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1

An individual consistently confuses white glue with white grout during an activity. Which of the following actions would the COTA implement to remain consistent with an activity adaptation approach?

Replace the white glue for blue glue.

2

An individual with the goal of increasing attn span is frequently observed watching the person next to her instead of performing the assigned task. This behavior MOST likely indicates a problem with?

Distractibility

3

A COTA is working with a group of pts who have orientation deficits resulting from TBI. Using an adaptive or compensatory approach, the MOST appropriate interventions would be to?

Provide verbal cues, external aids such as calendars/family pics, and opportunities to practice using external aids.

4

Which of the following is the MOST effective way for a COTA to structure the intervention environment for a pt who exhibits seductive or sexual acting out behavior?

Provide a large area of personal space where the person is protected from physical contact with others.

5

The COTA is working with a pt after a TBI at RLA Level IV in Acute Rehab. The pt is agitated and confused as well as confrontational. The pt participates for only a few sec or min in basic ADLs such as oral/facial hygiene, hair grooming, and dressing. They are not thorough in their efforts. What is the BEST way for the COTA to present OT interventions for this pt?

Structure the tasks one at a time, with break betw each one, in a distraction-free space, using single-step commands and allow for increased processing time.

6

When working with pts after a TBI the COTA must be aware of any visual impairments. The pt can undergo a vision "screening" which should include which of the following?

Visual attn, near/far acuity, ocular movements, convergence, accommodation, ocular alignment, depth perception, and visual field function.

7

When working with individuals with TBI it is common to encounter varying muscle tone; hypotonicity in the shoulder and hypertonicity in the elbow, wrist and hand. What can the COTA do to prevent muscle CONTRACTURE?

Daily PROM, positioning and splinting.

8

Which of the following is one of the most difficult psychosocial sequelae of TBI?

Self-concept.

9

An individual the COTA is treating with a TBI needs only one verbal cue to initiate oral hygiene. That individual continues to brush his teeth in only one area until told to move to another, and another. This impairment is called?

Perseveration.

10

The pt you are treating in the Acute Rehab Brain Injury Unit demonstrates poor safety awareness and impaired judgement. These are often the result of damage to which area of the brain?

Frontal Lobe.

11

You are treating an individual after a femur fracture and the physician's orders state "non-weight bearing RLE." This individual has only a tub/shower in the home. What adaptive equipment is NECESSARY for independence in bathing?

Tub Transfer Bench.

12

After spine surgery, such as lumbar laminectomy, OTPs will alter methods for ADLs by teaching adaptive techniques. We may also choose to use adaptive equipment. Please select the best possible choice given the example of a 55 year old male, plumber, and tennis player, married with 3 young children, and active in his community.

Use figure 4 technique to don socks and shoes.

13

What should OTP include in pt education for the scenario of a 55 year old male post laminectomy, who was a plumber, tennis player, married father of 3, and active in his community?

Proper Body Mechanics.

14

You have a pt that is post-op total hip replacement with a very large body habitus (bariatric). The physician's orders state "no hip flexion beyond 90 degrees, no internal rotation, and no crossing legs." What is the BEST method to complete toileting and peri hygiene?

Set up commode over the toilet and recommend a toilet tissue holder or bidet.

15

An individual in the hospital after a total knee replacement has physician's orders to "weight bear as tolerated, encourage AROM, and no brace." What is the BEST method for lower body bathing and dressing?

Prop the operated leg on a stool and have the pt don underwear, pants, and socks, then stand to pull up over hips.

16

The OTP is treating an individual after THR in a SNF. The individual's goal is to return to cooking once d/c from the facility. What modification is BEST for safe return to cooking?

Keep commonly used items at counter top level to avoid reaching into low cabinets and drawers.

17

The OTP is working with a pt after a lumbar laminectomy and educated on no bending, lifting, or twisting during ADL participation. How will the OTP KNOW when the pt has sufficiently learned these concepts?

Demonstration of ADL participation within the stated precautions.

18

An individual in the hospital has a LLE femur fracture and left distal radius fracture (Colles) after a fall. The physician's orders state "non-weight bearing left wrist and LLE." What device is BEST to use when engaging in functional mobility?

Platform walker on left side.

19

An individual is seen by OT after a THR. The individual has beginning stages of dementia. What is the MOST effective way of ensuring they can follow their precautions?

Place a handout with pictures and text of what to do and what to avoid.

20

The goals of an elective total knee replacement are to decrease pain, increase AROM and strength, and return to independence with ADL and IADL participation. What MUST the OTP complete to ensure the individual's goals are addressed?

Occupational Profile.

21

A person status post CVA has difficulty using his left upper extremity for reaching activities because of fluctuating muscle tone. According to the NDT approach, one of the MOST effective ways to teach the pt how to normalize tone prior to engaging in occupations is by:

Weight bearing through the UE in sitting or standing.

22

You are seeing a pt post-stroke in the home and she is progressing well with functional reach using the left arm. What are the BEST activities to include in the home exercise program to ensure continued progress?

Folding laundry and putting away in the linen closet shelf just above shoulder height.

23

A pt who suffered a stroke is copying a picture of a clock. The drawing appears as a lopsided circle with a flat side on the left. The numbers one-eight are written in numerical order around the right side. The hands are correctly drawn to represent 3:00. The pt appears to demonstrate:

Left unilateral neglect.

24

You are seeing a hospitalized pt post hemorrhagic stroke with a flaccid left hemiplegia, left neglect, and absent sensation throughout the affected LUE. The pt is right-handed. What is the BEST method for self-feeding to ensure success and include the affected limb?

Long sitting in bed with a tray table positioned in midline with the LUE acting as a stabilizer.

25

You are working with a pt that suffered an ischemic stroke that affected the left side. They are ambulatory and receiving OT services in outpatient setting. Which of the following interventions is considered to be "task-oriented?"

Completing a shaving task standing at the sink in the bathroom using the pt's own razor, shave cream and wash cloth.

26

You have completed an activity analysis as a pt with left hemiparesis dons their coat. They thread the right arm into the sleeve then struggle to thread the left arm due to decreased left elbow and wrist extension. What would be the BEST approach to help maximize independence with this task?

Instruct the pt to thread his left (affected) arm first by leaning forward to allow gravity to assist. Then, pull up over the left shoulder and reach right arm up into the other sleeve.

27

What is one of the BEST ways to assess which occupations are important to your pt?

COPM

28

Neuroplasticity is present in our brains and allows for motor relearning to occur. What other concept is linked to neuroplasticity?

Cortical reorganization

29

BEST practice for OT in adults with neurological impairments (according to evidence) is?

Task-oriented approach.

30

A pt with new left hemiplegia has poor trunk control. Which is the BEST way to address this when providing OT tx interventions?

Establish a neutral yet active starting alignment.

31

A pt c/o double vision and keeps one eye closed throughout your tx sessions and c/o headache afterward. What is the BEST way to modify your session to address the diplopia?

Place partial occlusion on the nasal portion of the eye glass lens over the non-dominant eye.

32

A pt may demonstrate poor sitting posture and midline disorientation after suffering a stroke. What is the BEST way to improve sitting posture during an OT session?

Ensure a neutral yet active starting alignment with dynamic reaching activities such as retrieving items from a surface just out of arm's reach.

33

A pt alternately exhibits laughing and crying throughout a tx session. This behavior should be documented as:

Emotional lability.

34

While working with your pt that has had a CVA and deficits in trunk control, which of the following activities BEST addresses anterior weight shift to bring the upper body forward?

Self-feeding.

35

A COTA is working with an individual with global aphasia. What can the COTA do to MAXIMIZE the individual's ability to understand and carry out directions?

Gestures and demonstration of routine ADLs.

36

Which of the following activities would BEST be an example of manipulating a task and the environment to address and challenge spatial dysfunction during meal preparation when treating your pt with CVA?

Prepare items that require your client to pour ingredients from one container to another.

37

A COTA is working with an individual who is unable to name or demonstrate the use of common household objects. This behavior MOST likely indicates:

Apraxia.

38

A pt on your caseload suffered a stroke that affected her right side. Despite active range of motion within functional limits she uses her left hand for most ADL tasks. The OT assessment states that she is right hand dominant. What tasks should you include in your ADL retraining program?

ADLs that require use of both arms/hands to complete such as folding large towels and sheets.

39

While your pt that has a recent CVA is completing full body dressing, you observe that he attempts to put his socks on after his sneakers, is unable to locate the arm holes of his shirt and is only dressing the right side of his body. Which of the following terms would you NOT use to describe your observations?

It is NOT: Premotor preservation.
(It IS: somatognosia, body neglect, ideational apraxia)

40

When working with a pt that has suffered a CVA: during a toothbrushing task you notice that she is having trouble squeezing toothpaste onto the toothbrush. While documenting, you would BEST describe this neurobehavioral impairment as?

Motor Apraxia.

41

The Confusion Assessment Method (CAM) is a standardized evidence-based tool that enables non-psychiatrically trained clinicians to identify and recognize delirium quickly and accurately. When using the CAM in the ICU, it is MOST important to consider which of the following?

The pt's baseline mental status.

42

If a pt demonstrates a score of -4 on The Richmond Agitation-Sedation Scale (RASS), then you would?

Not expect the pt to participate in treatment and not proceed with the CAM-ICU Assessment.

43

OT interventions for a pt with a Rancho Los Amigos Level II in the ICU may include functional sensory stimulation to reactivate highly processed neural pathways that had been established before the injury. This will MOST likely include which of the following activities?

Guiding the pt to wipe their mouth.

44

In your pt that is a Rancho Los Amigos Level I-III, sensory regulation increases neurological signals to the reticular activation system. The goal of intervention using controlled sensory input is BEST achieved by:

Introducing isolated sensory input.

45

When your pt is emerging from a persistent vegetative state to a minimally conscious state, there will be clearly discernible, reproducible behavior. At this time it would be MOST appropriate to incorporate which of the following into treatment?

Ask your pt situational orientation questions.

46

A pt that presents as Rancho Los Amigos Level II-generalized response, would most likely participate in OT tx in which of the following ways?

With limited responses that are often the same regardless of the stimulus presented.

47

When treating your pt with TBI, you notice that he has lost his ability to perform small adjustments in the distal and proximal ends of his extremities that are necessary for smooth, coordinated movements. You would MOST likely describe these movements as?

Ataxic.

48

The MOST appropriate OT education to provide for a staff involved in the care of your pt with a Rancho Los Amigos Level II would include all of the following EXCEPT:

NO: Education regarding bowel and bladder management.

(YES: Ed on fluctuations in tone as result of position changes; Ed on flux in tone as result of volitional movement; Ed on flux in tone as result of changes in environmental factors)

49

Your pt that is a Rancho Los Amigos Level III is developing spasticity in BUE. Your education to the family should include:

An explanation that spasticity is an involuntary increase in muscle resistance that is dependent on velocity.

50

When working with your pt in the ICU that presents at Rancho Los Amigos Level III, you notice that he has a loss of PROM and you notice a hard end-feel of the elbow joint. You contact the MD because this is MOST likely a result of:

Heterotopic Ossification

51

An individual with a C6 SCI is unable to button his shirt. The COTA would be MOST likely to select which type of adaptive equipment to assist this client with buttoning?

A button hook attached to a universal cuff around the palm.

52

An individual with a complete C7 quadriplegia demonstrates fair+ (3+) strength in the wrist extensors. Which of the following interventions would the COTA introduce to MOST effectively increase strength in the wrist extensors?

An occupation based activity using increasingly heavy hand tools.

53

An unmarried pt with a SCI is on a rehab unit and constantly flirts with the COTA. The MOST appropriate action for the COTA to take would be:

Set personal boundaries appropriate to the therapist-patient relationship.

54

An individual with a high SCI (C5) is returning home. Which type of assistive tech would the client MOST likely require to ENSURE SAFETY in the home?

A call system for emergency and non-emergency use.

55

A COTA is completing a shower chair transfer with an individual with C6 quadriplegia. Which is the BEST shower chair to use?

A high back chair with elevating footrests and ability to recline.

56

It is important to protect the tenodesis action of the wrist and hand when establishing the tx for individuals with a SCI at C5/6. Protecting this action can lead to which of the following?

Grasp.

57

A pt with SCI at C5 will achieve independence with many basic ADLs including self-feeding. What is a common adaptation the COTA could make to increase independence with drinking liquids?

Tumbler with lid and long straw.

58

Working with pts with SCI that result in paraplegia in Acute Rehab ADL retraining will commonly begin bed-level and progress to w/c level as which of the following improves?

Dynamic balance and transfer skills.

59

A pt with paraplegia in acute hospital is clearly depressed but dismisses any conversation regarding these observations. What recommendation might the COTA make to facilitate the pt's ability to cope?

Referral to a peer mentor.

60

A pt with paraplegia following a SCI MUST be educated on the importance of preserving the skin and avoiding pressure ulcers. Which adaptive device is crucial for this instruction by the OTP?

Mirror.

61

While participating in activities to improve strength, an individual with MS who was recently admitted to the hospital complains of fatigue. Which of the following actions is the MOST appropriate for the COTA to take?

Give the individual a break.

62

A COTA is treating a pt with Parkinson's whose primary functional problems are caused by shuffling gait. The MOST relevant environmental recommendation the COTA should make to address a potential safety hazard in the home is:

Environmental modification (remove tripping hazards, increase lighting, etc.)

63

The COTA is seeing a pt with Parkinson's in the skilled nursing facility after a fall onto outstretched hand that caused a Colles fracture in the left (non-dominant) hand. The COTA notices that each time this pt attempts to feed himself, his hand shakes and all the food falls off the utensil. The BEST modification for this task is?

A spoon that will calibrate according to the pt's tremor and accommodate by leveling the utensil.

64

You are seeing a pt with Alzheimer's Dementia in a home health setting. A goal states "caregiver will provide pt with customized activities daily as prescribed by OT." What is the BEST method to ensure the caregiver is meeting the goal?

The caregiver and pt are participating in the activities designed by the tailored activity program.

65

A pt with MS is admitted to the hospital where you work. The OT assessment indicates the pt has cognitive impairments in short term memory. What is the BEST way to improve the individual's independence at home?

Provide compensatory strategies that address memory such as using a planner and reminders.

66

A pt you are treating in a SNF suffers from early stage Parkinson's disease. What is the BEST way to maintain or maximize independence with ADLs?

HEP including FULL AROM and trunk flexibility, especially including extension.

67

An individual with early stages of Alzheimer's disease is working with OT to maximize participation in their favorite leisure activity of gardening. What is the BEST approach to ensure the pt can continue to participate in gardening?

Provide safe and structured gardening tasks that are graded to fit the current level of cognition.

68

You are working with a pt with Parkinson's in an outpatient clinic. You can see that the pt stops at the threshold of the room and is unable to advance the walker through the doorway. This is a clear demonstration of what symptom?

Freezing.

69

The pt you are treating at home health has MS and sensory impairments in the right (dominant) hand. What techniques MUST you include in your tx plan?

Sensory compensatory strategies such as using vision to ensure the hand is not at risk for injury.

70

A COTA is treating an individual with Guillain-Barre Syndrome (GBS) in the hospital. The pt is now out of the ICU and breathing on their own but still very weak. The COTA and PTA are co-treating and have assisted the pt to the edge of the bed. What are the BEST interventions for the COTA to complete?

Graded occupations that are meaningful to the pt.

71

Patients that have GBS and their families MUST be educated on which of the following?

GBS disease process and GBS support groups

72

The COTA is working w/an individual that suffered a brachial plexus injury after a motorcycle accident that occurred several months before, in an outpatient clinic. The pt has no proximal motor control but normal AROM and strength in the hand. Which of the following are the BEST types of interventions?

Closed chain activities where the weight of the arm is supported such as wiping the table.

73

Proximal nerve injuries occur after trauma from work, motor vehicle accidents, or self-harm. The initial medical tx is surgery followed by immobilization. Once cleared by the surgeon, the pt will be referred to OT to restore function and return to functional activities that are meaningful to pt. What MUST the OTP consider and address in addition to the typical tx plan?

Psychosocial support.

74

A pt with GBS has progressed and transferred to a SNF for continued OT/PT. You are providing ADL and IADL retraining to prepare for d/c home. What MUST the OTP consider when selecting appropriate interventions?

Functional activities that are meaningful to the pt.

75

A pt with a brachial plexus injury after a car accident is showing improvement in sensation and AROM in the C5 and C6 nerve distribution of the hand. Which of the following are the BEST methods to progress the individual?

Active use of the hand in ADLs and IADLs.

76

Myasthenia Gravis is a disorder of chemical transmission at the nerve-muscle synapse and initially causes which of the following symptoms?

Eyelid drooping.

77

A pt with brachial plexus injury in the lower (nerve) trunk will have the hand position identified as which of the following?

Intrinsic minus.

78

The brachial plexus injury known as Erb-Duchenne syndrome is seen when injury occurs in the upper (nerve) trunk and causes which of the following?

Weakness or paralysis on the proximal muscles of the upper extremity.

79

Surgery for a brachial plexus injury may include:

Nerve graft, Nerve transfer, and/or Muscle transfer (all answers)

80

You are treating a pt in the hospital after a CABG surgery. Sternal precautions state "avoid pushing back and down with the UEs." How should the pt be mobilized from supine in bed to the bathroom for toileting?

Log roll, side to sit to stand with walker, turn, back up to toilet, use grab bar, BLE flexion until seated.

81

A pt was admitted to the hospital with the diagnosis of COPD exacerbation. Physician's order states O2 via nasal cannula to maintain oxygen level above 90%. What is the BEST method for completing UB bathing and dressing?

Seated at EOB while incorporating pursed lip breathing.

82

A pt with CAD in the hospital has the co-morbidity of diabetes. They state peripheral neuropathy has caused numbness in both feet. What is the BEST adaptive device for the OTP to provide before d/c?

Long-handled mirror to inspect skin integrity of the feet.

83

A pt with End Stage Renal Disease in the hospital after a below knee amputation has good UB strength and is considered morbidly obese. What is the BEST method for LB dressing?

Long sitting in bed using a reacher if needed.

84

You are teaching energy conservation strategies to a pt in the hospital after CABG surgery. What MET LEVEL would be appropriate for this setting?

1-2.

85

An OTP working in the ICU is part of the Early Mobilization Team. In order to identify potential pts that would benefit from Early Mobilization, what assessment is BEST?

CAM-ICU.

86

A pt with End Stage Renal Disease and Peripheral Vascular Disease suffered a myocardial infarction (heart attack). You are treating this pt in a SNF. What is the BEST method to perform UB and LB bathing?

Seated in walk-in shower with handheld shower head.

87

A pt in SNF rehab after a BELOW KNEE AMPUTATION is receiving OT services including ADL/IADL retraining. The pt was independent in all I/ADLs and functional mobility. There is a residual limb shrinker in place. What is the BEST method for toileting?

Stand-pivot transfer with walker to toilet.

88

A pt is recovering from a myocardial infarction in an outpatient setting and has been educated on energy conservation strategies. What is the MOST IMPORTANT thing for the OTP to consider?

The individual's performance patterns.

89

You are treating an individual after a burn to the forearm and hand. What is the BEST splint to prevent contracture of the UE?

Intrinsic plus splint.