Multiple Choice Ratio

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Physical Dysfunction Anne has been diagnosed with ALS, stage 2. She has been experiencing moderate, selective weakness in both her upper and lower extremities and slightly decreased independence in ADLs. What intervention should you use to focus on performance in Areas of Occupation? a. Integrate hand orthotic use into daily activities b. Integrate energy conservation into daily activities, work and leisure c. Consider orthotic support d. Encourage deep breathing exercises, chest stretching, and postural draining if needed (pedretti) Answer: A: hand orthotic use is necessary to facilitate performance in ADLs since the patient experiences weakness in both her upper extremities. Incorrect: B is an intervention used in stage 1 ALS, since at this stage, the patient experiences mild weakness and clumsiness and is ambulatory and still independent with ADLs. C and D are interventions that focus on client factors. 2. A patient four days status post transtibial amputation is transported to occupational therapy for a scheduled treatment session. Assuming an uncomplicated recovery, the MOST appropriate patient transfer to utilize from a wheelchair to a mat table is: a. Two-person lift b. Hydraulic lift c. Stand pivot d. Sliding board (giles) Answer: C: this is used when a patient is able to stand and bear weight through one or both of the lower extremities; the patient must possess functional balance and the ability to pivot. Incorrect: A: this is used to transfer a patient between two surfaces of different heights or when transferring a patient to the floor. B: a device is required for dependent transfers when a patient is obese, when there is only one therapist available to assist with the transfer or when the patient is totally dependent. D: this is used with a patient who has sitting balance, some upper extremity strength, and can adequately follow directions. 3. A patient rehabilitating from extensive burns to the right upper extremity often complains of severe pain in the arm during occupational therapy treatment sessions. The present plan of care emphasizes range of motion, stretching, and positioning. The MOST appropriate action to address the patient’s complaint is to: a. Reduce the frequency and duration of the treatment sessions b. Schedule treatment sessions when the patient’s pain medication is most effective c. Avoid treatment activities that are uncomfortable for the patient d. Request that the referring physician increase the dosage of the patient’s pain medication (giles) Answer: B: patient should receive the optimal benefit of pain medication during their scheduled therapy session; greater tolerance may allow the patient to make more rapid progress in therapy. Incorrect: A: reducing the frequency and duration of treatment will not allow for adequate intervention and burn care; patient participation may decrease as well as secondary to pain if they are not treated in coordination with the pain medication schedule. C: patients with burns will likely have discomfort with all activities and treatments; avoiding certain treatments would be negligent. D: The physician is responsible for prescribing the correct amount of medication. Increasing the dosage of the pain medication may not benefit the patient if occupational therapy is not performed at an appropriate time. 4. An occupational therapist attempts to transfer dependent patient from a wheelchair to bed. The therapist is concerned about the size of the patient, but is unable to secure another staff member to assist with the transfer. Which type of transfer would allow the therapist to move the patient with the GREATEST ease? a. Dependent standing pivot 1.

b. Hydraulic lift c. Sliding board d. Assisted standing pivot (giles) Answer: B: this transfer allows the therapist to transfer the patient independently from the wheelchair to the bed without jeopardizing patient or staff safety. Incorrect: A: would not be appropriate for a therapist to that is concerned about the patient’s size. This transfer requires the therapist to perform 100% of the activity. C: requires the patient to possess adequate sitting balance and actively participate in the transfer; this type of transfer would not be appropriate for a dependent patient. D: requires the patient to stand and participate in the transfer. 5. An occupational therapist measures a patient for a wheelchair. When measuring back height, which method is MOST accurate? a. Measure from the seat of the chair to the base of the axilla and subtract 2 inches b. Measure from the seat of the chair to the base of the axilla and subtract 4 inches c. Measure from the seat of the chair to the acromion process and subtract 2 inches d. Measure from the seat of the chair to the acromion process and subtract 4 inches (giles) Answer: B: back height should be determined by measuring from the seat of the chair to the base of the axilla and subtracting four inches. This method will allow the back height to fall below the inferior angle of the scapula. The height of the seat cushion used, if applicable, must be added to the obtained measurement. Incorrect: A: measuring from the seat of the chair to the base of the axilla and subtracting 2 inches would result in the back height being at the mid-scapular level; this back height would be too high to allow for optimal mobility. C: measuring from the seat of the chair to the acromion process and subtracting two inches would result in a back height that is excessive and would significantly restrict the patient’s movement. D: Measuring from the seat of the chair to the acromion process and subtracting four inches is more desirable than option C, but would still not allow the back height to fall below the inferior angle of the scapula. 6. An occupational therapist transports a patient with multiple sclerosis to the OT room for her treatment session. The patient is wheelchair dependent and uses a urinary catheter. When transporting the patient, the MOST appropriate location to secure the collection bag is: a. In the patient’s lap b. On the patient’s lower abdomen c. On the wheelchair armrest d. On the wheelchair cross brace beneath the seat (giles) urine drains into a collection bag as a result of the effect of gravity; therefore the collection bag from a urinary catheter must be positioned below the level of the bladder. Answer: D. positioning the collection bag on the cross brace beneath the seat will allow it to be below the level of the bladder and will minimize the possibility that the bag or tubing will be pulled or snagged. Incorrect: A. securing the collection bag in the patient’s lap would result in the collection bag being at a similar level as the patient’s bladder. The position would interfere with virtually any activity that required movement. B. the lower abdomen is above the level of the bladder and would also interfere with any movement. Additionally, the patient may be embarrassed or bothered by having the collection bag in such a visible location. C. the wheelchair armrest is above the level of the bladder and therefore would impede the flow of urine into the collection bag. 7. Carson is a 5-year old client who sustained a C6 spinal cord injury secondary to a motor vehicle accident (MVA). The injury occurred to the right side of his spinal cord. The OT begins the evaluation knowing that the sensation will most likely be impaired on the left side of the body, below the level of the lesion is: a. Two-point discrimination b. Touch localization

c. Temperature d. Joint motion or kinesthesia (JBReview) Answer: C. Pain and temperature will be absent on the left side of the body below the level of the lesion to the right half of the spinal cord. Joint motion, touch localization, and two-point discrimination will likely remain intact. 8. The OT receives orders to evaluate and treat a patient with a T2 spinal cord injury (SCI). What will be the focus of the sensory testing? a. Peripheral nerve distribution b. Dermatomal distribution c. Central nervous distribution d. Brachial plexus distribution (JBReview) Answer: B. Peripheral nerve distributions are used for clients who experience trauma to the peripheral nerves either by injury or disease, and central nervous distributions occur when clients sustain head injuries or some other trauma to the brain or spinal cord. 9. Chris fractured his right wrist and underwent a closed reduction 7 weeks ago; his cast was removed today. Exercise in treatment today should focus on: a. Shoulder and elbow b. Passive wrist flexion and extension exercises c. Active wrist flexion and extension exercises d. Isolated extensor digitorum communis (EDC) exercises and wrist extension exercises (JBReview) Answer: C. It is important to retrain the wrist extensors independent of the EDC. It is also important to retrain the EDC independent of the intrinsics 10. The OT receives an order to splint a patient with carpal tunnel syndrome. The best splint for conservative management is: a. Wrist cock-up splint with the wrist in neutral b. Static MP extension splint c. Elbow extension splint d. Antideformity splint (JBReview) Answer: A. Static splinting of the wrist is recommended at night to minimize the pressure in the carpal tunnel. 11. Which flexor tendon protocol is used with very young children or adults who are noncompliant? a. Duran b. Kleinert c. Immobilization d. Chow (JBReview) Answer: C. Duran uses passive flexion and extension. Kleinert uses rubber bnd traction, and Chow uses a combination of Kleinert and Duran. Immobilization is the only protocol that does not require client participation. 12. The use of cryotherapy as a physical agent modality (PAM) is CONTRAINDICATED for clients who have which diagnoses? a. Raynaud’s Phenomenon
 b. Acute ligament sprain
 c. Myofascial trigger points
 d. Tenosynovitis (http://almostot.blogspot.com/2012/10/past-nbcotquestions-on-fb-otr-set.html) Answer: A Incorrect: B, C, D: Cryotherapy is the recommended modality immediately following an acute injury and during an acute inflammatory phase. These conditions respond positively to the use of a cold PAM 13. During which home maintenance tasks would symptoms related to constructional apraxia be MOST EVIDENT? a. Washing the interior sides of single pane windows b. Using a roller brush to paint an interior wall of the home c. Vacuuming floors in the main living area of the home d. Following written instructions for installing curtain rods (http://almostot.blogspot.com/2012/10/past-nbcotquestions-on-fb-otr-set.html) Answer: D. Individuals who have constructional apraxia have difficulty constructing/assembling objects; as in following instructions for installing curtain rods.

Incorrect:
A, B, C: These tasks require motor planning, but they do not require the detailed attention required to install curtain rods. they do not require the detailed attention required to follow instructions for installing the curtain rods. 14. An OTR is preparing to interview an outpatient who has a TBI and is functioning at Level VII (AutomaticAppropriate) on the Rancho Los Amigos Scale. Which characteristic of an individual’s cognitive-behavioral function is TYPICALLY included in the description of this level? a. Consistent orientation to person and place b. Realistic judgment for future planning c. Accurate insight about current abilities d. Reliable carry-over of learning for most ADL (http://almostot.blogspot.com/2012/10/past-nbcotquestions-on-fb-otr-set.html) Answer: A: patients at Level VII (Automatic-Appropriate) on the Rancho Los Amigos Scale appear appropriate and oriented. They frequently display robot-like behaviors and require minimal assistance for routine ADL. For questions 15-17: Scenario: An entry-level OTR who works in a long term care facility is screening a resident who has amyotrophic lateral sclerosis and uses a wheelchair. The resident’s upper extremity functional strength is Trace (1/5) on the left and Poor Minus (2-/5) on the right. The resident wants to eat meals in the facility dining room but is embarrassed about frequently dropping assistive eating devices and having several incidences of coughing while eating. 15. What care coordination task should the OTR complete FIRST based on the results of the screening? a. Advise the dietary staff to provide the resident with a room temperature clear liquid at every meal. b. Inform the dining staff to cut the resident’s food into small pieces and provide built-up utensils. c. Ask the physician to write an order for an immediate video fluoroscopy and a pureed diet. d. Coordinate with the multi-disciplinary team to identify specific feeding and swallowing objectives. (http://almostot.blogspot.com/2012/10/past-nbcotquestions-on-fb-otr-set.html) Answer: D. Screening results indicate the resident’s functional status may be declining. Care coordination with the multi-disciplinary team meets best practice standards. Independent evaluation and intervention of the resident’s swallowing difficulties is beyond the scope of practice for the entry-level OTR. Incorrect: A, B, C: These options should not be considered until after the team has established feeding and swallowing objectives. Reference: Radomski, MV, Trombly-Latham, C (2008). Occupational Therapy for Physical Dysfunction (6th ed.). Baltimore, MD: Lippincott, Williams and Wilkins. Pages 1092-1095, 1322 16. Which of the following symptoms is this resident MOST at risk for experiencing during a meal? a. Light-headedness when moving from a wheelchair to the dining chair b. Heavy sweating, flushed skin, and a pounding headache after eating c. Variation in voice quality or loss of voice after swallowing d. Regurgitation of food and liquids after swallowing (http://almostot.blogspot.com/2012/10/past-nbcotquestions-on-fb-otr-set.html) Answer: C. Amytrophic lateral sclerosis (ALS) is a progressive neurological disease. The resident’s symptoms of coughing while eating/swallowing could indicate dysphagia. A symptom associated with dysphagia is variation in voice quality or loss of voice after swallowing. Incorrect: A, B, D: These are not typically considered mealtime risks associated with ALS. Reference: Radomski, MV, Trombly-Latham, C (2008). Occupational Therapy for

Physical Dysfunction (6th ed.). Baltimore, MD: Lippincott, Williams and Wilkins. Pages 1092-1096, 1331 17. Which factor is MOST IMPORTANT for the OTR to initially determine when considering if this resident would benefit from a mobile arm support? a. Staff’s ability to set up the device for the resident b. Ability to attach the device to the patient’s wheelchair c. Amount of upper extremity passive joint mobility d. Presence of upper extremity athetoid movements (http://almostot.blogspot.com/2012/10/past-nbcotquestions-on-fb-otr-set.html) Answer: C. Amytrophic lateral sclerosis (ALS) is a progressive neurological disease. Screening results indicate this resident has significant weakness secondary to the disease. The resident must have sufficient passive ROM to effectively use a mobile arm support. Incorrect: A, B: Assessing the resident’s ROM should be done before identifying the staff’s ability or the ability to attach the device to the wheelchair. D: Athetoid movements typically are not associated with ALS. Reference: Radomski, MV, Trombly-Latham, C (2008). Occupational Therapy for Physical Dysfunction (6th ed.). Baltimore, MD: Lippincott, Williams and Wilkins. Pages 1092-1096, 445 18. A client who had a distal humerus fracture 8 weeks ago has been referred to OT one day after removal of a long arm cast. Evaluation results indicate the client has full functional ROM and normal sensation and skin pallor of the hand. The client rates the pain as a 3/10 using a visual analog scale. Elbow goniometric measurements show the client’s passive elbow ROM is significantly less than the norms. What should the OTR conclude is the PRIMARY cause for this discrepancy? a. Heterotopic ossification b. Secondary nerve injury c. Soft tissue tightness d. Post-traumatic ischemia (http://almostot.blogspot.com/2012/10/past-nbcotquestions-on-fb-otr-set.html) Answer: C. Soft tissue changes due to immobilization should be considered as the primary cause of the client’s elbow ROM deficits. Incorrect: A: This is typically associated with significant pain with active motion and swelling around the affected joint. It has the potential to be a secondary complication associated with aggressive passive ROM. B: Nerve injuries secondary to an elbow fracture typically impact the ROM and sensation of the hand. D: Volkmann’s ischemia is a complication associated with an elbow fracture. A client with this compartment syndrome would have sensory, motor and vascular changes in the hand. Reference: Radomski, MV, Trombly-Latham, C (2008). Occupational Therapy for Physical Dysfunction (6th ed.). Baltimore, MD: Lippincott, Williams and Wilkins. Pages: 124, 1113 19. An OTR has completed a manual muscle test of a client. Results indicate the client has Poor minus (2-/5) functional strength of the dominant upper extremity. What is the MOST EFFECTIVE method for grading an activity to improve the client’s muscular strength? a. Increasing the number of repetitions while maintaining the same resistance b. Decreasing the resistance and increasing the number of repetitions c. Increasing the amount of time an isometric contraction is held d. Completing movements through a full arc of motion against gravity (http://almostot.blogspot.com/2012/10/past-nbcotquestions-on-fb-otr-set.html) Answer: C. This client is very weak as noted in a muscle grade of Poor minus (2-/5). For clients with this amount of weakness, the most effective method for increasing strength is to increase the amount of time an isometric contraction is held. Incorrect: A: This grading method is best for increasing endurance. B, D: This may be too difficult for a client with

Poor minus (2-/5) strength. Reference: Radomski, MV, Trombly-Latham, C (2008). Occupational Therapy for Physical Dysfunction (6th ed.). Baltimore, MD: Lippincott, Williams and Wilkins. Page: 127,362 & Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages 433-434, 471-476 For questions 20-23: A client has moderate hemiplegia, dysarthria and diplopia secondary to having had a CVA several weeks ago. An OTR and COTA in an outpatient setting are collaborating to initially evaluate the client using an ecological model. Records indicate the client is a single parent of an adolescent. The client plans to return to work as a librarian. 20. What is the FIRST step the OTR should take when evaluating this client? a. Assess deficits related to the client’s performance skills and patterns. b. Observe specific client factors during a typical BADL task. c. Perform a standardized assessment of motor and process skills. d. Identify the areas of occupation the client wants or needs to do. (http://almostot.blogspot.com/2012/10/past-nbcotquestions-on-fb-otr-set.html) Answer: D. The practitioner should begin the evaluation process by learning what the client wants or needs to do. This information can then be used to help determine the type and focus of the remainder of the evaluation. Incorrect: A, B, C: These could be included as part of the initial evaluation but only after learning about the client’s wants and needs. Reference: "American Occupational Therapy Association (2008). Occupational Therapy Practice Framework: Domain & Process (2nd ed.). American Journal of Occupational Therapy, 62(6), 649. 21. Which task-oriented approach would be MOST BENEFICIAL to include as part of the intervention plan for maximizing the client’s physical abilities? a. Augmentative communication b. Constraint-induced movement therapy c. Dominance retraining activities d. Visual attention and scanning exercises (http://almostot.blogspot.com/2012/10/past-nbcotquestions-on-fb-otr-set.html) Answer: B. Constraint-induced movement therapy is a task-oriented approach to motor control acquisition. This approach focuses on facilitating use of the affected arm during activities and helping the client overcome learned nonuse. Incorrect: A, C, D: These will not help the client maximize physical abilities. Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages 38,793-798 22. Which type of activity should be included as part of the INITIAL intervention to remediate the client’s motor impairment? a. Repetitive practice of an occupational performance skill in context b. Training on the use of adaptive equipment to support an area of occupation c. Weight bearing through the affected upper extremity prior to an activity d. Dominance retraining during a variety of writing and drawing tasks (http://almostot.blogspot.com/2012/10/past-nbcotquestions-on-fb-otr-set.html) Answer: A. Evidence indicates that repetitive practice of a skill in context will help with cortical map reorganization for regaining functional use of the affected extremity. Incorrect: B, C, D: These are not remediation activities. Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages 793-798, 815, 576 & Gillen G. (2009). Cognitive and

Perceptual Rehabilitation: Optimizing Function. St. Louis, MO: Elsevier Mosby. Pages 38-42 23. Which assessment should be included as part of the initial evaluation and can be administered by the COTA? a. Functional Independence Measure (FIM) b. Bay Area Functional Performance Evaluation (BaFPE) c. Canadian Occupational Performance Measure (COPM) d. Allen Diagnostic Module (ADM) (http://almostot.blogspot.com/2012/10/past-nbcotquestions-on-fb-otr-set.html) Answer: C. The ecological model looks at the unique and dynamic relationship between people, environments, and occupations. The COPM is a clientcentered tool that supports this model by addressing a client’s perception of their performance in areas of occupation and their satisfaction with this performance across 3 key areas: self-care, productivity and leisure skills. This is a standardized assessment that a service competent COTA could administer. Incorrect: A: This tool is designed for collecting information about a client to generate group data and analyze functional outcomes in inpatient rehabilitation settings. B, D: These tools are designed primarily for clients who have a psychiatric diagnosis or cognitive deficit. Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages 38, 813 24. A patient who had a myocardial infarction 2 days ago is participating in Phase I of cardiac rehabilitation. Which of the following activities is CONTRAINDICATED for a patient to do during this phase of rehabilitation? a. Ambulate from the bed to the bathroom for BADL. b. Sit on a chair at the bathroom sink to complete grooming tasks. c. Measure perceived exertion during personal hygiene activities. d. Complete isometrics and gentle stretching prior to lower body dressing. (http://almostot.blogspot.com/2012/10/past-nbcotquestions-on-fb-otr-set.html) Answer: D. Isometric exercises can affect the cardiovascular system by causing a rapid and sudden increase in blood pressure. This physiological response is contraindicated during this phase of cardiac rehabilitation. Incorrect: A, B, C: These activities are typically included in the OT intervention during phase I cardiac rehabilitation. Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages: 674, 1145-1147 25. An inpatient sustained an incomplete cervical spinal cord injury 2 months ago. The patient’s upper extremity functional strength is Trace (1/5) on the left and Poor Minus (2-/5) on the right. The patient’s goal is to eat meals independently. Which factor MUST be considered when determining if this patient is a candidate for a mobile arm support? a. Amount of time needed to set up the device for each use b. Amount of upper extremity passive joint mobility c. Type of wheelchair the patient currently uses d. Presence of upper extremity athetoid movements (http://almostot.blogspot.com/2012/10/past-nbcotquestions-on-fb-otr-set.html) Correct: B. A patient must have adequate passive mobility to be able to operate the MAS. Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages: 719-724 Incorrect: A: This should not influence the decision as to whether a patient is a candidate for using this device. C: Mobile arm support mounts are adjustable to fit a variety of

wheelchairs. D: Athetoid movements are typically associated with lesions of the basal ganglia. Pediatric OT An occupational therapist completes a developmental assessment on a seven-month-old infant. Assuming normal development, which of the following reflexes would NOT be integrated? a. Asymmetrical tonic neck reflex b. Moro reflex c. Landau reflex d. Symmetrical tonic neck reflex (giles) Answer: C response begins at 3 months, it is not fully integrated until the child’s second year. Inorrect: A: normal response from birth to 6 months. B: normal response is from 28 weeks of gestation to 5 months. D: normal age of response 6-8 months. 2. An occupational therapist assesses a one-month-old infant. During the treatment session, the therapist strokes the cheek of the infant causing the infant to turn its mouth towards the stimulus. This action is utilized to assess: a. Moro reflex b. Rooting reflex c. Startle reflex d. Righting reflex (giles) Answer: B: this reflex assists the mother when feeding an infant. Incorrect: A: simulated by the head suddenly dropping into extension for a few inches. The response is abduction of the arms with the fingers open, followed by the arms crossing the trunk into adduction, and crying. C: stimulated by a loud, sudden noise; response is similar to Moro reflex but the elbows remain flexed and the hands closed. D: general term used to describe a group of reflexes that are responsible for the development of upright posture and smooth transitional movements; equilibrium reactions occur in response to a change in body position or surface support to maintain body alignment. 3. An occupational therapist identifies that an infant is unable to roll form prone to supine. Which reflex could interfere with the infant’s ability to roll? a. Asymmetrical tonic neck reflex b. Moro reflex c. Positive support reflex d. Symmetrical tonic neck reflex (giles) Answer: A: when the infant turns its head to one side, the upper and lower extremities on the face-side will extend while the upper and lower extremities on the skull-side flex; without integration, the child will be unable to roll. Incorrect: B: stimulated by a sudden change in position of the head; there is immediate abduction, extension, and splaying of the fingers followed by adduction of the upper extremities across the chest; will normally cause an infant to cry. C: stimulated as weight is placed on the balls of the feet when the infant is upright; produces an extension response within the lower extremities and trunk. D: stimulated by movement of the head; with flexion: upper extremities flex and the lower extremities extend; with extension: the upper extremities extend and lower extremities flex. 4. Katie can form all letters correctly but she presses hard, slumps while writing, and although it takes her longer than her peers, she can complete the assignment in the allotted time. This is a problem with: a. Her ability to copy b. Her overall posture and tone c. Her speed (JBReview) B. Her posture and tone are causing her decreased speed. Speed is an issue only when work cannot be completed within the parameters set in class, not necessarily when compared to peers. 5. You are working with Sally, an 8-year old female who has been referred to you to assist with her handwriting. While observing her writing her name on the paper, you notice that parts of her fingers are blanching due to how tightly she is holding her pencil. You have her put the 1.

pencil down ad instruct her to relax while you passively move her fingers, wrist, elbow, forearm, and shoulder through their range of motion. During this assessment, you find that there is not much resistance felt in her muscles as you move them. Based on this information, you decide that: a. She needs a harder surface to write on b. She is holding the pencil tightly because her tone is increased in her arms and hands. c. She holds the pencil tightly because she is fixating or blocking due to decreased tone in her arms and hands d. She needs a word processor (JBReview) Answer: C. Increased tone in her arms and hands would be revealed during range of motion. She is compensating for decreased shoulder stability by fixating. Giving her a harder surface would not change her performance, and whether or not a keyboard would improve her performance cannot be determined from passive range of motion. 6. You are asked by the classroom teacher to evaluate Jim, a third grader with mild cerebral palsy. The first thing you should do is: a. Gather handwriting samples and talk to his teacher about her concerns b. Evaluate Jim’s muscle tone c. Give a standardized writing test such as the ETCH d. Give a standardized visual motor test. (JBReview) Answer: A. you need to know what the specific concerns are before you can decide if a standardized test is necessary. Evaluation of tone may be part of your assessment at some point, but it would not be the first thing you would do. 7. You have looked at the samples and interviewed the teacher, and now you are going to directly observe Emma’s writing. What will you be able to tell through observation? a. If there are any avoidance of behaviors b. Ability to form letters c. Posture and pencil grip d. A, B, and C (JBReview) Answer: D. 8. You are asked to evaluate the pencil grip of a sixth grader. According to the teacher, the grip appears to be awkward. When you see the child, you find he does not use a dynamic tripod grasp, but more of a lateral quadruped grip (thumb slightly wrapped, pencil stabilized at tips of all four fingers). His writing is legible, and he has no complaints of fatigue. What do you do next? a. Instruct him on how to change his grip to dynamic tripod b. Give him a home program to work on in hand manipulation skills c. Nothing, this is an acceptable grip pattern d. Give him a pencil with a pencil grip to pattern his hand (JBReview) Answer: C 9. You are called to observe a kindergartner who is having difficulty with writing skills. During your observation, you notice that she is wiggling in her seat with her feet dangling, often stands up to write, or kneels on her chair. What may help improve the situation? a. Giving her something for under her feet to stabilize her b. Giving her an incentive program for increasing her attention span c. Making sure the table/desk is at the right height so she can see what she’s doing d. All of the above e. A and C (JBReview) Answer: E. She may not be able to steady herself or see her work, so she may be standing or kneeling to compensate, not because of her decreased attention span. For questions 10-16: Define which specialized pediatric setting would be most appropriate for intervention services

for the patients in the following case scenarios. Choose from the following possible intervention settings: A. B. C. D. Early Intervention School based Hospital-based acute Hospital-based outpatient

10. Alonzo is a child with Down Syndrome who has an active IFSP. Where would Alonzo most likely receive services? (JBReview) Answer: A. An IFSP or individualized family service plan is a result of the evaluation completed on an at-risk child that has been referred to early intervention. It is an outline of the family’s services and who is providing them. 11. Jennifer is a 3-year old with spastic diplegia whose family is concerned about her development. Her upper extremity tone and strength is within normal limits. Who would be most appropriate to provide consultative services? (JBReview) Answer: A. Jennifer is age 3 years or younger and at risk for developmental delay. She does not currently demonstrate significant tonal involvement that is greatly impacting her function. She would be best served in the least restrictive environment of early intervention services provided in the home or consultative group setting. 12. Jonathan is an 8-year old boy who is demonstrating handwriting difficulties and fine motor delays that are interfering with his ability to produce written workat a pace equal to his peers. He may benefit from assistive technology. Where would he most likely be referred for an evaluation for OT services? (JBReview) Answer: B. he is school aged, and his delay has a direct impact on his educational performance. 13. Tyrone is a 10-year old boy status post fracture to his radius and is having difficulty with writing postsurgery. Where would he most likely be referred for evaluation for occupational therapy services? (JBReview) Answer: D. although his difficulty is with writing and may impact his educational performance, it is due to a temporary impairment. School-based therapy services are not provided when a student has a temporary impairment. Rehabilitation is more appropriately addressed in the outpatient therapy setting. 14. Julie is a 6 year old female with left hemiparesis due to a stroke. She demonstrates significant range and strength limitations and increased tone in her left hand. She is able to self-ambulate around the school environment. She uses classroom tools appropriately. Where would she most likely receive therapy services? (JBReview) D. Although she demonstrates significant impairment with the left upper extremity, she is independent in her educational setting and would not qualify for school services. 15. Natasha is a 5 year old with a history of brain tumor whose parents are concerned about her IEP. She has endurance and coordination issues. She frequently drops objects and has difficulty with her dressing and feeding skills. Which setting would help the parents address these issues? (JBReview) Answer: B. the parent’s issue is with the IEP. An IEP is an individualized education plan and is developed in the school system to address the child’s present level of performance and how his or her disability impacts the child’s function in the school environment and participation in the curriculum. 16. Michael is a 13 year old male who is status postinvolvement in a motor vehicle accident in which he sustained a concussion and a fractured femur. Michael and his parents are concerned about him being able to dress his lower extremities due to his external fixator and about him being able to carry his books at school. Where would Michael most likely be referred to help his family address their concerns? (JBReview) Answer: C. In the acute setting patients are frequently referred to occupational therapy services just prior to discharge. The therapist and family identify strengths and

weaknesses in the discharge environment and develop an intervention plan. 17. If a child you are treating has increased tone in the flexor muscles of the arm resulting in severe elbow flexion, you would expect that: a. The extensor muscles are also tight b. The extensor muscles are overstretched and weak c. The extensor muscles have not been affected because they are innervated differently d. All of the above (JBReview) Answer: B. tightness and shortening in the agonist muscle almost always produces weakness and overstretching of the antagonist muscle. Care must be given in treatment to address the tightness, weakness, and shortening of the agonist as well as the lengthening and weakness of the antagonist muscle to provide appropriate biomechanical alignment of the joint and improve functioning. 18. You are working with a 4-year old male who has increased tone in the muscles of his upper arm. This tone is noted to increase with participation in all functional activities. Which techniques would be the best idea to help decrease the tone? a. Tap the muscle belly to inhibit or deactivate the muscle b. Use quick stroking movements along the muscle with the muscle on stretch c. Cast the arm for stretch and neutral warmth. d. Provide slow, firm massage strokes with stretch (JBReview) Answer: C. Tapping and quick stroking are both facilitatory and would increase tone. Slow, firm massage strokes can help decrease tone but are more temporary in nature. Casting the arm would provide a prolonged stretch and more long-lasting impact to the tone of the arm. 19. Evan is a 3-year old male with a history of cerebral palsy. He has significantly increased tone in his right upper extremity. He is holding his right upper extremity in elbow and wrist flexion. You know that his increased tone is interfering with his ability to participate in occupations. During treatment the best thing you could do would be which of the following? a. Place the child in supported sitting and slowly stretch and move his right upper extremity through full range b. During home program instruction encourage the parents to hand him things to his left upper extremity. c. Position him in right side sitting with support at his elbow and have him shoot baskets with his left hand d. Provide vibration to the right upper extremity (JBReview) Answer: C. Vibration is facilitatory and would increase tone. Handing the patient items in the left UE would not help address the child’s increased tone in his or her right UE and would encourage decreased use of the right UE. Weight bearing through right side sitting while facilitating use of the left UE is the best way to inhibit the tone in the right UE. 20. You are working with the family of a 5 year old child with cerebral paly who has increased extensor tone. The family has difficulty getting this patient from supine to sitting after completing his diaper changes. Which of the following statements best describes how you would teach the parents to bring their child from the supine to the sitting position? a. Tell them to place their hand behind his head and slowly push him up into a sitting position because hip flexion helps to break up tone b. Tell them it would be easiest to hold him by his hands and slowly pull him into a sitting position c. Tell them to hold his upper arms and gently lift and turn the shoulders to rotate the trunk slightly and then come up d. Tell them to flex his legs and knees so they face up in the air and use your body to hold his legs in this position; then, holding his upper arms

near the shoulders, gently lift his shoulders up and toward you as you use your body to push his legs back so that he ends up in a sitting position. (JBReview) Answer: C. Using rotation of the trunk and bringing him into flexion will help to decrease his extensor tone and mimics the natural progress of coming from supine into sitting. Placing your hand behind the head of someone with extension patterns usually encourages them to push into extension. Pulling the patient into sitting does not encourage active use of the abdominals through normal patterns. Option D does not facilitate the patient to be active in any way, it would be very difficult with a 5 year old and it would become more difficult as the child grows. 21. You are working with Tony, a 7 year old little boy. In treatment, you are having him play Connect Four, a game where you place checkers in slots and see who is the first to get four in a row of a particular color. What ADL skill could you be addressing with this activity? a. Feeding skills b. Gross Grasp skills c. Buttoning skills d. Bathing skills (JBReview) Answer: C. This works on a portion of buttoning, which is placing an object (button) into a slot (buttonhole). 22. You are working with a child with mental retardation, and his parents are concerned because he is not yet toilet trained at age 4 years of age. What do you tell his parents? a. There are larger diapers available and they should call their durable medical equipment (DME) company to get some because it is not likely that he will be toilet trained b. Many children with mental retardation just take longer to potty train and you can help them with some strategies to progress him along c. They should begin to remodel their bathroom because it is likely that he will not be independent with toileting d. Children with mental retardation have difficulty with sequencing activities, and because toileting requires the appropriate sequencing of several tasks, it is unlikely that the child will be able to be toilet trained (JBReview) Answer: B. Although the other statements might be true to a point and/or could be used appropriately during some point of treatment, the first place to start is evaluating the child and helping the parents address strategies to address the issues the child is having with developing independence in toileting. 23. The child you are trying to dress continues to go into asymmetric tonic neck reflex (ATNR) pattern. What would be the best thing to tell the parents to do to help make dressing the child easier? a. Gently roll the baby toward you so that the baby’s head comes into midline and his or her arms relax, making dressing easier. b. It will be easier to get the shirt on if you dress the extended arm first and then the flexed arm c. It will be easier if you dress the flexed arm first and then the extended arm because the flexed arm is closer to the head and easier to get in d. It would be best to dress the child in a sitting position because this is how a child at that age would be dressing (JBReview) Answer: A. Although B is true, it would be better to help inhibit the ATNR pattern by bringing the baby’s head into midline through rolling him or her into side lying 24. Your 5 year old patient, Luke, has decreased upper extremity strength and decreased hand strength. He is having problems with pulling up his pants after they are put on. Your goal is for him to be independent in donning his pants. What would be the best activity to use during treatment? a. Placing his leg through a ring b. Placing rings over his feet

c. Playing tug of war d. Stepping into a box (JBReview) Answer: C. You are specifically addressing Luke pulling up his pants after they are on. The other activities help in getting his legs in the pants 25. Jennifer is an 8 year old female with a history of developmental delay. She has difficulty with putting her clothes on in the appropriate order. Which activity would be the best to do with her during treatment? a. Play games or sing songs that help to identify body parts b. Use a set of sequencing cards that depict a child completing the different stages of dressing c. Change Jennifer’s positioning during dressing, such as having her sit supported in the corner to dress d. Provide wrist loops to make it easier for Jennifer to pull up her clothing (JBReview) Answer: B. although the other activities can be used to help with dressing, using sequencing cards is the best activity to help Jennifer put her clothes on in order. Psychiatric OT During an initial OT interview, a patient denies frequent cocaine use and cites a recent bonus as proof that work performance is not being negatively affected by substance use. The patient reports using cocaine only when under a deadline at work or when having to entertain business clients. The patient’s account indicates a lack of insight related to which of the following performance areas? a. Leisure-time management b. Current values and interests c. Interpersonal and coping skills d. Problem-solving and ethical behavior (http://almostot.blogspot.com/2012/10/past-nbcotquestions-on-fb-otr-set.html) Correct: C. Based on the patient’s account, the dependence on cocaine use appears to be in direct relation to the patient’s inability to manage stress appropriately. These performance areas should be addressed by developing an intervention plan that facilitates effective interpersonal and coping skill acquisition with the goal of promoting participation in all areas of occupation. Reference: Cara E, MacRae A (2005). Psychosocial Occupational Therapy: A Clinical Practice (2nd ed.). Thomson Delmar. Pages: 456-457 Incorrect: A, B, D: Although these areas may need to be addressed during the occupational therapy intervention, they do not directly relate to the situations described by the patient in the initial interview. 2. An OTR is facilitating a group for clients with polysubstance use. During the first group session, the OTR describes how trigger events and irrational thinking can lead to substance misuse. Which theoretical model does this approach exemplify?
 a. Cognitive-behavioral
 b. Psychodynamic
 c. Motivational
 d. Human occupation (http://almostot.blogspot.com/2012/10/past-nbcotquestions-on-fb-otr-set.html) Correct: A. The premise behind cognitive-behavioral therapy is that the individual can change their behavior (substance misuse) by first challenging their negative assumptions (cognitions) relating to trigger events.
Reference: Cara E, MacRae A (2005). Psychosocial Occupational Therapy: A Clinical Practice (2nd ed.). Thomson Delmar. Page: 453
 Incorrect: B: The premise behind psychodynamic models is that the individual’s substance misuse has resulted from earlier psychological conflicts
C: Motivational strategies encourage the individual to consider change through exploration and feedback on alternative options. 
D: The Model of Human Occupation emphasizes exploration, competence, and achievement as related to a client’s areas of occupation.
 3. As a component of cognitive assessment, an occupational therapist asks a patient to count from one to twenty-five 1.

by increments of three. Which cognitive function does this task MOST accurately assess? a. Attention b. Constructional ability c. Abstract ability d. Orientation (giles) Attention is defined as the capacity of the brain to process information from the environment or from long-term memory. The complexity and familiarity of the task determines the degree of attention required to complete the task. Answer: A. Attention can be assessed by asking a patient to count from one to twenty-five by increments of three. The task should be relatively easy for most individuals, however, it requires the person to exert a sustained, consistent effort. Attention deficits are common with many neurological disorders including brain injury, stroke and dementia. Incorrect: B. Constructional ability can be assessed by asking a person to copy figures consisting of varying sizes and shapes or to draw a known item such as a clock. C. Abstract ability can be assessed by asking a person to interpret a common proverb or to describe similarities or differences between two objects. D. Orientation can be assessed by asking a person to identify time (e.g. day, month, sseason_), person (e,g. name), and place (e.g. city, or state). 4. By using an interest checklist that includes a report of both interests and actual participation in activities, an OT practitioner will MOST likely collect information on an individual’s: a. use of time. b. developmental level. c. mood and affect. d. communication skills. (Anderson) Answer: (A) By comparing interests and actual participation, the OT practitioner may identify discrepancies between interests and actual play and leisure behavior. This information can help address the individual’s use of time, and facilitate temporal organization. Incorrect: The issues in answer B, C, and D are not directly addressed using this method. 5. An individual with mental illness wants to travel to the library independently, but keeps getting lost. Which of the following actions should the OT practitioner take FIRST in the evaluation process? a. Take the individual in the library and obtain a library card. b. Assess the individual’s ability to read. c. Identify the bus that goes to the library and obtain a bus schedule. d. Assess the individual’s topographical orientation skills. (Anderson) Answer: (D) To plan an appropriate intervention, the individual’s community mobility skills must first be assessed. Constantly getting lost is a strong indicator that the individual may be impaired in the area of topographical orientation. Incorrect: Learning to take the bus and obtaining a library card (answers A and C) are important steps toward independent library use, but should occur after evaluation has been completed. Individuals may enjoy using a library whether they can read or not so the ability to read is not essential to this goal and does not need to be evaluated (answer B). 6. During an initial evaluation, an OT practitioner documents that the individual’s chart reveals a dual diagnosis from two mental health diagnostic categories. The individual MOST likely has a history of: a. Depression and substance abuse. b. Depression, mental retardation, and arthritis. c. Arthritis and peripheral vascular disease. d. Bipolar disorder, depression, and amputation. (Anderson) Answer: (A) Examples of dual diagnostic categories are mental health and mental retardation and mental health and mental retardation (answer A). Incorrect: “Multiply handicapped” is the coexistence of physical and mental health types of problems such as

answers B and D, whereas answer C would reflect physical diagnostic categories. 7. An OT practitioner is treating an individual who has suddenly been diagnosed with a disabling condition. Which would be the adaptive response that would most likely pass in time without intervention? a. A dependency reaction b. A stress reaction c. A mourning response d. A desire to set unrealistic goals (Anderson) Answer: (C) Mourning (answer C) is an adaptive mechanism used for dealing with a disabling condition because a loss of function has occurred. Incorrect: Dependency, stress reaction, and unrealistic goals (answers A, B, and D) are responses that would not normally pass in time. They also can interfere with the recovery process when they are present in the extreme, as with mourning. 8. A woman who had a stoke tries unsuccessfully to put on a blouse using a one-handed technique. She states, “I can do it, I’m just not trying hard enough.” The OT practitioner most accurately recognizes this as: a. Denial. b. Projection. c. Rationalization. d. Regression. (Anderson) Answer: (A) “Defense mechanisms or defenses are uses unconsciously by the person’s ego in order to keep anxiety-producing thoughts, information or wishes out of consciousness”. This individual may be having difficulty accepting her stroke and is using denial to avoid dealing with it (answer A). Incorrect: Projection (answer B) is a process by which a “…person attributes to another person the unacceptable thoughts and feeling he/she is having”. Rationalization (answer C) is when an individual makes excuses for unacceptable behavior. Regression (answer D) is when an individual reverts to infantile or childlike behavior as a way of dealing with a difficult situation. 9. An OT practitioner who selects the behavioral frame or reference for an individual with a psychosocial issues is primarily seeking an approach which focuses on the: a. Level of skill required that is appropriate for the generally expected skills for that age. b. Symbolic potential and use of activities to explore personal meaning. c. Combined activity demand of sensations, perceptions, and motor skills. d. Observable analysis, measurable outcomes, and reinforcement for building specific skills. (Anderson) Answer: (D) Observation and analysis of behaviors as well as identifying specific measurable outcomes which will indicate change in behaviors are characteristic of the behavioral frame of reference, as is the use of reinforcement methods (applied reward systems) to develop desired behaviors and skills. Incorrect: Answer A is linked to developmental frames of reference, answer B is linked to psychoanalytical frames of reference, and answer C is linked to sensory integrative frames of reference. 10. An OT practitioner is treating an individual who has difficulty maintaining attention to a task, but is aware of the problem. The BEST example of a strategy that the therapist can teach the person to control effects of attention deficits would be: a. Simplifying the instructions given to accomplish the task so only one step is presented a time. b. Learning the self-monitoring technique of asking oneself if any part of the task has been missed. c. Providing practice in shape and number cancellation worksheets. d. Removing unnecessary objects from around the task area to decrease distractions. (Anderson) Answer: (B) Teaching the client to self-monitor is an example of a strategy to control the tendency to miss details involved in the task process.

Incorrect: Answer A, simplifying instructions, is an example of the method of adapting the amount of information presented during the task. Answer C, practicing shape and number cancellation worksheets, is an example of remedial skill training activity. Answer D, removing unnecessary objects from the task area to decrease distractions, is an example of adapting the environment to compensate for attention deficits. 11. An OT practitioner is planning group programming in an acute care psychiatry setting for severely mentally ill individuals who display disorganized thinking and difficulty functioning in many areas. The MOST appropriate type of group to use is a(n): a. Activity group. b. Psychoeducational group. c. Neurodevelopmental group. d. Directive group. (Anderson) Answer: (D) Directive groups have a highly structured approach and are often used in acute care psychiatric settings for patients with psychoses who display disorganized thinking and disturbed functioning. Incorrect: Activity groups (answer A) require a higher level of task behavior and ability to engage in occupation to enable skill development. Psychoeducation groups (answer B) which are based on cognitive behavioral theory and focus on teaching information and techniques require a level of learning capacity that may be impaired during acute mental illness. Neurodevelopmental group (answer C) use gross motor activity and sensory stimulation techniques to enhance sensory integration in persons with ling histories of schizophrenia. 12. An OT practitioner is planning a meal preparation activity for an individual with cognitive deficits in the areas of attentional and organizational skills. The most appropriate activity to use FIRST in addressing sequencing skills is: a. Setting the table. b. Planning a meal. c. Baking cookies using a recipe. d. Preparing a shopping list. (Anderson) Answer: (C) Baking cookies (answer C) is a well delineated meal-preparation activity that provides structure with a specific sequence of tasks. Incorrect: Setting a table or preparing a shopping list (answers A and D) do not necessarily require sequencing of tasks. Planning a meal (answer B) involves a great deal of organizational ability, and would not be an appropriate choice for an initial activity to address goals relating to sequencing tasks. 13. During the clean-up portion of a cooking activity, an elderly woman with a diagnosis of depression and dementia begins to dry the plates and utensils she has already dried. The OT practitioner should: a. Tell the client that the same dishes and utensils are being redried. b. Put the dried dishes away and begin to hand her wet dishes. c. Ask the client to stop the activity because it seems too difficult. d. Ask the client to describe what she is doing. (Anderson) Answer: (B) Compensating for mistakes helps to increase the sense of self-worth and integrity of individuals with dementia. This approach is preferable to drawing attention to errors, especially in situations in which safety is not an issue. Incorrect: Answers A, C, and D all draw attention to individual’s errors. 14. An OT practitioner is seeing a home health-care client who is in the middle stages of Alzheimer’s disease and whose memory is now interfering with the performance daily self-care activities. The MOST relevant OT intervention at this point would be: a. Memory retraining activities for the client. b. ADL retraining program for the client. c. Instructing caregivers in task breakdown. d. Leisure activity planning.

(Anderson) Answer: (C) Instructing the client’s caregivers in task breakdown, or breaking down tasks into simple steps and then providing step-by-step instructions, will allow the client to perform activities as capabilities decline. Incorrect: At this stage of the disease, memory retraining (answer A) and ADL retraining (answer B) will probably not be effective. Leisure activities (answer D) structured to meet the needs of the client with Alzheimer’s disease could be helpful, but will not address the primary problem of performance of self-care activities. 15. The PRIMARY functions of an OT practitioner leading a therapeutic group in the beginning stages of group development are to: a. Observe, set the climate, and model desired behaviors. b. Require group members to observe each other, set the climate, and model desired behaviors. c. Aid group members in separation and reinforce gains made in groups. d. Work individually with group members until each is ready to join group activity. (Anderson) Answer: (A) Answer A reflects typical leadership involvement in OT groups. Incorrect: Answer B is incorrect because it reflects minimal direction from the leader which is uncharacteristic of OT groups. Answer C is incorrect because the group leader perform these functions at the termination stage, rather than the initial stages of group development. Working individually with group members (answer D) is incongruous with current OT group treatment formats that use properties of the group to achieve therapeutic goals. 16. When working with an individual who is severely depressed and demonstrates psychomotor retardation, it is MOST important to: a. Encourage more rapid responses. b. Provide extensive visual and auditory sensory stimulation. c. Give simple directions and patiently wait for responses. d. Provide activities involving large groups. (Anderson) Answer: (C) Severe depression can result in slowing of cognitive and motor functions, known as psychomotor retardation. Incorrect: The OT practitioner must not rush the individual (answer A), but should give him or her time to process information and respond. Too much stimulation (answer B and D) may cause the individual to withdraw even further. 17. An individual with an anxiety disorder has been placed on new antianxiety medication. While monitoring the individual over the next few days, the OT practitioner should be particularly observant for which of the following side effects? a. Akathisia. b. Decreased arousal and drowsiness. c. Extrapyramidal syndrome. d. Tardive dyskinesia. (Anderson) Answer: (B) Medication side effects are typically observed and reported by OT practitioners. Antianxiety medications reduce anxiety, but also may produce sleep, relax muscles, and impair memory. Incorrect: Akathisia, extrapyramidal syndrome, and tardive dyskinesia (answers A, C, and D, respectively) are adverse effects commonly linked to antipsychotic medications. 18. Which of the following is the BEST support group to recommend to a husband who describes having difficulty in coping with the ups and downs of his wife’s bipolar disorder? a. Al-Anon b. Family therapy c. National Alliance for the Mentally Ill d. Recovery, Inc. (Anderson) Answer: (C) This is a support group that is open to clients and families and focuses on education and support related to all mental illnesses. Incorrect: Al-Anon (answer A) is a support group for alcohol use among family members. Family therapy (answer B) is not

a support group. Recovery, Inc. (answer D) is a self-help support group for clients with mental disorders. 19. The OT is working with a patient who needs to be independent in medication management prior to discharge. The MOST effective technique for the OT to teach the patient to remember whether he has taken his medication is to: a. Establish a routine of taking medications the same time every day. b. Keep the medications in a special, labeled location. c. Use a diary to record each dosage after it is taken. d. Arrange for a caregiver to remind the patient when medications should be taken. (Anderson) Answer: (C) Using a diary to record each dosage (answer C) would be most effective because it would provide the patient with a written record of when the medication was taken. Incorrect: Answer A, establishing a routine, and answer B, keeping the medications in a special location, could be helpful in reminding the patient to take the medication, but would not be as effective as a diary for remembering whether the medications where taken. Answer D, arranging to have a caregiver remind the patient, would not facilitate independence to medication management. 20. An OT practitioner is training an adult worker with a developmental disability to put a pencil in a box before putting a score pad in the box for the game packaging task in a sheltered workshop assembly line. Which of the following reinforcement schedules would MOST likely achieve the goal of learning this task sequence? a. Intermittent reinforcement with correct responses. b. Reinforcement over 10 minutes. c. Reinforcement for every fourth correct response. d. Continuous reinforcement of correct responses. (Anderson) Answer: (D) Continuous reinforcement is helpful with training of new behaviors and should be provided every time the correct behavior occurs. Incorrect: Intermittent reinforcement (answer A) and fixed interval reinforcement (answers B and C) are best for maintaining behaviors. 21. An OT practitioner consulting in a supervised living environment is teaching the residential staff strategies to help minimize the effect of hallucinations for residents with schizophrenia. Which of the following would be the MOST effective suggestion for the OT practitioner to offer? a. Teach staff not to disturb persons while they are experiencing the hallucinations. b. Suggest moving persons experiencing hallucinations to areas where they can be completely isolated from other people. c. Attempt to provide meaningful activities that will engage attention. d. Move the persons experiencing hallucinations to more stimulating environments. (Anderson) Answer: (C) Answer C, providing activities, is the best approach because activities can help people with hallucinations to “…divert attention from their symptoms”. Incorrect: Answer A, leaving people experiencing hallucinations alone would have no benefit in reducing attention to the hallucination. Answer B, completely isolating the person from others, is not recommended because interpersonal contact can be beneficial for reinforcing reality and reducing hallucinations. Answer D, moving a person to a more stimulating environment, can have the effect of increasing hallucinations if they find the environment stimuli too stressful. 22. An OT practitioner is planning a program to address the needs of persons with Alzheimer’s disease, and their families, as part of a hospital outreach program. The focus of the program that would be MOST beneficial maintaining safety and supporting function home for people in the advanced stages of Alzheimer’s is:

a. Strength and endurance activities. b. Cognitive rehabilitation techniques. c. Environmental modification. d. Assertiveness skills. (Anderson) Answer: (C) Environmental modification is the area of intervention that can be best assist in maintaining safety and supporting function at home by providing the physical and sensory environments to compensate for deficits. Incorrect: Strength and endurance activities (answer A) will have no direct effect on safety in the home. Cognitive rehabilitation techniques (answer B) are not indicated for conditions with progressive cognitive deterioration. Use of assertiveness skills (answer D) would be inappropriate for dealing with the kinds of communication problems encountered with persons who have Alzheimer’s 23. In carrying out inpatient treatment groups for individuals with schizophrenia, the OT practitioner would be MOST likely to use which of the following intervention methods initially? a. Projective media, such as clay, to facilitate expression of feelings. b. Allowing an individual group member to work in an isolated area away from the group. c. Simple and highly structured activities. d. Discussions about the individuals’ delusions. (Anderson) Answer: (C) Projective media, isolation, and discussing delusions are all contraindicated for people with schizophrenia. Incorrect: Projective activities (answer A) are most useful for encouraging expression of feelings. It may be appropriate to separate individuals (answer B) who are violent or unable to tolerate the presence of others nearby, but this would not be part of the regular group routine. Discussing delusions (answer D) is undesirable because it is likely to reinforce them. 24. An individual with an anxiety disorder feels so overwhelmed he cannot get himself from his room to OT group each morning. Which of the following strategies will be MOST helpful? a. Reduce distractions and keep the lights low. b. Provide a stimulating environment with real life opportunities. c. Give him a tour of the OT department and a schedule of activities. d. Leave doors open and avoid being alone with the individual. (Anderson) Answer: (C) Becoming familiar with an environment in an advance and knowing what to expect can help reduce anxiety. Incorrect: Reducing distractions and keeping lights low (answer A) may be useful environmental adaptations for individuals with mania or hyperactivity. Providing a stimulating environment and real life activities (answer B) is recommended for individuals experiencing delusions. OT practitioners should leave doors open and avoid being alone (answer D) with individuals who are hostile or violent. 25. An OT practitioner is leading an assertiveness group with clients demonstrating low self-esteem. The MOST important curative factor to regularly include in an assertiveness group is a: a. Leader who provides the group members with definitions of assertion, passivity, and aggression. b. Group leader who allows and encourages all group members to physically and verbally release their aggressive feelings toward inanimate objects. c. Practitioner who demonstrates common assertiveness techniques to the group members. d. Practitioner who encourages group members to share similar situations and reactions with one another. (Anderson) Answer: (D) Answer D is an approach designed to develop cohesiveness and universality among members.

Seeing others as similar has been identified by individuals as a curative factor. Incorrect: Answers A and C are approaches designed to impart information. Answer B is an example of catharsis, which may not be helpful to all members and requires the practitioner to understand precautions for the use of catharsis.

Professional Roles 1. An occupational therapist is responsible for supervising an occupational therapist assistant at an off site location. Which of the following would not necessitate a supervisory visit by the occupational therapist: a. A change in the patient’s medical status b. A modification in the patient’s plan of care c. A request by the occupational therapist assistant d. An alteration in the patient’s level of motivation (giles) Answer: D: OTA often deals with changes in patient’s level of motivation. This observation in isolation would not warrant a supervisory visit by the OT. Incorrect: A: a change in the patient’s medical status requires reassessment and possibly a change in the established plan of care. B: An OT is solely responsible for modifying an established plan of care; an OTA may be able to modify a parameter of an existing intervention within an established plan of care. C: An OT is required to provide patient-related consultation at the request of another practitioner. 2. An occupational therapist employed in an outpatient orthopedic clinic examines a patient diagnosed with cerebral palsy. The therapist has limited experience with cerebral palsy and is concerned about his ability to provide appropriate treatment. The MOST appropriate therapist action is: a. Inform the patient of your area of expertise b. Co-treat the patient with another more experienced therapist c. Treat the patient d. Refuse to treat the patient (giles) Answer: B: by co-treating the patient, the therapist receives external assistance and at the same time improves his skills with a particular patient population. Incorrect: A: informing the patient of their area of expertise would likely make the patient question the therapist’s competence. C: the question states that the therapist is concerned about his ability to treat the patient. This type of admission makes it inappropriate to simply treat the patient without utilizing available resources. D: refusing to treat the patient would not be necessary since the therapist has available resources to offer assistance. 3. A patient status post hand flexor tendon repair is examined in occupational therapy. The physician referral includes a very specific post-operative protocol. If the therapist plans on deviating from the established protocol, the MOST appropriate action is to: a. Secure the patient’s surgical report b. Complete a thorough examination c. Carefully document any modification d. Contact the referring physician (giles) Answer: D: protocols are often established by physicians to ensure that health care providers progress patients in a predictable manner without jeopardizing the patients’ post surgical status. As a result, it is necessary to contact the referring physician when deviating from the established protocol. Incorrect: A: familiarity with the surgical report would be helpful for the therapist, however, would not provide adequate justification for deviating from the established protocol. B: a thorough examination must be completed regardless of whether the referral includes a very specific protocol or simply an order to “evaluate and treat”. C: when possible the therapist should contact the referring physician prior to making any modifications to a protocol, however,

when a modification does occur it is necessary to document the change. 4. The first step an occupational therapist should take to incorporate current best evidence into the practice of occupational therapy is to: a. Pose an answerable clinical question b. Locate the most current best evidence from the literature c. Critically appraise the evidence for its validity, impact and applicability d. Integrate the evidence into clinical decision making (giles) the first step in evidence-based practice is to pose an answerable clinical question. This action is considered the starting point for searching the literature for information related to the question. A well-built, answerable clinical question usually has four components: 1) patient/problem of interest; 2) intervention; 3) comparison of intervention, if relevant 4) the clinical outcomes of interest. These components form the acronym PICO. Answer: A. this is the first step. nd Incorrect: B: 2 step: locate the best evidence to answer the rd question. C: 3 step: critically appraise the evidence you find. th D: 4 step: integrating the evidence, along with the clinical experience and the patient’s unique values and circumstances, to make clinical decisions. 5. A risk management committee composed of various members of the rehabilitation team is charged with identifying methods to prevent employee exposure to blood and body fluids. The MOST appropriate INITIAL action is: a. Provide follow-up to employees if exposed to blood and body fluids b. Provide free hepatitis B immunizations to staff c. Develop an infection control policy that conforms to Occupational Safety and Health Administration guidelines d. Educate staff about policies (giles) the Occupational Safety and Health Administration (O.S.H.A) requires that health care facilities provide employees with information and instruction in techniques to protect them from infectious diseases Answer: C: health care facilities are required to have a formal infection control policy that is consistent with O.S.H.A. requirements. It is important for all health care facilities to establish a committee who develops an infection control policy and then closely monitors the policy to ensure that it remains consistent with current O.S.H.A. guidelines. Incorect: A: Health care facilities are required to provide follow up to employees exposed to blood and body fluids; this is an important action, however, the committee was charged with identifying methods to prevent employee exposure to blood and body fluids. B: Health care facilities are required to offer the hepatitis B vaccine to employees who are at substantial risk of occupational exposure to hepatitis B; this vaccine does not have to be free, but usually is offered without charge or with a substantial discount. D: staff is required to be educated on established policies, however, the initial action needs to focus on developing a policy consistent with current O.S.H.A guidelines. 6. An occupational therapist wearing sterile protective clothing establishes a sterile field prior to changing a dressing on a wound. Which area od the protective clothing would NOT be considered sterile even before coming in contact with a non-sterile object? a. Gloves b. Sleeves of the gown c. Front of the gown above waist level d. Front of the gown below waist level (giles) once a sterile field has been established an occupational therapist must be careful to maintain the sterile field and minimize any chance of contamination. The four rules of asepsis that a therapist should follow are: 1. Know which items are sterile, 2. Know which items are not sterile. 3. Separate sterile items from non-sterile items, 4. If a sterile

item becomes contaminated, the situation must be remedied immediately. Answer: D. the front of the gown below the waist level is not considered to be sterile after the gown is applied since there is an increased chance of incidental contact with a non-sterile object without the therapist’s knowledge Incorrect: A. Gloves offer protection to the therapist’s hands to reduce the likelihood of becoming infected with microorganisms and decrease the risk of the patient receiving microorganisms from the therapist. Sterile gloves are considered to be sterile after they are applied. B. a gown is used to protect the therapist’s clothing from being contaminated or soiled by a contaminant. The gown also reduces the probability of the therapist transmitting a microorganism from their clothing to the patient. The sleeves of a sterile gown are considered to be sterile after they are applied. C. The front of the gown above the waist level is considered to be sterile after the gown is applied. 7. Which of the following are examples of proper documentation? a. Patient cannot lift 20 pounds b. Patient complains of pain constantly and is therefore magnifying c. Patient has not demonstrated proper body and lifting mechanics during a 30 pound unilateral carrying test over a distance of 20 feet. The patient exhibits trunk stiffening and cannot control appropriate faulty body and postural mechanics. Patient had been instructed on proper maintenance of body mechanics over a 50 minute period and still did not demonstrate proper control d. Patient dropped the box and could not explain his inability to hold it, therefore, he is malingering. (JBReview) Answer: C: this describes the most objective findings to explain why things are occurring. Choices A, B and D have no significant objective measures to back up the documentation. For questions 8-10: SCENARIO: An OTR attended a professional development activity on sensory integration strategies for children with autism spectrum disorder. During the seminar, the presenters discussed anecdotal evidence for the use of nutritional supplements to improve sensory processing. In researching the topic, the OTR reads a peer-reviewed article that indicates a correlation of 0.01 (r = 0.01) between the use of a specific nutritional supplement and sensory processing skills. The OTR is uncertain if nutritional supplements are within the professional standards of practice for the occupational therapy profession. 8. Which organization should the OTR contact for obtaining the most up-to-date resources for resolving this uncertainty? a. National Board Certification in Occupational Therapy (NBCOT)
 b. National Autism Association (NAA)
 c. American Council on Occupational Therapy Education (ACOTE)
 d. American Occupational Therapy Association (AOTA)

 (http://almostot.blogspot.com/2012/10/past-nbcotquestions-on-fb-otr-set.html) Answer: D. The American Occupational Therapy Association (AOTA) publishes the Standards of Practice for Occupational Therapy and the Reference Manual of Official Documents of the American Occupational Therapy Association, Inc. These documents clarify and support occupational therapy practice and define the minimum standards for the practice of occupational therapy. Incorrect: The NBCOT is responsible for issues related to certification and certification renewal The National Autism Association provides education and resources about autism but does not have jurisdiction about OT practice standards. The ACOTE is responsible for

accreditation of occupational therapy education standards in support of the practice standards set forth by the AOTA. Reference: http://www.aota.org/Practitioners/Official.aspx 9. What do the research findings from the peer-reviewed article indicate for the level of correlation?
 a. No correlation
 b. Low correlation c. High correlation d. Inverse correlation

 (http://almostot.blogspot.com/2012/10/past-nbcotquestions-on-fb-otr-set.html) Answer: A: "When calculating correlation, the symbol representing correlation = r. “The interpretation of the correlation coefficient is the strength of the relationship. The following is how values are typically interpreted • 0 -.20 suggests a negligible correlation • .20-.40 is a low correlation • .40-.60 is a moderate correlation • .60-.80 is a high correlation • .80-1.00 is a very high correlation” (Kielhofner, 2006, p. 263) “The strongest correlations are 1.00 and -1.00, and if there is no correlation, the correlation coefficient is 0.” (Kielhofner, 2006, p. 262). Incorrect: B, C, D: A correlation of 0 - .20 suggests a negligible correlation Reference: Kielhofner, G. (2006). Research in occupational therapy: Methods of inquiry for enhancing practice. Philadelphia, PA: F.A. Davis Co. 10. Which type of research should the OTR review to obtain the strongest level of evidence regarding this intervention?
 a. Case report with expert opinion
 b. Two-groups, non-randomized studies
 c. Single subject design, case series
 d. Systematic reviews, meta-analyses (http://almostot.blogspot.com/2012/10/past-nbcotquestions-on-fb-otr-set.html) Answer: D. Systematic reviews are considered to be the strongest level of evidence because they provide an overall conclusion based on review of all the evidence available on the topic. Incorrect: B, C, A : When considering the strongest level of evidence, these research designs appear lower on the hierarchy of evidence than a systematic review, and therefore may not be the best design to prevent threats to internal validity for an intervention study such as this. Reference: Kielhofner G. (2006). Research in Occupational Therapy: Methods of Inquiry for Enhancing Practice. Philadelphia, PA: FA Davis Company. Page: 666-670 11. An OTR is collaborating with a social worker and a registered nurse to develop a new domestic violence prevention program for a community mental health center. The need for this service has been identified through situational, social and epidemiological analyses. What is the NEXT step in program development when using an ecological model? a. Establish policies and procedures for the program b. Identify a process for tracking program outcomes c. Develop multi-disciplinary intervention protocols d. Determine behavioral and environmental risk factors (http://almostot.blogspot.com/2012/10/past-nbcotquestions-on-fb-otr-set.html) Answer: D. Decisions on program format and content should be based on identifying participants’ risk factors and understanding the impact of the environment on behavior. Incorrect: A, B, C: These steps are completed after behavioral and environmental factors are identified. Reference: Jacobs K, McCormack G (eds). (2011). The Occupational Therapy Manager (5th ed.). Rockville, MD: AOTA Press. Pages 319-320 Fazio L. (2008). Developing Occupation-Centered Programs for the Community (2nd ed.). Upper Saddle River, New Jersey: Pearson Prentice Hall. Pages 101-125 12. An occupational therapist participating in a research

project elects to use to use a simple random sample to draw a sample from the population. By selecting this type of sample, the researcher ensures: a. The data collected from the sample will be normally distributed b. The sample size will be large c. The sample will have proportional representation from all parts of the population d. That every member of the population has an equal opportunity of being chosen (giles) Probability samples are created through a process of random selection. Each selection is independent and every member of the population has an equal chance of being selected for the sample. Answer: D. a simple random sample is unbiased; each member of the population has an equal chance of being chosen. Incorrect: A. Simple random sampling does not ensure that the data collected will be normally distributed. The shape of the distribution of the data collected from the sample is independent of the type of sample. B. Simple random sampling does not determine the size of the sample. C. To ensure that the sample will have proportional representation from all parts of the population, the therapist would create a proportional stratified sample. 13. Upon completion of the initial interview and chart review, the NEXT step to be taken in the OT process is to: a. Analyze the data. b. Develop a treatment plan. c. Perform selected assessments. d. Select appropriate evaluation procedures. (Anderson) Answer: (D) An OT evaluation begins with the initial interview and chart review, which guide the OT practitioners in deciding on a frame of reference and the identification of specific evaluation procedures or assessments. Incorrect: Assessments are then performed (answer C) to gather information to identify problem areas and plan treatment. After the assessments are complete, the OTR uses clinical reasoning skills to analyze the data (answer A) and to identify the person’s strengths and weaknesses. The treatment plan (answer B) is develop after the individual’s problems have been identified and evaluation data have been analyzed. Finally, specific interventions are selected. 14. Which of the following is the BEST example of the plan section of a discharge summary when using the SOAP note format? a. “The patient reports intentions to continue to practice proper body mechanics at work.” b. “The patient demonstrates independence in performing the home exercise program.” c. “The patient expressed a desire to return to work, but does not yet demonstrate the capacity for the required sitting tolerance.” d. “Recommend the use of lumbar support and regular performance of home program.” (Anderson) Answer: (D) The plan section of a discharge summary contains the patient’s discharge d isposition (e.g., to a nursing home or to outpatient therapy), recommendations for additional therapy or actions on the part of the patient (e.g., outpatient therapy, home health, or performing a home program), equipment needs or equipment provided to the patient, and plans for discharge, answer D. Incorrect: Answer A is a subjective report. Answer B is an example of a statement that belongs in the objective section of a discharge summary. Answer C belongs in the assessment section. 15. The administrator of an assisted living facility has asked an OT practitioner to help implement programming that will decrease the number of residents needing to move from the assisted living facility to nursing homes. The MOST important area for the practitioner to address is: a. Adaptive equipment needs. b. Fall prevention. c. Meaningful use of leisure time. d. Balancing work, leisure, and rest.

(Anderson) Answer: (B) All of the answers are important to the quality of life and independence for individuals living in an ALF. However, falls are the leading cause of accidental death in people over 65 and are a major reason for nursing home placement. 16. When ordering a wheelchair for an individual who has Medicare, part B, the OT practitioner must be sure the wheelchair: a. Will increase functional independence. b. Is medically necessary. c. Will maintain patient function. d. Will reduce deformity. (Anderson) Answer: (B) Medicare defines medical necessity as “that which can withstand repeated use, is primarily and customarily used to serve a medical purpose, and is generally not useful to a person in the absence of illness or injury”. Medicare part B does not typically cover items such as elevated toilet seats, grab bars, or adaptive equipment because they are not considered to be medically necessary. Incorrect: Answers A, C, and D may all be a part of the broader statement of medical necessity not pertaining to Medicare part B. 17. An OT practitioner is supervising an OT aide. The MOST appropriate kinds of activities and level of supervision for the aide include: a. Selected tasks in which aides have been trained, with close supervision. b. Various intervention activities with routine supervision. c. Completing ADL training with a patient without supervision. d. Selective adaptive equipment from a catalog with general supervision. (Anderson) Answer: (A) To maximize efficiency and costeffectiveness of therapy services, there has been an increased use of OT aides. Such aides must be very closely supervised, and are expected to receive site specific training in selected activities determined by the supervising OT practitioner, and must be utilized in accordance with state regulations. \ Incorrect: Activities and levels of supervision in answers B, C, and D are all beyond the scope of the OT aide. 18. The term that BEST describes the mandate of confidentiality of patient information and also holds the practitioner to remain faithful to the pa tient’s BEST interest is: a. Informed consent. b. Fidelity. c. Beneficence. d. Nonmaleficence. (Anderson) Answer: (B) Fidelity. Fidelity is defined as remaining faithful to the patient’s best interest. This includes statements regarding the confidentiality of patient information. Incorrect: Answer A, informed consent, is in reference to the rights of individuals to be provided information regarding their health care as well as to make choices about their own health care. Answer C, beneficence, is the concept of striving to bring about the best possible outcome for patients served through treatment modalities. Answer D, nonmaleficence, is defined as “the obligation to avoid doing a harm to another or to avoid creating a circumstance in which harm could occur to another.” 19. An OT manager is preparing the outpatient OT staff for a visit from an accrediting agency. The accrediting agency that surveys inpatient and comprehensive outpatient rehabilitation programs is BEST represented by which of the following: a. AOTA b. JCAHO c. CARF d. NBCOT (Anderson) Answer: C. The Commission on Accreditation of Rehabilitation Facilities (CARF) is the regulatory agency for the provision of rehabilitation services. Incorrect: AOTA (answer A) was formed in March of 1917 as the National Society for the Promotion of Occupational

Therapy. JCAHO (Answer B) is the Joint Commission on Accreditation of Hospital Organizations. The JCAHO reviews the medical care provided by hospital organizations. The NBCOT (Answer D) is the agency that develops and administers the examination for registration as an OT, therefore answers A, B and D are incorrect. 20. An OT practitioner wishes to assess the results of a life skills training program provided to individuals at a shelter for abused women. Which of the following methods would be the MOST comprehensive method for obtaining this information? a. Final evaluation of each client involved b. Client satisfaction survey c. Program evaluation d. Utilization review (Anderson) Answer: C. “Program evaluation is an outcome monitoring system that reflects the results of services on consumers by defining and reviewing the outcomes of care.” Incorrect: Final evaluations of clients involved in the program and client satisfaction surveys (answers A and B) may both be components of the program evaluation. Utilization review (answer D) evaluates the care that is provided to ensure that services were appropriate and not overutilized or underutilized. Utilization review also analyzes the services to ensure that the interventions were provided in an economical manner. 21. A patient uses a self-administered assessment tool as a method to record daily progress. What type of reliability would be the MOST essential using this tool? a. Reliability of parallel forms b. Internal consistency c. Intratester d. Intertester (giles) Since the assessment tool is used to record daily progress, it will be administered repeatedly. If changes in the scores are to be attributed to real progress made in occupational therapy, and not to inconsistency or unreliable measurement the tool should be evaluated for reliability. Answer: C: Intratester reliability refers to the extent to which scores on the tool obtained by the same tester are consistent. The tools should have intratester reliability so that any changes recorded can be attributed to progress in therapy and not to reliable measurement Incorrect: A. Reliability of parallel forms refers to the consistency between results of two tests constructed in the same way from the same content domain. Parallel forms reliability is not an issue in this example because there is only one form of the assessment tool. B. Internal consistency reliability refers to the consistency of results across items within a test. The reliability of the instrument is evaluated by estimating how well the different items within the test, which are supposed to reflect the same construct, do yield similar results. This is not of concern in the example. D. Intertester reliability refers to the extent of agreement of the scores recorded by two or more individuals. Interrater reliability addresses the consistency of the implementation of a rating system. 22. An occupational therapist employed by a home health care agency knocks on the door of a patient that has a scheduled therapy session. After waiting several minutes, the therapist concludes the patient is not at home. The MOST appropriate therapist action is: a. Contact the patient and reschedule b. Notify the patient’s insurance provider c. Notify the referring physician d. Discharge the patient from OT (giles) OTs must decide how to handle missed appointments based on the relative frequency of occurrence and the rationale presented by the patient. There is not any information provided that indicates the patient has missed previous appointments and therefore the situation should be treated as an isolated incident Answer: A. there are a number of possible reasons why the patient may have missed the appointment such as an unexpected emergency or neglecting to write down the scheduled appointment. As a result, the therapist should

focus on rescheduling the patient’s session. Incorrect: B. the insurance provider would receive information on therapy sessions attended, however, it would be unnecessary to notify the provider about a single missed appointment. C. Physicians need to be updated on patient progress and relevant changes in medical status, however, missing a scheduled appointment would not meet this type of criteria. D. A single missed appointment would not be sufficient grounds to discharge the patient from OT. If missing scheduled appointments was a recurring theme, this option would be more plausible. 23. An occupational therapist participating in a research project decides it will be necessary to utilize a relatively large sample. By including a large number of subjects, the researcher hopes to increase: a. The effect size b. The likelihood of rejecting the null hypothesis c. The validity of the outcome measurements d. The reliability of the outcome measurements (giles) Sample size is critical to the probability that a statistical test will lead to rejection of the null hypothesis. Besides sample size, statistical power is a function of the significance criterion (alpha), the variance in the data, and the effect size. Answer: B. The larger the sample, the greater the probability that a statistical test will lead to rejection of the null hypothesis. Small samples are less likely to represent the population of interest. Therefore, true differences or relationships (whatever is being tested) are more likely to be detected in large samples. Incorrect: A. Effect size is a statistical expression of the magnitude of the difference between different treatments or the magnitude of the relationship between variables. Sample size has no specific effect on the effect size. C. Validity of measurement refers to the degree to which an instrument measures what it is intended to measure. Sample size has no specific effect on the validity of measurements. D. Reliability of measurement refers to the consistency with which an instrument or rater measures a variable. Sample size has no specific effect on the reliability of measurements 24. An individual covered by Medicare who has been receiving OT and PT in the home is now able to transfer in and out of the car with supervision of a caregiver and visit friends 30 minutes away. OT services are still required to improve mobility, upper extremity function, and home management skills. Which of the following actions should the OT practitioner take FIRST? a. Provide a home program and discharge the individual. b. Explain to the individual and caregiver that one must be “homebound” in order to be eligible for home care services c. Refer the individual for outpatient therapy and provide a comprehensive discharge summary to the outpatient setting d. Inform the PT of the individual’s status. (Anderson) Answer: B. In order to be eligible for home care services, the individual must be confined to home, a condition referred to as homebound. The individual need not be bedridden, but leaving the residence must require a considerable or taxing effort. Absences from the home are permitted, but must be infrequent in nature, short in duration or for the purpose of receiving medical treatment. given that the individual is able to leave the home for a social visit and tolerate riding in a car for 30 minutes, he is not considered homebound. Incorrect: B. The OT practitioner would first inform and explain this criterion to the individual and caregiver. D. After this has been explained, the OT practitioner would communicate with the PT. C. and refer the individual for outpatient therapy. Simply providing a home program and discharging the individual would not meet the individual’s needs because he continues to require therapeutic intervention. 25. An occupational therapist observes an intravenous line that is tangles around a patient’s bed rail. What type of medical asepsis is indicated prior to coming in contact

with the intravenous line? a. Gloves b. Gloves, gown c. Gloves, gown, mask d. None (giles) An intravenous (i.v) system can be used to infuse fluids, electrolytes, nutrients, and medication. The i.v. line most commonly consists of plastic tubing and is considered a non-sterile object. Answer: D. The tubing is a non-sterile object that would not require the use of protective clothing. The occupational therapist can reposition the I.V. line through direct hand contact. Incorrrect: A. Gloves offer protection to the physical therapist’s hands to reduce the likelihood of becoming infected with microorganisms from a patient and reduce the risk of patient receiving microorganism from the physical therapist. Gloves would not be necessary when handling an I.V. line. B. A gown is used to protect the OT’s clothing from being contaminated or soiled by a contaminant. The gown also reduces the probability of the OT transmitting a microorganism from their clothing to the patient. Gloves and gown would not be necessary when handling an I.V. line. C. A mask is designed to reduce the spread or microorganisms that are transmitted through the air. The mask protects the OT from inhalation of particles or droplets that may contain pathogens and also reduces the transmission of pathogens from the OT to the patient. Gloves, gown, and mask would not be necessary when handling an I.V. line.

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