual supports, such as pictures. Using pictures may help this child recall steps so that the child can perform them in the correct order.

B, C, D: The other activities, although they may be appropriate for a child with autism, do not address the need for the child to learn how to sequence the routine.

An OTR® at an acute care hospital is evaluating a client in the onset stage of Guillain-Barré syndrome (GBS) who requires total assistance for most tasks. At this stage, what goals should the OTR focus on?

A.

Patient and caregiver education on the progressive nature of this disease

B.

ADL performance, especially adaptive equipment training and other compensatory strategies

C.

ROM and strengthening to prevent muscles from further weakening

D.

Positioning to prevent skin breakdown or contractures and to allow access to needed items

Solution: The correct answer is D.

The symptoms of GBS in the acute inflammatory stage—which include edema, muscle weakness or paralysis, sensory loss, bladder incontinence, and pain—increase a client's risk for skin breakdown, especially a client who is totally dependent for most tasks. Such clients are likely not able to reposition themselves or independently clean up incontinence issues. At this stage focusing on preventing secondary complications, such as skin breakdown and contractures, and decreasing anxiety, by having items such as a call bell, telephone, communication devices, and fresh water in easy reach, will be paramount.

An OTR® working with families of children with autism wants to ensure a family-centered intervention program. Which strategy BEST reflects use of this approach?

A.

Ensuring that all of the children’s skill deficits are addressed

B.

Helping each family develop a weekend plan of activities

C.

Educating families about their child’s deficits and needs

D.

Modifying families’ lifestyle to ensure carryover of intervention at home

Solution: The correct answer is B.

Family-centered intervention required consideration of the family’s needs and priorities. Helping families select weekend activities reflects a family-centered approach to intervention. Ideally, the activities involve behaviors and skills that the children can generalize to a variety of settings.

A, C, D: These strategies do not consider families’ specific needs.

An OTR® is preparing to assess a student who is 17 years old and has moderate symptoms associated with autism spectrum disorder (ASD). The purpose of the assessment is to determine the student's strengths and needs for a work–study experience as part of a transition services program. What type of assessment would be MOST BENEFICIAL to administer when gathering information to achieve this goal?

A.

Self-administered occupational performance checklists

B.

Self-perception questionnaire related to occupational performance

C.

Social interactions and social adjustment inventory

D.

Functional capacities and work readiness evaluation

Solution: The correct answer is C.

Social skills such as getting along with others and functioning socially in a group situation have been found to be significant predictors of employment for individuals with ASD. This would be the most beneficial information to gather in this assessment.

A, B: Assessment of vocational potential to prepare for transition services should focus on social and vocational functioning for individuals with ASD; occupational performance areas that relate to work, leisure, and social skills should be the focus, not personal ADLs. Assessments addressing prevocational skills should be brief and focused on work-related skills to avoid discouraging the student.

D: Functional capacities and work readiness evaluation are appropriate in situations when a work injury has occurred; these services are not used in transition services planning.

An OTR® is explaining to a client who was recently evaluated the value and benefit of a transitional work program. Which of the following components would be included in a transitional work program?

A.

Client's performance of work conditioning activities in the clinic followed by performance of worksite light-duty tasks.

B.

Client's exploration of options for full-time employment while participating in work conditioning program.

C.

Client's return to full-time employment while performing at modified work capacity.

D.

Client's return to part-time employment, performing all required physical job demands.

Solution: The correct answer is A.

Transitional programs include monitoring the client's progress and reassessing performance to determine when job tasks can be upgraded to full time or full duty.

B, D: Transitional programs are offered during the transition period when the client is able to complete some but not all job tasks; the goal is to return the client to full duty or to maximize the client's work capacity. Early implementation of a rehabilitation program will increase the likelihood of a client's successful return to work.

C: Modified duty does not include the clinical portion of a return-to-work program.

While assessing muscle tone in an inpatient who has multiple sclerosis, the OTR® moves the patient's upper extremity rapidly through its full range while the patient relaxes the limb. The OTR® notes a slight catch of the upper extremity in the midrange of motion. Which of the following occurred during the assessment of this movement?

A.

Hypertonicity

B.

Flaccidity

C.

Spasticity

D.

Weakness

Solution: The correct answer is C.

Spasticity is indicated when a sudden catch or resistance occurs within a quick movement throughout the range of motion for the extremity

A: Hypertonicity is typically elicited during slow joint movements.

B: Flaccidity indicates a lack of muscle tone with no resistance during passive movement.

D: Weakness is assessed through active movement such as moving the extremity against gravity.

A client with developmental coordination disorder is referred for evaluation by the transition services team at a high school. Which assessment is the MOST appropriate for the OTR® to complete first with the client?

A.

Self-Directed Search

B.

Cognitive Status Examination

C.

Box and Block Test

D.

Functional capacity evaluation

Solution: The correct answer is A.

The Self-Directed Search measures a client's vocational interests.

B: The Cognitive Status Exam measures neurological behaviors (e.g., attention, speech, memory for work activity), which should be assessed after determining the client's vocational interests.

C: The Box and Block Test addresses performance skills, which should be assessed after determining the client's vocational interests.

D: A functional capacity evaluation is used to determine a client's physical capacity to perform the essential functions of a specific job.

An OTR® is working with a student with a learning disability to improve independence getting to and from community college. Which action represents a scaffolding approach to this intervention?

A.

The OTR® helps the student study the bus map to identify the appropriate route and then encourages to the student to look at the schedule to determine the times.

B.

The OTR® accompanies the student to and from the school on the bus and points out landmarks to serve as visual reminders of the route.

C.

The OTR® outlines what will be expected of the student regarding bus times, schedule, cost, and appropriate behavior on public transportation.

D.

The OTR® encourages the student to take the bus with a friend to ensure the student does not get lost.

Solution: The correct answer is A.

The OTR® assists the student with one of the more difficult tasks, identifying the appropriate bus route to and from school. The OTR® then allows the student to independently proceed with the public transportation planning. Scaffolding involves the OTR® working with the client on components of the activity that prove too difficult, but the client ultimately finishes the activity independently, thereby improving motivation.

B: Accompanying the student temporarily adapts the social environment by the presence of the OTR®.

C: Outlining expectations is a coaching approach.

D: Taking the bus with a friend is a change to the social environment, but it reduces the student’s independence.

An OTR® is discussing with a parent different types of technology to improve the handwriting skills of an 8-year-old child with autism. Which approach is the BEST example of a basic technology that can improve handwriting skills?

A.

An iPad application for correct letter formation

B.

Computer software that prompts a child to copy a sentence in cursive

C.

A pencil grip to facilitate pencil grasp during writing

D.

Internet games on visualperceptual skills

Solution: The correct answer is C.

Of the options, only a pencil grip is considered a basic technology.

A, B, D: These options are considered educational and electronic technologies.

While reviewing the chart of a client with spinal cord injury, the OTR® notices that the client has experienced past episodes of autonomic dysreflexia in the hospital. What is the BEST recommendation the OTR® can make to the client?

A.

Suggest the client seek another OTR® because the OTR® is unfamiliar with the condition.

B.

Suggest the client carry an emergency card describing the condition for medical personnel and others.

C.

Suggest the client wear elastic stockings and abdominal binders to increase blood pressure.

D.

Suggest the client leave sessions early if experiencing symptoms.

Solution: The correct answer is B.

Clients susceptible to autonomic dysreflexia are encouraged to carry an emergency card describing the condition and treatment.

A: OTR®s must be aware of the symptoms of and treatment for autonomic dysreflexia because it can occur at any time postinjury.

C: Increasing blood pressure is not indicated to prevent autonomic dysreflexia.

D: The client should not be left alone if experiencing symptoms of autonomic dysreflexia.

A client who has cardiac disease is participating in outpatient occupational therapy and is able to complete activities in the 1–4 metabolic equivalent (MET) range. Dyspnea and angina limit physical activity above 6 METs. Which activity is safe to include as part of the initial intervention for this client?

A.

Completing self-care tasks including dressing, bathing, grooming, and hygiene for 5-minute intervals each with 12 minutes rest between activities

B.

Participating in very light stationary biking for 5 minutes with a short rest of 1 minute and then standing to fold towels for 5 minutes

C.

Pedaling a stationary bicycle for several 5-minute intervals followed by a 1- to 2-minute rest between interval and continuing with 5-minute intervals until fatigued

D.

Walking on a treadmill at 10 miles per hour (16 km per hour) for 5 minutes followed by a 1- to 2-minute rest, then walking on treadmill at 5 miles per hour (8 km per hour)

Solution: The correct answer is B.

This routine targets different muscle groups for the same time interval while offering opportunities to gradually increase the intensity of the tasks.

A: Self-care tasks are within the MET range of 1.0–2.5, which the client is currently able to complete; therefore, this intervention would not provide sufficient challenge for the client.

C, D: Working on one piece of exercise equipment, such as pedaling on a stationary bike or walking on a treadmill, provides only one form of aerobic exercise and limits the targeted muscle groups. In addition, these exercises could push the client over the 6-MET limit.

Question

A client with Stage 1 Parkinson’s disease (PD) identifies grocery shopping as a valued occupation but lists fatigue as a barrier and states that occasional tremors can be embarrassing. What intervention approach would be meaningful as the OTR® prepares to accompany the client to the store for an occupation-based treatment session?

A.

Creating a list of needed items and making a route to navigate the store efficiently

B.

Providing the client with psychosocial support to focus on reducing the anxiety or shame associated with symptoms

C.

Having the client don wrist weights to reduce tremors while reaching for items to put in the shopping cart

D.

Instructing the client in the use of a rollator to take seated rest breaks or one of the store's power chairs to save energy

.

Solution: The correct answer is A.

Organizing a grocery list and planning the most efficient route through the store to obtain the needed items is an energy conservation technique that addresses the client’s fatigue which, in turn, enables engagement in a valued occupation while promoting client safety. The tremors are occasional, so addressing the client’s embarrassment, although important, is not the most urgent priority.

B: Psychosocial support is an ongoing intervention tool but not the most effective for successful participation in this client-chosen task.

C: Donning wrist weights may help some clients with PD reduce tremors, but adding weights might increase fatigue and may also draw attention to the disability.

D: A client with Stage 1 PD does not typically present with balance deficits; using assistive devices or a wheelchair may help conserve energy, but it is most likely inappropriate for this patient and may enhance feelings of shame or disability

An OTR® is writing treatment goals for a client receiving occupational therapy services in a work conditioning program after a right shoulder sprain. The client is employed full time as a surgical technician in an outpatient surgery center. Which option is the BEST example of a long-term goal?

A.

Client will return to full duty as a surgical technician in a full-time capacity within 4 weeks.

B.

Client's employer will implement reasonable accommodations to promote the client's ability to complete full-time physical demands as a surgical technician within 4 weeks.

C.

Client will return to full duty as a surgical technician with the ability to carry over proper body mechanics to reduce risk for reinjury.

D.

Client will use proper body mechanics 100% of the time while completing the job of a surgical technician within 4 weeks.

Solution: The correct answer is A.

The goal is client centered, objectively focused on the goal of full-duty and full-time employment in the role of surgical technician within a specified timeline.

B: The goal is not client centered; the focus is on the employer.

C: The goal lacks a specified timeframe in which the outcome is to be achieved

D: The goal lacks an objective measure specifying full-time and full-duty employment

A client is recovering from an acute flare-up of rheumatoid arthritis. An initial screening indicates significant joint laxity in both hands. What type of assessment would be CONTRAINDICATED for the OTR® to use during this stage of the client's disease process?

A.

Manual muscle testing

B.

Standardized test of hand function

C.

Goniometric ROM measurements

D.

Comprehensive sensory testing

Solution: The correct answer is A.

Resistance applied during manual muscle testing may be harmful to inflamed tissue and joints and is contraindicated in an acute phase of arthritis.

B: Standardized test of hand function is not contraindicated during an acute phase of arthritis though the practitioner should use caution when stressing painful or vulnerable joints.

C: Goniometric ROM measurements are used to assess active ROM and are not contraindicated in the acute phase of arthritis though the measurements may be difficult when joint deformity is present.

D: Comprehensive sensory testing is not contraindicated in the acute phase of arthritis and should be considered when nerves have been compressed or damaged because of swelling.

An OTR® completes an intervention session with a client and documents it using the SOAP note format. In which section would the OTR write “Client is making excellent progress toward goals and has met short-term goal 1?”

A. O

B. S

C. P

D. A

Solution: The correct answer is D.

A stands for the assessment part of the SOAP note. The data were interpreted by the OTR, who used professional judgment to determine the progress the client made toward the goals.

These answers relate to the other parts of the SOAP note.

An OTR® is working with an adolescent with traumatic brain injury on cooking skills. While completing an activity analysis of making simple meals on the stovetop, the OTR notes that the client must be able to judge the relative distance between self and the stove to safely complete a cooking task. Which visual–perceptual skill does the client need to be able to judge this distance?

A.

Visual closure

B.

Position in space

C.

Depth perception

D.

Visual memory

Solution: The correct answer is C.

Depth perception is a person's ability to judge the relative distance between self and another object in space.

A client with Down syndrome is preparing for transition from high school to work and is seeking a work placement. The client needs to identify vocational interests and abilities for general job tasks. To which service should the OTR®refer the client?

A.

Vocational rehabilitation

B.

Functional capacity evaluation

C.

Job site evaluation

D.

Prework screening

Solution: The correct answer is A.

Vocational rehabilitation services identify a client’s vocational interests and abilities along with physical and mental tolerances for general job activities. Such services can be incorporated into a client’s IEP transition planning.

B: Functional capacity evaluation provides information about a client’s physical abilities to complete a specific job activity.

C: Job site evaluations assess the physical demands and layout of a specific job setting.

D: Prework screening is done when a client has been offered a job.

Question

A client is referred to a return-to-work program 3 months postlaceration with subsequent flexor tendon repair to the index finger. The client sustained the injury while working as a sous chef. Which option would provide the OTR® with the MOST comprehensive summary of the physical demands of the client’s job?

A.

U.S. Department of Labor’s O*Net

B.

Occupational Safety and Health Administration (OSHA) and National Institute of Occupational Safety and Health (NIOSH)

C.

Employer-provided job description and Occupational Safety and Health Administration (OSHA)

D.

U.S. Department of Labor and job demand analysis

Solution: The correct answer is A.

O*Net is an online searchable database for information about occupations. Crosswalks of O*NET data and job information in other reference databases are available at https://www.onetonline.org/crosswalk/DOT/. Other crosswalks are available on the O*NET home page.

B: OSHA is an agency of the U.S. Department of Labor. Its mission is to ensure safe and healthful working conditions. NIOSH, a division of the Centers for Disease Control and Prevention, is responsible for conducting research and making recommendations for the prevention of work-related illnesses and injuries.

C: An employer-provided job description may not be the most inclusive or comprehensive source.

D: The U.S. Department of Labor is the department of the U.S. government responsible for occupational safety, wage and hour standards, unemployment insurance benefits, reemployment services, and some economic statistics.

An OTR® is working with a client in the postacute phase of L1 spinal cord injury. The client voices concern about the risk of pressure ulcers. What is the BEST recommendation regarding frequency of pressure-relief technique?

A.

Every 30 to 60 minutes

B.

Every 90 minutes

C.

Every 20 minutes

D.

Every 3 hours

Solution: The correct answer is A.

For clients using wheelchairs who can reposition themselves, pressure relief typically should be performed every 30 to 60 minutes for a duration of 1 to 2 minutes to prevent skin breakdown.

B, D: Performing pressure-relief strategies at intervals longer than 30 to 60 minutes could lead to pressure ulcers. 

C: Repositioning does not need to take place this frequently unless the client is at high risk for pressure ulcers.  

Question

An OTR® is using the Ayres Sensory Integration Intervention program for a 6-year-old child with attention deficit hyperactivity disorder and sensory-seeking behaviors. Which principle should the OTR® keep in mind when selecting activities for this intervention program?

A.

The sensory environment is completely structured to allow for optimum integration of sensory information.

B.

Sensory experiences are limited to one sensory factor at a time to ensure mastery.

C.

Passive participation on the part of the child is encouraged.

D.

Appropriate activities are done individually and not in a small group.

Solution: The correct answer is D.

The Ayres Sensory Integration Intervention program is applied individually rather than in groups.

A: In the Ayres program, complete structuring of the sensory environment is not recommended.

B: The Ayres program incorporates multiple sensory experiences to ensure mastery.

C: The OTR® encourages the child's active participation in the Ayres program.

A COTA® is working toward service competency for adaptive feeding equipment instruction. How would the OTR® BEST establish the COTA’s service competency?

A.

The OTR reviews the COTA’s documentation of multiple patients whose feeding impairments warranted adaptive equipment, then discusses the progress notes and related documentation with the COTA.

B.

The OTR observes the COTA educating clients on how to use adaptive feeding equipment to ensure that the COTA instructs clients following the plan of care.

C.

The COTA and OTR observe the same client using adaptive feeding equipment and, using established procedures and protocols, rate the client at the same level of performance.

D.

The OTR collects information from various sources, including other therapists, the COTA’s documentation, and feedback from clients, to determine competency.

Solution: The correct answer is C.

Service competency is defined as “the process of teaching, training, and evaluating in which the OTR determines that the COTA performs tasks in the same way that the OTR would and achieves the same outcomes” (AOTA, 2009, in Youngstrom & Gentile, 2019). In this example, both the COTA and the OTR observe the same client performing a task and rate that performance at the same level using the same outcome measure. Outcomes are a key component of service competency. There can be minor variations in how two different practitioners perform tasks such as instruction in adaptive feeding equipment, but the client outcomes must be similar. 

A, D: These are indirect approaches to determining the COTA’s skill; indirect approaches are insufficient to establish service competency.

B: Although it is important for the COTA to be able to instruct the client according to the plan of care, the outcomes are a key component of service competency. There can be minor variations in how two different practitioners perform tasks such as instruction in adaptive feeding equipment, but the client outcomes must be similar. 

An OTR® receives a referral to evaluate an older adult client with middle-stage dementia who resides in a long-term care facility. While the OTR is conducting the assessment, the client becomes agitated and tells the OTR that they are going to make the client late to pick up the client’s children from daycare.  What is the BEST approach for the OTR to take in this situation?

A.

Remind the client that the children are grown adults.

B.

Attempt to engage the client in an alternative activity.

C.

Leave the client alone and plan to return later in the day.

D.

Assure the client that the client will be able to get to the daycare on time.

Solution: The correct answer is D.

It is important to use therapeutic use of self with clients who have dementia. By acknowledging the client’s issue, the OTR is able to establish rapport and demonstrate empathy. In addition, by living in the client’s reality, the OTR will be able to observe how the client responds to stimuli and how to approach the client in the future and plan interventions.

A: Arguing with a client with dementia is never a good idea. Because people with dementia lack insight into their condition, argument is likely to increase agitation.

B: Asking a client with dementia who is agitated to complete any new task would not be wise; it might increase the client’s agitation.

C: Abandoning a client with dementia would not be wise because the OTR might be able to calm the client with therapeutic use of self.

An OTR® is working with a client with polyarticular juvenile rheumatoid arthritis (JRA). Which biomechanical technique would be MOST appropriate to include in the client’s intervention plan during an exacerbation?

1. A.

   A resistive exercise program

2. B.

   An AROM program

3. C.

   A taping program

4. D.

   A pacing program

Solution: The correct answer is B.

AROM exercises are most appropriate to include in the intervention plan for a child with JRA. Splinting, monitoring joint function, preventing deformation, teaching energy conservation techniques, and instruction in the use of adaptive equipment may also be components of the intervention.

A: A resistive exercise program is contraindicated because it would compromise the involved joints.

C: A taping program would not be recommended unless the child with JRA had a comorbid condition.

D: A pacing program would not be recommended unless the child with JRA had a comorbid condition

Question

A 6-year-old child with autism is trying to kick a ball through a goal 10 feet away. The child has made six attempts already. Although the child is able to kick the ball with correct movements, the child does not seem to be able to calibrate the amount of motor input to approximate the goal. When the child kicks the ball, it always lands beyond the goal. What skill seems to be impaired for this child?

A.

Executional praxis

B.

Upper-extremity coordination

C.

Feedforward praxis

D.

Eyehand coordination

Solution: The correct answer is C.

Feedforward praxis enables a person to compare previous motor plans and sensory information to detect potential errors and correct the plan before attempting it again.

A: Executional praxis is the ability to perform the motor action with precision.

B, D: The child is able to perform the shooting movement correctly and seems not to have any upper-extremity or eyehand coordination problems.

An OTR® working in a public school receives a referral for a middle school student with oppositional defiant disorder. Which method to gather reliable information about this student would be MOST effective?

A.

Interview the student

B.

Interview the teacher or caregiver

C.

Read the student's school file

D.

Observe the child at home

Solution: The correct answer is B.

People with oppositional defiant disorder are not always truthful and generally do not have insight into their oppositional behavior. They are unlikely to be able to articulate an accurate picture of their behavior.

A: Interviewing the student is an important step in the evaluation process, but the contents of the interview cannot be expected to be reliable.

C: Reading the student's file would not provide as much information as talking to the student's teacher or caregiver.

D: Although observing the student in his or her natural environment might provide reliable information, home visits are not typical in practice in a public school setting.

A client with a new diagnosis of bipolar disorder is struggling with the medication routine. The OTR® decides to address it with a scaffolding approach to the task. How is this approach BEST described?

A.

The OTR and the client work together to type a list of medications and their times and dosage. The OTR instructs the client to post it by the medicine and check off each dose taken.

B.

The OTR educates the client on the benefits of using an electronic pill-dispensing device that has been preprogrammed to dispense the medications at the proper time, and the OTR sets it up.

C.

The OTR and client collaborate on ways to remember to take medications; the client says that an alarm on the client’s cell phone would work, and the OTR sets it for the client at the appropriate times.

D.

The OTR meets with the client at the start of each week to help the client set up a daily pill box for the week ahead and reviews compliance from the previous week.

Solution: The correct answer is A.

Scaffolding is a type of chaining that occurs when the OTR helps the client perform the parts of the task that are difficult, but the client completes the task. The therapist breaks the task into manageable parts, thereby adjusting the learning process to create a just-right fit for the client’s abilities. In this example, the OTR helps the client create a detailed list of the medication routine, but the client posts it and checks it off every day. Eventually, the client will work on creating the medication list independently.

B, C, and D are treatment approaches for medication management that may be appropriate for different clients in various settings. This question, however, asks about scaffolding, and these answers do not describe this treatment technique. In these incorrect approaches, the OTR is taking on a predominantly active role and not motivating the client to finish.

An OTR® is working with a child who is recovering from a motor vehicle accident. During the session, the child seems to lose awareness and stops working on a puzzle for as long as 30 seconds at a time. On the basis of this information, what should the OTR be concerned about?

A.

The client is having tonic-clonic seizures.

B.

The client is having myoclonic seizures.

C.

The client is having absence seizures.

D.

The client is having akinetic seizures.

Solution: The correct answer is C.

People having absence seizures look like they are “zoning out” or daydreaming; these seizures are characterized by a brief lapse or loss of awareness. In addition, clients who experience absence seizures will suspend all motor activity (even eye blinking) during a seizure. These seizures usually last less than 30 seconds.

A: With tonic-clonic seizures, people experience an “aura” or a sensation that the seizure is about to begin. During this type of seizure, people usually lose consciousness and their body goes through a series of rhythmic clonic contractions.

B: Myoclonic seizures involve a single muscle group.

D: Akinetic, or atonic, seizures involve the loss of normal muscle tone for approximately 15 to 30 seconds.

A client will initiate dressing at the appropriate time of the day but will not attend to the day, temperature, or season. The client is able to don clothing slowly but has difficulty with fasteners or fails to see errors in the back (i.e., not tucking in the shirt). At what stage of the Allen Cognitive Level Screen is this client?

A.

4.4

B.

4.0

C.

3.6

D.

3.2

Solution: The correct answer is B.

The question describes typical dressing behaviors of clients at Mode 4.0; a client would attend to visible sensory cues and ignore what is not in plain sight (e.g., not tucking in the back of the shirt).

A: Clients at Mode 4.4 will be able to locate clothing and initiate dressing at a customary time of the day and dress in sequence. Clients may wear the same clothing over and over again because they like it and have worn it before.

C: At Mode 3.6, clients must be trained to initiate dressing at the customary time of day.

D: At Mode 3.2, clients will need cues to sequence through a dressing routine.