What Is Occupational Therapy?

1. A nine-year-old child identifies the assembly of a model as the most desired play activity. The occupational therapist determines that the child would have difficulty completing the selected model. Which action is most effective for therapist to take during next intervention session?

Allow the child to work on the model and provide maximum assistance as the child completes the project

Explore with the child why completing the model is desired by the child and provide alternative project choices

Break the project down into accomplishable segments and instruct the child to complete one segment at a time

The most effective action for the therapist to take in the next intervention session is to break the project down into accomplishable segments and instruct the child to complete one segment at a time. This approach allows the child to still engage in their desired play activity while also addressing their difficulty in completing the model. By breaking the project into smaller, manageable tasks, the child is more likely to experience success and build confidence in their abilities. This approach also promotes problem-solving skills and helps the child develop strategies for completing tasks independently.

Explanation

The most effective action for the therapist to take in the next intervention session is to break the project down into accomplishable segments and instruct the child to complete one segment at a time. This approach allows the child to still engage in their desired play activity while also addressing their difficulty in completing the model. By breaking the project into smaller, manageable tasks, the child is more likely to experience success and build confidence in their abilities. This approach also promotes problem-solving skills and helps the child develop strategies for completing tasks independently.

2. A patient is recovering from a right total hip placement (posterolateral incision, cementless fixation). Which is the best type of bed-to-wheelchair transfer for the occupational therapist to teach the patient to use?

Stand-pivot transfer to surgical side

Stand-pivot transfer to the non-surgical side

Lateral side transfer using a transfer board

Squat-pivot transfer to the surgical side

The best type of bed-to-wheelchair transfer for a patient recovering from a right total hip placement with a posterolateral incision and cementless fixation is a stand-pivot transfer to the non-surgical side. This transfer allows the patient to maintain weight-bearing precautions on the surgical side while using the non-surgical side for support during the transfer. It helps to minimize stress and strain on the surgical hip, promoting proper healing and reducing the risk of complications.

Explanation

The best type of bed-to-wheelchair transfer for a patient recovering from a right total hip placement with a posterolateral incision and cementless fixation is a stand-pivot transfer to the non-surgical side. This transfer allows the patient to maintain weight-bearing precautions on the surgical side while using the non-surgical side for support during the transfer. It helps to minimize stress and strain on the surgical hip, promoting proper healing and reducing the risk of complications.

3. An individual with developmental disabilities scores a Level 3 on the Allen Cognitive Level Test. Which activities should the occupational therapist include in the intervention plan to help meet the client's functional needs?

Community mobility activities such as taking a bus

Home management activities such as preparing a food shopping list

Self-care activities such as brushing teeth

Leisure activities such as completing a 50-piece puzzle

An individual with developmental disabilities who scores a Level 3 on the Allen Cognitive Level Test would benefit from self-care activities such as brushing teeth. This level indicates that the individual has the ability to perform simple self-care tasks with some assistance. By including self-care activities like brushing teeth in the intervention plan, the occupational therapist can help the client develop and maintain their personal hygiene skills, promoting independence and overall well-being.

Explanation

An individual with developmental disabilities who scores a Level 3 on the Allen Cognitive Level Test would benefit from self-care activities such as brushing teeth. This level indicates that the individual has the ability to perform simple self-care tasks with some assistance. By including self-care activities like brushing teeth in the intervention plan, the occupational therapist can help the client develop and maintain their personal hygiene skills, promoting independence and overall well-being.

4. An occupational therapist works with a survivor of a house fire. The client has burns on both hands that limit thumb mobility. The client identifies a personal goal of being able to pick up and hold cans to enable independent shopping and meal preparation activities. Which movement of the thumb should the goal statement include as desired functional outcome?

Carpometacarpal (CMC) palmar abduction

CMC extension

Metacarpophalangeal (MCP) flexion

Interphalangeal (IP) flexion

The goal statement should include Carpometacarpal (CMC) palmar abduction as the desired functional outcome. This movement of the thumb allows the client to pick up and hold cans, which is necessary for independent shopping and meal preparation activities.

Explanation

The goal statement should include Carpometacarpal (CMC) palmar abduction as the desired functional outcome. This movement of the thumb allows the client to pick up and hold cans, which is necessary for independent shopping and meal preparation activities.

5. A child with juvenile rheumatoid arthritis wears bilateral night resting splints with wrists in 0° of extension, MPs and IPs flexed, ulnar deviation of 10°, and thumbs in opposition. The child complains of pain in the wrists upon awakening. No redness is noted upon removing splints. ROM measurements show ulnar deviation of 5°. Which action should the occupational therapist take in response to this complaint and these observations?

Modify the splints at wrist

Pad the ulnar aspect on the inside of the splints

Discontinue the splints and monitor the status of pain for two weeks

Construct volar cock-up splints for use during the day

The child complains of pain in the wrists upon awakening and ROM measurements show a decrease in ulnar deviation. These observations suggest that the current splints may be causing discomfort and may not be providing the necessary support. Therefore, modifying the splints at the wrist would be the appropriate action to take in order to alleviate the pain and ensure proper alignment and support for the child's wrists.

Explanation

The child complains of pain in the wrists upon awakening and ROM measurements show a decrease in ulnar deviation. These observations suggest that the current splints may be causing discomfort and may not be providing the necessary support. Therefore, modifying the splints at the wrist would be the appropriate action to take in order to alleviate the pain and ensure proper alignment and support for the child's wrists.

6. An occupational therapist observes that an 18-month old child is not able to creep more than a few steps. When child looks up, both hips and knees flex and child ends up W sitting with both arms extended and propped forward. When documenting this observation, which is most accurate for occupational therapist to report child is demonstrating?

Typical development of locomotion skills

The influence of symmetrical tonic neck reflex (STNR) resulting in delayed gross motor skills

An obligatory asymmetrical tonic neck reflex (ATNR) resulting in delayed gross motor skills

An intact tonic labyrinthine reflex which facilitates balance responses

The observed behavior of the child, where both hips and knees flex and the child ends up in a W sitting position with both arms extended and propped forward, is indicative of the influence of symmetrical tonic neck reflex (STNR). The STNR is a reflex that emerges during infancy and affects the coordination of the upper and lower body. In this case, the STNR is causing a delay in the child's gross motor skills, specifically in their ability to creep or crawl. This reflex should typically integrate by the age of 12 months, so the observation suggests a delay in development.

Explanation

The observed behavior of the child, where both hips and knees flex and the child ends up in a W sitting position with both arms extended and propped forward, is indicative of the influence of symmetrical tonic neck reflex (STNR). The STNR is a reflex that emerges during infancy and affects the coordination of the upper and lower body. In this case, the STNR is causing a delay in the child's gross motor skills, specifically in their ability to creep or crawl. This reflex should typically integrate by the age of 12 months, so the observation suggests a delay in development.

7. A person recovering from skin grafting due to full thickness burns is prescribed splints to immobilize the grafted areas in anti-deformity positions. Which splint-wearing schedule is best to include in splinting protocol for first 72 hours post-surgery?

One hour on, with 10 minutes off

Four hours on, with 20 minutes off

Eight hours on, with 30 minutes off

On at all times, except for dressing changes

After skin grafting surgery, it is important to keep the grafted areas immobilized in anti-deformity positions to promote proper healing and prevent complications. The best splint-wearing schedule for the first 72 hours post-surgery is to keep the splints on at all times, except for dressing changes. This means that the splints should be worn continuously to provide constant support and protection to the grafted areas, except when they need to be temporarily removed for dressing changes to ensure proper wound care. This schedule allows for consistent immobilization and minimizes the risk of deformities or complications during the initial healing period.

Explanation

After skin grafting surgery, it is important to keep the grafted areas immobilized in anti-deformity positions to promote proper healing and prevent complications. The best splint-wearing schedule for the first 72 hours post-surgery is to keep the splints on at all times, except for dressing changes. This means that the splints should be worn continuously to provide constant support and protection to the grafted areas, except when they need to be temporarily removed for dressing changes to ensure proper wound care. This schedule allows for consistent immobilization and minimizes the risk of deformities or complications during the initial healing period.

8. A child with tactile defensiveness is receiving intervention from an occupational therapist using a sensory integrative approach. Which method is most effective for therapist to use when introducing tactile stimuli to the child?

Provide deep touch and firm pressure when the child can see the stimuli

Apply the stimuli in the direction opposite of hair growth with vision occluded

Apply light touch across the face and abdomen with vision occluded

Provide light brushing across the palmar surfaces of the extremities with child watching

Providing deep touch and firm pressure when the child can see the stimuli is the most effective method for introducing tactile stimuli to a child with tactile defensiveness. This approach allows the child to visually anticipate and prepare for the tactile input, reducing anxiety and increasing their ability to tolerate and process the stimuli. Deep touch and firm pressure provide a more calming and organizing effect on the nervous system, helping the child to regulate their sensory responses.

Explanation

Providing deep touch and firm pressure when the child can see the stimuli is the most effective method for introducing tactile stimuli to a child with tactile defensiveness. This approach allows the child to visually anticipate and prepare for the tactile input, reducing anxiety and increasing their ability to tolerate and process the stimuli. Deep touch and firm pressure provide a more calming and organizing effect on the nervous system, helping the child to regulate their sensory responses.

9. An individual is recovering from deep partial thickness burns on the upper extremities, chest, and lower neck. The occupational therapist provides equipment to prevent positions that can result in contractures. Which are the most important positions for the therapist to prevent?

Positions of comfort

Anti-deformity positions

Positions resulting in edema

Positions of pain

The most important positions for the therapist to prevent are positions of comfort. This is because when an individual is recovering from deep partial thickness burns, they may naturally assume positions that are comfortable for them but can lead to contractures. Contractures are the permanent shortening of muscles and tendons, resulting in limited range of motion. By preventing positions of comfort, the therapist can help maintain and improve the individual's range of motion and prevent the development of contractures.

Explanation

The most important positions for the therapist to prevent are positions of comfort. This is because when an individual is recovering from deep partial thickness burns, they may naturally assume positions that are comfortable for them but can lead to contractures. Contractures are the permanent shortening of muscles and tendons, resulting in limited range of motion. By preventing positions of comfort, the therapist can help maintain and improve the individual's range of motion and prevent the development of contractures.

10. A child with attention deficit with hyperactivity disorder (ADHD) and conduct disorder attends an after school program that utilizes sensory-integrative and behavioral management approaches to achieve intervention goals. Snacks are provided and occasionally used as rewards. A parent insists that a child not be given any foods containing sugar. Which is the occupational therapist's best response to this request?

Discontinue providing sugary snacks but continue their use as rewards in the behavioral management program

Provide parent with recent research that refutes the link between sugar and problem behaviors

Discontinue providing sugary snacks for the child to comply with the parent’s request

The occupational therapist's best response to the parent's request to not give the child any foods containing sugar is to discontinue providing sugary snacks for the child to comply with the parent's request. This response acknowledges and respects the parent's wishes while also ensuring that the child's dietary restrictions are followed.

Explanation

The occupational therapist's best response to the parent's request to not give the child any foods containing sugar is to discontinue providing sugary snacks for the child to comply with the parent's request. This response acknowledges and respects the parent's wishes while also ensuring that the child's dietary restrictions are followed.

11. An individual with Parkinson's disease exhibits difficulty moving from sitting in a chair to standing. Which technique is best for the therapist to recommend the person use to help successfully complete this functional mobility activity?

Rise from the chair while sitting with buttocks against the back of the chair

Extend both legs so that both feet are in front of the chair while rising

Sit at the edge of the chair and rock back and forth before rising

Rise while weight-bearing on one foot and pushing up with both arms

Rocking back and forth while sitting at the edge of the chair can help the individual with Parkinson's disease to shift their weight and generate momentum before rising. This technique can assist in overcoming the difficulty in initiating movement and provide the necessary momentum to stand up from a seated position.

Explanation

Rocking back and forth while sitting at the edge of the chair can help the individual with Parkinson's disease to shift their weight and generate momentum before rising. This technique can assist in overcoming the difficulty in initiating movement and provide the necessary momentum to stand up from a seated position.

12. During a classroom screening, an 8-year-old is observed holding a pencil with tight grip. The student appears to rely heavily on visual cues to assist during both fine and gross motor tasks. During gross motor activities, the student moves in an uncoordinated manner. The occupational therapist uses a sensory integrative frame of reference to interpret evaluation of data. Which impairment should the therapist document as needing further evaluation?

Vestibular processing dysfunction

Proprioceptive system dysfunction

Hyporesponsive tactile system

Hyperresponsive tactile system

The correct answer is Proprioceptive system dysfunction. The student's tight grip on the pencil and reliance on visual cues suggest difficulty with proprioception, which is the sense of body position and movement. This can affect both fine motor skills, like holding a pencil, and gross motor skills, leading to uncoordinated movements. The occupational therapist would document this as needing further evaluation to assess the extent of the proprioceptive system dysfunction and develop appropriate interventions.

Explanation

The correct answer is Proprioceptive system dysfunction. The student's tight grip on the pencil and reliance on visual cues suggest difficulty with proprioception, which is the sense of body position and movement. This can affect both fine motor skills, like holding a pencil, and gross motor skills, leading to uncoordinated movements. The occupational therapist would document this as needing further evaluation to assess the extent of the proprioceptive system dysfunction and develop appropriate interventions.

13. During an intervention session, a client complains of dry mouth due to prescribed medications. What is the most effective strategy for the occupational therapist to suggest to the client to manage this side effect?

Suck on ice

Suck on hard candies

Drink iced tea

Sip water

Sipping water is the most effective strategy for managing dry mouth caused by prescribed medications. Water helps to hydrate the mouth and stimulate saliva production, providing relief from dryness. Sucking on ice or hard candies may provide temporary relief, but they do not address the underlying issue of dehydration. Drinking iced tea may actually worsen dry mouth due to its diuretic effect. Therefore, sipping water is the best recommendation to manage this side effect.

Explanation

Sipping water is the most effective strategy for managing dry mouth caused by prescribed medications. Water helps to hydrate the mouth and stimulate saliva production, providing relief from dryness. Sucking on ice or hard candies may provide temporary relief, but they do not address the underlying issue of dehydration. Drinking iced tea may actually worsen dry mouth due to its diuretic effect. Therefore, sipping water is the best recommendation to manage this side effect.

14. An older adult recovering from a myocardial infarction is referred to occupational therapy for home care evaluation. The referral states that the client has high blood pressure and medication-related orthostatic hypotension. Which precaution is most important for the occupational therapist to observe with this client?

Adherence to dietary restrictions during meal preparation activities

Avoidance of activities that require movement against gravity

Delay of OT evaluation until client’s medications are stabilized

Avoidance of activities that require sudden postural changes

The client is experiencing orthostatic hypotension, which is a drop in blood pressure upon standing or changing positions. Avoiding activities that require sudden postural changes is important because these movements can further decrease blood pressure and potentially cause dizziness or fainting. By avoiding such activities, the occupational therapist can help prevent any potential falls or injuries that may occur as a result of the client's orthostatic hypotension.

Explanation

The client is experiencing orthostatic hypotension, which is a drop in blood pressure upon standing or changing positions. Avoiding activities that require sudden postural changes is important because these movements can further decrease blood pressure and potentially cause dizziness or fainting. By avoiding such activities, the occupational therapist can help prevent any potential falls or injuries that may occur as a result of the client's orthostatic hypotension.

15. A fifth grade student is having difficulty self-feeding and frequently spills beverages. The student has non-spastic cerebral palsy resulting in fluctuating muscle tone and poor motor control. Which is best for the occupational therapist to recommend the student use to improve independence in self-feeding and minimize spillage?

Sippy cup

Both hands to hold the cup

Cup with a handle

Straw

The best option for the occupational therapist to recommend to the student is a straw. This is because the student has poor motor control and fluctuating muscle tone, which makes it difficult for them to hold and control a cup or sippy cup. Using a straw requires less fine motor control and allows the student to drink without the risk of spilling. Additionally, using a straw promotes independence in self-feeding as the student can easily access and control the flow of liquid.

Explanation

The best option for the occupational therapist to recommend to the student is a straw. This is because the student has poor motor control and fluctuating muscle tone, which makes it difficult for them to hold and control a cup or sippy cup. Using a straw requires less fine motor control and allows the student to drink without the risk of spilling. Additionally, using a straw promotes independence in self-feeding as the student can easily access and control the flow of liquid.

16. An OT administrator is designing a patient satisfaction questionnaire to be administered upon discharge from the OT program. The administrator designs the questionnaire so that the individuals will indicate their level of agreement with a series of statements by circling a number with 1=very dissatisfied, 2=dissatisfied, 3=neutral, 4=satisfied, and 5=very satisfied. Which method of data collection is the administrator using?

Gutman scale rank ordering

Likert scale

Retrospective data

Semantic differential

The administrator is using the Likert scale method of data collection. The Likert scale is a commonly used survey response scale that allows individuals to indicate their level of agreement or disagreement with a series of statements. In this case, the individuals are asked to circle a number from 1 to 5 to indicate their level of satisfaction, with 1 being very dissatisfied and 5 being very satisfied. The Likert scale provides a quantitative measure of attitudes or opinions.

Explanation

The administrator is using the Likert scale method of data collection. The Likert scale is a commonly used survey response scale that allows individuals to indicate their level of agreement or disagreement with a series of statements. In this case, the individuals are asked to circle a number from 1 to 5 to indicate their level of satisfaction, with 1 being very dissatisfied and 5 being very satisfied. The Likert scale provides a quantitative measure of attitudes or opinions.

17. An individual with C3 spinal cord injury is participating in a community mobility group at a shopping mall. The client expresses the desire to return to the rehabilitation center due to a pounding headache. The occupational therapist notices the client is sweating profusely. Which is the best initial action for the therapist to take in response to this observation and request?

Check the client’s urinary catheter and collecting bag

Call the rehabilitation center’s transportation department to relay the client’s request

Escort client to outside of mall to cool off in fresh air

Immediately activate the recline feature of the patient’s tilt-in-space wheelchair

The best initial action for the therapist to take in response to the client's observation and request is to check the client's urinary catheter and collecting bag. This is because the client is sweating profusely, which may indicate autonomic dysreflexia, a potentially life-threatening condition that can occur in individuals with spinal cord injury. Checking the urinary catheter and collecting bag is important as it could be a potential cause of autonomic dysreflexia, such as urinary retention or a blocked catheter. By addressing this issue, the therapist can help alleviate the client's symptoms and prevent further complications.

Explanation

The best initial action for the therapist to take in response to the client's observation and request is to check the client's urinary catheter and collecting bag. This is because the client is sweating profusely, which may indicate autonomic dysreflexia, a potentially life-threatening condition that can occur in individuals with spinal cord injury. Checking the urinary catheter and collecting bag is important as it could be a potential cause of autonomic dysreflexia, such as urinary retention or a blocked catheter. By addressing this issue, the therapist can help alleviate the client's symptoms and prevent further complications.

18. An adult diagnosed with bipolar disorder has been taking lithium for five years. Prior to a weekly occupational therapy vocational planning group, the client reports noticeable functional changes since the last group session. In describing these changes, the client reports symptoms that may be indicative of a possible lithium overdose. With the client's permission, the therapist contacts the psychiatrist to describe the client's concerns. Which symptom would the therapist most likely report as indicative of this problem?

Reduction in mood swing

Gross hand tremors

Decreased velocity of speech

Fine hand tremors

The therapist would most likely report gross hand tremors as indicative of a possible lithium overdose. Hand tremors are a common side effect of lithium and can occur at therapeutic levels but are more likely to be seen at toxic levels. This symptom is important to report to the psychiatrist as it may indicate that the client's lithium levels need to be monitored and adjusted to prevent further complications.

Explanation

The therapist would most likely report gross hand tremors as indicative of a possible lithium overdose. Hand tremors are a common side effect of lithium and can occur at therapeutic levels but are more likely to be seen at toxic levels. This symptom is important to report to the psychiatrist as it may indicate that the client's lithium levels need to be monitored and adjusted to prevent further complications.

19. An occupational therapist receives a referral to evaluate an individual's executive functioning following a mild cerebral vascular accident. Which are the most relevant foci for this evaluation?

Person’s attention and memory

Person's job interests and efficacy

Person's spatial relations and praxis

Person's initiation and planning

The most relevant foci for evaluating an individual's executive functioning following a mild cerebral vascular accident would be their initiation and planning abilities. Executive functioning refers to the cognitive processes involved in goal-directed behavior, and initiation and planning are key components of this. After a cerebral vascular accident, individuals may experience difficulties in initiating tasks and planning their actions. Therefore, evaluating their initiation and planning skills would provide valuable information about their executive functioning abilities.

Explanation

The most relevant foci for evaluating an individual's executive functioning following a mild cerebral vascular accident would be their initiation and planning abilities. Executive functioning refers to the cognitive processes involved in goal-directed behavior, and initiation and planning are key components of this. After a cerebral vascular accident, individuals may experience difficulties in initiating tasks and planning their actions. Therefore, evaluating their initiation and planning skills would provide valuable information about their executive functioning abilities.

20. A client with chronic depression and a spouse attend a discharge meeting with the occupational therapist following the client's six-week hospitalization for a major depressive episode. They state that they have few activities in common and spend little time together. The client retired two months ago and the spouse continues to work full time. Which of the following should the therapist encourage this couple to do first to address this concern?

Immediately participate in one activity together

Become involved in their own individualized activities during the day

Explore activities enjoyed together and alone

Delay planning activities until the depression is totally resolved

The therapist should encourage the couple to explore activities that they can enjoy both together and individually. This will help them to find common interests and also have their own personal hobbies, which can improve their overall relationship and well-being. It is important for them to have a balance between shared activities and individual pursuits, especially considering the client's recent retirement and the spouse's full-time work. Delaying planning activities until the depression is resolved may not be beneficial as engaging in enjoyable activities can actually aid in the recovery process.

Explanation

The therapist should encourage the couple to explore activities that they can enjoy both together and individually. This will help them to find common interests and also have their own personal hobbies, which can improve their overall relationship and well-being. It is important for them to have a balance between shared activities and individual pursuits, especially considering the client's recent retirement and the spouse's full-time work. Delaying planning activities until the depression is resolved may not be beneficial as engaging in enjoyable activities can actually aid in the recovery process.

21. The parents of a school-aged child with Rett syndrome ask the occupational therapist for activities to do at home to help their child regain lost skills. Which of the following should the therapist include in the home program for the parents to do with their child?

Encourage the child to use pressure distribution techniques

Use four-step sequencing cards to increase attention

Give positive feedback for active ROM performance

Perform passive ROM to prevent contractures

Performing passive range of motion (ROM) exercises can help prevent contractures in children with Rett syndrome. Rett syndrome is a neurodevelopmental disorder that affects motor skills and causes a loss of purposeful hand skills. Contractures, or the permanent shortening and tightening of muscles, can occur if the child does not have adequate movement and stretching of their joints. By performing passive ROM exercises, the parents can help maintain joint mobility and prevent contractures from developing. This can ultimately support the child in regaining lost skills and improving their overall function.

Explanation

Performing passive range of motion (ROM) exercises can help prevent contractures in children with Rett syndrome. Rett syndrome is a neurodevelopmental disorder that affects motor skills and causes a loss of purposeful hand skills. Contractures, or the permanent shortening and tightening of muscles, can occur if the child does not have adequate movement and stretching of their joints. By performing passive ROM exercises, the parents can help maintain joint mobility and prevent contractures from developing. This can ultimately support the child in regaining lost skills and improving their overall function.

22. An individual prepares for discharge home following rehabilitation for a left CVA. Residual difficulties include fair dynamic balance, decreased upper extremity (UE) strength and poor dexterity. The individual's stated priority is to be able to ambulate safely to the senior center located in the client's apartment building. Which ambulatory aid would be most effective for the occupational therapist to recommend to this client?

A hemi-walker

A rolling walker

A side-stepper walker

A standard walker

A rolling walker would be the most effective ambulatory aid to recommend to this client. A rolling walker provides stability and support while allowing the client to move more easily. It would help with the client's fair dynamic balance and decreased upper extremity strength. The rolling walker also offers a larger base of support and may be easier for the client to maneuver compared to a standard walker or a side-stepper walker. This would enable the client to ambulate safely to the senior center located in their apartment building.

Explanation

A rolling walker would be the most effective ambulatory aid to recommend to this client. A rolling walker provides stability and support while allowing the client to move more easily. It would help with the client's fair dynamic balance and decreased upper extremity strength. The rolling walker also offers a larger base of support and may be easier for the client to maneuver compared to a standard walker or a side-stepper walker. This would enable the client to ambulate safely to the senior center located in their apartment building.

23. A two-year-old child receives home care early intervention services. The occupational therapy intervention plan includes a goal to develop child's pincer grasp. Which is the most appropriate activity for the occupational therapist to work on with the child during an intervention session?

Finger-feeding of O-shaped cereal

Picking up marbles

Drawing with jumbo crayons

Stacking one-inch cubes

The most appropriate activity for the occupational therapist to work on with the child during an intervention session is finger-feeding of O-shaped cereal. This activity specifically targets the development of the child's pincer grasp, which is an important fine motor skill. By picking up and manipulating the small cereal pieces using their thumb and index finger, the child can improve their ability to grasp and manipulate objects using their fingers. This activity also provides sensory input and can help improve hand-eye coordination.

Explanation

The most appropriate activity for the occupational therapist to work on with the child during an intervention session is finger-feeding of O-shaped cereal. This activity specifically targets the development of the child's pincer grasp, which is an important fine motor skill. By picking up and manipulating the small cereal pieces using their thumb and index finger, the child can improve their ability to grasp and manipulate objects using their fingers. This activity also provides sensory input and can help improve hand-eye coordination.

24. An occupational therapist develops a task group for the newly admitted patients of a psychiatric inpatient unit of a busy city hospital. The therapist considers several activities to use for the group's first session. Which activity is best for the therapist to present to the group members?

Planning a weekend pizza party for the patients and their visitors

Decorating styrofoam cups and planting cuttings in them

Publishing a weekly newsletter about city attractions for patients on the unit

Painting large mural to cover one wall of day room

Decorating styrofoam cups and planting cuttings in them is the best activity for the therapist to present to the group members. This activity promotes creativity and engagement, as the patients can decorate the cups according to their preferences and then plant cuttings in them. It also provides a sense of responsibility and nurturing, as the patients will need to take care of the plants. Additionally, this activity can be therapeutic and calming, as it allows the patients to focus on a task and connect with nature.

Explanation

Decorating styrofoam cups and planting cuttings in them is the best activity for the therapist to present to the group members. This activity promotes creativity and engagement, as the patients can decorate the cups according to their preferences and then plant cuttings in them. It also provides a sense of responsibility and nurturing, as the patients will need to take care of the plants. Additionally, this activity can be therapeutic and calming, as it allows the patients to focus on a task and connect with nature.

25. A person blinded in an accident begins an occupational therapy program for persons with vision loss. The occupational therapist collaborates with the individual to develop an intervention plan. Which should be included in the plan as an initial focus of intervention?

Developing the client's computer skills

Adapting meal preparation techniques

Exploring vocational interests

Organizing the client's morning routine

The initial focus of intervention should be organizing the client's morning routine. This is important because a person who is newly blinded may struggle with adjusting to their daily activities and routines. By organizing their morning routine, the occupational therapist can help the individual regain a sense of control and independence in their daily life. This can also set a foundation for the client to develop other skills and adapt to their vision loss in other areas of their life.

Explanation

The initial focus of intervention should be organizing the client's morning routine. This is important because a person who is newly blinded may struggle with adjusting to their daily activities and routines. By organizing their morning routine, the occupational therapist can help the individual regain a sense of control and independence in their daily life. This can also set a foundation for the client to develop other skills and adapt to their vision loss in other areas of their life.

26. An individual with bilateral proximal weakness identifies a goal of independence in self-feeding. Which equipment is most beneficial for the occupational therapist to recommend for goal attainment?

Extended long-handled utensils

Built-up handled utensils

An electric feeder

Mobile arm supports

Mobile arm supports would be the most beneficial equipment for the occupational therapist to recommend for goal attainment. Bilateral proximal weakness refers to weakness in both arms and shoulders, which can make self-feeding challenging. Mobile arm supports provide external support and stability to the arms, allowing the individual to have better control and movement while self-feeding. This equipment helps to increase independence and improve the individual's ability to feed themselves. Extended long-handled utensils and built-up handled utensils may also be helpful, but they do not provide the same level of support and stability as mobile arm supports. An electric feeder may not be necessary if the individual is able to feed themselves with the use of mobile arm supports.

Explanation

Mobile arm supports would be the most beneficial equipment for the occupational therapist to recommend for goal attainment. Bilateral proximal weakness refers to weakness in both arms and shoulders, which can make self-feeding challenging. Mobile arm supports provide external support and stability to the arms, allowing the individual to have better control and movement while self-feeding. This equipment helps to increase independence and improve the individual's ability to feed themselves. Extended long-handled utensils and built-up handled utensils may also be helpful, but they do not provide the same level of support and stability as mobile arm supports. An electric feeder may not be necessary if the individual is able to feed themselves with the use of mobile arm supports.

27. A graduate student with an anxiety disorder reports feeling confused about the future. During the OT evaluation, the client relates decreased feelings of competence for a chosen field of study and overall poor personal causation. Which is the best initial action for the therapist to take in response to the client's stated concerns?

Administer a vocational interest inventory

Provide activities related to the client’s chosen field of study

Refer the client to the state office of vocational and educational services

Establish short-term goals with high potential for attainment

The best initial action for the therapist to take in response to the client's stated concerns is to establish short-term goals with high potential for attainment. This approach would help the client regain a sense of competence and personal causation by setting achievable goals that can provide a sense of accomplishment and direction. It would also address the client's confusion about the future by breaking it down into smaller, manageable steps. Administering a vocational interest inventory or providing activities related to the client's chosen field of study may not directly address the client's feelings of confusion and decreased competence. Referring the client to the state office of vocational and educational services may be a helpful step, but it may not be the best initial action.

Explanation

The best initial action for the therapist to take in response to the client's stated concerns is to establish short-term goals with high potential for attainment. This approach would help the client regain a sense of competence and personal causation by setting achievable goals that can provide a sense of accomplishment and direction. It would also address the client's confusion about the future by breaking it down into smaller, manageable steps. Administering a vocational interest inventory or providing activities related to the client's chosen field of study may not directly address the client's feelings of confusion and decreased competence. Referring the client to the state office of vocational and educational services may be a helpful step, but it may not be the best initial action.

28. A person diagnosed with dementia, Alzheimer type is evaluated by the occupational therapist. Although the client demonstrates diminished memory skills, the therapist determines that the patient is still able to live at home with supportive structure. The therapist collaborates with the client to identify the activities to include in a structured routine that enables the client's continued occupational performance. Which activity is best for the occupational therapist to recommend to the client?

Cooking dinner

Doing laundry

Walking with a neighbor

Watching television

Walking with a neighbor is the best activity for the occupational therapist to recommend to the client. This activity promotes social interaction and physical exercise, which can be beneficial for individuals with dementia. It allows the client to engage in a meaningful occupation while also providing an opportunity for social support and connection with others. Additionally, walking can help improve mood and overall well-being.

Explanation

Walking with a neighbor is the best activity for the occupational therapist to recommend to the client. This activity promotes social interaction and physical exercise, which can be beneficial for individuals with dementia. It allows the client to engage in a meaningful occupation while also providing an opportunity for social support and connection with others. Additionally, walking can help improve mood and overall well-being.

29. A three-year-old child with left spastic hemiplegia due to cerebral palsy is evaluated for early intervention services. During the evaluation the occupational therapist observes behaviors that seem to indicate the presence of visual deficits. Based on these observations, which action should the occupational therapist take?

Complete a motor-free visual perceptual assessment

Complete a developmental vision assessment

Refer child to an optician

Refer child to an optometrist

The occupational therapist should refer the child to an optometrist because the observations indicate the presence of visual deficits. An optometrist is a healthcare professional who specializes in examining the eyes and visual system, and can diagnose and treat visual impairments. Completing a motor-free visual perceptual assessment or a developmental vision assessment may provide additional information, but referring the child to an optometrist would be the appropriate next step in order to address the visual deficits.

Explanation

The occupational therapist should refer the child to an optometrist because the observations indicate the presence of visual deficits. An optometrist is a healthcare professional who specializes in examining the eyes and visual system, and can diagnose and treat visual impairments. Completing a motor-free visual perceptual assessment or a developmental vision assessment may provide additional information, but referring the child to an optometrist would be the appropriate next step in order to address the visual deficits.

30. An occupational therapist is evaluating a child with developmental delay characterized by hypotonicity. According to the Rood approach, which is the first stability pattern that the therapist should facilitate during intervention?

Roll over

Quadruped

Neck co-contraction

Prone on elbows

According to the Rood approach, the first stability pattern that the therapist should facilitate during intervention for a child with developmental delay characterized by hypotonicity is neck co-contraction. This is because neck co-contraction helps to provide stability and control in the upper body, which is important for the child's overall development and functional abilities. By facilitating neck co-contraction, the therapist can help improve the child's postural control and stability, which can then support their progress in other areas of motor development.

Explanation

According to the Rood approach, the first stability pattern that the therapist should facilitate during intervention for a child with developmental delay characterized by hypotonicity is neck co-contraction. This is because neck co-contraction helps to provide stability and control in the upper body, which is important for the child's overall development and functional abilities. By facilitating neck co-contraction, the therapist can help improve the child's postural control and stability, which can then support their progress in other areas of motor development.

31. A client with traumatic below-elbow amputation of the dominant right arm has participated in occupational therapy for prosthetic training. The therapist prepares a discharge plan that incorporates recommendations to facilitate independence in meal preparation and feeding. Which method is best for the therapist to recommend the client use to cut meat?

Hold a regular knife in the terminal device and hold a regular fork in the left hand

Hold a knife with a built-up handle in the terminal device and hold the plate with the left hand

Use a one-handed technique with a rocker knife in the left hand and hold the plate with the terminal device

Hold a regular fork in the terminal device and hold a regular knife in the left hand

The client with a below-elbow amputation of the dominant right arm can best facilitate independence in meal preparation and feeding by holding a regular fork in the terminal device and holding a regular knife in the left hand. This method allows the client to use their non-dominant hand to hold the knife for cutting while using the terminal device to hold and manipulate the fork for eating. Holding a regular fork in the terminal device provides a secure grip, and using a regular knife in the left hand allows for better control and precision in cutting meat.

Explanation

The client with a below-elbow amputation of the dominant right arm can best facilitate independence in meal preparation and feeding by holding a regular fork in the terminal device and holding a regular knife in the left hand. This method allows the client to use their non-dominant hand to hold the knife for cutting while using the terminal device to hold and manipulate the fork for eating. Holding a regular fork in the terminal device provides a secure grip, and using a regular knife in the left hand allows for better control and precision in cutting meat.

32. A ten-year-old with congenital anomalies wears bilateral ankle-foot orthoses. The parents want the child to be able to don and doff shoes independently, but the child cannot tie shoes. Which is the beast footwear recommendation for the therapist to make for the child to wear?

Leather slip-on loafers

Slip-on tennis shoes with no laces

Running shoes with Velcro shoe closures

Hi-rise sneakers with sliding adapters on the laces

The best footwear recommendation for the therapist to make for the child to wear is running shoes with Velcro shoe closures. This option allows the child to independently don and doff the shoes without needing to tie laces, which the child cannot do. Additionally, running shoes provide good support and stability for the child's feet, which is important considering the child wears bilateral ankle-foot orthoses. Velcro closures make it easier for the child to put on and take off the shoes, promoting independence and convenience.

Explanation

The best footwear recommendation for the therapist to make for the child to wear is running shoes with Velcro shoe closures. This option allows the child to independently don and doff the shoes without needing to tie laces, which the child cannot do. Additionally, running shoes provide good support and stability for the child's feet, which is important considering the child wears bilateral ankle-foot orthoses. Velcro closures make it easier for the child to put on and take off the shoes, promoting independence and convenience.

33. An occupational therapist conducts an in-service at an outpatient wheelchair clinic for individuals with central nervous system dysfunction. According to the principles of wheelchair prescription, which of the following statements is accurate for the therapist to make during the presentation?

Firm seats are needed to provide stability

Soft seats are needed to prevent decubiti

Back heights should be extended to facilitate weight shifting

Seat angles should be 45° to prevent falling forward

Firm seats are needed to provide stability because they offer better support and prevent individuals from sliding or falling out of the wheelchair. The firmness of the seat helps distribute the weight evenly, ensuring proper balance and stability for the user. This is especially important for individuals with central nervous system dysfunction who may have limited control over their body movements. A firm seat also promotes proper posture and alignment, reducing the risk of developing musculoskeletal issues.

Explanation

Firm seats are needed to provide stability because they offer better support and prevent individuals from sliding or falling out of the wheelchair. The firmness of the seat helps distribute the weight evenly, ensuring proper balance and stability for the user. This is especially important for individuals with central nervous system dysfunction who may have limited control over their body movements. A firm seat also promotes proper posture and alignment, reducing the risk of developing musculoskeletal issues.

34. A client in the descending phase of Guillain-Barré syndrome has bilateral shoulder strength of 2/5. The client fatigues easily. Which equipment should the occupational therapist recommend to enhance the person's performance of activities of daily living?

An overhead suspension sling

Long-handled utensils and tools

Angled/curved-handled utensils and tools

An environmental control unit

An overhead suspension sling would be the most appropriate equipment to enhance the person's performance of activities of daily living in this case. Guillain-Barré syndrome can cause weakness and fatigue in the muscles, including the shoulder muscles. An overhead suspension sling can provide support and assistance to the shoulders, allowing the client to perform activities with less effort and fatigue. This can help improve their independence and quality of life. Long-handled utensils and tools, angled/curved-handled utensils and tools, and an environmental control unit may be beneficial for other conditions or limitations, but they would not specifically address the bilateral shoulder weakness and fatigue seen in Guillain-Barré syndrome.

Explanation

An overhead suspension sling would be the most appropriate equipment to enhance the person's performance of activities of daily living in this case. Guillain-Barré syndrome can cause weakness and fatigue in the muscles, including the shoulder muscles. An overhead suspension sling can provide support and assistance to the shoulders, allowing the client to perform activities with less effort and fatigue. This can help improve their independence and quality of life. Long-handled utensils and tools, angled/curved-handled utensils and tools, and an environmental control unit may be beneficial for other conditions or limitations, but they would not specifically address the bilateral shoulder weakness and fatigue seen in Guillain-Barré syndrome.

35. An elementary school teacher has been recently diagnosed with multiple sclerosis (MS). Which adaptation is best for the occupational therapist to recommend the teacher use to accommodate for effects of MS on classroom teaching?

Large print written material to compensate for visual impairments

Daily list of tasks to compensate for cognitive deficits

Motorized scooter to compensate for decreased endurance

High stool to compensate for LE weakness

The best adaptation for the occupational therapist to recommend the teacher use to accommodate for the effects of MS on classroom teaching is a high stool to compensate for lower extremity (LE) weakness. This would provide support and stability for the teacher while reducing the strain on their legs, allowing them to continue teaching while minimizing the impact of their weakness. Large print written material would be more suitable for visual impairments, a daily list of tasks for cognitive deficits, and a motorized scooter for decreased endurance.

Explanation

The best adaptation for the occupational therapist to recommend the teacher use to accommodate for the effects of MS on classroom teaching is a high stool to compensate for lower extremity (LE) weakness. This would provide support and stability for the teacher while reducing the strain on their legs, allowing them to continue teaching while minimizing the impact of their weakness. Large print written material would be more suitable for visual impairments, a daily list of tasks for cognitive deficits, and a motorized scooter for decreased endurance.

36. In measuring the ROM of a client's elbow, the occupational therapist records a flexion measurement of 145°. Which is the most accurate for the therapist to document based on this measurement?

Hypomobility

Dysfunctional elbow ROM

Hypermobility

Normal elbow ROM

Based on the measurement of 145° for flexion of the client's elbow, the most accurate documentation for the therapist would be "Normal elbow ROM." This is because a flexion measurement of 145° falls within the typical range of motion for a healthy elbow joint.

Explanation

Based on the measurement of 145° for flexion of the client's elbow, the most accurate documentation for the therapist would be "Normal elbow ROM." This is because a flexion measurement of 145° falls within the typical range of motion for a healthy elbow joint.

37. An adult is hospitalized in the recovery phase of Guillain Barré Syndrome. The patient complains of tingling, aching and weakness in both hands, causing difficulty in grasping grooming supplies. The patient requests relief from the hand symptoms. Which action should the occupational therapist take to address the patient's concerns?

Provide soft tissue to massage to both hands prior to grooming activities

Apply hot packs to both hands and complete stretching exercises prior to grooming activities

Refer the client to a neurologist for follow-up of possible condition regression

Educate the patient about sensory deficits and related adaptive ADL strategies

In this scenario, the patient is experiencing tingling, aching, and weakness in both hands, which are common symptoms of Guillain Barré Syndrome. These symptoms can make it difficult for the patient to grasp grooming supplies. By educating the patient about sensory deficits and related adaptive activities of daily living (ADL) strategies, the occupational therapist can help the patient understand their condition better and provide them with strategies to manage their symptoms and perform daily tasks more effectively. This approach focuses on empowering the patient to take control of their own care and improve their quality of life.

Explanation

In this scenario, the patient is experiencing tingling, aching, and weakness in both hands, which are common symptoms of Guillain Barré Syndrome. These symptoms can make it difficult for the patient to grasp grooming supplies. By educating the patient about sensory deficits and related adaptive activities of daily living (ADL) strategies, the occupational therapist can help the patient understand their condition better and provide them with strategies to manage their symptoms and perform daily tasks more effectively. This approach focuses on empowering the patient to take control of their own care and improve their quality of life.

38. A 19-year-old with diagnoses of dysthymic disorder and narcissistic personality disorder attends a vocational rehabilitation program. When the client arrives for the work adjustment group, the therapist notes that the client demonstrates an unsteady gait and slurred speech. The client's breath smells of alcohol. Which is the best action for the therapist to take in response to these observations?

Follow program procedures to arrange for transportation to bring client home

Introduce the topic of alcohol’s effect on work performance as the focus of the scheduled group session

Have the client meet with social worker to discuss treatment options for potential alcohol abuse

Contact the client’s parents to pick up the client up to bring the client home

The therapist should follow program procedures to arrange for transportation to bring the client home because the client is showing signs of intoxication, such as an unsteady gait, slurred speech, and smelling of alcohol. It is important to ensure the client's safety and well-being by not allowing them to drive or engage in any activities that could put themselves or others at risk.

Explanation

The therapist should follow program procedures to arrange for transportation to bring the client home because the client is showing signs of intoxication, such as an unsteady gait, slurred speech, and smelling of alcohol. It is important to ensure the client's safety and well-being by not allowing them to drive or engage in any activities that could put themselves or others at risk.

39. The parents of an infant born at 32 weeks gestation are about to take the baby home after four weeks in the neonatal intensive care nursery. Which is most important for the occupational therapist to instruct the parents to avoid?

Placing the infant in the prone position for sleeping

Placing the infant in the supine position for sleeping

Using an infant swing with a head support for calming

Presenting toys in the midline with infant in prone position for playing

The correct answer is placing the infant in the prone position for sleeping. This is because placing the infant in the prone position increases the risk of Sudden Infant Death Syndrome (SIDS). The American Academy of Pediatrics recommends that infants should be placed on their backs to sleep to reduce the risk of SIDS.

Explanation

The correct answer is placing the infant in the prone position for sleeping. This is because placing the infant in the prone position increases the risk of Sudden Infant Death Syndrome (SIDS). The American Academy of Pediatrics recommends that infants should be placed on their backs to sleep to reduce the risk of SIDS.

40. An adult recently diagnosed with scleroderma receives occupational therapy services to deal with the functional changes caused by this disease. Which recommendation is best for the occupational therapist to make to this individual?

Dress in lightweight clothing for thermal comfort

Dress in layers for neutral warmth

Use pull-on clothing to ease donning and doffing

Use Velcro/or a button hook to ease fastening

The best recommendation for the occupational therapist to make to an adult recently diagnosed with scleroderma is to dress in layers for neutral warmth. Scleroderma is a disease that affects the skin and connective tissues, causing them to become thick and hard. This can lead to poor circulation and difficulty regulating body temperature. Dressing in layers allows the individual to adjust their clothing to maintain a comfortable body temperature. It also provides insulation and helps to trap heat without causing overheating. This recommendation would help the individual manage the functional changes caused by the disease and maintain thermal comfort.

Explanation

The best recommendation for the occupational therapist to make to an adult recently diagnosed with scleroderma is to dress in layers for neutral warmth. Scleroderma is a disease that affects the skin and connective tissues, causing them to become thick and hard. This can lead to poor circulation and difficulty regulating body temperature. Dressing in layers allows the individual to adjust their clothing to maintain a comfortable body temperature. It also provides insulation and helps to trap heat without causing overheating. This recommendation would help the individual manage the functional changes caused by the disease and maintain thermal comfort.

41. An individual with spinal cord injury at C7 reports noticeable redness on the ischial tuberosity during self-examination with a mirror. Which action is most effective for the occupational therapist to recommend in response to client's observations?

Integrate weight shifting into daily activities

Use a tilt-in-space wheelchair

Use an angled foam cushion

Self-directed caregivers to assist with weight shifting at least once every 30 minutes

Integrate weight shifting into daily activities. This is the most effective action to recommend because weight shifting helps to relieve pressure on the ischial tuberosity, which can prevent the development of pressure ulcers. By incorporating weight shifting into daily activities, the individual can regularly relieve pressure on the affected area, reducing the risk of skin breakdown and promoting overall skin health. This recommendation is based on the understanding that pressure ulcers are a common complication for individuals with spinal cord injury, particularly at the ischial tuberosity, and that regular weight shifting is a key preventative measure.

Explanation

Integrate weight shifting into daily activities. This is the most effective action to recommend because weight shifting helps to relieve pressure on the ischial tuberosity, which can prevent the development of pressure ulcers. By incorporating weight shifting into daily activities, the individual can regularly relieve pressure on the affected area, reducing the risk of skin breakdown and promoting overall skin health. This recommendation is based on the understanding that pressure ulcers are a common complication for individuals with spinal cord injury, particularly at the ischial tuberosity, and that regular weight shifting is a key preventative measure.

42. An individual is evaluated for a repetitive stress disorder. The individual complains of numbness and tingling of the thumb, index, middle, and radial half of the ring finger and aching pain in the proximal forearm. The client states that these symptoms are not evident at night. The occupational therapist notes a positive Tinel's sign. Which site should be the therapist document as the location of this sign for this client?

Wrist

Guyon's canal

Elbow

Forearm

The individual's symptoms of numbness and tingling in the thumb, index, middle, and radial half of the ring finger, along with aching pain in the proximal forearm, suggest the presence of a repetitive stress disorder. The fact that these symptoms are not evident at night further supports this diagnosis. The positive Tinel's sign, which is a tingling sensation felt when tapping over a compressed nerve, indicates nerve compression or irritation. Given the location of the symptoms and the positive Tinel's sign, the therapist should document the forearm as the site of the Tinel's sign for this client.

Explanation

The individual's symptoms of numbness and tingling in the thumb, index, middle, and radial half of the ring finger, along with aching pain in the proximal forearm, suggest the presence of a repetitive stress disorder. The fact that these symptoms are not evident at night further supports this diagnosis. The positive Tinel's sign, which is a tingling sensation felt when tapping over a compressed nerve, indicates nerve compression or irritation. Given the location of the symptoms and the positive Tinel's sign, the therapist should document the forearm as the site of the Tinel's sign for this client.

43. A person fell and sustained bilateral Colle's fractures. The client wore bilateral short-arm casts for six weeks. After cast removal, the client began OT sessions to increase endurance and strength prior to returning to work. The client tends to work hard when performing resistive exercises with both wrists. The therapist monitors the client for overextension. Which behavior indicates overextension?

Decreased respiration rate during resistive wrist flexion

Increased ability to achieve full ROM of the wrist

Complaints of pain in the wrist extensors

Consistent strength in wrist extension activities

Complaints of pain in the wrist extensors indicate overextension. When a person overextends their wrists during resistive exercises, it can put excessive strain on the wrist extensor muscles, leading to pain and discomfort. This suggests that the client may be pushing themselves too hard and potentially causing harm to their wrists. The therapist should closely monitor the client's technique and provide guidance to prevent overextension and ensure a safe and effective exercise session.

Explanation

Complaints of pain in the wrist extensors indicate overextension. When a person overextends their wrists during resistive exercises, it can put excessive strain on the wrist extensor muscles, leading to pain and discomfort. This suggests that the client may be pushing themselves too hard and potentially causing harm to their wrists. The therapist should closely monitor the client's technique and provide guidance to prevent overextension and ensure a safe and effective exercise session.

44. An adult incurred an injury to the anterior spinal artery at the T12 level. The occupational therapist completes a sensory evaluation with this client. Which sensation is most likely for the therapist to document that the individual has retained?

Proprioception

Pain

Light touch

Temperature

Given that the injury is to the anterior spinal artery at the T12 level, it is likely that the individual has retained proprioception. Proprioception refers to the sense of the position and movement of our body parts. The anterior spinal artery supplies blood to the anterior part of the spinal cord, which includes the pathways responsible for proprioception. Therefore, despite the injury, the individual may still have intact proprioceptive sensation.

Explanation

Given that the injury is to the anterior spinal artery at the T12 level, it is likely that the individual has retained proprioception. Proprioception refers to the sense of the position and movement of our body parts. The anterior spinal artery supplies blood to the anterior part of the spinal cord, which includes the pathways responsible for proprioception. Therefore, despite the injury, the individual may still have intact proprioceptive sensation.

45. An elementary school-aged child with Duchenne's muscular dystrophy receives occupational therapy services. The family establishes a goal of maintaining the child's leisure and social participation. Which is the best activity for the occupational therapist to recommend the family pursue with the child?

Electronic sports (e.g. Wii bowling)

Adapted little league baseball

Wheelchair basketball

Recreational swimming

Recreational swimming is the best activity for the occupational therapist to recommend because it provides a variety of physical and social benefits for a child with Duchenne's muscular dystrophy. Swimming is a low-impact exercise that can help maintain muscle strength and flexibility, which is important for individuals with muscular dystrophy. Additionally, swimming can improve cardiovascular health and overall endurance. Socially, swimming can provide opportunities for the child to interact with peers and engage in leisure activities. Overall, recreational swimming is a well-rounded activity that can address the child's goals of maintaining leisure and social participation.

Explanation

Recreational swimming is the best activity for the occupational therapist to recommend because it provides a variety of physical and social benefits for a child with Duchenne's muscular dystrophy. Swimming is a low-impact exercise that can help maintain muscle strength and flexibility, which is important for individuals with muscular dystrophy. Additionally, swimming can improve cardiovascular health and overall endurance. Socially, swimming can provide opportunities for the child to interact with peers and engage in leisure activities. Overall, recreational swimming is a well-rounded activity that can address the child's goals of maintaining leisure and social participation.

46. An occupational therapist working in a spinal cord injury unit evaluates a client for bowel and bladder training. The client and therapist set a goal of independence in all aspects of bowel and bladder care, including skin inspection. Which of the following is the highest or most severe level of complete spinal cord injury the client can have to be able to achieve this goal?

C7-C8

C4-C5

C5

C6

A client with a C7-C8 level of complete spinal cord injury has the highest or most severe level of injury among the given options, but still has the potential to achieve independence in all aspects of bowel and bladder care, including skin inspection. This level of injury indicates that the client has some movement and sensation in the upper extremities, which can enable them to perform self-care tasks with assistance or adaptive devices. With proper training and support from the occupational therapist, the client can learn techniques and strategies to manage their bowel and bladder care independently.

Explanation

A client with a C7-C8 level of complete spinal cord injury has the highest or most severe level of injury among the given options, but still has the potential to achieve independence in all aspects of bowel and bladder care, including skin inspection. This level of injury indicates that the client has some movement and sensation in the upper extremities, which can enable them to perform self-care tasks with assistance or adaptive devices. With proper training and support from the occupational therapist, the client can learn techniques and strategies to manage their bowel and bladder care independently.

47. A home care occupational therapist sees to enhance an elder's compliance with occupational therapy intervention program. After discussing the goals of the program with the person, which intervention is most effective for the therapist to use?

Provide individual with limited opportunities for practice of skills to decrease boredom

Use multiple, variable instructions to ensure retention of new learning

Integrate previously learned strategies into new activities to facilitate generalization

Teach family members positive techniques to reinforce activity performance in the home

The most effective intervention for the therapist to use is to integrate previously learned strategies into new activities to facilitate generalization. This approach helps the elder to apply the skills they have learned in occupational therapy to different contexts and situations, promoting a more comprehensive and lasting improvement in their daily functioning. By incorporating these strategies into new activities, the therapist can ensure that the elder can transfer their skills and adapt them to various situations, ultimately enhancing their compliance with the intervention program.

Explanation

The most effective intervention for the therapist to use is to integrate previously learned strategies into new activities to facilitate generalization. This approach helps the elder to apply the skills they have learned in occupational therapy to different contexts and situations, promoting a more comprehensive and lasting improvement in their daily functioning. By incorporating these strategies into new activities, the therapist can ensure that the elder can transfer their skills and adapt them to various situations, ultimately enhancing their compliance with the intervention program.

48. An elder with peripheral neuropathies resulting from the chronic effects of diabetes expresses concern over the ability to have a satisfying sexual relationship with a partner. Which is the most beneficial recommendation for the occupational therapist to make to the elder?

Experiment with different positions during sexual expression activities

Focus on intact senses and areas of intact sensation

Schedule sexual expression activities after rest periods

Advise the elder to accept decreased abilities in sexual expression as a normal part of aging

The most beneficial recommendation for the occupational therapist to make to the elder is to focus on intact senses and areas of intact sensation. This suggestion acknowledges the concerns of the elder while also providing a practical solution. By focusing on areas of the body that still have sensation, the elder can explore different ways to experience pleasure and maintain a satisfying sexual relationship with their partner. This recommendation takes into account the specific challenges posed by peripheral neuropathies resulting from diabetes and offers a proactive approach to addressing the elder's concerns.

Explanation

The most beneficial recommendation for the occupational therapist to make to the elder is to focus on intact senses and areas of intact sensation. This suggestion acknowledges the concerns of the elder while also providing a practical solution. By focusing on areas of the body that still have sensation, the elder can explore different ways to experience pleasure and maintain a satisfying sexual relationship with their partner. This recommendation takes into account the specific challenges posed by peripheral neuropathies resulting from diabetes and offers a proactive approach to addressing the elder's concerns.

49. A child with developmental delay has mastered the ability to cut simple figure shapes with scissors. Which scissor activity is best for the occupational therapist to next introduce to child?

Cutting simple geometric figures

Cutting complex figure shapes

Cutting multiple scissors

Cutting additional simple figure shapes

The child with developmental delay has already mastered cutting simple figure shapes with scissors. To further challenge and develop their skills, the occupational therapist should introduce cutting complex figure shapes. This will help the child improve their fine motor skills, hand-eye coordination, and problem-solving abilities. By gradually increasing the difficulty level, the therapist can support the child's progress and promote their overall development in scissor skills.

Explanation

The child with developmental delay has already mastered cutting simple figure shapes with scissors. To further challenge and develop their skills, the occupational therapist should introduce cutting complex figure shapes. This will help the child improve their fine motor skills, hand-eye coordination, and problem-solving abilities. By gradually increasing the difficulty level, the therapist can support the child's progress and promote their overall development in scissor skills.

50. A patient who is status-post left frontal lobe ischemia has difficulty bearing weight through the right lower extremity during reaching activities (e.g. standing at a sink during morning self-care routine). The occupational therapist implements a Motor Relearning Program (MRP). Which is the bet intervention for the therapist to provide according to this approach?

Therapeutic handling to affect the central nervous system

A stool to sit on during reaching activities

Joint compression to the right lower extremity during reaching activities

Verbal and visual feedback while practicing reaching

The Motor Relearning Program (MRP) focuses on retraining the central nervous system to improve motor function. Providing verbal and visual feedback while practicing reaching activities helps the patient to better understand and integrate sensory information, enhancing their motor learning and performance. This intervention can improve the patient's ability to bear weight through the right lower extremity and perform reaching activities more effectively. Therapeutic handling, a stool to sit on, and joint compression may have their own benefits but they are not specific to the MRP approach in addressing the patient's difficulty.

Explanation

The Motor Relearning Program (MRP) focuses on retraining the central nervous system to improve motor function. Providing verbal and visual feedback while practicing reaching activities helps the patient to better understand and integrate sensory information, enhancing their motor learning and performance. This intervention can improve the patient's ability to bear weight through the right lower extremity and perform reaching activities more effectively. Therapeutic handling, a stool to sit on, and joint compression may have their own benefits but they are not specific to the MRP approach in addressing the patient's difficulty.

51. An occupational therapist provides intervention to develop independent feeding skills in an 18-month old child with significant developmental delays. The child has mastered the ability to hold a spoon and bang it on the tray of the high chair. The child can also hold and suck on a cracker. Which activity is best for the therapist to provide next during intervention?

Finger-feeding soft foods

Scooping food and bringing it to the mouth

Taking cereal from a spoon held by the therapist

Bringing a filled spoon to the mouth

Finger-feeding soft foods would be the best activity for the therapist to provide next during intervention. This activity would help the child develop their fine motor skills and hand-eye coordination, as they would need to use their fingers to pick up and feed themselves soft foods. It would also encourage self-feeding and independence, as the child would be able to control the amount and pace of their own feeding. This activity builds upon the child's current abilities of holding objects and sucking on a cracker, allowing them to further develop their feeding skills.

Explanation

Finger-feeding soft foods would be the best activity for the therapist to provide next during intervention. This activity would help the child develop their fine motor skills and hand-eye coordination, as they would need to use their fingers to pick up and feed themselves soft foods. It would also encourage self-feeding and independence, as the child would be able to control the amount and pace of their own feeding. This activity builds upon the child's current abilities of holding objects and sucking on a cracker, allowing them to further develop their feeding skills.

52. An occupational therapist works with an individual recovering from traumatic brain injury who demonstrates behaviors consistent with Level VII of the Rancho Level of Cognitive Functioning Scale. The client is a resident in a transitional living program. Which is the most important focus for the therapist to include in the client's intervention plan?

Provision of high degree of environmental structure to decrease confusion and ensure safety

Development of strategies to accurately and safely complete IADL with minimal assistance

Development of adaptive techniques to accurately and safely complete BADL with moderate assistance

Provision of maximum assistance to accurately and safely complete IADL

The most important focus for the therapist to include in the client's intervention plan is the development of strategies to accurately and safely complete Instrumental Activities of Daily Living (IADL) with minimal assistance. This is because the client is in a transitional living program and is at Level VII of the Rancho Level of Cognitive Functioning Scale, indicating that they have emerging awareness and can carry out complex tasks with some assistance. Developing strategies to complete IADLs with minimal assistance will help the client regain independence and successfully transition back into their daily life activities.

Explanation

The most important focus for the therapist to include in the client's intervention plan is the development of strategies to accurately and safely complete Instrumental Activities of Daily Living (IADL) with minimal assistance. This is because the client is in a transitional living program and is at Level VII of the Rancho Level of Cognitive Functioning Scale, indicating that they have emerging awareness and can carry out complex tasks with some assistance. Developing strategies to complete IADLs with minimal assistance will help the client regain independence and successfully transition back into their daily life activities.

53. A patient is recovering from right CVA resulting in severe left hemiplegia and visuospatial deficits. The person's left lower extremity has pitting edema. Which wheelchair would be best for the occupational therapist to recommend for this patient?

Powered wheelchair with a joystick control and dual elevating leg rests

Lightweight active duty wheelchair with dual elevating leg rests

One-arm drive chair with elevating leg rest on the left

Hemiplegic chair with elevating leg rest on the left

The patient is recovering from a right CVA, which has resulted in severe left hemiplegia and visuospatial deficits. Additionally, the person has pitting edema in their left lower extremity. A hemiplegic chair with an elevating leg rest on the left would be the best recommendation for this patient. This type of wheelchair is specifically designed for individuals with hemiplegia, providing support and stability to the affected side while allowing the user to elevate their leg to reduce edema. This chair would accommodate the patient's specific needs and help facilitate their recovery and mobility.

Explanation

The patient is recovering from a right CVA, which has resulted in severe left hemiplegia and visuospatial deficits. Additionally, the person has pitting edema in their left lower extremity. A hemiplegic chair with an elevating leg rest on the left would be the best recommendation for this patient. This type of wheelchair is specifically designed for individuals with hemiplegia, providing support and stability to the affected side while allowing the user to elevate their leg to reduce edema. This chair would accommodate the patient's specific needs and help facilitate their recovery and mobility.

54. A child with mild spastic diplegia wants to participate in neighborhood activities with peers. The family's main goal for the child is to ride a bicycle. Which bicycle is best for the occupational therapist to recommend?

A hand-propelled bicycle with hand brakes

A foot-propelled bicycle with hand brakes

A foot-propelled bicycle with foot brakes

An adapted tricycle with foot brakes

A foot-propelled bicycle with hand brakes would be the best recommendation for the child with mild spastic diplegia. This type of bicycle allows the child to use their lower extremities to propel themselves forward, which can help improve their leg strength and coordination. The hand brakes provide an additional level of control and safety, allowing the child to easily stop the bicycle when needed. This combination of foot propulsion and hand brakes would be most suitable for the child's needs and goals.

Explanation

A foot-propelled bicycle with hand brakes would be the best recommendation for the child with mild spastic diplegia. This type of bicycle allows the child to use their lower extremities to propel themselves forward, which can help improve their leg strength and coordination. The hand brakes provide an additional level of control and safety, allowing the child to easily stop the bicycle when needed. This combination of foot propulsion and hand brakes would be most suitable for the child's needs and goals.

55. An occupational therapist evaluates a client using the Allen Cognitive Level (ACL) Screen. The client successfully completes three running stitches. Which step should the therapist take next?

Demonstrate the whip stitch and ask the client to imitate this and complete three stitches

Demonstrate the single cordovan stitch and ask the client to imitate this and complete three stitches

Demonstrate the double cordovan stitch and ask the client to imitate this and complete three stitches

Document that the person demonstrates a cognitive level consistent with Level 3 of Cognitive Disabilities Model

The correct answer is to demonstrate the whip stitch and ask the client to imitate this and complete three stitches. This is the next step because the client has successfully completed three running stitches, indicating that they have the ability to imitate and replicate a demonstrated stitch. By demonstrating the whip stitch and asking the client to imitate it, the therapist can assess the client's ability to learn and perform a new stitch, which provides further information about their cognitive level and abilities.

Explanation

The correct answer is to demonstrate the whip stitch and ask the client to imitate this and complete three stitches. This is the next step because the client has successfully completed three running stitches, indicating that they have the ability to imitate and replicate a demonstrated stitch. By demonstrating the whip stitch and asking the client to imitate it, the therapist can assess the client's ability to learn and perform a new stitch, which provides further information about their cognitive level and abilities.

56. An individual is status post carpal tunnel release. When the occupational therapist conducts a sensory test for sharp/dull (pain), the person reports dull as sharp on the palmar surface of the thumb and index finger. All other responses were correct. Which is accurate for the therapist to document about the individual's sensation?

Impaired for pain along C5 and C6 dermatomes

Hypersensitive along the ulnar nerve distribution of the palmar surface of the hand

Hypersensitive along the median nerve distribution of the thumb and index fingers

Absent for pain along the median nerve distribution

The individual's report of dull as sharp on the palmar surface of the thumb and index finger suggests hypersensitivity along the median nerve distribution. This is because the median nerve innervates the thumb and index fingers, and the abnormal sensation indicates an exaggerated response to sharp stimuli in this area. The other options, such as impaired for pain along C5 and C6 dermatomes or hypersensitivity along the ulnar nerve distribution, do not accurately explain the individual's specific sensory findings.

Explanation

The individual's report of dull as sharp on the palmar surface of the thumb and index finger suggests hypersensitivity along the median nerve distribution. This is because the median nerve innervates the thumb and index fingers, and the abnormal sensation indicates an exaggerated response to sharp stimuli in this area. The other options, such as impaired for pain along C5 and C6 dermatomes or hypersensitivity along the ulnar nerve distribution, do not accurately explain the individual's specific sensory findings.

57. The occupational therapist plans intervention for a client with a recent diagnosis of complex regional pain syndrome (CRPS) Type 1. Which intervention approach is most effective to use to reduce pain and increase function?

Hot packs

Biofeedback

Paraffin

Passive range of motion

Biofeedback is the most effective intervention approach to use for a client with complex regional pain syndrome (CRPS) Type 1. Biofeedback is a technique that helps individuals gain control over their physiological processes by providing real-time feedback about their body's responses. It can be used to reduce pain and increase function by teaching the client to regulate their autonomic nervous system and reduce stress levels. By using biofeedback, the client can learn to control their pain and improve their overall functioning.

Explanation

Biofeedback is the most effective intervention approach to use for a client with complex regional pain syndrome (CRPS) Type 1. Biofeedback is a technique that helps individuals gain control over their physiological processes by providing real-time feedback about their body's responses. It can be used to reduce pain and increase function by teaching the client to regulate their autonomic nervous system and reduce stress levels. By using biofeedback, the client can learn to control their pain and improve their overall functioning.

58. Upon screening, an eight-month old child demonstrates a positive downward parachute reflex. Which action should the occupational therapist take next in response to this observed behavior?

Document that child exhibits normal reflex development

Document that child exhibits developmental delay

Evaluate the protective extension downward reflex

Evaluate the standing tilting reflex

The correct answer is to document that the child exhibits normal reflex development. The downward parachute reflex is a protective reflex that typically emerges around 6-9 months of age. It is characterized by the extension of the arms and legs when the child is tilted downward. This reflex is an important milestone in motor development and indicates that the child's central nervous system is developing appropriately. By documenting that the child exhibits normal reflex development, the occupational therapist acknowledges that the child is progressing as expected in their motor development.

Explanation

The correct answer is to document that the child exhibits normal reflex development. The downward parachute reflex is a protective reflex that typically emerges around 6-9 months of age. It is characterized by the extension of the arms and legs when the child is tilted downward. This reflex is an important milestone in motor development and indicates that the child's central nervous system is developing appropriately. By documenting that the child exhibits normal reflex development, the occupational therapist acknowledges that the child is progressing as expected in their motor development.

59. The client is now seven weeks postoperation. Which are the most appropriate intervention activities for the occupational therapist to use with this client?

Home management activities such as doing laundry

Light activities of daily living such as grooming

Strengthening exercises using high resistance theraband

Passive exercises using a dynamic splint

The client is now seven weeks postoperation, indicating that they have had enough time to recover and regain some level of function. Light activities of daily living, such as grooming, are appropriate intervention activities for the occupational therapist to use with this client at this stage. These activities will help the client regain independence and improve their functional abilities. Home management activities such as doing laundry may still be too physically demanding, while strengthening exercises using high resistance theraband and passive exercises using a dynamic splint may not be necessary or appropriate at this point in the client's recovery.

Explanation

The client is now seven weeks postoperation, indicating that they have had enough time to recover and regain some level of function. Light activities of daily living, such as grooming, are appropriate intervention activities for the occupational therapist to use with this client at this stage. These activities will help the client regain independence and improve their functional abilities. Home management activities such as doing laundry may still be too physically demanding, while strengthening exercises using high resistance theraband and passive exercises using a dynamic splint may not be necessary or appropriate at this point in the client's recovery.

60. An occupational therapist plans individual and group activities for a child with oppositional defiant disorder. Which is most important for the therapist to address during group activities?

Child's willingness to take on a variety of group roles

Child's ability to attend to complete a task

Child's distorted body image

Child's self-regulation of energy and activity levels

The most important aspect for the therapist to address during group activities for a child with oppositional defiant disorder is their ability to attend to complete a task. This is crucial because children with this disorder often struggle with staying focused and completing tasks, which can hinder their participation and progress in group activities. By addressing and improving their ability to attend and complete tasks, the therapist can help the child engage effectively in the group activities and enhance their overall development and functioning.

Explanation

The most important aspect for the therapist to address during group activities for a child with oppositional defiant disorder is their ability to attend to complete a task. This is crucial because children with this disorder often struggle with staying focused and completing tasks, which can hinder their participation and progress in group activities. By addressing and improving their ability to attend and complete tasks, the therapist can help the child engage effectively in the group activities and enhance their overall development and functioning.

61. A nine-year-old girl with diagnosis of cystic fibrosis is hospitalized in a small rural hospital. Currently, there are no other children in the hospital and the hospital does not have a pediatric play area. The head nurse asks the occupational therapist to suggest appropriate play activities that hospital volunteers can provide for the child. Which is the most age appropriate activity for the therapist to suggest?

Dressing paper dolls

Coloring in coloring books

Playing card games

Cutting and pasting pictures onto cards

Playing card games would be the most age-appropriate activity for the therapist to suggest. Card games can be engaging and entertaining for a nine-year-old girl, providing mental stimulation and social interaction. It can also help improve her cognitive skills, such as memory, concentration, and strategic thinking. Additionally, card games can be easily adapted to accommodate different skill levels and can be played with just one or two players, making it suitable for the current situation where there are no other children in the hospital.

Explanation

Playing card games would be the most age-appropriate activity for the therapist to suggest. Card games can be engaging and entertaining for a nine-year-old girl, providing mental stimulation and social interaction. It can also help improve her cognitive skills, such as memory, concentration, and strategic thinking. Additionally, card games can be easily adapted to accommodate different skill levels and can be played with just one or two players, making it suitable for the current situation where there are no other children in the hospital.

62. An elementary school student is referred to occupational therapy to improve fine motor skills. The student is having difficulty drawing simple shapes (i.e. circle, square, and triangle) and cutting a straight line with scissors. Which of the following activities is best to help develop the arches of the hand and increase hand strength to improve the student's ability to grasp a writing utensil or scissors?

Spell vocabulary words using 3-D letter shapes

Identify simple shapes with vision occluded

Complete a puzzle lying prone on the floor

Chair push-ups before tabletop activities

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Explanation

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63. An individual with a body mass index (BMI) of 35 is joining a community-based wellness program conducted by an occupational therapist. When formulating an individualized wellness plan, which condition should the occupational therapist take into consideration as an increased risk for this person?

Hypothermia during exertion

Hyperthermia during exertion

Rapid weight loss during the initial weeks

Increased anxiety and depression

An individual with a BMI of 35 is considered obese, which puts them at an increased risk of hyperthermia during exertion. Obesity can impair the body's ability to regulate temperature, leading to overheating during physical activity. This can be dangerous and potentially lead to heat-related illnesses such as heat exhaustion or heat stroke. Therefore, the occupational therapist should consider hyperthermia during exertion as an increased risk for this person when formulating their wellness plan.

Explanation

An individual with a BMI of 35 is considered obese, which puts them at an increased risk of hyperthermia during exertion. Obesity can impair the body's ability to regulate temperature, leading to overheating during physical activity. This can be dangerous and potentially lead to heat-related illnesses such as heat exhaustion or heat stroke. Therefore, the occupational therapist should consider hyperthermia during exertion as an increased risk for this person when formulating their wellness plan.

64. A client recovering from left CVA demonstrates increased flexor tone in the dominant right upper extremity while trying to relearn to write with the left hand. Which of the following is most accurate for the therapist to state the client is exhibiting when documenting this observation?

Associated reaction

Crossed flexion reaction

Tonic labyrinthine reflex

Asymmetrical tonic neck reflex

The therapist would state that the client is exhibiting an associated reaction when documenting this observation. An associated reaction refers to an involuntary movement that occurs in a limb opposite to the one being intentionally moved. In this case, the client's dominant right upper extremity is demonstrating increased flexor tone while they are trying to write with their left hand, indicating an associated reaction.

Explanation

The therapist would state that the client is exhibiting an associated reaction when documenting this observation. An associated reaction refers to an involuntary movement that occurs in a limb opposite to the one being intentionally moved. In this case, the client's dominant right upper extremity is demonstrating increased flexor tone while they are trying to write with their left hand, indicating an associated reaction.

65. A child with congenital anomalies has severe developmental delay. The child demonstrates motor and cognitive skills at the nine-month level. Which is the best adaptation for the occupational therapist to use during intervention to develop child's visual and auditory awareness?

A hand-held rattle of the child's favorite cartoon character

A wrist bracelet with blinking lights that make noise when moved

A button switch that activates a CD player when the switch is pressed

A communication device that offers selections of "yes" and "no"

The best adaptation for the occupational therapist to use during intervention to develop the child's visual and auditory awareness is a button switch that activates a CD player when the switch is pressed. This adaptation encourages the child to use their motor skills to press the button and activates the CD player, which provides auditory stimulation. It also helps develop the child's visual awareness as they learn to associate the action of pressing the button with the sound produced by the CD player. This adaptation promotes the child's overall development and helps improve their visual and auditory awareness.

Explanation

The best adaptation for the occupational therapist to use during intervention to develop the child's visual and auditory awareness is a button switch that activates a CD player when the switch is pressed. This adaptation encourages the child to use their motor skills to press the button and activates the CD player, which provides auditory stimulation. It also helps develop the child's visual awareness as they learn to associate the action of pressing the button with the sound produced by the CD player. This adaptation promotes the child's overall development and helps improve their visual and auditory awareness.

66. In an outpatient rehabilitation clinic, an occupational therapist is developing a fall prevention group for at risk elderly clients with Parkinson's disease. The clients live alone and have had at least three falls within the past six months. When presenting strategies to prevent falls, which is the most common risk factor for falls in the elderly that the therapist should review with the clients?

Ascending and descending stairs

Dressing while seated in chair

Walking with walker with wheels

Transferring out of the shower with grab bars

The therapist should review ascending and descending stairs as the most common risk factor for falls in the elderly. This is because navigating stairs requires balance, coordination, and strength, which can be challenging for individuals with Parkinson's disease. By addressing this specific activity, the therapist can provide strategies and exercises to improve the clients' ability to safely navigate stairs and reduce the risk of falls.

Explanation

The therapist should review ascending and descending stairs as the most common risk factor for falls in the elderly. This is because navigating stairs requires balance, coordination, and strength, which can be challenging for individuals with Parkinson's disease. By addressing this specific activity, the therapist can provide strategies and exercises to improve the clients' ability to safely navigate stairs and reduce the risk of falls.

67. An occupational therapist meets with the patient with fibromyalgia who has had difficulty meeting intervention goals. The patient complains of being hurt and frustrated in attempts to resolve pain and fatigue issues. Which is the most effective technique for the therapist to use to help patient increase insight into this situation?

Offer a variety of options for pain management

Reflect the patient's verbal expressions back to the patient

Refer patient to specialized pain management center

Repeat the patient's exact words back to the patient

Reflecting the patient's verbal expressions back to the patient is the most effective technique for the therapist to use to help increase the patient's insight into the situation. By doing so, the therapist validates the patient's feelings and experiences, showing empathy and understanding. This technique can help the patient feel heard and understood, which can contribute to building a therapeutic relationship and increasing insight into their pain and fatigue issues. Offering a variety of options for pain management, referring the patient to a specialized pain management center, and repeating the patient's exact words back to them may also be helpful strategies, but reflecting the patient's verbal expressions back to them is the most effective technique in this context.

Explanation

Reflecting the patient's verbal expressions back to the patient is the most effective technique for the therapist to use to help increase the patient's insight into the situation. By doing so, the therapist validates the patient's feelings and experiences, showing empathy and understanding. This technique can help the patient feel heard and understood, which can contribute to building a therapeutic relationship and increasing insight into their pain and fatigue issues. Offering a variety of options for pain management, referring the patient to a specialized pain management center, and repeating the patient's exact words back to them may also be helpful strategies, but reflecting the patient's verbal expressions back to them is the most effective technique in this context.

68. An individual recovering from a head trauma exhibits a motor pattern indicative of being influenced by symmetrical tonic neck reflex (STNR). Which is most likely for the occupational therapist to observe the client having difficulty with during functional mobility?

Moving both arms to midline when supine

Moving from lying supine to sitting

Flexing the head from supine position

Extending head from prone position

The symmetrical tonic neck reflex (STNR) is a primitive reflex that is typically present in infants and should disappear by the age of 6-9 months. This reflex is characterized by the extension of the head causing the arms to straighten and the legs to flex, and the flexion of the head causing the arms to bend and the legs to extend. In the case of an individual recovering from a head trauma, the presence of the STNR can interfere with functional mobility, particularly when transitioning from lying supine to sitting. This is because the extension of the head during this movement can cause the arms to straighten, making it difficult for the individual to lift themselves into a sitting position.

Explanation

The symmetrical tonic neck reflex (STNR) is a primitive reflex that is typically present in infants and should disappear by the age of 6-9 months. This reflex is characterized by the extension of the head causing the arms to straighten and the legs to flex, and the flexion of the head causing the arms to bend and the legs to extend. In the case of an individual recovering from a head trauma, the presence of the STNR can interfere with functional mobility, particularly when transitioning from lying supine to sitting. This is because the extension of the head during this movement can cause the arms to straighten, making it difficult for the individual to lift themselves into a sitting position.

69. An occupational therapist providing home-based occupational therapy services implements a bed positioning plan for a person recovering from a cerebral vascular accident. The person is receiving care from family members and personal care assistants employed by a home care agency. Which action should the therapist take to ensure the accurate implementations of this plan by the client's caregivers?

Provide verbal step-by-step directions of the desired positions to the client’s caregivers

Post written step-by-step directions of the desired positions on the way by client’s bed

Post pictures of desired positions next to the headboard of client’s bed

Require each caregiver to demonstrate the replication of the desired positions

To ensure the accurate implementation of the bed positioning plan by the client's caregivers, the therapist should post pictures of the desired positions next to the headboard of the client's bed. This visual aid will provide clear and easy-to-understand instructions for the caregivers, allowing them to accurately replicate the desired positions. Verbal directions may be forgotten or misunderstood, and written directions may not be as effective as visual cues in ensuring accurate implementation. Requiring each caregiver to demonstrate the replication of the desired positions may not be practical or necessary in this situation.

Explanation

To ensure the accurate implementation of the bed positioning plan by the client's caregivers, the therapist should post pictures of the desired positions next to the headboard of the client's bed. This visual aid will provide clear and easy-to-understand instructions for the caregivers, allowing them to accurately replicate the desired positions. Verbal directions may be forgotten or misunderstood, and written directions may not be as effective as visual cues in ensuring accurate implementation. Requiring each caregiver to demonstrate the replication of the desired positions may not be practical or necessary in this situation.

70. A therapist in a rehabilitation hospital receives a physician's order to evaluate a patient who has metastatic bone caner with pathologic fracture of the ribs. The physician requests information about the patient's ability to tolerate resistive activities of the upper extremities. Which action is best for the occupational therapist to take in response to this request?

Complete a manual muscle test with less than full resistance

Provide isometric strengthening exercises for the upper extremities

Evaluate tolerance during functional ADL tasks

Initiate theraband stretches and report tolerance to physician

The best action for the occupational therapist to take in response to the physician's request is to evaluate the patient's tolerance during functional activities of daily living (ADLs). This will provide the therapist with valuable information about the patient's ability to perform everyday tasks and assess their overall functional capacity. By observing the patient's performance during ADLs, the therapist can determine if they are able to tolerate resistive activities of the upper extremities and provide appropriate recommendations for their rehabilitation.

Explanation

The best action for the occupational therapist to take in response to the physician's request is to evaluate the patient's tolerance during functional activities of daily living (ADLs). This will provide the therapist with valuable information about the patient's ability to perform everyday tasks and assess their overall functional capacity. By observing the patient's performance during ADLs, the therapist can determine if they are able to tolerate resistive activities of the upper extremities and provide appropriate recommendations for their rehabilitation.

71. An occupational therapist completes a cognitive screening for a person with chronic schizophrenia, undifferentiated type. Therapist uses Allen's cognitive disabilities model to guide the evaluation process. During screening, person is able to imitate whipstitch but cannot imitate single cordovan stitch. Based upon results, the occupational therapist determines that further evaluation is indicated. Which ability is most relevant for therapist to assess?

Performance of multi-step tasks using over trial and error problem-solving

Performance of multi-step tasks using analytical reasoning

Performance of simple tasks independently using visual cues

Performance of simple tasks with long-term repetitive training

The person's ability to imitate the whipstitch but not the single cordovan stitch suggests that they are able to perform simple tasks independently using visual cues. This indicates that they have the visual perception and motor skills necessary to complete the task, but may struggle with more complex problem-solving or analytical reasoning required for multi-step tasks. Therefore, the therapist should assess their ability to perform simple tasks independently using visual cues to further evaluate their cognitive abilities.

Explanation

The person's ability to imitate the whipstitch but not the single cordovan stitch suggests that they are able to perform simple tasks independently using visual cues. This indicates that they have the visual perception and motor skills necessary to complete the task, but may struggle with more complex problem-solving or analytical reasoning required for multi-step tasks. Therefore, the therapist should assess their ability to perform simple tasks independently using visual cues to further evaluate their cognitive abilities.

72. An individual with complete C5 spinal cord injury prepares for discharge. The client plans to return to work as an editor of children's books. Which adaptive equipment is best for the occupational therapist to recommend the client use to access desktop publishing programs?

Wrist splint in the functional position with a slot to hold a typing stick

Balanced forearm orthosis with a slot to hold a typing stick

Wrist-driven flexor hinge splint with a slot to hold a typing stick

Universal cuff to hold a typing stick

The wrist splint in the functional position with a slot to hold a typing stick is the best adaptive equipment for the client to use to access desktop publishing programs. This equipment will provide support and stability to the client's wrist, allowing them to maintain the correct typing position and reduce the risk of wrist strain or fatigue. The slot in the splint will securely hold the typing stick, enabling the client to accurately and efficiently navigate the desktop publishing programs. This adaptive equipment is specifically designed to meet the needs of individuals with C5 spinal cord injury and will enhance the client's ability to perform their job as an editor of children's books.

Explanation

The wrist splint in the functional position with a slot to hold a typing stick is the best adaptive equipment for the client to use to access desktop publishing programs. This equipment will provide support and stability to the client's wrist, allowing them to maintain the correct typing position and reduce the risk of wrist strain or fatigue. The slot in the splint will securely hold the typing stick, enabling the client to accurately and efficiently navigate the desktop publishing programs. This adaptive equipment is specifically designed to meet the needs of individuals with C5 spinal cord injury and will enhance the client's ability to perform their job as an editor of children's books.

73. An individual with moderate intellectual disability moves into a group home. An initial goal established for the resident is the development of socially acceptable table manners. The occupational therapist uses a behavior modification approach to achieve this goal. Which intervention technique is best for the therapist to include in the design of the group home dining experience?

Negative reinforcement for socially inappropriate behaviors

Clear explanations of behaviors expected during dining

Clear explanations about the effects of inappropriate behaviors on others

Rewards for socially appropriate behaviors

The best intervention technique for the therapist to include in the design of the group home dining experience is rewards for socially appropriate behaviors. By providing rewards for socially acceptable table manners, the therapist can reinforce and encourage the resident to engage in these desired behaviors. This positive reinforcement approach will motivate the individual to develop and maintain socially acceptable table manners, ultimately achieving the goal of the intervention.

Explanation

The best intervention technique for the therapist to include in the design of the group home dining experience is rewards for socially appropriate behaviors. By providing rewards for socially acceptable table manners, the therapist can reinforce and encourage the resident to engage in these desired behaviors. This positive reinforcement approach will motivate the individual to develop and maintain socially acceptable table manners, ultimately achieving the goal of the intervention.

74. In an acute inpatient psychiatric facility, an occupational therapist designs a therapeutic activity group for individuals with poor orientation to reality. What is the best activity choice for therapist to provide in this group?

A discussion of the effects of hospitalization on occupational roles

The assembly of wooden toys for a children’s unit

Guided imagery for stress management

Structured verbalizations of personal assets and limitations

The assembly of wooden toys for a children's unit would be the best activity choice for individuals with poor orientation to reality in an acute inpatient psychiatric facility. This activity provides a concrete and tangible task that can help individuals focus and engage in a meaningful way. It also allows for the development of fine motor skills and can provide a sense of accomplishment and satisfaction. Additionally, working with toys designed for children can evoke positive emotions and memories, which can help improve mood and overall well-being.

Explanation

The assembly of wooden toys for a children's unit would be the best activity choice for individuals with poor orientation to reality in an acute inpatient psychiatric facility. This activity provides a concrete and tangible task that can help individuals focus and engage in a meaningful way. It also allows for the development of fine motor skills and can provide a sense of accomplishment and satisfaction. Additionally, working with toys designed for children can evoke positive emotions and memories, which can help improve mood and overall well-being.

75. An adult with amyotrophic lateral sclerosis frequently coughs and chokes when eating finely chopped foods and drinking thin liquids. The speech pathologist and occupational therapist collaborate and recommend a video/fluoroscopy procedure. Which behavioral information would be most relevant for the occupational therapist to include on the referral?

The client demonstrates minimal limitations in cognitive level

The client is able to consume chopped foods and apple juice with no difficulty

The client demonstrates only oral stage problems during eating

The client cannot tolerate therapy focused on improving feeding and swallowing skills

The client's minimal limitations in cognitive level are relevant for the occupational therapist to include on the referral because it suggests that the client's difficulties with coughing and choking while eating and drinking are not due to cognitive impairments. This information helps the occupational therapist to focus on addressing the physical and motor aspects of the client's swallowing and feeding difficulties, rather than cognitive interventions.

Explanation

The client's minimal limitations in cognitive level are relevant for the occupational therapist to include on the referral because it suggests that the client's difficulties with coughing and choking while eating and drinking are not due to cognitive impairments. This information helps the occupational therapist to focus on addressing the physical and motor aspects of the client's swallowing and feeding difficulties, rather than cognitive interventions.

76. An occupational therapist provides services to a homeless shelter, which includes residents who are HIV positive. The therapist conducts several activity groups. Which should the therapist do while working with this population?

Wash hands before and after each group session

Always wear latex gloves during groups

Wear latex gloves when handling food

Implement transmission-based precautions

The therapist should wash their hands before and after each group session when working with a population that includes residents who are HIV positive. This is important to maintain proper hygiene and prevent the spread of any potential infections or diseases. By washing their hands, the therapist can minimize the risk of transmitting any pathogens and ensure the safety and well-being of both themselves and the residents. Wearing latex gloves during groups or when handling food may not be necessary unless there is a specific reason to do so, and implementing transmission-based precautions may not be needed unless there is a known risk of transmission.

Explanation

The therapist should wash their hands before and after each group session when working with a population that includes residents who are HIV positive. This is important to maintain proper hygiene and prevent the spread of any potential infections or diseases. By washing their hands, the therapist can minimize the risk of transmitting any pathogens and ensure the safety and well-being of both themselves and the residents. Wearing latex gloves during groups or when handling food may not be necessary unless there is a specific reason to do so, and implementing transmission-based precautions may not be needed unless there is a known risk of transmission.

77. A teenager with congenital bilateral above-elbow amputations is referred to OT to increase independence in ADL. The adolescent wants to be independent in donning and doffing shirts. Which action is best for the therapist to take first?

Refer the patient to a prosthetist

Evaluate the abdominal strength

Evaluate the use of adapted equipment in dressing

Evaluate trunk and lower extremity ROM

In order to determine the most appropriate intervention for the teenager with bilateral above-elbow amputations, the therapist should first evaluate the range of motion (ROM) in the trunk and lower extremities. This is important because the adolescent will need to rely on their trunk and lower body strength and flexibility to compensate for the lack of arm function. By assessing the ROM, the therapist can determine the level of mobility and potential limitations that may affect the ability to don and doff shirts independently. This evaluation will provide valuable information for developing an effective treatment plan.

Explanation

In order to determine the most appropriate intervention for the teenager with bilateral above-elbow amputations, the therapist should first evaluate the range of motion (ROM) in the trunk and lower extremities. This is important because the adolescent will need to rely on their trunk and lower body strength and flexibility to compensate for the lack of arm function. By assessing the ROM, the therapist can determine the level of mobility and potential limitations that may affect the ability to don and doff shirts independently. This evaluation will provide valuable information for developing an effective treatment plan.

78. A person with traumatic brain injury is assessed to score a 6 on Glasgow Coma Scale. Which should the occupational therapist use to initiate intervention with this person?

Demonstrated directions

Sensory stimulation

Verbal cues

Hand-over-hand assistance

Sensory stimulation should be used to initiate intervention with a person who has a Glasgow Coma Scale score of 6. This is because sensory stimulation helps to awaken and engage the person's senses, promoting arousal and awareness. It can involve various techniques such as providing visual, auditory, tactile, or olfactory stimuli to stimulate the person's sensory pathways and encourage responsiveness. By using sensory stimulation, the occupational therapist can help the person with traumatic brain injury regain consciousness, improve attention, and increase their overall level of engagement in therapeutic activities.

Explanation

Sensory stimulation should be used to initiate intervention with a person who has a Glasgow Coma Scale score of 6. This is because sensory stimulation helps to awaken and engage the person's senses, promoting arousal and awareness. It can involve various techniques such as providing visual, auditory, tactile, or olfactory stimuli to stimulate the person's sensory pathways and encourage responsiveness. By using sensory stimulation, the occupational therapist can help the person with traumatic brain injury regain consciousness, improve attention, and increase their overall level of engagement in therapeutic activities.

79. A person is 5 days post coronary artery bypass graft (CABG). The patient expresses anxiety about performing any type of activity and reports chest pain during ambulation. The cardiologist has approved activities at a metabolic equivalent (MET) level of 2-3. Which activity is best for the occupational therapist to use when initiating intervention with this person?

Grooming while standing at the sink

Grooming in sitting

Sponge bathing while sitting

Performing light housework

Grooming while standing at the sink is the best activity for the occupational therapist to use when initiating intervention with this person because it allows the patient to gradually increase their activity level while still being within the approved MET level of 2-3. Standing and grooming at the sink requires more energy expenditure compared to sitting activities like grooming or sponge bathing, but it is still a relatively low-intensity activity that is suitable for a person who is 5 days post CABG and experiencing anxiety and chest pain during ambulation. Performing light housework may be too strenuous at this stage of recovery.

Explanation

Grooming while standing at the sink is the best activity for the occupational therapist to use when initiating intervention with this person because it allows the patient to gradually increase their activity level while still being within the approved MET level of 2-3. Standing and grooming at the sink requires more energy expenditure compared to sitting activities like grooming or sponge bathing, but it is still a relatively low-intensity activity that is suitable for a person who is 5 days post CABG and experiencing anxiety and chest pain during ambulation. Performing light housework may be too strenuous at this stage of recovery.

80. An elementary school student with hypotonic cerebral palsy receives school-based occupational therapy to improve fine motor skills. The child holds a thick marker with a static tripod grasp and holds a No.2 pencil with a gross grasp. The occupational therapist revises the intervention plan based on the child's attained skills. Which grasp would be best for the therapist to address next in the revised occupational therapy intervention plan?

Dynamic tripod with thick marker

Static tripod with a pencil

Lateral pinch with a thick marker

Dynamic tripod with a pencil

The correct answer is "Static tripod with a pencil." This is because the child is already using a static tripod grasp with a thick marker, indicating that they have developed some level of fine motor control. Introducing a pencil and continuing to work on the static tripod grasp will help the child transfer their skills to a different tool and improve their fine motor skills further.

Explanation

The correct answer is "Static tripod with a pencil." This is because the child is already using a static tripod grasp with a thick marker, indicating that they have developed some level of fine motor control. Introducing a pencil and continuing to work on the static tripod grasp will help the child transfer their skills to a different tool and improve their fine motor skills further.

81. A child with short attention span and processing difficulties is referred to occupational therapy. Based on the results of a screening, the therapist decides to focus the evaluation on sensory processing performance skills. Which should the therapist evaluate?

Form constancy

Right-left discrimination

Proprioception

Spatial relations

The therapist should evaluate proprioception. Proprioception refers to the body's ability to sense its position, movement, and orientation in space. Children with short attention span and processing difficulties may have challenges with proprioception, which can affect their ability to coordinate movements and maintain balance. By evaluating proprioception, the therapist can assess the child's sensory processing skills and develop appropriate interventions to address any deficits in this area.

Explanation

The therapist should evaluate proprioception. Proprioception refers to the body's ability to sense its position, movement, and orientation in space. Children with short attention span and processing difficulties may have challenges with proprioception, which can affect their ability to coordinate movements and maintain balance. By evaluating proprioception, the therapist can assess the child's sensory processing skills and develop appropriate interventions to address any deficits in this area.

82. An older adult diagnosed three years ago with dementia, Alzheimer type has been admitted to the hospital for regulation of medication. The occupational therapist determines that the patient demonstrates diminished memory skills since the previous evaluation, but is still able to live independently at home with support and supervision. During the discharge planning meeting, which activity should the therapist recommend family members perform for the patient?

Weeding the garden

Sorting and folding laundry

Preparing cold sandwiches

Cooking hot meals

The therapist should recommend family members to perform the activity of cooking hot meals for the patient. This is because the patient has demonstrated diminished memory skills, indicating a decline in cognitive abilities. Cooking hot meals requires more complex cognitive skills compared to weeding the garden, sorting and folding laundry, or preparing cold sandwiches. By having family members cook hot meals for the patient, it ensures that the patient receives proper nutrition and reduces the risk of accidents or injuries that may occur during cooking.

Explanation

The therapist should recommend family members to perform the activity of cooking hot meals for the patient. This is because the patient has demonstrated diminished memory skills, indicating a decline in cognitive abilities. Cooking hot meals requires more complex cognitive skills compared to weeding the garden, sorting and folding laundry, or preparing cold sandwiches. By having family members cook hot meals for the patient, it ensures that the patient receives proper nutrition and reduces the risk of accidents or injuries that may occur during cooking.

83. A seven-year-old child with spina bifida at the C7 level receives home-based occupational therapy services. Which ability is most relevant for occupational therapist to focus on during intervention?

Dressing lower body

Dressing upper body

Brushing teeth

Playing tabletop games

Given that the child has spina bifida at the C7 level, which affects the lower body, it is most relevant for the occupational therapist to focus on dressing the lower body during intervention. Spina bifida at this level can result in paralysis or weakness in the lower limbs, making it challenging for the child to independently dress their lower body. By addressing this ability, the occupational therapist can help the child gain independence and improve their overall functional skills.

Explanation

Given that the child has spina bifida at the C7 level, which affects the lower body, it is most relevant for the occupational therapist to focus on dressing the lower body during intervention. Spina bifida at this level can result in paralysis or weakness in the lower limbs, making it challenging for the child to independently dress their lower body. By addressing this ability, the occupational therapist can help the child gain independence and improve their overall functional skills.

84. An adult with arthritis of both hands has ulnar drift of myofascial pain syndrome (MPS) during finger extension and flexion and at rest. The patient also has lengthening of the central slips of the extensor digitorum communis tendons of the right index and middle fingers. Which of the following should the occupational therapist report the person is exhibiting?

Swan-neck deformities

Trigger-finger deformities

MP palmar subluxation-dislocations

Boutonniere deformities

The occupational therapist should report that the person is exhibiting Boutonniere deformities. This is indicated by the ulnar drift of myofascial pain syndrome during finger extension and flexion and at rest, as well as the lengthening of the central slips of the extensor digitorum communis tendons of the right index and middle fingers. Boutonniere deformities occur when there is a flexion deformity at the proximal interphalangeal joint and hyperextension at the distal interphalangeal joint.

Explanation

The occupational therapist should report that the person is exhibiting Boutonniere deformities. This is indicated by the ulnar drift of myofascial pain syndrome during finger extension and flexion and at rest, as well as the lengthening of the central slips of the extensor digitorum communis tendons of the right index and middle fingers. Boutonniere deformities occur when there is a flexion deformity at the proximal interphalangeal joint and hyperextension at the distal interphalangeal joint.

85. During meal preparation asks the client ignores items on the left side of the counter. The therapist decides to use a compensatory functional approach to improve client's performance. Which is the most appropriate method for the therapist to use during intervention to develop meal preparation skills?

Encourage bilateral activities

Place all items on the right side of the counter

Practice scanning activities

Place a brightly colored placemat on the left side of the counter

Placing a brightly colored placemat on the left side of the counter can help the client improve their meal preparation skills by increasing their attention and awareness of items on that side. The bright color can serve as a visual cue, drawing the client's attention to the left side of the counter and prompting them to acknowledge and interact with the items there. This method can help the client overcome their tendency to ignore items on the left side and promote more balanced and efficient meal preparation.

Explanation

Placing a brightly colored placemat on the left side of the counter can help the client improve their meal preparation skills by increasing their attention and awareness of items on that side. The bright color can serve as a visual cue, drawing the client's attention to the left side of the counter and prompting them to acknowledge and interact with the items there. This method can help the client overcome their tendency to ignore items on the left side and promote more balanced and efficient meal preparation.

86. A child with myelomeningocele meets the short term goals of achieving functional gross grasp and lateral pinch. After several additional weeks of occupational therapy, the child does not meet the goals of demonstrating pincer grasp and three jaw chuck. Consequently, the therapist modifies the child's intervention plan. Which intervention is best to include in the revised plan?

Splint the index finger in 30° PIP flexion and 30° DIP flexion to achieve pincer grasp

Increase strength of lateral pinch as a basis to develop pincer grasp and three jaw chuck

Teach the child to use gross grasp and lateral pinch for functional activities

Teach the child to use ulnar grasp for functional activities

The child with myelomeningocele has not been able to achieve the goals of demonstrating pincer grasp and three jaw chuck after several weeks of therapy. Therefore, the therapist modifies the intervention plan to include teaching the child to use gross grasp and lateral pinch for functional activities. This intervention is best because it focuses on utilizing the child's current abilities and strengths to perform functional tasks. By teaching the child to use gross grasp and lateral pinch, they can still engage in activities despite not being able to achieve more advanced grasping techniques.

Explanation

The child with myelomeningocele has not been able to achieve the goals of demonstrating pincer grasp and three jaw chuck after several weeks of therapy. Therefore, the therapist modifies the intervention plan to include teaching the child to use gross grasp and lateral pinch for functional activities. This intervention is best because it focuses on utilizing the child's current abilities and strengths to perform functional tasks. By teaching the child to use gross grasp and lateral pinch, they can still engage in activities despite not being able to achieve more advanced grasping techniques.

87. An adult diagnosed with multiple sclerosis (MS) over 10 years ago experiences exacerbation of symptoms. The individual's principle complaint is decreased strength and endurance. The person can ambulate short distances within a cane in the home and uses a wheelchair outside of the home. The client asks for suggestions to enable independent home maintenance. Which is the best positioning recommendation for the occupational therapist to suggest the person use during meal preparation?

Sitting in the wheelchair with a tray table

Sitting at the kitchen table

Leaning against the counter while standing

Leaning against a tall stool while standing

Sitting at the kitchen table is the best positioning recommendation for the individual during meal preparation. This allows the person to have a stable surface to work on and provides support for decreased strength and endurance. Sitting in the wheelchair with a tray table may not provide enough stability and may limit the person's ability to reach items on the table. Leaning against the counter while standing or leaning against a tall stool while standing may not provide enough support for the individual's decreased strength and endurance.

Explanation

Sitting at the kitchen table is the best positioning recommendation for the individual during meal preparation. This allows the person to have a stable surface to work on and provides support for decreased strength and endurance. Sitting in the wheelchair with a tray table may not provide enough stability and may limit the person's ability to reach items on the table. Leaning against the counter while standing or leaning against a tall stool while standing may not provide enough support for the individual's decreased strength and endurance.

88. An occupational therapist implements an activity program at a hospital that provides long-term care to elderly persons with severe and persistent mental illnesses (SPMI). The occupational therapist uses a sensorimotor approach to guide the program design. Which activity is best for the therapist to incorporate into a group?

Ballroom dancing using pictures of feet on the floor as visual cues for dance steps

Exercising along with a video routine

A sing-along using songbooks and recorded music

Keeping balloons afloat while music plays

The activity of keeping balloons afloat while music plays is the best choice for the occupational therapist to incorporate into a group. This activity engages both the sensorimotor skills and the cognitive abilities of the elderly persons with severe and persistent mental illnesses. It requires hand-eye coordination and physical movement to keep the balloons in the air, while also providing auditory stimulation through the music. Additionally, the activity promotes social interaction and group participation, which can have therapeutic benefits for the individuals in the long-term care setting.

Explanation

The activity of keeping balloons afloat while music plays is the best choice for the occupational therapist to incorporate into a group. This activity engages both the sensorimotor skills and the cognitive abilities of the elderly persons with severe and persistent mental illnesses. It requires hand-eye coordination and physical movement to keep the balloons in the air, while also providing auditory stimulation through the music. Additionally, the activity promotes social interaction and group participation, which can have therapeutic benefits for the individuals in the long-term care setting.

89. An occupational therapist works in a program for survivors of domestic violence. Which of the following would the therapist do when using a client-centered approach?

Offer specific concrete behavioral suggestions for dealing with confrontations

Respond to participants’ self-deprecating comments with positive feedback on personal characteristic

Reinforce only the participant’s neutral comments about themselves and personal skills

Reflectively paraphrase the participants’ statements to help clarify their feelings

In a client-centered approach, the occupational therapist would reflectively paraphrase the participants' statements to help clarify their feelings. This means that the therapist would listen attentively to the participants' comments and then repeat or rephrase what they said in order to show understanding and help them gain insight into their own emotions. This approach focuses on the client's own experiences and feelings, rather than offering concrete suggestions or reinforcing neutral comments. By reflecting and clarifying their feelings, the therapist can support the participants in exploring their emotions and working towards healing and growth.

Explanation

In a client-centered approach, the occupational therapist would reflectively paraphrase the participants' statements to help clarify their feelings. This means that the therapist would listen attentively to the participants' comments and then repeat or rephrase what they said in order to show understanding and help them gain insight into their own emotions. This approach focuses on the client's own experiences and feelings, rather than offering concrete suggestions or reinforcing neutral comments. By reflecting and clarifying their feelings, the therapist can support the participants in exploring their emotions and working towards healing and growth.

90. Following a left CVA, an individual receives OT services at a sub-acute rehabilitation facility. The patient's personal goal is to be independent in dressing. The patient demonstrates decreased memory, poor sequencing skills, and ideational apraxia. Which of the following is most effective for the therapist to provide when teaching one-handed dressing techniques to this patient?

Step-by-step verbal instructions

Sequenced photographs of the steps in dressing

Physical prompts to initiate steps in dressing

Full length mirror for the client to observe self-dressing performance

Physical prompts to initiate steps in dressing is the most effective method for teaching one-handed dressing techniques to a patient with decreased memory, poor sequencing skills, and ideational apraxia. This is because the patient may have difficulty remembering and sequencing the steps involved in dressing independently. Physical prompts can help the patient initiate and complete each step correctly. Verbal instructions may be difficult for the patient to remember and follow, while sequenced photographs may not be as effective in providing immediate guidance. A full-length mirror may be helpful for the patient to observe their self-dressing performance, but physical prompts would be more beneficial in addressing the specific deficits mentioned.

Explanation

Physical prompts to initiate steps in dressing is the most effective method for teaching one-handed dressing techniques to a patient with decreased memory, poor sequencing skills, and ideational apraxia. This is because the patient may have difficulty remembering and sequencing the steps involved in dressing independently. Physical prompts can help the patient initiate and complete each step correctly. Verbal instructions may be difficult for the patient to remember and follow, while sequenced photographs may not be as effective in providing immediate guidance. A full-length mirror may be helpful for the patient to observe their self-dressing performance, but physical prompts would be more beneficial in addressing the specific deficits mentioned.

91. An adolescent student with Duchenne muscular dystrophy and depression is being evaluated for a power wheelchair. Which is the most important area to be considered during the occupational therapy evaluation of the student's readiness for wheelchair?

Level of interest

Fine motor skills

Cognitive skills

Postural control

During the occupational therapy evaluation for a power wheelchair, the most important area to consider is the student's cognitive skills. This is because operating a power wheelchair requires cognitive abilities such as attention, problem-solving, decision-making, and spatial awareness. The student needs to have the cognitive capacity to understand and follow safety instructions, navigate their environment, and make appropriate judgments while using the wheelchair. Without adequate cognitive skills, the student may not be able to safely and effectively use the power wheelchair, which could potentially lead to accidents or injuries.

Explanation

During the occupational therapy evaluation for a power wheelchair, the most important area to consider is the student's cognitive skills. This is because operating a power wheelchair requires cognitive abilities such as attention, problem-solving, decision-making, and spatial awareness. The student needs to have the cognitive capacity to understand and follow safety instructions, navigate their environment, and make appropriate judgments while using the wheelchair. Without adequate cognitive skills, the student may not be able to safely and effectively use the power wheelchair, which could potentially lead to accidents or injuries.

92. A client participates in occupational therapy for intervention following a rotatory cuff injury. The therapist provides progressive resistive exercises. When grading these exercises, which of the following is best for the therapist to increase?

The amount of resistance provided with stronger level of therapy band

The range of motion involved in completing the exercises

The proximal load on the muscles the client uses during the exercises

The repetitions of external rotation exercises with less distal weight

The therapist should increase the amount of resistance provided with a stronger level of therapy band. This is because progressive resistive exercises involve gradually increasing the resistance to challenge the muscles and promote strength and endurance. By increasing the resistance provided by the therapy band, the therapist can ensure that the client is continually challenged and making progress in their rehabilitation.

Explanation

The therapist should increase the amount of resistance provided with a stronger level of therapy band. This is because progressive resistive exercises involve gradually increasing the resistance to challenge the muscles and promote strength and endurance. By increasing the resistance provided by the therapy band, the therapist can ensure that the client is continually challenged and making progress in their rehabilitation.

93. An individual recovering from hepatitis type C as decreased upper and lower extremity muscle strength, and hypertension. Six months ago the client had an angioplasty and is very fearful of having a heart attack. Which should the occupational therapist instruct the client to perform to increase muscle strength?

Isotonic exercises

Isometric exercises

Contract-relax exercise

Muscle contractions and holds

Isotonic exercises involve the movement of joints and muscles through a full range of motion, which can help to increase muscle strength. By performing isotonic exercises, the individual can improve their upper and lower extremity muscle strength. This will help to address the decreased strength that they are experiencing. Additionally, isotonic exercises can also have cardiovascular benefits, which may help to alleviate the client's fear of having a heart attack.

Explanation

Isotonic exercises involve the movement of joints and muscles through a full range of motion, which can help to increase muscle strength. By performing isotonic exercises, the individual can improve their upper and lower extremity muscle strength. This will help to address the decreased strength that they are experiencing. Additionally, isotonic exercises can also have cardiovascular benefits, which may help to alleviate the client's fear of having a heart attack.

94. An adult with persistent balance difficulty and a history of recent falls (two in the last 3 months) receives home care occupational therapy services. During the initial session, which client factors are most important for the occupational therapist to consider?

Spinal musculoskeletal changes secondary to degenerative joint disease

Cardiovascular endurance and level of dyspnea during IADL

Mental functions of attention and orientation during functional mobility

Sensory functions and sensory organization of balance

The most important client factors for the occupational therapist to consider in this scenario are sensory functions and sensory organization of balance. This is because the client has persistent balance difficulty and a history of recent falls, indicating a potential issue with their balance and coordination. By assessing their sensory functions and sensory organization of balance, the occupational therapist can identify any sensory deficits or impairments that may be contributing to their balance difficulties. This information will then guide the development of an appropriate treatment plan to address these specific issues and improve the client's balance and overall functional mobility.

Explanation

The most important client factors for the occupational therapist to consider in this scenario are sensory functions and sensory organization of balance. This is because the client has persistent balance difficulty and a history of recent falls, indicating a potential issue with their balance and coordination. By assessing their sensory functions and sensory organization of balance, the occupational therapist can identify any sensory deficits or impairments that may be contributing to their balance difficulties. This information will then guide the development of an appropriate treatment plan to address these specific issues and improve the client's balance and overall functional mobility.

95. An elementary school student with autism is referred to occupational therapy. One of the student's goals is to self-initiate goal-directed play to decrease the frequency of self-stimulating behaviors of hand waving and rocking. The student's verbal communication is impaired but the student compensates by using picture cards to let others know what is wanted or needed. Which of the following approaches to initiate self-play in the home environment is best for the occupational therapist to suggest to the student's parents?

Provide limited choices using picture cards and only give verbal praise when the child participates in the chosen play activity

Include the child in after-school programs to socialize with other children and provide role modeling opportunities for typical play behaviors

Provided limited play choices using picture cards, encourage choosing and give verbal praise when child chooses an activity

The best approach for the occupational therapist to suggest to the student's parents is to provide limited play choices using picture cards, encourage choosing, and give verbal praise when the child chooses an activity. This approach takes into consideration the student's impaired verbal communication and compensates by using picture cards. By providing limited choices, the therapist allows the student to have some control over their play activity while still promoting self-directed decision making. Encouraging the child to choose and providing verbal praise reinforces positive behavior and helps decrease the frequency of self-stimulating behaviors.

Explanation

The best approach for the occupational therapist to suggest to the student's parents is to provide limited play choices using picture cards, encourage choosing, and give verbal praise when the child chooses an activity. This approach takes into consideration the student's impaired verbal communication and compensates by using picture cards. By providing limited choices, the therapist allows the student to have some control over their play activity while still promoting self-directed decision making. Encouraging the child to choose and providing verbal praise reinforces positive behavior and helps decrease the frequency of self-stimulating behaviors.

96. The occupational therapist administers the Allen Cognitive Level (ACL) Screen to an individual. During this evaluation, the most complex behavior the individual can perform is to do the three running stitches, imitating the therapist's example. Based upon these results, the therapist selects an activity to use for intervention that is consistent with the individual's functional level. According to the Cognitive Disabilities Model, which activity is best for the therapist to use when implementing intervention with this patient?

Exercises that require imitation of another’s posture

Sorting laundry by matching colors of clothing items

Sanding wooden bookends

Planning a three-course meal

Based on the information provided, the individual's most complex behavior is imitating the therapist's example of doing three running stitches. This suggests that the individual has a moderate cognitive impairment and is at a lower functional level. Sanding wooden bookends would be the most appropriate activity for intervention because it requires a moderate level of cognitive ability and motor skills. The other activities listed, such as sorting laundry and planning a three-course meal, may be too complex for the individual's current cognitive level.

Explanation

Based on the information provided, the individual's most complex behavior is imitating the therapist's example of doing three running stitches. This suggests that the individual has a moderate cognitive impairment and is at a lower functional level. Sanding wooden bookends would be the most appropriate activity for intervention because it requires a moderate level of cognitive ability and motor skills. The other activities listed, such as sorting laundry and planning a three-course meal, may be too complex for the individual's current cognitive level.

97. The occupational therapist plans the client's early mobilization program. Which is the most appropriate exercise routine for the occupational therapist to use within the limits of a dorsal block splint?

Active flexion / Passive extension

Active flexion / Active extension

Active extension / Passive flexion

Passive flexion / Passive extension

The most appropriate exercise routine for the occupational therapist to use within the limits of a dorsal block splint is active extension / passive flexion. This means that the client will actively extend their affected joint while the therapist assists with passive flexion. This exercise routine allows for movement and stretching of the joint while still providing support and protection with the dorsal block splint.

Explanation

The most appropriate exercise routine for the occupational therapist to use within the limits of a dorsal block splint is active extension / passive flexion. This means that the client will actively extend their affected joint while the therapist assists with passive flexion. This exercise routine allows for movement and stretching of the joint while still providing support and protection with the dorsal block splint.

98. A person recovering from a cerebral vascular accident has left-sided weakness and dysphagia. Which of the following is the most effective direct intervention approach to help the person successfully swallow ingested food?

Provide pureed, thick liquids

Provide thermal stimulation to inferior faucial arches

Tilt the person's head back and towards the left side

Provide small, warm boluses

Providing small, warm boluses is the most effective direct intervention approach to help the person successfully swallow ingested food. Small boluses reduce the risk of aspiration by minimizing the amount of food or liquid entering the mouth at once. Warm temperature can enhance swallowing function and improve the coordination of swallowing muscles. This approach is particularly beneficial for individuals with left-sided weakness and dysphagia, as it promotes safe and efficient swallowing while minimizing the risk of choking or aspiration.

Explanation

Providing small, warm boluses is the most effective direct intervention approach to help the person successfully swallow ingested food. Small boluses reduce the risk of aspiration by minimizing the amount of food or liquid entering the mouth at once. Warm temperature can enhance swallowing function and improve the coordination of swallowing muscles. This approach is particularly beneficial for individuals with left-sided weakness and dysphagia, as it promotes safe and efficient swallowing while minimizing the risk of choking or aspiration.

99. An individual recently had a left transfemoral amputation as a result of complications of diabetes. The client is 2 years status-post a right transtibial amputation as a result of same precipitant. The client is referred to OT for preprosthetic interventions. The referral notes that the complications of neuromas and phantom limb pain are present in left residual limb. Which intervention is best for occupational therapist to implement during first session?

Upper extremity strengthening with emphasis on the biceps

Percussion to the left lower extremity’s residual limb

Upper extremity strengthening with emphasis on the triceps

Lower extremity dressing with emphasis on donning and doffing prostheses

The client has complications of neuromas and phantom limb pain in the left residual limb. These complications are specific to the lower extremity. Therefore, the best intervention for the occupational therapist to implement during the first session would be upper extremity strengthening with emphasis on the triceps. This intervention focuses on the upper extremities, which are not affected by the complications in the lower extremity.

Explanation

The client has complications of neuromas and phantom limb pain in the left residual limb. These complications are specific to the lower extremity. Therefore, the best intervention for the occupational therapist to implement during the first session would be upper extremity strengthening with emphasis on the triceps. This intervention focuses on the upper extremities, which are not affected by the complications in the lower extremity.

100. An occupational therapist works in a school system with a child with developmental delays. One of the goals of treatment is to develop pre-writing skills. The child exhibits ability o grasp a pencil proximally with crude approximation of thumb, index and middle fingers and ring and little fingers slightly flexed. Therapist develops an intervention plan. Which grasp should be the focus for implementation of intervention?

Digital pronate grasp

Static tripod posture grasp

Dynamic tripod grasp

Palmar supinate grasp

The dynamic tripod grasp should be the focus for implementation of intervention. This grasp involves holding the pencil with the thumb and index finger, while the pencil rests on the middle finger. This grasp allows for precise control and movement of the pencil, which is important for developing pre-writing skills. The child's current grasp, with the thumb, index, and middle fingers approximating the pencil, is a crude approximation of the dynamic tripod grasp. By focusing on developing this grasp, the therapist can help the child improve their pre-writing skills.

Explanation

The dynamic tripod grasp should be the focus for implementation of intervention. This grasp involves holding the pencil with the thumb and index finger, while the pencil rests on the middle finger. This grasp allows for precise control and movement of the pencil, which is important for developing pre-writing skills. The child's current grasp, with the thumb, index, and middle fingers approximating the pencil, is a crude approximation of the dynamic tripod grasp. By focusing on developing this grasp, the therapist can help the child improve their pre-writing skills.

What Is Occupational Therapy?

1. A nine-year-old child identifies the assembly of a model as the most desired play activity. The occupational therapist determines that the child would have difficulty completing the selected model. Which action is most effective for therapist to take during next intervention session?

2.

What first name or nickname would you like us to use?

2. A patient is recovering from a right total hip placement (posterolateral incision, cementless fixation). Which is the best type of bed-to-wheelchair transfer for the occupational therapist to teach the patient to use?

3. An individual with developmental disabilities scores a Level 3 on the Allen Cognitive Level Test. Which activities should the occupational therapist include in the intervention plan to help meet the client's functional needs?

7. A person recovering from skin grafting due to full thickness burns is prescribed splints to immobilize the grafted areas in anti-deformity positions. Which splint-wearing schedule is best to include in splinting protocol for first 72 hours post-surgery?

8. A child with tactile defensiveness is receiving intervention from an occupational therapist using a sensory integrative approach. Which method is most effective for therapist to use when introducing tactile stimuli to the child?

9. An individual is recovering from deep partial thickness burns on the upper extremities, chest, and lower neck. The occupational therapist provides equipment to prevent positions that can result in contractures. Which are the most important positions for the therapist to prevent?

11. An individual with Parkinson's disease exhibits difficulty moving from sitting in a chair to standing. Which technique is best for the therapist to recommend the person use to help successfully complete this functional mobility activity?

13. During an intervention session, a client complains of dry mouth due to prescribed medications. What is the most effective strategy for the occupational therapist to suggest to the client to manage this side effect?

19. An occupational therapist receives a referral to evaluate an individual's executive functioning following a mild cerebral vascular accident. Which are the most relevant foci for this evaluation?

21. The parents of a school-aged child with Rett syndrome ask the occupational therapist for activities to do at home to help their child regain lost skills. Which of the following should the therapist include in the home program for the parents to do with their child?

23. A two-year-old child receives home care early intervention services. The occupational therapy intervention plan includes a goal to develop child's pincer grasp. Which is the most appropriate activity for the occupational therapist to work on with the child during an intervention session?

24. An occupational therapist develops a task group for the newly admitted patients of a psychiatric inpatient unit of a busy city hospital. The therapist considers several activities to use for the group's first session. Which activity is best for the therapist to present to the group members?

25. A person blinded in an accident begins an occupational therapy program for persons with vision loss. The occupational therapist collaborates with the individual to develop an intervention plan. Which should be included in the plan as an initial focus of intervention?

26. An individual with bilateral proximal weakness identifies a goal of independence in self-feeding. Which equipment is most beneficial for the occupational therapist to recommend for goal attainment?

30. An occupational therapist is evaluating a child with developmental delay characterized by hypotonicity. According to the Rood approach, which is the first stability pattern that the therapist should facilitate during intervention?

32. A ten-year-old with congenital anomalies wears bilateral ankle-foot orthoses. The parents want the child to be able to don and doff shoes independently, but the child cannot tie shoes. Which is the beast footwear recommendation for the therapist to make for the child to wear?

33. An occupational therapist conducts an in-service at an outpatient wheelchair clinic for individuals with central nervous system dysfunction. According to the principles of wheelchair prescription, which of the following statements is accurate for the therapist to make during the presentation?

34. A client in the descending phase of Guillain-Barré syndrome has bilateral shoulder strength of 2/5. The client fatigues easily. Which equipment should the occupational therapist recommend to enhance the person's performance of activities of daily living?

35. An elementary school teacher has been recently diagnosed with multiple sclerosis (MS). Which adaptation is best for the occupational therapist to recommend the teacher use to accommodate for effects of MS on classroom teaching?

36. In measuring the ROM of a client's elbow, the occupational therapist records a flexion measurement of 145°. Which is the most accurate for the therapist to document based on this measurement?

39. The parents of an infant born at 32 weeks gestation are about to take the baby home after four weeks in the neonatal intensive care nursery. Which is most important for the occupational therapist to instruct the parents to avoid?

40. An adult recently diagnosed with scleroderma receives occupational therapy services to deal with the functional changes caused by this disease. Which recommendation is best for the occupational therapist to make to this individual?

41. An individual with spinal cord injury at C7 reports noticeable redness on the ischial tuberosity during self-examination with a mirror. Which action is most effective for the occupational therapist to recommend in response to client's observations?

44. An adult incurred an injury to the anterior spinal artery at the T12 level. The occupational therapist completes a sensory evaluation with this client. Which sensation is most likely for the therapist to document that the individual has retained?

47. A home care occupational therapist sees to enhance an elder's compliance with occupational therapy intervention program. After discussing the goals of the program with the person, which intervention is most effective for the therapist to use?

48. An elder with peripheral neuropathies resulting from the chronic effects of diabetes expresses concern over the ability to have a satisfying sexual relationship with a partner. Which is the most beneficial recommendation for the occupational therapist to make to the elder?

49. A child with developmental delay has mastered the ability to cut simple figure shapes with scissors. Which scissor activity is best for the occupational therapist to next introduce to child?

53. A patient is recovering from right CVA resulting in severe left hemiplegia and visuospatial deficits. The person's left lower extremity has pitting edema. Which wheelchair would be best for the occupational therapist to recommend for this patient?

54. A child with mild spastic diplegia wants to participate in neighborhood activities with peers. The family's main goal for the child is to ride a bicycle. Which bicycle is best for the occupational therapist to recommend?

55. An occupational therapist evaluates a client using the Allen Cognitive Level (ACL) Screen. The client successfully completes three running stitches. Which step should the therapist take next?

57. The occupational therapist plans intervention for a client with a recent diagnosis of complex regional pain syndrome (CRPS) Type 1. Which intervention approach is most effective to use to reduce pain and increase function?

58. Upon screening, an eight-month old child demonstrates a positive downward parachute reflex. Which action should the occupational therapist take next in response to this observed behavior?

59. The client is now seven weeks postoperation. Which are the most appropriate intervention activities for the occupational therapist to use with this client?

60. An occupational therapist plans individual and group activities for a child with oppositional defiant disorder. Which is most important for the therapist to address during group activities?

64. A client recovering from left CVA demonstrates increased flexor tone in the dominant right upper extremity while trying to relearn to write with the left hand. Which of the following is most accurate for the therapist to state the client is exhibiting when documenting this observation?

65. A child with congenital anomalies has severe developmental delay. The child demonstrates motor and cognitive skills at the nine-month level. Which is the best adaptation for the occupational therapist to use during intervention to develop child's visual and auditory awareness?

68. An individual recovering from a head trauma exhibits a motor pattern indicative of being influenced by symmetrical tonic neck reflex (STNR). Which is most likely for the occupational therapist to observe the client having difficulty with during functional mobility?

72. An individual with complete C5 spinal cord injury prepares for discharge. The client plans to return to work as an editor of children's books. Which adaptive equipment is best for the occupational therapist to recommend the client use to access desktop publishing programs?

74. In an acute inpatient psychiatric facility, an occupational therapist designs a therapeutic activity group for individuals with poor orientation to reality. What is the best activity choice for therapist to provide in this group?

76. An occupational therapist provides services to a homeless shelter, which includes residents who are HIV positive. The therapist conducts several activity groups. Which should the therapist do while working with this population?

77. A teenager with congenital bilateral above-elbow amputations is referred to OT to increase independence in ADL. The adolescent wants to be independent in donning and doffing shirts. Which action is best for the therapist to take first?

78. A person with traumatic brain injury is assessed to score a 6 on Glasgow Coma Scale. Which should the occupational therapist use to initiate intervention with this person?

81. A child with short attention span and processing difficulties is referred to occupational therapy. Based on the results of a screening, the therapist decides to focus the evaluation on sensory processing performance skills. Which should the therapist evaluate?

83. A seven-year-old child with spina bifida at the C7 level receives home-based occupational therapy services. Which ability is most relevant for occupational therapist to focus on during intervention?

89. An occupational therapist works in a program for survivors of domestic violence. Which of the following would the therapist do when using a client-centered approach?

91. An adolescent student with Duchenne muscular dystrophy and depression is being evaluated for a power wheelchair. Which is the most important area to be considered during the occupational therapy evaluation of the student's readiness for wheelchair?

92. A client participates in occupational therapy for intervention following a rotatory cuff injury. The therapist provides progressive resistive exercises. When grading these exercises, which of the following is best for the therapist to increase?

94. An adult with persistent balance difficulty and a history of recent falls (two in the last 3 months) receives home care occupational therapy services. During the initial session, which client factors are most important for the occupational therapist to consider?

97. The occupational therapist plans the client's early mobilization program. Which is the most appropriate exercise routine for the occupational therapist to use within the limits of a dorsal block splint?

98. A person recovering from a cerebral vascular accident has left-sided weakness and dysphagia. Which of the following is the most effective direct intervention approach to help the person successfully swallow ingested food?