NBCOT Cardiopulmonary Questions

An OTR® is providing occupational therapy services to a client in acute care who was diagnosed with a pulmonary embolism. What is the most typical cause of a pulmonary embolism?

A. Deep vein thrombosis

B. Pulmonary hypertension

C. Pulmonary edema

D. Lung cancer

The right answer is A

Most pulmonary embolisms are caused by a deep vein thrombosis in a lower extremity.

Smith-Gabai, H. (2011). The pulmonary system. In H. Smith-Gabai (Ed,), Occupational therapy in acute care (pp. 147-182). Bethesda, MD: AOTA Press; p. 165.

Explanations of Incorrect Answers

B, C, D: Clients with pulmonary hypertension, pulmonary edema, and lung cancer are not at high risk for pulmonary embolism.

When evaluating a client in a skilled nursing facility, the OTR® notes that the client's skin has a yellowish cast, the fingernail beds are bluish in color, and the client has noticeable edema in both lower extremities. What condition would MOST likely cause these symptoms?

A. Right-sided congestive heart failure

B. Left-sided congestive heart failure

C. Aortic stenosis

D. Aortic insufficiency

The right answer is A

When the right side of the heart fails, blood flows back into the venous system. Symptoms of right-sided heart failure include cyanotic nail beds, jaundice, and lower-extremity edema.

Smith-Gabai, H. (2011). The cardiac system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 75-120). Bethesda, MD: AOTA Press; p. 99.

Explanations of Incorrect Answers

B: When the left side of the heart fails, blood flows back into the lungs, causing difficulty breathing, anxiety, and cerebral hypoxia.

C, D: Aortic stenosis and aortic insufficiency have symptoms similar to those of left-sided heart failure.

An OTR® is working with a client with chronic obstructive pulmonary disease (COPD) on a morning ADL routine. Which treatment strategy BEST describes how this client can be independent in showering?

A. Use a shower chair, bathe with hot water from a handheld shower, use relaxation breathing, and inhale on exertion

B. Use a shower chair, bathe with warm water from a handheld shower, use pursed lip breathing, and exhale on exertion

C. Sit in the tub for support, bathe with hot water from the tub spout, pace by washing one extremity at a time and then resting, and lean backward in the tub

D. Sit in the tub for support, bathe with cool water from the tub spout, use a fan to decrease humidity, and rest arms on the sides of the tub

The right answer is B

Using a shower chair, bathing with warm water from a handheld shower, using pursed lip breathing, and exhaling on exertion all contribute to independent showering for a client with COPD.

Huntley, N. (2008). Cardiac and pulmonary diseases. In M. V. Radomski & M. C. Trombly Latham (Eds.), Occupational therapy for physical dysfunction (6th ed., pp. 1295-1320). Baltimore: Lippincott Williams & Wilkins.

Explanations of Incorrect Answers

A: Hot water adds to humidity and makes breathing more difficult. The client should use pursed lip rather than relaxation breathing techniques and should exhale rather than inhale on exertion.

C: Using a shower chair takes less energy than getting into and out of a tub. Hot water adds to humidity and makes breathing more difficult. Leaning forward in the tub releases the diaphragm and makes breathing easier.

D: Using a shower chair takes less energy than getting into and out of a tub. Cool water may chill the client and require more energy for tasks. Resting the arms on the thighs, not on the sides of tub, releases the diaphragm and makes breathing easier.

An OTR® is working with a client who suddenly complains of pressure and tightness in the chest. The client's symptoms resolve with rest and a nitroglycerin tablet administered under the tongue. What condition is the client MOST likely to have experienced during the treatment session?

A. Stable angina

B. Unstable angina

C. Myocardial infarction

D. Atrial flutter

The right answer is A

Stable angina usually resolves with rest, nitroglycerin, or both.

Smith-Gabai, H. (2011). The cardiac system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 75-120). Bethesda, MD: AOTA Press; p. 83.

Explanations of Incorrect Answers

B: Unstable angina does not resolve with rest or nitroglycerin. It requires emergency treatment.

C: Myocardial infarction also requires emergency treatment.

D: Atrial flutter is usually treated with other medications, ablation, or cardioversion.

An OTR® is working with an acute-care client who has a ventricular assist device. Which precaution is essential when engaging this client in occupational activities?

A. Do not administer an exercise stress test to this client.

B. Instruct the client in sterile dressing changes to prevent infection.

C. Educate the client to avoid yearly influenza and pneumonia vaccines.

D. Avoid disconnecting the drive line to the power source during movement.

The right answer is D

A ventricular assist device requires a power source to function properly. The drive line connects to the power source. If the OTR is not careful, the drive line can become disconnected during activity.

Smith-Gabai, H. (2011). The cardiac system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 75-120). Bethesda, MD: AOTA Press; p. 104.

Explanations of Incorrect Answers

A: OTRs do not generally administer exercise stress tests.

B: Clients with burns or open wounds (not clients with a ventricular assist device) are usually instructed in sterile dressing changes by a nurse.

C: Clients with a ventricular assist device are educated by nursing professionals, not OTRs, to receive yearly vaccines to prevent influenza and pneumonia.

An OTR® is working with a client who is experiencing dyspnea while performing a daily occupation in sitting. What sitting position would BEST minimize the client's dyspnea while performing the occupational task?

A. Sitting with trunk erect and rigidly in midline

B. Sitting with trunk extended and slightly to one side in a more relaxed posture

C. Slouching to one side and leaning on one arm for improved trunk support

D. Slouching forward while avoiding maximum forward trunk bending

The right answer is D

To ease breathing, lean partially forward, propping the forearms on the upper thighs.

Smith-Gabai, H. (2011). The pulmonary system. In H. Smith-Gabai (Ed,), Occupational therapy in acute care (pp. 147-182). Bethesda, MD: AOTA Press; p. 180.

Explanations of Incorrect Answers

A, B, C: Other supine and standing positions can improve dyspnea, but these three alternative sitting positions would not ease respiration more adequately than slouching partially forward.

A client who has cardiac disease is participating in outpatient occupational therapy and is able to complete activities in the 1-3 metabolic equivalent (MET) range. Dyspnea and angina limit physical activity above 5 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 1-2 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 pack moderate weight items into boxes 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)

The right answer is B

Discontinuous exercise involves using various exercise activities for the same time interval while gradually increasing the intensity of the tasks.

Huntley, N. (2008). In M. V. Radomski & C. A. Trombly Latham (Eds.), Occupational therapy for physical dysfunction (6th ed., pp. 1295-1320). Baltimore: Lippincott Williams & Wilkins; p. 1306.

Explanations of Incorrect Answers

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 (continuous exercise) such as pedaling on a stationary bike or walking on a treadmill limits muscle groups that are targets and provides only one form of aerobic exercise.

An OTR® is developing an intervention plan for a client with postacute myocardial infarction on the cardiac care unit. What metabolic equivalent of task (MET) should the client's early activity intervention not exceed?

A. 1-2 METs

B. 3-4 METs

C. 5-6 METs

D. 7-8 METs

The right answer is A

When a client is on the cardiac care unit, activities should not exceed 1 to 2 METs. Any higher MET level requires too much exertion, which results in increased oxygen consumption and a higher heart rate than may be tolerated.

A: Smith-Gabai, H. (2011). The cardiac system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 75-120). Bethesda, MD: AOTA Press; pp. 84, 111.

Explanations of Incorrect Answers

B, C, D: When a client is transferred off the cardiac care unit to a hospital floor, activities can exceed 2 METs in progresssion of the cardiac rehabilitation program. Clients can walk, shower seated, and perform upper-body exercises (3 to 4 METS) as tolerated

An OTR® is working in a cardiac rehabilitation program. Of the four clients on the OTR's caseload, which client would require a longer warm-up and cool-down period during exercise and activity sessions?

A. The client with congenital heart disease

B. The client with a coronary artery bypass graft

C. The client with a heart transplant

D. The client with an automatic defibrillator

The right answer is C

Because a donor heart is denervated, the autonomic nervous system does not control the client's heart rate. The heart relies on circulating hormones, which take longer to increase and decrease the heart rate.

Smith-Gabai, H. (2011). Transplantation. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 499-534). Bethesda, MD: AOTA Press; p. 519.

Explanations of Incorrect Answers

A, B, D: In congenital heart disease and after cardiac surgery, the heart remains innervated, so the client's autonomic nervous system regulates the heart rate.

In a pulmonary rehabilitation setting, what would an OTR® instruct a client to do to ensure that the client is not holding his or her breath during the strenuous part of an activity?

A. Hold the neck in midline

B. Count out loud or talk

C. Prop elbows on the countertop

D. Lift both arms to 90° of flexion

The right answer is B

Pulmonary rehabilitation clients may be instructed to count out loud, sing, or talk to ensure that they are exhaling during the strenuous part of an activity.

Smith-Gabai, H. (2011). The pulmonary system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 147-182). Bethesda, MD: AOTA Press; pp. 173-174.

Explanations of Incorrect Answers

A: Holding the neck in midline improves swallowing more than breathing.

C: Propping elbows on a countertop assists in stabilizing the upper extremities when incoordination interferes with upper-extremity tasks.

D: Lifting both arms to 90° of flexion would make breathing more difficult.

A: Smith, J., & Jenks, K. N. (2013). Eating and swallowing. In H. M. Pendleton & W. Schultz-Krohn (7th ed.), Pedretti's occupational therapy: Practice skills for physical dysfunction (pp. 678-717). St. Louis, MO: Mosby/Elsevier; pp. 679-680, 697.

C: Foti, D., & Koketsu, J. S. (2013). Activities of daily living. In H. M. Pendleton & W. Schultz-Krohn (7th ed.), Pedretti's occupational therapy: Practice skills for physical dysfunction (pp. 157-232). St. Louis, MO: Mosby/Elsevier; p. 204.

D: Smith-Gabai, H. (2011). The pulmonary system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 147-182). Bethesda, MD: AOTA Press; pp. 173-175.

An OTR® is working with a client who is being treated medically with a wound vacuum-assisted closure (wound VAC). What precaution does the OTR need to take during a therapy session with the client with a wound VAC?

A. Do not turn off the wound VAC during treatment.

B. Keep the client in a supine position.

C. Do not have the client ambulate.

D. Avoid moving the extremity with the wound VAC.

The right answer is A

The wound VAC should not be turned off without the nurse's knowledge because it can only be turned off for 2 hours within a 24-hour period.

Hudson, R. (2011). The vascular system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 121-146). Bethesda, MD: AOTA Press; pp. 141-142.

Explanations of Incorrect Answers

B, C, D: Movement is not usually restricted when a client is wearing a wound VAC.

Hudson, R. (2011). The vascular system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 121-146). Bethesda, MD: AOTA Press; pp. 141-142.

An OTR® is working with a client who is experiencing congestive heart failure that has developed gradually over a long period. The client is displaying limited tolerance for light to moderate homemaking activities. Which compensatory strategy would be BEST for the OTR® to demonstrate to the client to improve tolerance to these activities?

A. Pursed lip breathing

B. Sternal precautions

C. Work simplification techniques

D. Use of adaptive devices

The right answer is C

For clients who show limited endurance for or tolerance of activities, work simplification techniques can improve their ability to complete tasks independently.

Huntley, N. (2008). Cardiac and pulmonary diseases. In M. V. Radomski & M. C. Trombly Latham (Eds.), Occupational therapy for physical dysfunction (6th ed., pp. 1295-1320). Baltimore: Lippincott Williams & Wilkins; p. 1305.

Explanations of Incorrect Answers

A: Pursed lip breathing is more appropriate for clients with respiratory conditions.

B: Sternal precautions are not needed with clients with congestive heart failure unless they have recently undergone open-heart surgery.

D: Adaptive devices generally compensate for decreased ROM or muscle strength, not low tolerance for activity.

Huntley, N. (2008). Cardiac and pulmonary diseases. In M. V. Radomski & M. C. Trombly Latham (Eds.), Occupational therapy for physical dysfunction (6th ed., pp. 1295-1320). Baltimore: Lippincott Williams & Wilkins.

An OTR® is working with transplant recipients who have recently been discharged from a major hospital. Which type of client would be MOST likely to develop an infection posttranplantation and require greater infection control measures?

A. A client with a kidney transplant

B. A client with a heart transplant

C. A client with a lung transplant

D. A client with a liver transplant

The right answer is C

A client with a lung transplant is the most susceptible to infection because the transplanted organ is exposed to bacteria and germs on inhalation.

Smith-Gabai, H. (2011). Transplantation. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 499-534). Bethesda, MD: AOTA Press; pp. 521-522.

Explanations of Incorrect Answers

A, B, D: Clients with kidney, heart, and liver transplants are not as likely to experience infection as lung transplant recipients, because these internal organs are more protected from direct infections.

Smith-Gabai, H. (2011). Transplantation. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 499-534). Bethesda, MD: AOTA Press; pp. 521-522.

An OTR® is working with a client 3 days post open-heart surgery. The OTR® emphasizes to the client to follow all sternal precautions during exercise and activities for 3 months. Which precaution is part of sternal precautions?

A. Scar massage to the sternal scar

B. Wearing of a sternal splint guard when out of bed

C. Breathing out on exertion

D. Avoidance of one-sided lifting or pulling up

The right answer is D

The sternum is broken during open-heart surgery, so the client must avoid one-sided lifting over 10 lb, pulling up (body weight), and other movements that would strain the sternum for 6 to 12 weeks.

Huntley, N. (2008). Cardiac and pulmonary diseases. In M. V. Radomski & M. C. Trombly Latham (Eds.), Occupational therapy for physical dysfunction (6th ed., pp. 1295-1320). Baltimore: Lippincott Williams & Wilkins; p. 1305.

Explanations of Incorrect Answers

A: Scar massage is not part of sternal precautions.

B: A sternal splint guard is not usually recommended to protect the broken sternum.

C: Breathing out on exertion is a breathing technique for clients with chronic obstructive pulmonary disease.

An OTR® is working on the organ transplant unit of a major hospital. What psychiatric condition is a client with a long-term transplantation MOST likely to experience?

A. Depression

B. Anxiety

C. Dementia

D. Personality disorder

The right answer is B

Clients may experience anxiety because of the guilt they feel over benefiting from someone else's death or while waiting for a matching donor. Organ recipients may also be affected by a type of posttraumatic stress disorder.

Smith-Gabai, H. (2011). Transplantation. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 499-534). Bethesda, MD: AOTA Press; p. 528.

Explanations of Incorrect Answers

A: Clients may experience depression, but it is not the most common psychiatric condition for transplant receipients.

C, D: Dementia and personality disorder are not considered complications or psychological disorders common to clients with organ transplants.

An OTR® is working with a client with orthostatic hypotension. The client becomes lightheaded and complains of blurred vision while sitting on the edge of the bed. What action does the OTR need to take if the client remains lightedheaded?

A. Instruct the client to raise both arms simultaneously.

B. Have the client use a reacher to pick up items rather than bend over.

C. Remove the client's thrombolitic stockings immediately.

D. Elevate the client's lower extremities.

The right answer is D

If the client remains lightheaded and his or her blood pressure drops more than 20 mm HG systolic and 10 mm HG diastolic, then the client's lower extremities need to be elevated to return blood flow to the head.

Hudson, R. (2011). The vascular system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 121-146). Bethesda, MD: AOTA Press; p. 127.

Explanations of Incorrect Answers

A, B, C: These actions will not significantly raise the person's blood pressure or provide greater blood flow to the head.

An OTR® is working on the intensive care unit of a hospital. The client has hypertension and has an arterial line catheter inserted in the radial artery. What change in the client is the OTR MOST likely to record during treatment?

A. A decrease in blood pressure when the head of the bed is elevated

B. A decrease in heart rate when client is positioned from supine to short sitting at the edge of the bed

C. An inaccurate blood pressure reading when the wrist is moved

D. An increase in respiration rate when the client is positioned side lying

The right answer is C

An arterial line catheter is inserted in the radial artery at the wrist to continuously monitor arterial pressure. When the wrist is moved, it can disrupt the catheter and affect the blood pressure reading.

Smith-Gabai, H. (2011). The cardiac system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 75-120). Bethesda, MD: AOTA Press; p. 81.

Explanations of Incorrect Answers

A: A client with hypotension, not hypertension, would generally have a decrease in blood pressure when the head of the bed is elevated.

B: A client would generally have an increase in heart rate when going from supine to sitting.

D: Depending on the client, side lying may increase or decrease the respiration rate.

A: Hudson, R. (2011). The vascular system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp.121-146). Bethesda, MD: AOTA Press; p. 127.

B: Smith-Gabai, H. (2011). The cardiac system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 75-120). Bethesda, MD: AOTA Press; p. 108.

D: Smith-Gabai, H. (2011). The pulmonary system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 147-182). Bethesda, MD: AOTA Press; pp. 175-176.

An OTR® is working with a client who has ventricular tachycardia. The client's vital signs include a heart rate greater than 100 beats per minute. What is the appropriate therapeutic response to this client's situation?

A. Allow the client to rest 10 minutes, then begin an occupational task that focuses on upper-extremity movement.

B. Work with the client in a supported sitting position with the client's legs elevated.

C. Instruct the client in adapting performance of grooming and feeding tasks.

D. Defer the client's participation in occupational therapy until later, because the client is medically unstable.

The right answer is D

Ventricular tachycardia of more than 100 beats per minute can cause sudden cardiac death. Therapy should be deferred until the client is medically stable.

Smith-Gabai, H. (2011). The cardiac system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 75-120). Bethesda, MD: AOTA Press; p. 93.

Explanations of Incorrect Answers

A: A client with stable angina, not ventricular tachycardia, can be safe resuming therapy after a rest period.

B: Supported sitting and leg elevation are unlikely to prevent or improve ventricular tachycardia.

C: Continuing occupational therapy can be detrimental to this client's medical condition and may trigger a cardiac arrest.

An OTR® is conducting a treatment session with a client with chronic obstructive pulmonary disease. The client is engaged in a light work task while sitting, suddenly experiences extreme shortness of breath, and panics. Which response by the OTR® would be MOST appropriate?

A. Ask the client to lean backward and rest the arms on the chair arms, then practice pursed lip breathing

B. Ask the client to lean forward and place the forearms on the thighs, then practice pursed lip breathing

C. Ask the client to sit upright and allow the arms to dangle and guide the client to use visual imagery

D. Ask the client to sit upright, use one arm for the work task, and use the other arm to bear weight and support the trunk

The right answer is B

Resting the arms on the thighs releases the diaphragm, making breathing easier and lessening fear. Pursed lip breathing can slow breathing and reduce anxiety.

Huntley, N. (2008). Cardiac and pulmonary diseases. In M. V. Radomski & M. C. Trombly Latham (Eds.), Occupational therapy for physical dysfunction (6th ed., pp. 1295-1320). Baltimore: Lippincott Williams & Wilkins.

Explanations of Incorrect Answers

A, C, D: Leaning backward or forward or sitting upright does not release the diaphragm.

An OTR® is working with a client in an outpatient center who has been diagnosed with Raynaud's syndrome affecting the fingers. What home program instruction is MOST appropriate for a client with Raynaud's syndrome?

A. Wear a flexion glove at night.

B. Use a cold pack to increase finger circulation.

C. Wear gloves when exposing the fingers to a cold environment.

D. Visually inspect the fingers daily for tumor growth.

The right answer is C

Raynaud's syndrome disrupts blood flow to the digits in vasospastic attacks. The client needs to be educated to wear gloves when exposing hands to the cold, such as reaching into a freezer.

Hudson, R. (2011). The vascular system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 121-146). Bethesda, MD: AOTA Press; p. 135.

Explanations of Incorrect Answers

A: A flexion glove is worn when passive range of motion in flexion is limited in the digits, which does not occur with Raynaud's syndrome.

B: A cold pack wil trigger a Raynaud's episode.

D: Fingers need to be inspected frequently for ulcers, scars, and discoloration. Tumor growth is not a part of Raynaud's syndrome.

Which psychiatric condition is MOST frequently seen as interfering with the occupational engagement of a client with cardiac disease?

A. Panic attack

B. Major depression

C. Personality disorder

D. Hypochondriasis

The right answer is B

Among clients with cardiac disease, 15%-20% meet the criteria for major depression. Clients with depression have poorer outcomes and increased morbidity and mortality.

Smith-Gabai, H. (2011). The cardiac system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 75-120). Bethesda, MD: AOTA Press; pp. 106-107.

Explanations of Incorrect Answers

A: Clients with cardiac disease may exhibit increased stress and anxiety, but not panic attacks specifically.

C, D: Clients with cardiac disease do not show a significant increase in either personality disorder or hypochondriasis.

A client with morbid obesity and obstructive sleep apnea is collaborating with an OTR® on improved sleep routines and positioning. What sleep position is optimal for this client?

A. Supine position with head of the bed elevated

B. Supine position with only the client's head elevated

C. Side-lying position with head of the bed elevated

D. Side-lying position with only the client's head elevated

The right answer is C

Because of the obesity, the client will be able to breathe better in a side-lying position with the entire upper trunk elevated.

Smith-Gabai, H. (2011). The pulmonary system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 147-182). Bethesda, MD: AOTA Press; p. 168.

Explanations of Incorrect Answers

A, B, D: The supine postion is not preferred because the weight of the body makes breathing more difficult. Elevation of the entire upper body improves breathing more than elevation of the head only.

An OTR® is working with a client in acute care who is complaining of leg cramps and pain when walking. These problems are a common symptom of what condition or surgical procedure?

A. Cardiac arrhythmia

B. Peripheral artery disease

C. Lung transplantation

D. Coronary artery bypass graft

The right answer is B

Cramping and pain when walking—also known as intermittent claudication—are caused by decreased blood flow when exercising and are common symptoms of peripheral artery disease.

Smith-Gabai, H. (2011). The cardiac system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 75-120). Bethesda, MD: AOTA Press; p. 82.

Explanations of Incorrect Answers

A: Cardiac arrhythmia does not generally cause leg cramps or leg pain.

C: Problems after lung transplantation usually include infections, fatigue, and breathing difficulties, not leg cramps or pain.

D: A client may have stitches in the leg from removal of the saphenous vein for grafting in the heart, but stitches do not result in leg cramps or pain.

An OTR® is evaluating a new client and notes that the client has a bluish tinge to the skin and lips. The client also presents with significant edema. Which medical condition is this client MOST likely to have?

A. Emphysema

B. Chronic bronchitis

C. Cystic fibrosis

D. Cirrhosis of the liver

The right answer is B

A client with chronic bronchitis has poor oxygenation, resulting in a bluish tinge to skin and lips, along with edema.

Smith-Gabai, H. (2011). The pulmonary system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 147-182). Bethesda, MD: AOTA Press; p. 157.

Explanations of Incorrect Answers

A: A client with emphysema is most likely to have pinkish skin.

C: A client with cystic fibrosis may have yellowing of the skin.

D: A client with cirrhosis of the liver will tend to have an orange tint to the skin.

An OTR® is working with a client with myocardial infarction during the early rehabilitation phase in an outpatient facility. In reviewing the home program with the client, the OTR® discusses activity and exercise limitations according to metabolic equivalent (MET) levels. Which activity would be contraindicated within the first 4 weeks after a myocardial infarction because of the activity's MET level?

A. Light housekeeping

B. Knitting and crocheting

C. Dressing and undressing

D. Carrying groceries upstairs

The right answer is D

Healing of the heart muscle takes 4 to 8 weeks. During this time, activities are limited to the 2 to 4 MET range. Carrying groceries upstairs requires 6 to 10 METs.

Huntley, N. (2008). Cardiac and pulmonary diseases. In M. V. Radomski & M. C. Trombly Latham (Eds.), Occupational therapy for physical dysfunction (6th ed., pp. 1295-1320). Baltimore: Lippincott Williams & Wilkins; p. 1304.

Explanations of Incorrect Answers

A, B, C: Light housekeeping, knitting and crocheting, and dressing and undressing require 1.0 to 2.5 METs, well within the 2.0 to 4.0 MET range.

An OTR® is working with a client who has been placed on bedrest because of a deep vein thrombosis. After anticoagulation therapy has been initiated, what is the accepted waiting period to resume occupational therapy interventions involving ambulation?

A. 12 hours

B. 2-3 days

C. 5-7 days

D. 8-10 days

The right answer is B

Recent literature has indicated that ambulation may be permitted on the 2nd or 3rd day after anticoagulation therapy has been initiated.

Hudson, R. (2011). The vascular system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 121-146). Bethesda, MD: AOTA Press; pp. 131-132.

Explanations of Incorrect Answers

A: It takes longer than 12 hours for the partial thromboplastin time to be within therapeutic range.

C, D: Recent research has indicated that bedrest should not be continued for more than 3 to 4 days.

In reading a client's medical chart, the OTR® notes that the client has a history of postprandial orthostatic hypotension. What activity precautions should the OTR give the client?

A. Limit standing to 30 minutes while completing an occupation, such as cooking.

B. Avoid a positional change from lying down to standing within 30 minutes of eating a meal.

C. Take several minutes in the morning to move from lying down to sitting and then standing after being in bed all night.

D. Avoid leaning the head too far forward, for example, bending over to tie shoes while sitting.

The right answer is B

Postprandial orthostatic hypotension occurs when a person goes from supine to standing shortly after eating a meal. It generally affects older adults, people with hypertension, and people with Parkinson's disease.

Hudson, R. (2011). The vascular system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 121-146). Bethesda, MD: AOTA Press; pp. 126-127.

Explanations of Incorrect Answers

A: This precaution applies to neurally mediated hypotension, which occurs in children and young adults after standing for extended periods of time.

C: This precaution applies to orthostatic or postural hypotension, which occurs in people on prolonged bedrest who sit or stand too quickly.

D: This precaution would be unnecessary because inverting the head would increase blood flow to the head, not decrease it.

An OTR® is interviewing a new client who physically presents with a "barrel chest." This appearance is most often associated with what condition?

A. Cystic fibrosis

B. Asthma

C. Collapsed lung

D. Emphysema

The right answer is D

Clients with emphysema have hyperinflated lungs, which partially expand the ribcage.

Smith-Gabai, H. (2011). The pulmonary system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 147-182). Bethesda, MD: AOTA Press; pp. 155-156.

Explanations of Incorrect Answers

A, B, C: Cystic fibrosis, asthma, and collapsed lung affect breathing but do not expand the chest.

An OTR® is working with a client who had a pacemaker implanted 10 days ago. Which activity would be contraindicated because of pacemaker precautions?

A. Heating tea in a microwave at waist level

B. Lifting a light jacket from one surface to another

C. Placing hair in a ponytail using both upper extremities simultaneously

D. Brushing hair using the upper extremity opposite the pacemaker placement

The right answer is C

Pacemaker precautions include no shoulder flexion or abduction greater than 90° on the side on which the pacemaker was implanted for the first 4 weeks.

Smith-Gabai, H. (2011). The cardiac system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 75-120). Bethesda, MD: AOTA Press; p. 104.

Explanations of Incorrect Answers

A: Electrical devices that affect pacemaker function, such as magnets, MRI machines, metal detectors, and portable media players, should be avoided. Newer pacemakers are not affected by the use of microwaves.

B: Lifting a light jacket is within the guidelines of lifting no more than 10 pounds.

D: Shoulder abduction or flexion greater than 90° on the side opposite pacemaker placement is acceptable movement. Clients' shoulder movement is restricted only on the operated side.

While an OTR® is working with a client on the grooming task of brushing teeth, the client mentions having to take antibiotics before going to the dentist for any dental work. What condition is MOST likely a part of the client's medical history?

A. Chronic obstructive pulmonary disease

B. Lung cancer

C. Hip replacement

D. Endocarditis

The right answer is D

People with a history of endocarditis generally take antibiotics before any dental procedures to prevent an infection from migrating to the heart.

Smith-Gabai, H. (2011). The cardiac system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 75-120). Bethesda, MD: AOTA Press; p. 87.

Explanations of Incorrect Answers

A, B: Although people with chronic obstructive pulmonary disease or lung cancer are prone to respiratory infections, they do not need to take antibiotics before dental work.

C: People with a hip replacement may be at risk for infection at the operative site, but not from dental work.

A, B: Smith-Gabai, H. (2011). The pulmonary system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 147-182). Bethesda, MD: AOTA Press; p. 157.

C: Lawson, S. C., & Murphy, L. F. (2013). Hip fractures and lower extremity joint replacements. In H. M. Pendleton & W. Schultz-Krohn (7th ed.), Pedretti's occupational therapy: Practice skills for physical dysfunction (pp. 1074-1090). St. Louis, MO: Mosby/Elsevier; p. 1080.

An OTR® is working with a client population with severe intellectual disabilities. What risk factor MOST predisposes this client population to pneumonia?

A. History of smoking

B. Antibiotic overuse

C. Aspiration of food

D. Chest surgery

The right answer is C

Among people with severe intellectual disabilities, the most frequent cause of pneumonia is aspiration of food or liquids.

Smith, J., & Jenks, K. N. (2013). Eating and swallowing. In H. M. Pendleton & W. Schultz-Krohn (7th ed.), Pedretti's occupational therapy: Practice skills for physical dysfunction (pp. 678-717). St. Louis, MO: Mosby/Elsevier; p. 685.

Explanations of Incorrect Answers

A, B, D: Smoking, antibiotic use, and chest surgery are all risk factors for pneumonia in the the general population.

Smith-Gabai, H. (2011). The pulmonary system. In H. Smith-Gabai (Ed.), Occupational therapy in acute care (pp. 147-182). Bethesda, MD: AOTA Press; pp. 161-162.