Spec Pop Final

Question 1

Which of the following strategies would be helpful for an elder who has perceptual difficulties?

A. Instruct the elder to put the fork or spoon down between bites to pace the amount of food entering the mouth.
B. Limit conversation while eating to prevent aspiration.
C. Alternate food textures during the meal, order foods that are easy to chew, or have six small meals per day instead of three.
D. Use hand-over-hand guiding to provide tactile cueing while bringing food to the mouth.

Answer 1

D. Use hand-over-hand guiding to provide tactile cueing while bringing food to the mouth.

Question 2

Which of the following is a safe swallowing technique during the pharyngeal phase of swallowing for elders with dysphagia?

A. Elders with hemiplegia should be given less time between bites to swallow.
B. Check for voice clarity after swallowing to make sure no food was left on the vocal folds.
C. Limit swallowing to one or two swallows after taking a bite of food.
D. Elders with hemiplegia can tilt their heads backward to prevent aspiration.

Answer 2

B. Check for voice clarity after swallowing to make sure no food was left on the vocal folds.

Question 3

Which of the following strategies would be useful to the elder who is on a ventilator or has difficulty breathing?

A. Instruct the elder to put the fork or spoon down between bites to pace the amount of food entering the mouth.
B. Limit conversation while eating.
C. Alternate food textures during the meal, order foods that are easy to chew, or have six small meals per day instead of three.
D. Use hand-over-hand guiding to provide tactile cueing while bringing food to the mouth.

Answer 3

B. Limit conversation while eating.

Question 4

Which elder would benefit from the use of an assistive device for self-feeding?

A. An elder with slight tremors of both hands and history of a stroke in the dominant arm
B. An elder with severe dementia who only has a sucking reflex
C. An elder with no grasp in the dominant arm
D. All of the above

Answer 4

D. All of the above

Question 5

You are considering making a few suggestions for improving the dining experience for elders in an assisted living facility. Which of the following would you recommend as an environmental change to improve social interaction during mealtimes?

A. Take food items off the serving tray and place them directly on the table.
B. Provide natural light without glare or soft, diffused overhead lighting.
C. Turn off the TV during the meals and use age-appropriate soft music.
D. Serve the meals soon after the elders arrive at the table.

Answer 5

C. Turn off the TV during the meals and use age-appropriate soft music.

Question 6

You are preparing to feed a frail 70-year-old resident at breakfast in a long-term care facility. Which of the following would you do first?

A. Collect information about the elder such as presence of dysphagia, any recent medical or medication changes, and the current diet order.
B. Create an environment that is positive and conducive to eating.
C. Position the elder in a dining room chair with armrests.
D. Check the food tray to make sure it is the correct diet and any assistive equipment is present.

Answer 6

A. Collect information about the elder such as presence of dysphagia, any recent medical or medication changes, and the current diet order.

Question 7

Select the phase of swallowing where the bolus passes enters the pharynx and the soft palate elevates to seal the entrance to the nose and the vocal folds close.

A. Oral preparatory phase
B. Oral phase
C. Pharyngeal phase
D. Esophageal phase

Answer 7

C. Pharyngeal phase

Question 8

Select the phase of swallowing where the bolus is prepared and formed by the tongue and then propelled by the tongue to the back of the mouth and over the base of the tongue.

A. Oral preparatory phase
B. Oral phase
C. Pharyngeal phase
D. Esophageal phase

Answer 8

B. Oral phase

Question 9

In frail elders, which age-related swallowing change would you expect to see in the pharyngeal phase?

A. Decreased strength in the lips and tongue and jaw muscles may result in drooling, decreased chewing, and problems moving the bolus in the mouth.
B. Food content may reflux from the stomach and reenter the esophagus and pharynx.
C. Cognitive impairment, missing teeth, or poor-fitting dentures may result in slow eating.
D. The time of passage of the bolus increases, increasing the risk of aspiration.

Answer 9

D. The time of passage of the bolus increases, increasing the risk of aspiration.

Question 10

Alex is a COTA who is completing a self-feeding treatment session during breakfast when they notice that another resident across the table loses a great deal of food out of the front of his mouth during feeding. Alex concludes that this resident may have deficits in which phase of the swallow?

A. Oral preparatory
B. Oral
C. Pharyngeal
D. Esophageal

Answer 10

A. Oral preparatory

Question 11

What is the preferred seating method for an elder during mealtime?

A. Geriatric chair
B. Wheelchair
C. Dining room chair with armrests
D. Geriatric chair with armrests

Answer 11

C. Dining room chair with armrests

Question 12

Which of the following activities would be appropriate for an entry-level COTA?

A. Videofluoroscopic swallow studies
B. Correct Meal preparation
C. Assist tracheostomized elder with self-feeding
D. All of the above

Answer 12

B. Correct Meal preparation

Question 13

What is least likely a compensation that elders may make spontaneously to assist themselves in eating safely and efficiently?

A. Smaller bites
B. Longer chewing time
C. Softer food
D. Thicker drinks

Answer 13

D. Thicker drinks

Question 14

In healthy elders, which age-related swallowing change would you expect to see?

A. Muscle tone decreases in the lips, tongue, and esophagus.
B. Cognitive impairments distract elders from eating all of their food.
C. Reflux of stomach contents occurs into the esophagus and pharynx.
D. Decreased endurance in eating limits the amount of time spent eating.

Answer 14

A. Muscle tone decreases in the lips, tongue, and esophagus.

Question 15

When feeding an elder, how would you know when they are ready to take another spoonful or bite of food?

A. It is impossible to know when a person is ready for another bite or spoonful of food, and just raising the spoon to their mouth will trigger the elder to open their mouth.
B. When the COTA is ready to provide the next spoonful or bite of food and a sip of fluids
C. When a few minutes go by and it is time to give another spoonful or bite of food
D. When they have swallowed the last bite of food and signals that they are ready for the next bite of food

Answer 15

D. When they have swallowed the last bite of food and signals that they are ready for the next bite of food

Question 16

Clive was referred for an occupational therapy evaluation for weakness and deconditioning. When reviewing the electronic medical record (EMR), the COTA notices that the he has lost weight over the last 3 months, and she begins to wonder if Clive has dysphagia which is contributing to the weight loss. What information in the EMR might indicate dysphagia or aspiration?

A. Diagnosis of cardiovascular disease
B. Recurrent pneumonias
C. Type II diabetes
D. Previous joint replacement

Answer 16

B. Recurrent pneumonias

Question 17

Vo Nguyen takes her medications with sips of water every morning. However, she states that at times she feels they get stuck after she swallows and requests more water to wash them down. How much liquid is recommended following each pill to ensure adequate transport to the stomach?

A. 10 mL
B. 15 mL
C. 20 mL
D. 45 mL

Answer 17

D. 45 mL

Question 18

Santiago is a COTA who is providing intervention for self-feeding with an elder during breakfast. During the meal, he notices that after the client swallows, there are small bits of food on the back of her tongue. What strategy could Santiago try to help remove food residue after the swallow?

A. Alternating solids and liquids
B. Tongue sweeps
C. Placing food on the center of the tongue
D. Alternating food temperature

Answer 18

A. Alternating solids and liquids

Question 19

Ms. Bell has symptoms of urinary incontinence, including uncontrollable loss of urine when she coughs, laughs, and sneezes. Which type of incontinence does she have?

A. Stress incontinence
B. Overflow incontinence
C. Mixed incontinence
D. Functional incontinence

Answer 19

A. Stress incontinence

Question 20

A COTA is working on a toileting program for a frail elder who has recently experienced a cognitive decline. This elder has had previous problems with skin breakdown related to incontinence so it is imperative to avoid accidents as much as possible. Which of the following would be the best strategy for the COTA to include?

A. Timed voiding and habit training
B. Prompted voiding
C. Bladder training
D. Pelvic floor exercise

Answer 20

B. Prompted voiding

Question 21

Your client is experiencing incontinence only at night and in the early morning when she hears water running. She also has some dribbling when she laughs or coughs. Which type of incontinence does she have?

A. Stress incontinence
B. Overflow incontinence
C. Urge incontinence
D. Mixed incontinence

Answer 21

D. Mixed incontinence

Question 22

Your client is having symptoms of urinary incontinence, including the inability to hold her urine until she gets to the bathroom. What type of incontinence does she have?

A. Stress incontinence
B. Overflow incontinence
C. Urge incontinence
D. Functional incontinence

Answer 22

C. Urge incontinence

Question 23

Your client is a 77-year-old homebound woman living with her daughter and son-in-law in a house. The client has her own large room that serves as a bedroom and living room in one, with an attached large bathroom. The client has a new complaint of incontinence, especially at night. Which of the following adaptations would be most appropriate for this client’s needs?

A. Add incontinence pads and a plastic sheet to the bed to preserve the mattress and bedclothes during the night.
B. Add a call light to the bedroom or a way to signal to the rest of the family when the client needs to ambulate to the bathroom at night.
C. Place a commode near the bedside and a night light on the wall outlet near the commode.
D. Eliminate throw rugs from the bathroom and add a nonskid mat in front of the toilet.

Answer 23

C. Place a commode near the bedside and a night light on the wall outlet near the commode.

Question 24

What is the first step to correcting stress, urge, and mixed incontinence?

A. Prompted voiding
B. Timed voiding and habit training
C. Bladder training
D. Pelvic floor exercise

Answer 24

C. Bladder training

Question 25

How does reimbursement from private and government health insurance programs (Medicare and Medicaid) affect elders with urinary incontinence?

A. Reimbursement for urinary incontinence is covered under all health insurance policies.
B. Poor reimbursement for evaluation and treatment of urinary incontinence encourages management of the problem instead of treatment.
C. Reimbursement does not cover the costs for managing this at home and results in elders being institutionalized.
D. All of the above

Answer 25

B. Poor reimbursement for evaluation and treatment of urinary incontinence encourages management of the problem instead of treatment.

Question 26

How many elders in the community relay incontinence problems to their physicians for treatment?

A. 1 in 10
B. 1 in 5
C. 1 in 3
D. 1 in 2

Answer 26

D. 1 in 2

Question 27

The caregivers of a skilled nursing facility are working with Mr. Jones to decrease episodes of incontinence. When Mr. Jones feels the need to urinate, his caregivers tell him to resist the urge for at least 10 minutes longer than yesterday. What type of strategy is this?

A. Biofeedback
B. Habit training
C. Bladder Training
D. Prompted voiding

Answer 27

C. Bladder Training

Question 28

Which of the following is a major cause of constipation?

A. Lack of exercise
B. Malabsorption
C. C-diff
D. Inflammatory bowel disease

Answer 28

A. Lack of exercise

Question 29

Which of the following health care professionals would treat incontinence by determining the family dynamics and support systems available to elders and help determine the effect that incontinence has on the involvement of elders in social activities and relationships?

A. Dietitians
B. Nurses
C. Social service specialists
D. Speech and language pathologists

Answer 29

C. Social service specialists

Question 30

VRE can spread from one person to another, often via contaminated hands, or through contact with contaminated surfaces (toilet seats, door knobs, grab bars, & walkers).
True
False

Answer 30

True

Question 31

What does VRE stand for?

Answer 31

Vancomycin Resistant Enterococci

Question 32

What is vancomycin? (1 word)

Answer 32

Antibiotic

Question 33

After providing OT tx to an acute care patient that has C-diff, the use of gel-based hand sanitizer or proper hand-washing should be completed before leaving the room.
True
False

Answer 33

False

Question 34

What is polypharmacy?

Answer 34

○ Refers to an individual using multiple medications
○ Increases chance of adverse side effects; 2 meds may have same side effect—double whammy
○ Physicians may prescribe a med to counteract a (misidentified) side effect of an initial medication
○ Multiple specialists may prescribe meds with similar effects/side effects

Question 35

What are the factors Affecting Medication Risk in Elders

Answer 35

○ Elders are the greatest consumers of medication in the population
○ > 40% of elders take 5 or more prescription medications per day; if OTC meds are included the calculation, elders take an estimated 10 medications in a given day
○ Vitamin and herbal supplements may also be used and are under-reported

Question 36

What should the COTA be aware of with meds for elders

Answer 36

○ Be aware of meds the elder is taking and potential side effects
○ Dizziness due to CV meds is common
○ Frequent urination due to diuretics is common; night dosing not indicated > falls, interrupted sleep
○ Muscle pain due to cholesterol-lowering meds is common
○ Easy bruising due to blood-thinning medications may occur; report if bruising is excessive
○ GI distress and HTN due to OTC pain meds
○ Dizziness, drowsiness, and confusion due to narcotic pain meds

Question 37

Strategies for Minimizing Med Probs in Elders

Answer 37

○ Elders may be hesitant to ask questions of various providers that may simplify medication schedules
○ Under- or over-adherence to medication schedules may occur
○ OTC and supplements must be considered when assessing the elder’s medication regimen and schedule

Question 38

What are assistive Aids for meds with Elders?

Answer 38

○ Calendars
○ Pillboxes; advantages, disadvantages
○ Insulin holders
○ Pill splitters
○ Pill crushers
○ Alarms and watches
○ Medication diary
○ Pill cups

Question 39

Role of the COTA for restraints

Answer 39

○ Collaborate with OTR to:
§ Assess the need for restraint
§ Seek alternatives
§ Intervene to avoid restraint use
§ Use the least restrictive intervention that will protect from harm.

Question 40

Environmental Adaptations for restraints

Answer 40

§ Alarms
§ Nursery monitors
§ Comfortable/appropriate seating
§ Familiar pictures or memory boxes outside elder’s room
§ Signage for orientation and safety
§ Adapted beds, adaptations to existing bed