AOTA-Questions Flashcards
A client diagnosed with dissociative identity disorder (DID) is admitted to an inpatient psychiatric hospital as a result of suicidal behavior and impulses, severe anxiety, and periods of disruptive behavior brought on by the emergence of new personalities. How is the OTR® in this milieu therapy setting likely to intervene?
A] Provide a safe, nonthreatening, success-oriented environment to increase the client’s sense of control.
B] Offer group therapy opportunities for verbalizing experiences and describing other personalities.
C] Offer group training in development of coping skills.
D] Offer participation in psychodrama groups to encourage catharsis.
Solution: The correct answer is A.
Clients in the acute phases of DID require opportunities for safe and supportive exploration of new personalities.
B, C, D: These options describe cathartic, verbal, and coping groups, respectively, which are not recommended for clients with DID. Clients with DID will tend to show more severe symptoms when provided with more opportunities to self-express, such as in nondirective cathartic and verbal groups.
A client who has schizophrenia stopped taking prescribed antipsychotic medications 2 weeks ago and is experiencing rhythmic tongue movements, grimacing, and lip smacking. What neurological condition is associated with these symptoms?
Postural hypotension
Tardive dyskinesia
Increased hypoglycemia
Tyramine reaction
Solution: The correct answer is B.
Tardive dyskinesia involves facial movements and writhing motions of the tongue and fingers as a result of antipsychotic medication. It can persist even after medication discontinuation.
A: Postural hypotension is a possible side effect of antipsychotic drugs; however, it does not result in the movements described in the scenario.
C: Hypoglycemia involves a drop in blood sugar, which may be a result of antipsychotic medications. This side effect does not result in the movements described in the scenario.
D: Tyramine reaction is a side effect of antipsychotic drugs; however, it does not results in the movements described in the scenario.
An OTR® wants to develop a group activity for clients with personality disorder in an inpatient psychiatric facility. The group has Allen Cognitive Level (ACL) scores ranging from 5.0 to 5.4. What activity would be MOST appropriate to use with these clients in the initial stages of the group?
A] Volunteer activities in the community
B] Long-term budgeting for house repairs
C] Vocational retraining and job seeking
D] Role playing social interactions
Solution: The correct answer is D.
People with personality disorders and people with an ACL in the low 5s have difficulty with social interactions because they are egocentric. Role playing social interactions would be best option when initiating a group with these clients. Improving social interaction will form the basis for the rest of the interventions appropriate for this group.
A: Volunteer activities would be more appropriate for clients at ACL 5.6 and above. The tasks involved would be too complex for lower levels.
B: Long-term budgeting and house maintenance would be more appropriate for clients at ACL 5.6 and above. The tasks involved would be too complex for lower levels.
C: Vocational retraining and job seeking would be appropriate for clients at ACL 5.2 and above, but job seeking would be more appropriate for clients at ACL 5.4 and above, and levels for vocational training could vary. Clients at ACLs from 5.2 to 5.4 would need more repetition in training to solve problems and create solutions so that they would not have to problem-solve independently.
Using the Allen Cognitive Level Screen–5 for screening, followed by use of the Allen Diagnostic Module and the Routine Task Inventory for confirmation of screening results, an OTR® identifies Level 4 as the current level of functioning of a client in an adult day treatment center. What is the MOST appropriate scenario for activity completion for this client?
The activity includes mostly familiar steps but has one step requiring new learning.
The activity involves relatively repetitive and routine tasks.
The activity includes a model of the completed project for the client to imitate.
The activity is designed to encourage relatively independent planning and organizing to complete tasks.
Solution: The correct answer is C.
Level 4 activities typically require a model as a guide to task completion, simple directions, and unshared tools. Unstructured tasks, problem solving, planning, and even independent completion of unfamiliar steps without guidance are likely too challenging for a person at Level 4.
A: This choice is appropriate for Level 5 of the Allen Cognitive Level Screen. A client at Level 5 can engage in trial-and-error learning and use inductive reasoning to find new ways of performing activities.
B: This choice is appropriate for Level 3 of the Allen Cognitive Level Screen. A client at Level 3 can engage in repetitive, unstructured actions.
D: This choice is appropriate for Level 6 of the Allen Cognitive Level Screen. A client at Level 6 can anticipate problems and resolve problems or challenges mentally.
A team of OTR®s begins to recognize the need for a program to promote work participation for the young adults with mental illness they serve. Which statement MOST accurately reflects the evidence about developing such a program?
Prevocational training sufficiently prepares clients with mental illness for work.
Supported employment programs with a “place-and-train” perspective are more effective than other vocational approaches.
Transitional employment placement through a clubhouse model is a time-honored method for increasing job placement.
Sheltered workshops are useful programs for advancing work participation.
Solution: The correct answer is B.
Current rehabilitation focus is on the place-and-train supportive employment approach, and evidence supports its use.
A, C, D: Prevocational training, transitional employment, and sheltered workshops use the classic train-then-place methodology. Because of the emphasis on preparatory skills in these settings, opportunities to transfer skills to actual work settings yield a lower percentage of employment.
During an initial interview with a young adult who has mild autism, the OTR® notices that the client lives alone and is isolated, does not go out much, does not value family relationships, and does not seem to have any friends. Additionally, the client is not gainfully employed and does not take care of the apartment. The client spends most of the day surfing the Web and watching TV. Using the Model of Human Occupation, which of the following assessments would be the MOST appropriate?
A projective test such as House–Tree–Person
Worker Role Interview
Role Checklist
Canadian Occupational Performance Measure
Solution: The correct answer is C.
The Role Checklist gathers information on the client’s former and current roles and the value the client places on these roles, consistent with the Model of Human Occupation.
A: A projective test such as the House–Tree–Person is not designed to evaluate roles or role behavior but rather to reveal a client’s personality.
B: The Worker Role Interview is associated with the Model of Human Occupation and would yield valuable information, but it is too narrowly focused on the worker role.
D: The Canadian Occupational Performance Measure helps clients identify their perceptions of their own occupational performance.
With the Allen Diagnostic Module, an OTR® measures a client at an Allen Cognitive Level (ACL) of 4.0. The OTR is working with the client in an adult day treatment center. When the OTR is designing intervention activities, what type of project is appropriate for this client?
A project with mostly familiar steps; no more than two steps of the task should require new learning.
A project that is unstructured; the client should be given opportunities for hands-on manipulation of materials.
A project that is set up with a model final product; simple instructions should be provided, along with supervision.
A project that encourages relatively independent planning and organizing to complete.
Solution: The correct answer is C.
A person with an ACL of 4.0 can perform only simple tasks and will have difficulty with problem solving. A model with clear instructions should be provided along with supervision for cues and guidance when needed.
A: This type of project would be more appropriate for a client with an ACL of 5; a client at this ACL level will still be challenged with problem solving.
B: This type of project would be more appropriate for a client with an ACL of 3; a client at this level is not able to be goal directed and would do best with projects that are unstructured and focus on object manipulation and tactile cues.
D: This type of project would be appropriate for a client with an ACL of 6, because a client at this level should be able to independently plan activities.
An OTR® is working in a clubhouse with a group of clients who have mental health issues. Which leadership style would be MOST effective?
Director
Authority figure
Facilitator
Advisor
Solution: The correct answer is D.
The Clubhouse Model puts the locus of control on the members. When designing groups, the members formulate the goals, and the OTR® acts as an advisor.
A, B: Leading a group as a director or authority figure is not congruent with the Clubhouse Model, in which the clients direct the program. Although at times the OTR may need to provide the group with some direction, control of the goals and decision making remain in the hands of group participants.
C: A group leader as facilitator maintains control over goals and decision making, so this leadership style would not be best for this group.
Which occupational therapy group would benefit MOST from a highly directive leadership style?
A group of preschool children exploring sensory experiences
A group of adolescents attending a gang prevention group in an alternative education setting in which they have been placed for behavioral issues stemming from a diagnosis of oppositional defiant disorder
A group of middle-aged clients in an outpatient day treatment setting who are learning to manage their depression following inpatient hospitalization
A group of healthy older adults in an apartment complex exploring ways to stay fit and healthy
Solution: The correct answer is B.
Adolescents, particularly those diagnosed with oppositional defiant disorder, need boundaries; a directive leadership style, in which the leader selects activities and determines group structure, is critical to successfully managing this group.
A: Children engaging in exploratory sensory experiences should be allowed to direct their activity choices whenever possible.
C: An outpatient treatment facility is designed for clients who have stabilized enough to live independently, so these clients can be more self-directed and would not require an authoritative or directive leader.
D: Although elements of a voluntary group for well elders may require the OTR to be more directive at times, such as during an exercise session, overall the group focus should be client centered.
A client with multiple sclerosis (MS) is displaying symptoms of depressed mood. The client has been referred to occupational therapy by a physician because of increasing feelings of difficulty with life tasks secondary to depression. The OTR® asks how the client feels, and the client responds, “I just don’t feel like I can do anything right.” Which strategy would be appropriate for the OTR to implement?
Provide tasks that are graded for successful completion
Implement energy conservation techniques
Provide fine motor tasks to improve motor skills
Discuss areas of life in which the client feels unhappy
Solution: The correct answer is A.
Providing the client with a task that is graded for successful completion gives the client an opportunity to feel a sense of mastery over the environment.
B: Although a client with MS might benefit from energy conservation techniques, the client’s statement indicates that the client is struggling with feelings of decreased mastery of the environment secondary to depression. Energy conservation does not specifically address the need identified reflected in the statement.
C: Providing fine motor tasks for someone who has MS might be indicated, but it would not specifically address the concern discussed in the question.
D: Discussing unhappy feelings would be considered a psychological approach and not necessarily provided by OTRs as a specific intervention strategy. This technique could be used to help develop future interventions, however.
An 18-year-old client is admitted to an inpatient psychiatric hospital. The psychiatrist describes an uninterrupted 18-month period of illness that includes visual and auditory hallucinations. What type of issues would the OTR® expect to see when the client attempts to do a task?
Behavioral outbursts when frustrated with a project
Overassertive, controlling behaviors during group activities
Difficulty engaging in problem solving
Panic over task choices
Solution: The correct answer is C.
Clients with schizophrenia often have cognitive impairments, such as difficulty with working memory and executive function, which can interfere with task performance.
A, B, D: These behaviors are more indicative of Bipolar I disorder. Bipolar I disorder typically consists of more than one combined depressive and manic episode. Schizophrenia includes symptoms such as hallucinations, delusions, and disorganized speech.
Of what is the place-and-train approach an example?
Supported employment
Transitional employment
Job matching
The clubhouse model
Solution: The correct answer is A.
The place-and-train approach first places the client in a supported employment situation and then trains the client to do the job.
B, C, D: These are examples of work participation settings in which occupational therapists work, but these settings do not use the place-and-train model.
