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Question 1

Scenario Item

Use the information in the following scenario to answer the next five questions:

A client had a middle finger PIP joint dislocation of the non-dominant hand 4 weeks ago. The client did not seek medical attention for the injury stating: “I just put it back in place myself and wrapped the joint for comfort until it healed.” The client now has limited ROM of the involved joint and decreased grip strength. The physician consult reads: “Increase ROM, orthosis as indicated.” ROM of the involved digit is as follows:

Active ROM (extension / flexion) 
MCP joint = 0/75 PIP joint = 30/70 
DIP joint = +15/0  
Passive ROM 
MP= 0/85 
PIP= 20/80 
DIP= +35/25 

The client’s primary insurance company requires copies of the initial evaluation prior to authorizing OT visits beyond the first visit. The client is concerned that wearing an orthosis will interfere with work activities.

Item #1:
At a minimum, what information should the OTR document to increase the likelihood of additional authorized visits?
A. Functional problem statements indicating the need for skilled services
B. Calculation of the total active motion for each digit on the affected hand
C. Expected number of times the client will need to have the orthotic modified

Answer 1

Item #1: Correct Answer: A

Rationale: Third-party payers typically base authorization for visits on the medically necessity of skilled care based on evidence of a client’s functional limitations.

Incorrect Responses B: The total active motion calculations may indicate joint restriction but this alone does not indicate a functional deficit. C: Orthosis modification provides an indication of skilled services need, but does not address the functional limitations and additional client needs.

Question 2

Item #2:
Based on the information presented, which deformity BEST describes the client’s finger injury?
A. Boutonniere deformity with joint stiffness
B. Swan-neck deformity with ligament laxity
C. Mallet finger with lateral band disruption

Answer 2

Item #2: Correct Answer: A

Rationale: Boutonniere deformity is described as posturing of the digit in PIP joint flexion with DIP joint hyperextension.

Incorrect Responses: B, C: These conditions are not consistent with the client’s current active and passive ROM measurements.

Question 3

Item #3:
In addition to considering the use of serial casting, which of the following orthotics should the OTR consider when deciding which type of orthotic would be MOST BENEFICIAL for the client’s middle finger?
A. Dorsally-based static PIP and DIP joint extension gutter orthotic secured with self-adhering elastic wrap
B. Volar-based static DIP joint gutter orthotic that permits PIP joint active motion
C. Finger-based dynamic PIP joint extension orthotic extending from the MCP joint crease to the DIP joint crease

Answer 3

Item #3: Correct Answer: C

Rationale: This orthosis promotes PIP joint extension while allowing DIP joint flexion.

Incorrect Responses: A, B: These orthoses do not adequately target the structures/joints needed to address the specific deformity.

Question 4

Item #4:
How should the OTR respond to the client’s concerns about the orthosis?
A. Listen empathetically and remind the client that wearing the orthosis is temporary.
B. Encourage full participation in daily tasks by collaborating on ways to modify typical daily activities.
C. Provide the client with a few assistive devices that require the use of only one hand.

Answer 4

Item #4: Correct Answer: B

Rationale: The OTR used a client-centered strategy to determine the client’s needs and priorities based on the client’s daily activity schedule.

Incorrect Responses: A, C: It is most important to gather information about the needs and priorities of the client prior to providing assistive devices or advice to the client.

Question 5

Item #5:
What type of exercise should be included as part of the client’s home program and would be MOST EFFECTIVE for facilitating lengthening of the oblique retinacular ligaments and promoting glide of the lateral bands?
A. Active and passive DIP joint flexion with the PIP supported in extension
B. Passive PIP joint extension with the MCP joint supported in extension
C. Active PIP joint flexion with the MCP joint blocked in extension

Answer 5

Item #5: Correct Answer: A

Rationale: Active and passive ROM of the DIP joint with the PIP joint supported in extension facilitates lengthening of the oblique retinacular ligament which will help to decrease the hyperextension of the DIP joint.

Incorrect Responses: B, C: These exercises do not effectively target the structure impacted by this injury.

Question 6

An OTR employed at a university-based hospital hand therapy clinic is completing a research proposal investigating the effectiveness of copper tooling versus therapy putty for increasing pinch strength of patients attending the clinic. Which step should the OTR take NEXT as part of research process?

A. Perform a small pilot study on similar subjects.
B. Obtain informed consent from the subjects.
C. Submit the proposal to the facility review board.

Answer 6

Correct Answers: C

Rationale: Prior to conducting research in a hospital setting the study must be approved by the facility’s Institutional Review Board (IRB). The IRB has a legal responsibility to approve and monitor the ethical conduct of research within the facility.

Incorrect Responses: A, B: These options are completed only after obtaining IRB approval.

Question 7

An OTR is designing a wheelchair seating system for a student who has scoliosis secondary to spina bifida. Which feature should be considered FIRST for achieving optimal functional seating?

A. Width and placement of lateral trunk supports
B. Type and contour of the chair seat cushion
C. Position and stability of the pelvis in the chair
D. Configuration and attachment of chest harness

Answer 7

Correct Answers: C

Rationale: Posture is directly linked to overall functional performance. The position and stability of the pelvis is critical in achieving optimal sitting posture.

Incorrect Responses: A, B, D: These features are considered after first assessing the student’s posture and stability in the chair.

Question 8

An OTR is planning a group for clients who have mild-moderate cognitive decline secondary to Alzheimer’s disease. One of the group goals is for the clients to follow directions to complete a tile picture frame. The OTR plans to use a directive leadership style during the group. Which strategy illustrates the use of this group leadership style?

A. Inform the clients of the expected end product by showing them a completed frame at the start of the group.

B. Provide examples of three different framing materials and give general guidelines for how the items could be used.

C. Show the clients several pictures of completed frames and allow each client to decide which frame to make.

Answer 8

Correct Answers: A

Rationale: Clients with this diagnosis require guidance and direction. The OTR should limit choices and provide clear expectations and guidance throughout the activity.

Incorrect Responses: B, C: These options represent a facilitative leadership role. This group leadership style is generally used with clients who are functioning at a higher cognitive level.  

Question 9

Question:

An adolescent-age student has athetoid cerebral palsy and has been participating in school-based OT since pre-school. After transitioning to the sixth grade in a new school, the teachers report the student is not using assistive devices, is sullen, and does not interact with peers. What INITIAL action should the OTR take in response to the teachers’ reports about this student?

A. Revise the IEP goals to focus on student preferences.
B. Establish new goals to work toward self-sufficiency.
C. Develop a transition plan for promoting autonomy.
D. Complete an evaluation using a top-down approach

Answer 9

Correct Answers: D

Rationale: The OTR should first assess the student’s current function in relation to context and curriculum-based needs prior to considering changes to the student’s IEP.

Incorrect Responses: A, B, C: A comprehensive occupation-based assessment should be completed prior to considering these options.

Question 10

Question:

An OTR is evaluating the effectiveness of an OT home program for clients who have been diagnosed with an anxiety disorder. Which qualitative measure would be MOST BENEFICIAL to use as part of this evaluation process?

A. Retrospective record reviews to measure the percentage of clients who attained occupation-based goals
B. Occupational role checklists administered at the start and then several months after completion of the program
C. Standardized, norm-referenced or criterion-referenced occupation-based assessments

Answer 10

Correct Answers: B

Rationale: This method provides the BEST qualitative evidence of the effectiveness of a program based on client-specific occupational roles.

Incorrect Responses: A: These do not provide the BEST qualitative evidence of the effectiveness of the program. C: These types of assessments yield quantitative information.

Question 11

Question:

An OTR has completed an initial evaluation of an 18-month-old child who has hypotonicity. The child’s mother reports the child does not crawl and resists being placed in a hands and knees crawling position. During the evaluation the child is able to maintain head control, roll, and sit unsupported for several minutes. After the OTR places the child in a crawling position, the child is able to maintain the position for about 30 seconds. The child does not spontaneously initiate locomotion. What statement accurately reflects the child’s current motor skills?

A. The child exhibits tactile hypersensitivity that impacts the child’s ability to maintain postural stability.
B. The child has decreased postural stability for completing developmentally appropriate gross motor tasks.
C. The child has the ability to initiate transitional movement patterns and achieve developmentally-appropriate locomotion.
D. The child has the potential to develop skills for engagement in age-appropriate childhood occupations.

Answer 11

Correct Answers: B

Rationale: This statement provides the most accurate information based on the information gathered during the initial evaluation.

Incorrect Responses: A, C, D: The description of the child’s performance does not provide enough evidence to record these statements about the child’s motor skills.

Question 12

Question:

A Level II fieldwork OT student and a supervising OTR are meeting a client for the first time. The OT student greets the client by stating, “I am the occupational therapist who will be working with you.” The supervising OTR immediately informs the client that the student is completing a fieldwork rotation and has not yet graduated from an OT program. After the session, the OTR meets with the student to review the professional code of ethics. Which ethical principle directly relates to this situation?

A. Beneficence
B. Fidelity
C. Veracity

Answer 12

Correct Answers: C

Rationale: Veracity is a duty to avoid deception. In this situation the student is misrepresenting their professional credentials which is a form of deception.

Incorrect Responses: A, B: These ethical principles do not directly relate to this situation.  

Question 13

Question:

An OTR working in an outpatient clinic is using a 360 degree goniometer to measure a client’s active shoulder internal rotation. The client is sitting upright with the shoulder abducted to 90 degrees and the elbow flexed to 90 degrees. At the start position, the OTR places the axis of the goniometer on the olecranon process of the ulna. Where should the OTR position the moveable arm of the goniometer?

A. Parallel to the longitudinal axis of the ulna
B. Perpendicular to the floor of the clinic
C. Along the midline of the client’s torso

Answer 13

Correct Answers: A

Rationale: The stationary arm should be positioned parallel to the forearm.

Incorrect Responses: B, C: The stationary arm should be perpendicular to the floor, which will be parallel to the midline of the client’s torso when the client is sitting fully upright.

Question 14

Question:

An OTR is collaborating with a social worker and a registered nurse to develop a new domestic violence prevention program for a community mental health center. The need for this service has been identified through situational, social and epidemiological analyses. What is the NEXT step in program development when using an ecological model?

A. Establish policies and procedures for the program.
B. Identify a process for tracking program outcomes.
C. Develop multi-disciplinary intervention protocols.
D. Determine behavioral and environmental risk factors

Answer 14

Correct Answers: D

Rationale: Decisions on program format and content should be based on identifying participants’ risk factors and understanding the impact of the environment on behavior.

Incorrect Responses: A, B, C: These steps are completed after behavioral and environmental factors are identified.

Question 15

Question:

An OTR is teaching joint protection strategies to a client recently diagnosed with rheumatoid arthritis. The client enjoys cooking large family meals but pain in the MCP joints and wrist are interfering with the ability to cut meats and vegetables. In addition to recommending the use of an adapted cutting board, which type of knife would be beneficial for the client to use?

A. Serrated knife with finger contoured handle
B. Universal cuff attachment for standard slicing knife
C. Wheel configured knife with non-slip padded grip
D. Carving knife with handle set at 90o angle

Answer 15

Correct Answers: D

Rationale: This type of grip minimizes ulnar forces against the MCP joints during cutting.

Incorrect Responses: A, B, C: These options will not reduce ulnar-directed forces against the MCP joints when cutting.

Question 16

Question:

Which physical agent modality is MOST EFFECTIVE for reducing pain and inflammation within the first 24 to 48 hours of sustaining a soft tissue injury?

A. Fluidotherapy
B. Moist hot packs
C. Cryotherapy
D. Thermal ultrasound

Answer 16

Correct Answers: C

Rationale: Cryotherapy is the application of cold to lower tissue temperature and promote vasoconstriction. This sets up a metabolic process for decreasing inflammation and edema. The application of ice also increases the threshold for pain.

Incorrect Responses: A: Fluidotherapy is a thermal modality that uses forced air that is typically heated between 105-118o Fahrenheit. This modality is not an effective PAM for cooling tissue temperatures.

B: Moist hot packs are a superficial thermal modality typically used to improve soft tissue extensibility.

D: Thermal ultrasound is considered a deep heating modality. Therapeutic effects of thermal ultrasound include increasing blood flow, improving extensibility of tendons ligaments, decreasing muscle spasms and modulating pain.  

Question 17

Question:

An OTR is preparing to administer a standardized developmental screening to a premature infant who is at-risk for developmental delay. In addition to noting the assessment date and the infant’s birth date, what information MUST be gathered in order to calculate the infant’s corrected age?

A. Original projected due date
B. Typical gestational age
C. Number of weeks premature

Answer 17

Correct Answers: A

Rationale: To calculate the corrected age, subtract the prematurity value (due date minus the birth date) from the chronological age (testing date minus the birth date)

Incorrect Responses: B, C: These dates may be helpful as part of the information gathering process but are not needed to calculate the corrected age.

Question 18

Question:

A client who has cognitive and motor deficits secondary to the onset of Huntington’s disease is participating in OT. One of the client’s goals is to be independent with dressing. Which intervention activity is BEST to include as part of the initial intervention plan?

A. Educate the client and caregivers about methods for adapting the fasteners on the client’s clothing.
B. Teach the client to use a sequenced checklist to mark off tasks as they are completed during dressing.
C. Have the client practice using a button-hook and long-handled reacher when completing dressing tasks.
D. Use backward chaining methods and hand-over-hand assistance to teach adapted dressing skills.

Answer 18

Correct Answers: A

Rationale: Huntington’s disease is a disorder characterized by progressive neurodegeneration. Symptoms typically include choreo-athetoid movements and alterations in behavior and cognitive functions. A client who is in the early stages of HD would most benefit from learning techniques to compensate for motor deficits.

Incorrect Responses: B, D: These cognitive strategies may be indicated in the later stages of HD. Cognitive symptoms typically are not associated with onset HD. C: These devices would not be helpful for the client due to the choreo-athetoid movements associated with HD.

Question 19

Question:

A client who has cognitive and motor deficits secondary to the onset of Huntington’s disease is participating in OT. One of the client’s goals is to be independent with dressing. Which intervention activity is BEST to include as part of the initial intervention plan?

A. Educate the client and caregivers about methods for adapting the fasteners on the client’s clothing.
B. Teach the client to use a sequenced checklist to mark off tasks as they are completed during dressing.
C. Have the client practice using a button-hook and long-handled reacher when completing dressing tasks.
D. Use backward chaining methods and hand-over-hand assistance to teach adapted dressing skills.

Answer 19

Correct Answers: A

Rationale: Huntington’s disease is a disorder characterized by progressive neurodegeneration. Symptoms typically include choreo-athetoid movements and alterations in behavior and cognitive functions. A client who is in the early stages of HD would most benefit from learning techniques to compensate for motor deficits.

Incorrect Responses: B, D: These cognitive strategies may be indicated in the later stages of HD. Cognitive symptoms typically are not associated with onset HD. C: These devices would not be helpful for the client due to the choreo-athetoid movements associated with HD.

Question 20

Question:

An OTR has completed the initial evaluation of an inpatient who had a total hip replacement one day ago. Medicare is the primary insurance provider. To maximize third party reimbursement, which statement is BEST to include as part of the initial documentation?

A. “Intervention will include upper extremity exercises to maintain active ROM and strength.” B. “The patient will navigate a front-wheeled walker a distance of at least 30 feet during each session.” C. “OT services are medically necessary to teach movement precautions during self-care tasks.” D. “Daily OT is recommended to monitor the patient’s bathing and dressing skills.”

Answer 20

Correct Answers: C

Rationale: For Medicare reimbursement, the documentation it is necessary to document medical necessity with a functional purpose/outcome. The documentation should clearly differentiate services that require the skill of an occupational therapist and those services that are routine or maintenance in nature.

Incorrect Responses: A: This is a maintenance activity that does not require skilled OT services. B: This is not a unique service requiring skilled OT services. D: This entry does not specify medical necessity related to the patient’s current condition.

Question 21

Question:

An OTR has completed the initial evaluation of an inpatient who had a total hip replacement one day ago. Medicare is the primary insurance provider. To maximize third party reimbursement, which statement is BEST to include as part of the initial documentation?

A. “Intervention will include upper extremity exercises to maintain active ROM and strength.”
B. “The patient will navigate a front-wheeled walker a distance of at least 30 feet during each session.”
C. “OT services are medically necessary to teach movement precautions during self-care tasks.”
D. “Daily OT is recommended to monitor the patient’s bathing and dressing skills.”

Answer 21

Correct Answers: C

Rationale: For Medicare reimbursement, the documentation it is necessary to document medical necessity with a functional purpose/outcome. The documentation should clearly differentiate services that require the skill of an occupational therapist and those services that are routine or maintenance in nature.

Incorrect Responses: A: This is a maintenance activity that does not require skilled OT services. B: This is not a unique service requiring skilled OT services. D: This entry does not specify medical necessity related to the patient’s current condition.

Question 22

Question:

A patient had a myocardial infarction 2 days ago and is participating in Phase I of cardiac rehabilitation. Which of the following activities is CONTRAINDICATED for a patient to do during this phase of rehabilitation?

A. Ambulate from the bed to the bathroom for BADL.
B. Measure perceived exertion during personal hygiene activities.
C. Complete isometrics and stretching prior to lower body dressing.

Answer 22

Correct Answers: C

Rationale: Isometric exercises can affect the cardiovascular system by causing a rapid and sudden increase in blood pressure. This physiological response is contraindicates during this phase of cardiac rehabilitation.

Incorrect Responses: A, B: These activities are typically included in the OT intervention during phase I cardiac rehabilitation.

Question 23

Question:

During an initial OT interview, a patient denies frequent cocaine use and cites a recent bonus as proof that work performance is not being negatively affected by substance use. The patient reports using cocaine only when under a deadline at work or when having to entertain business clients. The patient’s account indicates a lack of insight related to which of the following performance areas?

A. Leisure-time management
B. Current values and interests
C. Interpersonal and coping skills
D. Problem-solving and ethical behavior

Answer 23

Correct Answers: C

Rationale: Based on the patient’s account, the dependence on cocaine use appears to be in direct relation to the patient’s inability to manage stress appropriately. These performance areas should be addressed by developing an intervention plan that facilitates effective interpersonal and coping skill acquisition with the goal of promoting participation in all areas of occupation.

Incorrect Responses: A, B, D: Although these areas may need to be addressed during the occupational therapy intervention, they do not directly relate to the situations described by the patient in the initial interview

Question 24

Question:

A client who had a distal humerus fracture 8 weeks ago has been referred to OT one day after removal of a long arm cast. Evaluation results indicate the client has full functional ROM and normal sensation and skin pallor of the hand. The client rates the pain as a 3/10 using a visual analog scale. Elbow goniometric measurements show the client’s passive elbow ROM is significantly less than the norms. What should the OTR conclude is the PRIMARY cause for this discrepancy?

A. Heterotopic ossification
B. Secondary nerve injury
C. Soft tissue tightness
D. Post-traumatic ischemia

Answer 24

Correct Answers: C

Rationale: Soft tissue changes due to immobilization should be considered as the primary cause of the client’s elbow ROM deficits.

Incorrect Responses: A: This is typically associated with significant pain with active motion and swelling around the affected joint. It has the potential to be a secondary complication associated with aggressive passive ROM. B: Nerve injuries secondary to an elbow fracture typically impact the ROM and sensation of the hand. D: Volkmann’s ischemia is a complication associated with an elbow fracture. A client with this compartment syndrome would have sensory, motor and vascular changes in the hand.

Question 25

Question:

A client had a posterolateral approach total hip arthroplasty 10 days ago. During which of the following activities would assistive devices be MOST BENEFICIAL for the client to use during the rehabilitative phase of recovery?

A. Putting a sock on the unaffected foot while seated on the edge of the bed
B. Slipping the foot of the affected leg into a non-tie shoe while standing
C. Getting clothing that is hanging on a hanger in the bedroom closet

Answer 25

Correct Answer: A

Rationale: The client would have to flex the affected hip more than 90 degrees to complete this task. This movement is contraindicated this soon after the surgery. The client would benefit from the use of a sock-aid during this task.

Incorrect Responses: B, C: These tasks can be completed without a significant amount of hip flexion. Therefore, assistive devices are not indicated during these tasks.