Post-Test: 170 Questions-3 Clinical Simulations

Clinical Simulation 1 Background Information:

• A 66 year-old male client who recently experienced a C8 ASIA B SCI has been transferred to an inpatient rehabilitation unit to receive intensive OT and PT services. Per the chart review, the client must adhere to spinal precautions, though is not required to don a brace.
• An entry-level OT is completing the evaluation process with the client.

Clinical Simulation 1A: As it relates to the level of SCI the client has experienced, which of the following are CORRECT?

• The OT begins the evaluation process with the client.

Clinical Simulation 1B: As it relates to the OT evaluation and intervention planning process, which of the following are appropriate to perform?

• The OT begins the intervention process with the client.

Clinical Simulation 1C: As it relates to the OT intervention process at this setting, which of the following are appropriate to perform?

• The OT considers the pieces of adaptive equipment, durable medical equipment, and modifications that will be necessary to promote safety and independence during the client’s occupational performance.

Clinical Simulation 1D: As it relates to equipment recommendations in preparation for discharge, which of the following are appropriate and necessary?

Clinical Simulation 2 Background Information:

• An OT working in a pediatric outpatient facility has received a referral to evaluate and treat a child presenting with apparent deficits in sensory processing, feeding, eating, and swallowing abilities, and motor control.
• Following the initial screening, the OT considers the use of standardized assessments as part of the evaluation process.

Clinical Simulation 2A: As it relates to standardized assessment procedures and examples, which of the following are CORRECT?

• The OT administered the PDMS-2, and the child scored 2.0 standard deviations below the mean in the fine motor subtest.
• The OT also administered the Sensory Profile, and further demonstrates advanced training in the Sensory Integration Approach and administered the Sensory Integration and Praxis Test (SIPT). Based on the results, deficit areas include vestibular and proprioceptive processing, tactile defensiveness, and praxis.
• The OT continues in the evaluation process to address the possible deficit areas inclusive of feeding, eating, and swallowing.

Clinical Simulation 2B: As it relates to the assessment process for the child’s feeding, eating, and swallowing abilities, which of the following are appropriate?

• Based on the results of the evaluation process, the child presents with concerns of aspiration. A video-fluoroscopic swallow study was completed in collaboration with the speech-language pathologist. The child demonstrates signs of aspiration with certain textures of foods, and in collaboration with the speech-language pathologist, it has been recommended that the child be placed at Level III: Dysphagia Advanced on the Dysphagia Diet.

Clinical Simulation 2C: As it relates to recommended food items on the Dysphagia Advanced Diet (Level III), which of the following are appropriate and recommended?

• The OT is beginning to address the child’s deficits in sensory processing through the Sensory Integration Approach.
• Along with the previously noted deficit areas in sensory processing, the child appears to demonstrate deficits in effective righting and equilibrium reactions. As part of the intervention process, a therapist-initiated experience has been used to facilitate participation on a platform swing to provide vestibular input, with the child appearing to tolerate this well, though the OT is aware of potential autonomic responses to be aware of.

Clinical Simulation 2D: As it relates to the continued use of the swing to promote use of the Sensory Integration Approach, which of the following are appropriate?

Clinical Simulation 3 Background Information:

• An OT in a hospital-owned outpatient facility has been approached by the rehab director to discuss the possibility of creating and implementing the use of aquatic therapy with clients diagnosed with arthritis, based on an article that the director reviewed. The OT notes that the article the rehab director has reviewed is a case series study. The OT is not trained or educated on the use of the treatment and is unsure of the efficacy of the intervention.
• The OT will be following the EBP process in order to determine the efficacy of the intervention with the defined population.

Clinical Simulation 3A: As it relates to the EBP process that the OT will follow in this scenario, which of the following are appropriate?

• The OT searches available literature databases for relevant and recent evidence in preparation to appraise the literature. The OT takes into account the Levels of Evidence, and initially finds articles that are at Level III and Level IV on the levels of evidence.

Clinical Simulation 3B: Which of the following would be classified as a Level III or Level IV based on the Levels of Evidence?

• Through the literature review, the OT notes that there appears to be a scarcity of Level I evidence relating to the topic.
• With approval and guidance from the rehab director, the OT heads a research study regarding the use of aquatic therapy as a form of intervention with clients diagnosed with arthritis. The OT assembles a research team consisting of occupational therapists and occupational therapy assistants. The ultimate goal is to create a Research study consistent with a Level I study based on the levels of evidence.
• The OT has identified the problem of interest, completed the literature review, and has chosen the frame of reference.

Clinical Simulation 3C: The OT is continuing the Research Process: What should occur in the immediate next steps of the process?

• The OT has completed the Randomized Control Trial, with greater than 80% follow-up of participants. The experimental group received aquatic therapy in conjunction with simultaneous interventions to address strength, endurance, and pain, whereas the control group received traditional interventions to address strength, endurance, and reduction of pain.
• The OT notes that during the analysis of the results of the study, .05 was set as the cut-off value for testing statistical significance between the control group and experimental group, with the p-value of the study being .053.

Clinical Simulation 3D: Which of the following are true/appropriate based on the previous information regarding the RCT?

An OT is working with an individual with a diagnosis of dementia. According to the client’s family, the client previously enjoyed activities such as crafting and painting. After completing a battery of assessments, the client is determined to be functioning at an Allen Cognitive Level 4.6. Based on this, which of the following recommendations is most appropriate to include for a client at this level?

A client with a diagnosis of arthritis with an acute exacerbation is being seen in an outpatient therapy facility. The client presents with acute inflammation and pain, with hot and red joints and stiffness. Which of the following is CONTRAINDICATED as part of the intervention process at this stage?

A client has experienced a low laceration to the median nerve, and is presenting for OT services in the immediate post-operative phase following a repair to the nerve. Which of the following is appropriate to include with the client as part of this phase?

A client with DeQuervain’s has been completing isotonic exercises of the affected hand and wrist to improve strength. The client is ready to progress to the next course of action based on the biomechanical model. Which of the following represents the NEXT step as it relates to appropriate therapeutic exercises for use with this client?

A 30 year-old client in an outpatient facility presents with a positive froment’s sign following damage to a peripheral nerve. Which of the following functional activities would you expect this client to demonstrate the MOST difficulties with?

An OT is making recommendations for a client who has recently underwent a right total hip arthroplasty. The OT has instructed the client that a supine bed position for sleeping is optimal following a hip replacement. The client insists that she is not able to rest unless she sleeps on the right side. What should the OT’s recommendation be to this client?

An OT is writing a SOAP note following a session completed with a client focused on ADL tasks. As part of the SOAP Note, the OT has written the following: “Client would benefit from the use of a Long-Handled Sponge during completion of LB bathing to assist in bathing bilateral lower extremities to promote improved safety”. Which of the components of the SOAP Note will this information be included?

A client who presented with full thickness burns 3 days ago is being seen for intervention during the pre-graft phase of the burn recovery process. The client presents with burns to the dorsum of both hands with possible extensor tendon exposure. Which of the following is the MOST appropriate option to include as part of the intervention process with this client?

A 45 year-old male experienced a TBI 30 days ago and is functioning between a RLA Level VI-VII. He has currently just been admitted to an inpatient rehabilitation unit. After assessing the client, the OT meets with the client’s wife to discuss treatment planning options and her role in relation to ADLs and IADLs. Which of the following is MOST appropriate considering the client’s RLA Level?

A 4 year-old client who experiences Down Syndrome is hypotonic in the mouth, legs, arms, and hands. An OT is treating the client secondary to deficits with self-feeding and eating. The OT has included establishing a proximal base of support and control during feeding and eating as the first aspect of the intervention process. Which of the following is appropriate to include as the NEXT step towards working on the goal of improved self-feeding?

A 2 year old child is being seen for OT early intervention services in the home environment. The OT is in the process of creating updated goals for the client in collaboration with his family. Which of the following goals is appropriate to create in this scenario?

An OT is completing an evaluation with a client who has experienced a CVA in an acute care facility. The client lives alone at home, with the closest family member residing three hours away. The OT determines that the client requires continued skilled OT services, though the client becomes significantly fatigued following approximately 10 minutes of activity during the evaluation process and requires maximal assistance during the evaluation for mobility and ADLs. Which of the following discharge options is MOST appropriate for this client?

During an evaluation at an outpatient facility, an OT is evaluating a client and assessing two-point discrimination with the Foley Gauge applied in a parallel manner to the longitudinal axis over the volar fingertip of the 4th digit. The client reports feeling the Gauge only on the radial half of the 4th digit. Which of the following conclusions can be drawn from this scenario?

You are working with an adult client who experiences neuromuscular impairments affecting trunk and oral musculature, which has resulted in limitations with feeding, eating, and swallowing, with noted deficits in oral sensory awareness and facial/oral musculature strength. Which of the following is most appropriate to include as a compensatory approach to address the client’s eating and swallowing abilities?

You are working with a client who presents with a C6 ASIA A SCI. You are providing education on pressure relief strategies, with one of the client’s goals being to facilitate improved independence with pressure relief to the greatest extent possible while seated in a wheelchair. Which of the following choices would be appropriate to implement with this client?

An OT is assessing the severity of upper extremity spasticity in a client with cerebral palsy. Which of the following techniques should be utilized to achieve the most accurate results during the assessment?

A client who experienced a TBI presents with difficulties performing a supine to sit movement pattern. Which of the following is MOST likely impaired based on this information?

A client being seen in an acute care setting presents with oral apraxia of speech. The OT and Speech Language Pathologist are collaborating with nursing staff to improve the client’s abilities to communicate during his stay at the hospital. Which of the following is MOST appropriate to achieve this goal?

A client is being seen for an OT evaluation in an outpatient facility with his wife present. During development of the occupational profile, the client’s wife reports that during sleep the client gasps frequently and appears to have periods of briefly holding his breath. As a result, the sleeping patterns of both the client and his wife have been disrupted. Which of following is the NEXT step the OT should take in this scenario?

An OT is writing a SOAP note following a session completed with a client focused on ADL tasks. As part of the SOAP Note, the OT has written the following: “Dyspnea appears to impact the client’s abilities to complete lower body bathing with greater independence”. Which of the components of the SOAP Note will this information be included?

A client just diagnosed with De Quervain’s Tenosynovitis is entering the first week of treatment for OT services at an outpatient hand clinic. Which of the following is MOST appropriate to initiate with the client during this stage of the healing process?

A client diagnosed with Klumpke’s paralysis is being seen for an evaluation in an outpatient therapy center. In regards to this diagnosis, which of the following options would you expect a client to present with the most difficulties in as it relates to the completion of oral hygiene?

You are working with a client who has recently experienced a CVA. You note during the evaluation that the client appears to be experiencing ideomotor apraxia. Which of the following actions would lead you to this conclusion?

A client presents with chronic insomnia which has affected his sleeping patterns and subsequently affects performance in daytime occupations. The client presents with anxiety about his lack of sleep and a fear of staying awake all night. Which of the following is MOST appropriate to implement during the OT intervention process with the client to address this concern?

A client has recently experienced a right-hemispheric CVA, presenting with impairments in contralateral sensation, strength, and postural malalignment. The client also presents with apparent deficits in noticing items in the left visual field. During the intervention process the client demonstrates a lack of understanding for the need to utilize compensatory strategies. Which of the following diagnoses does the client MOST likely present with?

An OT has recently completed the cover-uncover test with a client in an outpatient therapy facility. Which of the following diagnoses does this client likely present with?

A client who experienced an ASIA A C6 SCI is being educated on strategies to complete UB Dressing. Which of the following techniques is MOST appropriate for the client to utilize to promote independence with the task?

A client is engaging in a session focused on the performance of lower body dressing. The client is not able to stand independently due to poor balance, though the client presents with good strength and coordination of the lower extremities. The client also presents with poor safety awareness. Which of the following positions should the OT recommend to promote safety during the task?

A client is receiving OT services in an outpatient facility. The client receives 8 minutes of therapeutic exercise, 8 minutes of therapeutic activities, and 23 minutes of self-care ADL retraining. Which of the following is appropriate for the OT to bill in regards to timed minutes and units of service?

Which of the following types of scales does the measurement of a client’s range of motion represent?

An OT employed in a school system is completing an evaluation with a 5-year old kindergarten student. The student appears to demonstrate significant delays in fine motor abilities which has affected performance in school occupations. The student also demonstrates significant difficulties following instructions and requires maximal cueing for engagement in tasks throughout the school day due to cognitive limitations. Which of the following is the MOST appropriate assessment for the OT to administer as part of the evaluation process to gather more information regarding the child’s deficit areas?

An OT is working with a child who is about to begin kindergarten. The child is 5 years old and experiences developmental delays, performing dressing at the level of a 2.5 to 3 year-old. Which of the following choices represents an example of an appropriate FIRST priority for the focus of treatment?

A client who has experienced a peripheral nerve injury is being seen for an occupational therapy evaluation. During development of the occupational profile the client reports he resides alone in his home environment and is responsible for all ADLs and IADLs. Which of the following is MOST important for the OT to first assess as part of the evaluation process?

An OT is leading a Tier 2 group based on the multi-tiered systems of support in a school systems setting. Each student in the group is developing typically though presents at-risk for the development of mental health concerns. As part of the group, the students are involved in selecting and engaging in a long-term task, and the OT provides facilitative leadership. Based on this information, the students in this group must be at LEAST what age range?

A client diagnosed with schizophrenia is being educated on strategies to use during IADL tasks to account for deficits in memory and concentration. The client first practices the strategies in a quiet laundromat, then practices the strategies in a crowded grocery store. Which of the following options is this approach consistent with?

A client presents with peripheral neuropathy affecting touch sensation of bilateral hands. The client lives alone and is responsible for all ADLs and IADLs. The client’s main concern is to improve ease of completion during dressing tasks. Which of the following is most important to FIRST implement as part of the OT intervention implementation process with this client?

An OT is assessing upper extremity range of motion of a client with Parkinson’s Disease. The client demonstrates resistance manifested by an increase in tone noted throughout the entire movement pattern. Which of the following forms of hypertonicity does this represent?

Which of the following represents an example of the principles of Universal Design?

An OT is completing a session with a client involving LB Dressing. The OT is instructing safety methods for completing the task while sitting at edge of bed. During the session, the client notes he is concerned about going home and being able to safely navigate around the house while managing a walker. What aspect of the SOAP note should the OT include the client’s concerns?

The parents of a child being screened for occupational therapy services expresses concerns that their child is delayed in bathing skills. The child is 8 years-old and requires a substantial amount of assistance for washing and drying themselves. Which of the following choices represents the child’s skills in this occupation as it relates to typical development?

A 6.5 month-old child is being seen by an occupational therapist to address possible development delays. As you observe the child grasping a teether, you note that she picks up the teether with her left hand and holds the object at midline, then simultaneously grasps the teether with her right hand while releasing the teether with her left hand. Which of the following statements is correct regarding the OT’s assessment of this release pattern?

An OT in an acute care facility is evaluating a client who experienced a TBI. During a screening of vision, the client appears to present with impairments in lateral eye movements. Which of the following cranial nerves is MOST likely affected in this scenario?

One of the main goals of therapy during the proliferative phase of wound healing will be to:

A client who presents with a peripheral nerve injury is being treated through a sensory re-education process, through graded discrimination training. Through the use of the tactile sense, the client is able to differentiate between a nut and a bolt. Which of the following represents the next step of progression in this training process?

An OT is working with a client diagnosed with CRPS. The OT is utilizing the McGill Pain Questionnaire to assess the client’s perception of the affective dimensions of pain. Which of the following words will the client MOST likely utilize to describe his pain under this dimension?

An OT is working with a client diagnosed with schizophrenia, framing the intervention process through the Cognitive Disabilities Model. The client functions at a level IV based on the model. Which of the following BEST describes the highest level of environmental awareness the client will attend to during completion of tasks?

An OT is leading a school assembly at a middle school focused on health promotion. As part of the assembly, the entire student body is present and receives strategies to support healthy eating and sleeping habits. Based on the multi-tiered system of support, which of the following levels does this intervention represent?

An OT employed in a school system has been consulted to complete a screen with a first-grade student to determine the need for occupational therapy services. The teacher reports that the child demonstrates difficulties with handwriting, playtime at recess, and engaging in other school-related occupations throughout the day. Which of the following is MOST appropriate for the OT to complete as part of the screen with this client?

An OT is working with a child who experiences deficits with feeding and eating due to poor oral motor control, and the child presents with a tongue thrust. Which of the following choices represents an appropriate recommendation to facilitate optimal performance and safety with feeding and eating?

An OT is working with a client diagnosed with schizophrenia, framing the intervention process through the Cognitive Disabilities Model. During intervention sessions, the client is able to follow a new recipe to make different meals, but frequently burns items when using the stove and oven to cook. Which of the following levels is this client MOST likely functioning at based on the Cognitive Disabilities Model?

An OT is planning to use autogenic training as a relaxation strategy for an individual with generalized anxiety disorder. Which of the following represents an example of the implementation of this strategy?

A long-term care resident in a skilled nursing facility presents with advanced dementia. The OT is working with nursing staff to make recommendations regarding appropriate strategies to use with this client to reduce problem behaviors. Which of the following is the MOST appropriate recommendation for the OT to make?

A client presents with incoordination of the upper extremities which has affected her performance during self-feeding. As a result, the client has recently experienced social isolation due to being embarrassed to eat with friends and family in social and public settings. Which of the following is MOST appropriate to recommend the client use to promote reduced spillage during mealtime routines with friends and family?

An OT is discussing DME needs with an 85 year-old client’s responsible medical party, who expresses concern regarding being able to afford the recommended DME. Which of the following will the OT explain is covered under Medicare services?

A male client who was recently in a car injury must don a CTLSO brace according to physician’s orders, along with adhering to spinal precautions. The OT is working with the client to implement techniques and strategies to promote improved independence with self-care tasks. Which of the following is most appropriate to recommend for this client to improve independence during ADLs?

An OT is writing a SOAP note following a session completed with a client focused on ADL tasks. As part of the SOAP Note, the OT has written the following: “treatment sessions will continue to address increasing independence during completion of ADLs including LB task components with education on use of adaptive equipment”. Which of the components of the SOAP Note will this information be included?

An OT is working with a child to address difficulties with feeding and eating. The child exhibits a tonic bite reflex, along with oral hypersensitivity. Given this information, which of the following options would be the BEST tactic to use with this child during the intervention implementation process?

An OT is working in a preschool setting with a 4.5 year old child, assessing the child’s abilities as they relate to the development of handwriting skills. Which of the following abilities represents the HIGHEST level of progression regarding handwriting skills for a typically developing child of this age?

Which of the following does NOT represent one of the fundamental approaches of motivational interviewing?

An OT is working with a client who has experienced a TBI with resulting memory impairments. The OT is instructing the client on strategies to assist with completion of a light meal preparation task. Which of the following is MOST appropriate to utilize to promote learning with this client?

A client abducts the shoulder to reach for a cup of coffee located on a table beside the client. Which of the following planes of movement does this motion occur in?

A client with COPD with a recent acute exacerbation is being seen for OT services in a home health setting. During a light meal preparation task, the client rates their exertion as a 9 on the Borg Perceived Rate of Exertion Scale. What is the OT’s NEXT appropriate response to take in this scenario?

During a session focused on self-feeding a client suddenly becomes quiet and motions for the universal choking sign. The therapist quickly asks the client “are you choking”, and the client begins to cough. What should the therapist’s NEXT response be in this scenario?

An OT is writing a progress note for a client who experienced a CVA. As part of the note, the OT writes the following: The client’s RUE hemiparesis continues to interfere with ADL performance”. What portion of the SOAP Note will this statement be included in?

An OT is treating a client recovering from COVID-19 who presents with shortness of breath, dyspnea, and increased respiratory rate with light activity. Which of the following represents the MOST appropriate goal to create in collaboration with the client as part of the intervention planning process?

A client is engaging in a treatment session focused on lower body dressing. The OT sets up the task for the client and remains within close sight, with the client then completing all aspects of lower body dressing requiring no physical assistance though requiring 1 verbal cue from the OT for safety. How will the OT grade the client’s performance of this task?

A client presents with impairments in strength following a recent bout of pneumonia. The client is able to actively flex her elbows against gravity to 100 degrees. Which of the following MMT scores will the OT grade the client’s elbow flexion strength?

An OT is writing a SOAP note following a session completed with a client focused on ADL tasks. The client reported “I am so excited about my grandson coming to visit me this week”. Which of the components of the SOAP Note will this information be included?

An OT is working with a client in an outpatient setting who is experiencing an acute flare-up of rheumatoid arthritis. The client presents with weakness of the lumbrical muscles and pain and acute inflammation at the MCP joints. Which of the following represents the MOST important component of the acute stage of intervention with this client?

A child with a sensory processing disorder does not respond to sensory input. The child appears to have a limited awareness of environmental cues, demonstrates a flat affect, and appears disconnected from their surroundings. Based on this information, all of the following are appropriate intervention tactics to use with this child, EXCEPT?

An OT is completing an evaluation with a client who has experienced a peripheral nerve injury. The client winces and reports pain when being touched over the hand by a cotton ball. The OT documents that the client is likely experiencing which of the following?

A client diagnosed with Bipolar Disorder is receiving supportive services for prevocational training in a psychosocial clubhouse setting. Which of the following types of employment is the client MOST likely participating in?

An OT is working with a client in the pre-contemplation stage of change based on the transtheoretical model of change. Which of the following strategies will be MOST appropriate for the OT to include with the client at this stage?

Which of the following represents a CONTRAINDICATION for the use of continuous mode therapeutic ultrasound?

A client with a diagnosis of Carpal Tunnel Syndrome has been referred for an evaluation and treatment at an outpatient facility. The OT has completed a review of the client’s medical history, a brief interview and observation of the client, and has developed the occupational profile. Which of the following is the most appropriate NEXT step for the OT to complete?

An OT employed at an outpatient pediatric therapy facility is leading a group session focused on modulation of behavior during play activities consisting of children who are between the ages of 7 and 9 who present with ADHD, though cognition is typically developed. Which of the following options is MOST appropriate to implement during the session to facilitate age-appropriate play for these clients?

You are working with a child who has a retained tonic labyrinthine supine reflex. This affects the child’s participation with the completion of dressing. Which of the following options represents an appropriate recommendation to make to the parents of a child with this retained reflex?

An entry level OT is part of an interdisciplinary team working with a client diagnosed with Borderline Personality Disorder. The client is being treated from a Dialectical Behavior Therapy perspective. The OT will likely be involved in all of the following components of this approach EXCEPT:

A 5 year-old child diagnosed with autism is being seen for occupational therapy services. The child is functioning developmentally at a 3 year-old level. In regards to dressing, he is able to don a pullover shirt with minimal assistance, and is able to don his socks. All of the following represent an appropriate next dressing task that should be implemented into treatment sessions EXCEPT?

A client who has experienced a TBI is functioning at a Rancho Los Amigos Level III.  The client presents with an immature tonic labyrinthine reflex. Which of the following is the MOST appropriate option to include as part of occupational therapy treatment with this client?

A client presents for a wheelchair evaluation. The evaluation determines that the client has good trunk control, is ambulatory using a walker, and will mainly use the wheelchair for community outings and appointments. What type of wheelchair seat cushion will best fit this client’s needs?

A client who presents with a flexible deformity of a right pelvic obliquity has been referred for OT services as it relates to seating and positioning needs. Which of the following is MOST appropriate for the client’s seating surface secondary to the presence of the obliquity?

Which of the following is MOST appropriate to implement as part of the intervention process for a client in the late stages of Parkinson’s Disease?

A client who experienced a CVA demonstrates impairments consistent with unilateral neglect, flaccidity of the affected LUE, and pain consistent with symptoms of thalamic pain. The client also demonstrates impairment of cognition and appears to lack an awareness of his deficits. The client currently requires maximal assistance with all ADLs based on the initial evaluation. Which of the following goals is MOST appropriate to create with this client as part of the intervention planning process?

An individual s/p experiencing a CVA will be discharged shortly from an inpatient rehab stay. The OT has written a goal stating “the client will complete lower body dressing in a seated position edge of bed with independence before discharge”. What conclusion can be made regarding the specific condition for this task based on the COAST goal writing method?

A client who is receiving Home Health services under Medicare Part A alerts the OT that she plans to attend weekly church services on Sunday mornings with transportation provided by her son. She asks the OT how this will affect her eligibility for Home Health Services. Which of the following is an appropriate course of action for the OT to take?

An OT has completed a research study regarding the effectiveness of CIMT on upper extremity function with clients who have experienced a stroke. The OT used a true experimental design for the study. During the analysis of the results, .05 was set as the cut-off value for testing statistical significance. The OT concluded that the p-value of the study was .051. Which of the following statements is correct regarding the conclusions that can be drawn from this study?

An OT notes that a client’s wound is producing serous exudate. How will this present?

An OT is working with a child who is in fourth-grade who has a diagnosis of autism. The child demonstrates outbursts that seem to be preceded by a bell in the classroom ringing. The OT works with the child’s teacher to implement a consequence intervention approach to address this. Which of the following options represents this approach?

An OT is utilizing an errorless learning approach to teach life and social skills to a client with schizophrenia. Which of the following skills is MOST conducive to training using an errorless learning approach?

A client presents with adhesive capsulitis. Based on the patterns of impairment associated with this diagnosis, which of the following components of functional activities would you expect the client to present with the MOST difficulties in as it relates to driving?

A client presents with a swan neck deformity. Which of the following options is indicated as a splinting mechanism to address this deformity?

A client presents with Rheumatoid Arthritis and inflammation at the MCP joints in the acute stage, and the client reports pain at the MCP joints. According to the client’s chart review, she also presents with a comorbidity of Raynaud’s Syndrome. Which of the following techniques to reduce pain is BEST for use during intervention with the client in this stage?

An OT plans to use a cognitive behavioral frame of reference with a client diagnosed with acute schizophrenia to guide cognitive restructuring. Which of the following is the MOST important determining factor of the successful use of this frame of reference?

An OT is working with a client with major depressive disorder. The client reports to the OT that he believes he is unproductive during each day which results in increased feelings of hopelessness. The OT instructs the client to record his behavior on an hourly basis for 5 days. Which of the following strategies does this represent?

A client who has experienced a recent bout of pneumonia is being seen for OT services in a skilled nursing facility. The OT is instructing the client on techniques for the completion of an upper extremity Home Exercise Program. During the chart review the OT noted that the client also presents with diabetic retinopathy and presbycusis. Which of the following methods of instruction will be MOST effective to utilize for this client to promote performance?

A client who recently experienced a TBI is being seen in an inpatient rehabilitation setting. The client presents with deficits in attention, memory, and executive functioning abilities. The OT is initially addressing the client’s metacognitive status as part of the intervention process. Which of the following represents a metacognitive component of intervention that the OT may engage the client in?

A Home Health OT is studying the differences between symptoms of Insulin Reaction and Ketoacidosis in order to be equipped to assist clients with diabetes in the event of a medical emergency. Which of the following symptoms would indicate that a client may be experiencing a reaction to Insulin?

A client who has experienced a recent CVA is engaging in performance of upper body dressing hemi-dressing strategies, and is in the acquisition phase of the learning process. Which of the following examples would result in the highest level of contextual interference present during the task?

An individual s/p experiencing a CVA will be discharged shortly from an inpatient rehab stay. The OT has written a goal stating “the client will complete lower body dressing in a seated position edge of bed using a sock-aid and Reacher as indicated before discharge”. What conclusion can be made regarding the assist level for this task based on the COAST goal writing method?

An OT is working with a client in an inpatient rehab facility. The client has requested that his wife be present during all sessions, which is permissible by the facility standards. The OT suspects that the client is magnifying his limitations which has been exacerbated by his wife, and the client is not making progress at the rate initially expected. The client also complains that the treating OTA “hasn’t been helping me out at all”. Which of the following is MOST appropriate for the OT to complete in this scenario?

An OT is working in a home health setting with a client who has experienced an ASIA A T12 SCI. The client has a ramp at his home, although it does not meet ADA requirements, and has a steep grade. The client has asked the OT to provide his wife with training on how to best maneuver his wheelchair on the ramp, and on the curbs outside his house adjoining the sidewalk. Which of the following is MOST appropriate for the OT to recommend?

An OT is treating an SCI client insured by Medicare who is preparing for discharge to the home environment from inpatient rehab. The client and his wife express concern that Medicare will not pay for certain DME, and that he cannot afford the pieces of recommended adaptive equipment. Based on this information, which of the following is MOST appropriate for the OT to complete?

A client who underwent a posterolateral hip replacement is preparing for discharge to his home environment on the 4th postoperative week. The OT is completing a home evaluation with the client, and making recommendations to the client and his wife. Which of the following is MOST appropriate for the OT to consider?

An OT is working with a client receiving home health services. A neighbor occasionally helps the client with care throughout the day when his wife has to be away for brief periods of time. During the second week of OT home health, the client states that he doesn’t need OT services anymore. The client is adamant in his statement. Which of the following is the MOST appropriate course of action for the OT to take?

An OT is working with a client who has experienced an ASIA A T12 SCI. The client has good motor control of the upper extremities and good trunk stability. It has been determined that the client would benefit from a light-weight custom manual wheelchair. Which of the following are appropriate measurements for the OT to make?

An OT is treating a client who has experienced a CVA for the first session post-evaluation. An OT aide will be assisting the OT in the session. At the start of the session, the client is in bed. As it relates to the OT Aide’s role in the intervention process, which of the following is MOST appropriate in this scenario?

A client with a trans-radial amputation has been provided with a myoelectric prosthesis. The OT is in the use training process with the client. Which of the following activities is MOST appropriate during this stage?

A client is being seen at an outpatient occupational therapy center for occupational performance deficits related to damage of the long thoracic nerve. Based on the occupational profile the OT notes the client is a carpenter. Which of the following options would you MOST likely observe the client experiencing difficulties with?

A client presents with adhesive capsulitis. Based on the patterns of impairment associated with this diagnosis, which of the following would you expect the client to present with the MOST difficulties in?

You are working with a client who has experienced a left-hemisphere CVA, and the client is demonstrating motor return in the RUE. You are using a PNF approach with the client, and are using diagonal patterns to facilitate improved use of the RUE. Which of the following represents a functional example of the D2 flexion or extension patterns using the RUE?

An OT is completing interventions in an outpatient facility with a 7 year-old child. The OT gathered information from the child’s parents during the evaluation process that lead the OT to suspect the child may be experiencing impairments of smooth pursuit eye movements. Which of the following activities did the child’s parents MOST likely report difficulties with?

An OT is treating a client who experienced burns on an inpatient rehab unit. The client has skin tightness of the shoulder and hand affecting range of motion secondary to scar formation. The client also presents with significant edema of the hands and forearms. Which of the following is MOST appropriate for the OT to complete with the client during the intervention process?

An OT is working with a client who demonstrates left-sided unilateral neglect, and the client requires maximal multi-modal cues to attend to the left hemi-body and environment. The client also demonstrates deficits in spatial relations, and anosognosia. However, the client demonstrates the ability to initiate ADLs. Which of the following is MOST appropriate for the OT to complete with the client as part of the intervention process at this initial stage?

A client has experienced damage to the musculocutaneous nerve. Which of the following options would the client demonstrate the MOST impairments in?

You are working with a 35 year-old client who recently experienced an ankle fracture. The client had been using crutches for mobility for a little over one month. As a result, the client has experienced compression of the axillary nerve. Based on this information, which of the following interventions is MOST appropriate to include with this client?

The mean for a given norm-referenced assessment is 100, and the standard deviation is 15. The results of the assessment for a single participant indicate that the participant has scored within 1 standard deviation below the mean. Which of the following statements is TRUE regarding the participant’s standard score on the assessment?

An OT employed in an acute care hospital is completing interventions with a 69 year-old male client who has experienced a C6 ASIA A SCI 5 days ago. As it relates to the client’s needs in the acute care setting, which of the following is MOST appropriate to complete?

An OT is making recommendations to a wheelchair user regarding home modifications to increase ease of access to the environment. Which of the following options is NOT consistent with standard ADA requirements?

A 5 year-old child is being seen for OT services in a pediatric therapy facility. The child is currently functioning at the developmental level of a typically developing 3 year-old child during the performance of ADLs. Though the child scored within normal limits on the Sensory Profile, the child presents with delayed fine motor and visual-motor skills which have the potential to be a barrier to successful play occupations by affecting the child’s ability to manipulate toys and play objects. The child’s attention and concentration in its current state also poses problems to the ability to engage in play occupations of multistep games, board games, and longer play activities. Based on this information, which of the following is MOST appropriate for the OT to implement during treatment sessions with the child?

A client presents with compression/overuse of the muscles/tendons located in extensor compartment 2. The client is a teacher and is concerned regarding how her occupational performance at work will be impacted. Which of the following motions will the client demonstrate the MOST pain with as a result of the compression/overuse of the tendons in this compartment?

A 3 year, 8 month-old male child diagnosed with Autism Spectrum Disorder (ASD) has been referred to an outpatient pediatric therapy center to receive OT services. The child scored 1.5 standard deviations below the mean for fine motor skills on the PDMS-2. However, fine motor abilities and strength appear to be in the normal range during preferred activities. The child used a fine pincer grasp during observation of feeding and a static tripod grasp during the preferred activity of coloring, with performance during fine motor tasks appearing to be affected by sensory processing dysfunction and behavioral impairments. Results from assessments indicate dysfunction in social participation, tactile, proprioceptive, oral hypersensitivity and vestibular functioning, with the child demonstrating hyper-responsivity to these sensations which affects the child’s abilities to socially interact with other children. Which of the following is MOST appropriate for the OT to implement as part of the intervention process with this child given this information?

A client presents with damage to the posterior cord of the brachial plexus. Which of the following nerves is most likely be damaged as a result?

A 2 year-old child is being seen for early intervention services. The OT administered the PDMS-2, with the child scoring .5 standard deviations below the mean in gross motor ability and 2 standard deviations below the mean in fine motor ability on the assessment. During structured observations, the child uses a scissor grasp to pick up a goldfish, and appears to have weakness of the lumbrical muscles. The child also has a retained asymmetric tonic neck reflex. Based on this information, which of the following is MOST appropriate for the OT to include as part of the treatment process?

A client presents with incoordination of the bilateral upper extremities. Which of the following pieces of adaptive equipment or adaptations is MOST appropriate for the OT to recommend the client use to address the incoordination?

A client who has experienced a CVA is being seen for an ADL session. The client presents with hemiparesis of the affected upper extremity, deficits in sensation including temperature awareness and pain perception of the affected upper extremity, and impaired standing balance. The client demonstrates good sitting balance, muscle strength and range of motion of the unaffected upper and lower extremity. The client will require cueing upon discharge home, and the OT is making recommendations to the client’s spouse regarding strategies to promote safety and independence at home. Which of the following compensation strategies will be MOST effective to recommend to the client’s spouse in preparation for the client’s discharge home?

An OT is working with a client during an ADL session focused on dressing strategies. The client presents with bilateral paresis of the lower extremities. What is the minimum MMT score for the LEs that will be required for a client to position the lower extremities during dressing, without assistance of the upper extremities?

A client presents with a proximal ulnar fracture, and is presenting for therapy services. Which of the following represents the general progression of intervention for this client as it relates to the biomechanical model?

A client presents with stage III Parkinson’s Disease. The home health OT has been instructed to make appropriate recommendations to the client and his caregiver to optimize the client’s level of safety and independence in the home environment. Which of the following represents the BEST option as it relates to the OT’s recommendations at this stage of the client’s disease process?

Which of the following PAMs is MOST likely to be used for desensitization?

One of the main goals of therapy during the maturation phase of wound healing will be to:

A child being seen for OT services under the Sensory Integration approach is engaged in active vestibular stimulation on a platform swing. The clinician notes that the child begins to demonstrate a distractible state upon increased movement of the swing. Which of the following is the BEST option for the therapist to take in this scenario?

A group of athletes is participating in a non-experimental study regarding the correlation between completing an online module to address anxiety and anxiety levels as measured through an anxiety scale pre-test and post-test, with higher scores indicating decreased levels of anxiety. Aggregate scores for the pre-test were 50, and for the post-test after completion of the module were 75. Which of the following statements is MOST appropriate to make given these results?

A clinician is working with a preterm infant in the neonatal intensive care unit (NICU). Which of the following represents the BEST principle of positioning to implement with this child in the NICU?

Which of the following represents a null hypothesis for a true experimental research study?

An OT is working with a client who experienced a TBI with resulting cognitive impairment. The OT is using the quadraphonic approach to guide intervention with the client. Which of the following options correctly describes this approach?

An OT completing a quantitative study is MOST likely to use which of the following data collection methods?

An OT is working with a client who has experienced a mild TBI, and as a result has deficits in attention and sequencing. During a treatment session, the OT is instructing the client on making a cup of coffee, with the OT limiting extrinsic feedback provided to the client. Which of the following represents the best method for this functional activity to be taught to this client?

A client is being seen in an inpatient rehab facility for occupational therapy services secondary to experiencing a TBI. An OT is using a remedial approach to address the client’s executive functioning, attention, and memory impairments. Which of the following is an example of a remedial approach that could be used as part of the intervention process?

An OT is testing the strength of a client’s right wrist extension. The client is able to actively extend her wrist 70 degrees in an against gravity position, though the client is not able to tolerate any resistance. Which of the following scores will the OT grade this client’s wrist extension strength at according to the MMT scores?

An OT is completing a correlational study regarding the use of occupation-based activities to address anxiety for residents in a skilled nursing facility. Which of the following questions is MOST appropriate for the OT to use in this scenario?

A client and his caregiver are being instructed on transfer techniques as part of an OT session. The caregiver and client are practicing the use of the sliding board transfer technique, and it has been determined that the client is able to sufficiently assist with the completion of this type of transfer. Based on this information, which of the following diagnoses does this client most likely present with?

An OT is working with a client in a psychosocial clubhouse to gain supported employment. Which of the following is representative of this type of employment?

A study participant completed the post-test for a given research study in a crowded coffee shop. As a result, which of the following may be affected in terms of dependability of the data?

A client who had previously experienced a CVA is being seen in an outpatient therapy facility by an entry-level OT. The OT has determined that the client would benefit from the administration of a driving safety screen to determine if the client is at risk for unsafe driving. Which of the following is the appropriate course of action for the OT to take?

A client recently experienced a fall in the home, and was admitted to a local hospital. The client experienced a fracture of the right wrist secondary to the impact of the fall. The client was discharged from the hospital after 1 day, and received a referral for home health services, with OT included. The client has original Medicare. How will the home health OT services be paid for in this scenario?

A client who has experienced a TBI has deficits in attention and concentration, which is affecting his participation at work, particularly with attending long meetings. The client also only demonstrates intellectual awareness. Given this information, as part of the intervention process the OT recommends that the client record every meeting at work so that he can go back and listen to the meetings later if necessary. Which of the following forms of compensation does this represent?

A child being seen for OT services under the Sensory Integration approach is engaged in active vestibular stimulation on a tire swing. The clinician notes that the child begins to demonstrate a lethargic state upon increased movement of the swing. Which of the following is the BEST option for the therapist to take in this scenario?

You are working with a client who has recently experienced a L-hemispheric CVA. During the evaluation focused on assessment of ADLs, you point to a comb and cue the client  to “tell me the name of this item”. The client is not able to respond to this cue. You suspect that the client may present with anomia. However, the client then immediately places the comb in their mouth. Which of the following statements is MOST likely correct?

An OT is testing the strength of a client’s bilateral shoulders. The client is able to actively flex her shoulders to approximately 60 degrees in an against gravity position. Which of the following scores will the OT grade this client’s shoulder flexion strength at according to the MMT scores?

A clinician is working with a child using the Sensory Integration intervention approach. The child demonstrates deficits in effective righting and equilibrium reactions. As part of the intervention process, a therapist-initiated experience has been used to facilitate participation on a platform swing to provide vestibular input, with the child tolerating this well. Which of the following represents the MOST appropriate step for the therapist to take next in this scenario based on the Sensory Integration approach?

A client presents with a diagnosis of right lateral epicondylitis. Which of the following activities, with use of the affected extremity, will likely exacerbate the symptoms associated with this diagnosis?

A client who has experienced a peripheral nerve injury is being seen for OT services in an outpatient facility. The OT is completing an assessment of touch pressure using Semmes-Weinstein monofilaments. The smallest monofilament that the client is able to perceive over the corresponding area of injury is the red monofilament. What does this indicate regarding the client’s touch perception?

A client presents to a SNF with general deconditioning following a bout of pneumonia. The client presents with limitations in strength, endurance, and ability to complete ADLs and IADLs without assistance or multiple rest breaks. Which of the following goals will address relevant performance skills as they relate to this client’s patterns of impairment?

An OT with one year of experience is working in a skilled nursing facility (SNF). She is the only OT on staff and works Monday through Friday only. The director has asked that the OTA manage the evaluation process on the weekends for newly admitted clients. Which of the following would be considered the best approach for the OT to follow in handling this situation?

An OT works in a pediatric therapy facility, and has a standing appointment with the same client at 5 p.m. every Wednesday. The OT is no longer able to commit to this time, but this is the only time that works for the client and his parents to be seen for services. The OT works with the family in facilitating a transition for the client to begin receiving services from another OT at the facility. Which of the following code of ethics principles has this OT adhered to?

An OT is completing an intervention session with a client with a history of congestive heart failure. The OT is closely observing for the signs of cardiac distress. Which of the following would indicate a sign of distress or abnormal response to activity that would require the OT’s attention?

An OT is working in a skilled nursing facility with a client who has experienced a CVA. The client’s granddaughter is frequently present and observes during the sessions. After one afternoon session, the granddaughter asks the OT out on a date. Which of the following principles of the code of ethics will best guide the OT as it pertains to this situation?

An OT is completing an assessment of motor control with a client who has recently experienced a TBI. During the context of the evaluation, the client demonstrates difficulties with completing quick alternating movements between pronation and supination. Which of the following deficits does this client present with?

An individual who resides in long-term care facility has experienced a CVA and has begun to demonstrate spasticity of the elbow flexors. The OT has been consulted to recommend methods to the nursing staff to decrease tone. Which of the following represents an approach to meet this goal that is consistent with a Rood approach?

A client has been referred for occupational therapy services secondary to a diagnosis of De Quervain’s Tenosynovitis. During the evaluation process, the client does not report pain during the Finklestein’s test. However, the client reports pain at the forearm and on the back of the hand, which is exacerbated by extension of the fingers. Which of the following courses of action is MOST appropriate for the OT to take in this scenario?

A client with arthritis presents with a Boutonniere deformity. How will the client’s joints affected by this deformity be positioned?

An OT is leading a thematic group in a community based mental health setting. Which of the following options most represents the focus of this type of group?

An OT working in acute care hospital has received an order to evaluate a client who has experienced a CVA. The hospital has a policy that clients who have experienced an acute CVA must be evaluated for services within 24 hours of admission. The OT completes the evaluation within that time period. Which of the following ethical principles has the OT adhered to?

A client who has recently experienced a L-hemispheric CVA with resultant R hemiplegia is being seen in an inpatient rehab facility. Based on the status of the client’s muscle tone of the RUE, particularly the elbow flexors, the OT decides to use inhibitory techniques during the context of functional activities. Which of the following is appropriate to achieve this goal?

A client with DeQuervain’s has just regained full AROM of the affected hand and wrist. Which of the following represents the NEXT step as it relates to appropriate therapeutic exercises for use with this client?

A client with a diagnosis of rheumatoid arthritis with an acute exacerbation is being seen in an outpatient therapy facility. The client presents with acute inflammation and pain, with hot and red joints and stiffness. Which of the following  is appropriate to complete with the client as part of the intervention process at this stage?

An OT is completing research regarding participants who attend a psychosocial clubhouse. Which of the following represents a quantitative design?

A 4.5 year-old child with a developmental delay functions at the level of a 2 year-old child based on the sequence of typical development. The child has just begun to remove their coat, with all fasteners and laces untied. Based on this information, what is the most appropriate skill to work on next?

A client in an acute care facility with a TBI is graded at a Level II on the Ranchos Los Amigos Scale. The client presents with decorticate posturing. Which of the following techniques is appropriate to use with this client as part of the intervention process?