Domain 1 Practice Questions Flashcards
A client has persistent pitting edema of the hand secondary to mild hemiplegia. Which method would be MOST RELIABLE for monitoring the client’s edema over time?
A) measure the hand circumference at the MCP joint level
B) use a volumeter to measure water displacement
C) trace an outline of the hand & fingers placed flat on a tabletop
B
- Volumetric measurement procedures are standardized and would produce the most reliable results when measuring hand edema in clients with this diagnosis
An OTR working in an inpatient mental health setting is using a cognitive behavioral approach to select an intervention activity for a young adult undergoing treatment for symptoms associated with body dysmorphic disorder. The patient is employed in a successful career and enjoys outdoor activities such as jogging and hiking, but has difficulty forming and maintaining interpersonal relationships. One of the patient’s goals is to improve self-image and the ability to express feelings. Which activity would be MOST BENEFICIAL to include as part of the intervention for supporting this goal when using this approach?
A) Engaging the patient in an art project using a variety of media during which the patient is encouraged to release emotions
B) Teaching the patient to use a dysfunctional thought record for describing distressing situations and emotional responses
C) Guiding the patient through avocational exploration of activities that provide opportunities for social interaction
B
- Having the client maintain a journal of distressing events and associated feelings or thought processes is integral to a cognitive behavioral approach.
An OTR is using a top-down approach to select interventions for a client who has unilateral neglect secondary to a CVA. Which intervention would be MOST BENEFICIAL to include as part of the client’s intervention when using this approach?
A) Place commonly used toiletry items to the client’s affected side during self-care tasks.
B) Teach drills for practicing head turning to find an object placed near the affected side.
C) Determine compensatory options the client can use in the home environment.
D) Use tactile-kinesthetic guiding to the client’s involved extremity during a dressing task.
C
- This represents a top-down approach because it focuses on a strategy the client can use in everyday life.
For a typically developing child, which postural reflex becomes evident between 6-9 months of age and continues throughout life?
A) Forward protective extension
B) Tonic labyrinthine
C) Asymmetrical tonic neck
D) Head righting
A
- Forward protective extension is a postural reflex that typically becomes evident between 6-9 months of age and continues throughout life
A student in the second grade has autism spectrum disorder and is scheduled to begin school-based OT. The teacher reports the student has difficulty attending to academic tasks and typically has outbursts when in close proximity to other people. In which environment should the majority of the student’s intervention sessions take place?
A) Self-contained occupational therapy treatment room
B) Classroom during routine curriculum-based activities
C) Playground in an area apart from other students
B
- OT goals and objectives in school-based settings support students’ academic and functional abilities. Providing services in the natural classroom environment during typical routines would increase the likelihood for carry-over and consistency.
A client sustained a closed fracture of the humeral shaft 6 weeks ago. The physician refers the client to OT with a consult that reads: “Begin elbow and shoulder ROM”. An initial screening of the affected upper extremity indicates the client has elbow and shoulder stiffness and mild swelling of the hand. The client has full active flexion and full passive extension and flexion of the wrist and digits. Active extension of the wrist and digits is absent. What INITIAL action should the OTR take based on these findings?
A) Fabricate a dynamic orthotic to compensate for loss of finger extension.
B) Complete a comprehensive manual muscle test of the affected upper extremity.
C) Confirm whether the client has a secondary radial nerve injury.
C
*The radial nerve is commonly injured with a fracture of the humerus. This results in weak or absent wrist and finger extensors. The OTR should contact the physician to confirm this diagnosis and to clarify the consult before proceeding with rehabilitation for the hand.
An OTR who works in an elementary school is preparing to evaluate a student in fifth grade who has a learning disability and ADHD. Which standardized assessments would be MOST EFFECTIVE for the OTR to include as part of the evaluation process?
A) Wee-FIM™ and Ranchos Los Amigos Levels of Cognitive Function-Revised™
B) Hawaii Early Learning Profile (HELP) and Barthel Index of ADL
C) Bruininks-Oseretsky Test of Motor Proficiency (BOT) and Evaluation Tool of Children’s Handwriting (ETCH)
C
- These assessment tools are used to measure skills and abilities that are associated with school-related occupational performance.
A 2-year-old child has developmental delay due to mild spastic cerebral palsy. The child has mastered four-point positioning. Which movement component should the OTR plan to facilitate NEXT?
A) Scooting on the belly
B) Creeping on hands and knees
C) Rocking on hands and knees
D) Unsupported upright sitting
C
*In the developmental sequence of gross motor development and mobility skills, a child who has mastered four-point positioning would be expected to progress to rocking on hands and knees NEXT.
An OTR is working with a 5-year-old child who has severe spastic diplegic cerebral palsy and will soon be attending kindergarten. The child has been approved for a power wheelchair. Before beginning training in the use of the chair in a school setting, which client factor is MOST IMPORTANT for the OTR to re-evaluate?
A) Visual perceptual skills
B) Upper extremity range of motion
C) Object permanence
A
*Cerebral palsy is associated with visual impairments that need to be screened prior to initiating power mobility training.
An OTR, who works in the home health setting, is evaluating a client with pneumonia who was recently discharged home from the hospital. The OTR plans to interview the client and administer a standardized assessment to gather information about the client and the home environment. Which additional evaluation method is MOST BENEFICIAL for the OTR to include in the information-gathering process to understand the client’s priorities?
A) Complete a comprehensive social participation inventory.
B) Measure spaces and features in the natural environment.
C) Conduct skilled observations while in the client’s home.
C
*Observing while the client engages in functional tasks in the natural context of the home will provide the MOST BENEFICIAL information related to the client’s priorities in this environment.
A 2-year-old toddler, who has a developmental delay, recently learned to release a 2-inch (5.08 cm) ball into a large toy box. What fine motor skill should the OTR work on NEXT?
A) Color within the lines on a page.
B) Complete a 3- to 4-piece puzzle.
C) Transfer toys from hand to hand.
B
- In the development of play occupations, a child who is able to release an object into a toy box would NEXT be expected to be able to put together a 3- to 4-piece puzzle.
An OTR is evaluating a client who has an ulnar nerve injury at the wrist level of the right dominant extremity. During which task would this injury be MOST evident?
A) Carrying a briefcase
B) Operating a desktop calculator
C) Turning a key in the car ignition
D) Holding coins in the palm of the hand
C
*Ulnar nerve palsy at the wrist impairs the hypothenar muscles and first dorsal interosseous muscle resulting in the difficulty turning a key or performing a lateral pinch
What critical functional advantage is TYPICALLY observed in a client who has a complete C6 spinal cord injury compared to a client who has a complete C5 spinal cord injury?
A) Ability to use triceps strength during transfers
B) Improved trunk control to bend side to side without falling
C) Ability to use the radial wrist extensors to supplement grasp
D) Improved gross grasp from innervation of the extrinsic flexors
C
*Clients who have a complete C6 spinal cord injury TYPICALLY have innervation of the radial wrist extensors. This allows the use of a tenodesis grasp to attain a higher level of functional independence.
An OTR is evaluating an inpatient diagnosed with a glioblastoma multiform in the right frontal lobe. The patient has an extensive fund of knowledge and intact long-term memory, but does not understand the meaning of a joke when engaged in social conversation with family members. Which option BEST describes this behavior?
A) Confabulation
B) Concrete thinking
C) Flight of ideas
B
*A client who exhibits concrete thinking interprets events and communication in a literal fashion making it difficult to understand the underpinnings of a joke.
A client in an outpatient setting sustained an acquired brain injury 2 months ago. Evaluation results indicate the client has functional ROM and strength, but continues to require assistance with ADL due to moderate visual and vestibular processing deficits. Which intervention represents an adaptive approach for improving the client’s performance in areas of occupation?
A) Providing the client with an exercise program for improving gaze stabilization
B) Teaching the client to use proprioceptive cues during functional activities
C) Incorporating progressively more challenging tasks into a functional activity
D) Engaging the client in valued activities that promote postural stability and balance
B
*The adaptive approach places emphasis on the client’s abilities. This top-down approach aims to facilitate functional performance through compensatory techniques.
Which of the following symptoms TYPICALLY indicates that a client who has been on prolonged bed rest is experiencing orthostatic hypotension?
A) Pounding headache upon moving into a semi-reclined position
B) Lightheadedness upon moving from a supine to seated position
C) Shortness of breath when sitting up from a supine position
D) Diaphoresis when turning over from supine to side-lying position
B
*Orthostatic hypotension is a decrease in blood pressure that reduces blood flow to the brain and results in lightheadedness.
Which dressing task requires the MOST challenging integration of performance skills and patterns for a typically developing 3-year-old child?
A) Unfastening the zipper of a front-opening jacket
B) Finding armholes in a pull-over shirt
C) Taking off a pair of ankle-high socks
D) Pulling down a pair of elastic waist pants
A
- This skill requires a complex integration of visual and somatosensory systems that typically develops by the third year of age
An OTR is evaluating the visual function of a patient who is emerging from coma. The patient opens eyes spontaneously and in response to auditory stimulation. What visual function is MOST IMPORTANT for the OTR to observe in a patient at this level of function?
A) Oculomotor control
B) Scanning
C) Pattern recognition
A
- It is beneficial to assess basic visual skills such as oculomotor control when a patient is emerging from coma.
A client in an outpatient setting sustained a frontal lobe TBI 2 months ago. The client has good motor control but has residual problems with executive functioning. One of the client’s goals is to be independent with homemaking tasks. During a meal preparation session, the client cooks a meal, but makes no attempt to clean the cooking utensils and dishes or put the food items away after completing the cooking task. Which area of executive function appears to be MOST affected by the TBI as evidenced by this behavior?
A) Emergent awareness
B) Selective attention
C) Episodic memory
D) Environmental gnosia
A
*Deficits in emergent awareness are characterized by difficulty or inability to recognize and correct errors in performance.
An older adult in an inpatient setting has moderate-severe debilitation from prolonged bed rest secondary to general medical-surgical post-operative complications. The patient’s primary goal is to be as independent as possible with BADL prior to discharge home. The patient has full passive ROM and Fair minus (3-/5) functional muscle strength of the upper extremities. The patient can ambulate for several feet using a walker and contact guard assistance, but uses a wheelchair in the hospital room and depends on caregivers for wheelchair transport to various areas of the hospital. Based on the patient’s current status, which dressing activity would be MOST difficult for this patient to complete while seated in the wheelchair?
A) Getting a pair of pants hanging in the closet and putting them on
B) Putting on a front-opening shirt after reaching for the shirt off a bedside stand
C) Crossing one leg over the other and putting on loose-fitting slip-on shoes
D) Washing hands at a sink and drying the hands using a towel placed next to the sink
A
- Patients with this muscle strength have low endurance and fatigue quickly. An analysis of the components (e.g., weight shift, dynamic balance, movement against gravity) of each option presented indicates this option is physically more demanding than the other three options.
