Here's the OTR set of questions.

Just like the OTA set, there may be a couple of questions here with no answers or rationales due to my forgetfulness.) OTR Exam Prep Question: SCENARIO: An OTR attended a professional development activity on sensory integration strategies for children with autism spectrum disorder. During the seminar, the presenters discussed anecdotal evidence for the use of nutritional supplements to improve sensory processing. In researching the topic, the OTR reads a peer-reviewed article that indicates a correlation of 0.01 (r = 0.01) between the use of a specific nutritional supplement and sensory processing skills. The OTR is uncertain if nutritional supplements are within the professional standards of practice for the occupational therapy profession.

MC Question #1: Which organization should the OTR contact for obtaining the most up-to-date resources for resolving this uncertainty? A. National Board Certification in Occupational Therapy (NBCOT) B. National Autism Association (NAA) C. American Council on Occupational Therapy Education (ACOTE) D. American Occupational Therapy Association (AOTA) MC Question #2: What do the research findings from the peer-reviewed article indicate for the level of correlation? A. No correlation B. Low correlation C. High correlation D. Inverse correlation MC Question #3: Which statement BEST describes the findings from the peer-reviewed article? A. No relationship is evident between nutritional supplements and sensory processing skills. B. Sensory processing skills somewhat improved with the use of nutritional supplements. C. Children who have autism spectrum disorder should have

nutritional counseling. D. Children with sensory processing challenges should take nutritional supplements. MC Question #4: Which type of research should the OTR review to obtain the strongest level of evidence regarding this intervention? A. Case report with expert opinion B. Two-groups, non-randomized studies C. Single subject design, case series D. Systematic reviews, meta-analyses

MC1: Correct Answer: D Rationale:The American Occupational Therapy Association (AOTA) publishes the Standards of Practice for Occupational Therapy and the Reference Manual of Official Documents of the American Occupational Therapy Association, Inc. These documents clarify and support occupational therapy practice and define the minimum standards for the practice of occupational therapy. Incorrect Rationale: The NBCOT is responsible for issues related to certification and certification renewal The National Autism Association provides education and resources about autism but does not have jurisdiction about OT practice standards. The ACOTE is responsible for accreditation of occupational therapy education standards in support of the practice standards set forth by the AOTA. Classification: Domain 04 Task 02 Knowledge 09

Reference: http://www.aota.org/Practitioners/Official.aspx MC2: Correct Answer: A Rationale: "When calculating correlation, the symbol representing correlation = r. The interpretation of the correlation coefficient is the strength of the relationship. The following is how values are typically interpreted 0 -.20 suggests a negligible correlation .20-.40 is a low correlation .40-.60 is a moderate correlation .60-.80 is a high correlation .80-1.00 is a very high correlation (Kielhofner, 2006, p. 263) The strongest correlations are 1.00 and -1.00, and if there is no correlation, the correlation coefficient is 0. (Kielhofner, 2006, p. 262). Incorrect Rationale: B, C, D: A correlation of 0 - .20 suggests a negligible correlation Classification: Domain 04 Task 01 Knowledge 04 Reference: Kielhofner, G. (2006). Research in occupational therapy: Methods of inquiry for enhancing practice. Philadelphia, PA: F.A. Davis Co.

MC4: Correct Answer: D Rationale: Systematic reviews are considered to be the strongest level of evidence because they provide an overall conclusion based on review of all the evidence available on the topic. Incorrect Rationale: B, C, A : When considering the strongest level of evidence, these research designs appear lower on the hierarchy of evidence than a systematic review, and therefore may not be the best design to prevent threats to internal validity for an intervention study such as this. Classification: Domain 02 Task 01 Knowledge 02 Reference: Kielhofner G. (2006). Research in Occupational Therapy: Methods of Inquiry for Enhancing Practice. Philadelphia, PA: FA Davis Company. Page: 666-670 OTR Exam Prep Question: A 5-year-old child who has mild developmental delay is learning to self-dress. Most recently, the child has mastered putting on and taking off a coat, as well as buttoning and unbuttoning it. From the dressing tasks listed, which should the child learn to do NEXT based on the typical developmental sequence for dressing? A. Pulling up a jacket zipper B. Putting a belt in pant waistband loops C. Tying shoelaces D. Tightening and fastening a belt buckle Correct Answer: A Rationale: Based on a typical

developmental sequence for dressing, pulling up a jacket zipper would be the next dressing skill the child should learn. When compared to option A, the complexity of the dressing tasks presented in response options B, C, D require higher levels of visual, somatosensory, and fine motor skills, and/or dynamic postural stability. OTR Exam Prep Question: The use of cryotherapy as a physical agent modality (PAM) is CONTRAINDICATED for clients who have which diagnoses? A. Raynauds Phenomenon B. Acute ligament sprain C. Myofascial trigger points D. Tenosynovitis

Correct Answer: A Rationale: B, C, D: Cryotherapy is the recommended modality immediately following an acute injury and during an acute inflammatory phase. These conditions respond positively to the use of a cold PAM

OTR Exam Prep Question: During which home maintenance tasks would symptoms related to constructional apraxia be MOST EVIDENT? A. Washing the interior sides of single pane windows B. Using a roller brush to paint an interior wall of the home C. Vacuuming floors in the main living area of the home D. Following written instructions for installing curtain rods
Rationale: Individuals who have constructional apraxia have difficulty constructing/assembling objects; as in following instructions for installing curtain rods. A, B, C Rationale: These

tasks require motor planning, but they do not require the detailed attention required to install curtain rodsdo not require the detailed attention required to follow instructions for installing the curtain rods.they do not require the detailed attention required to follow instructions for installing the curtain rods

OTR Exam Prep Question: An OTR is preparing to interview an outpatient who has a TBI and is functioning at Level VII (Automatic-Appropriate) on the Rancho Los Amigos Scale. Which characteristic of an individuals cognitive-behavioral function is TYPICALLY included in the description of this level? A. Consistent orientation to person and place B. Realistic judgment for future planning C. Accurate insight about current abilities D. Reliable carry-over of learning for most ADL Correct Answer: A Rationale: Patients at Level VII (Automatic-Appropriate) on the Rancho Los Amigos Scale appear appropriate and oriented. They frequently display robot-like behaviors and require minimal assistance for routine ADL. OTR Exam Prep Question: Scenario: An entry-level OTR who works in a long term care facility is screening a resident who has amyotrophic lateral sclerosis and uses a wheelchair. The residents upper extremity functional strength is Trace (1/5) on the left and Poor Minus (2-/5) on the right. The resident wants to eat meals in the facility dining room but is embarrassed about frequently dropping assistive eating devices and having several incidences of coughing while eating. MC#1: What care coordination task should the OTR

complete FIRST based on the results of the screening? A. Advise the dietary staff to provide the resident with a room temperature clear liquid at every meal. B. Inform the dining staff to cut the residents food into small pieces and provide built-up utensils. C. Ask the physician to write an order for an immediate video fluoroscopy and a pureed diet. D. Coordinate with the multi-disciplinary team to identify specific feeding and swallowing objectives.

Correct Answer: D Rationale: Screening results indicate the residents functional status may be declining. Care coordination with the multi-disciplinary team meets best practice standards. Independent evaluation and intervention of the residents swallowing difficulties is beyond the scope of practice for the entry-level OTR. A, B, C: These options should not be considered until after the team has established feeding and swallowing objectives. Classification: Domain 02 Task 02 Knowledge 02 Reference: Radomski, MV, Trombly-Latham, C (2008). Occupational Therapy for Physical Dysfunction (6th ed.). Baltimore, MD: Lippincott, Williams and Wilkins. Pages 1092-1095, 1322

MC#2: Which of the following symptoms is this resident MOST at risk for experiencing during a meal? A. Light-headedness when moving from a wheelchair to the dining chair B. Heavy sweating, flushed skin, and a pounding headache

after eating C. Variation in voice quality or loss of voice after swallowing D. Regurgitation of food and liquids after swallowing Correct Answer: C Rationale: Amytrophic lateral sclerosis (ALS) is a progressive neurological disease. The residents symptoms of coughing while eating/swallowing could indicate dysphagia. A symptom associated with dysphagia is variation in voice quality or loss of voice after swallowing. A, B, D: These are not typically considered mealtime risks associated with ALS. Classification: Domain 03 Task 01 Knowledge 01 Reference: Radomski, MV, Trombly-Latham, C (2008). Occupational Therapy for Physical Dysfunction (6th ed.). Baltimore, MD: Lippincott, Williams and Wilkins. Pages 1092-1096, 1331

MC#3: Which factor is MOST IMPORTANT for the OTR to initially determine when considering if this resident would benefit from a mobile arm support? A. Staffs ability to set up the device for the resident B. Ability to attach the device to the patients wheelchair C. Amount of upper extremity passive joint mobility D. Presence of upper extremity athetoid movements

Correct Answer: C Rationale: Amytrophic lateral sclerosis (ALS) is a progressive neurological disease. Screening results indicate this resident has significant weakness secondary to the

disease. The resident must have sufficient passive ROM to effectively use a mobile arm support. A, B: Assessing the residents ROM should be done before identifying the staffs ability or the ability to attach the device to the wheelchair. D: Athetoid movements typically are not associated with ALS. Classification: Domain 03 Task 01 Knowledge 09 Reference: Radomski, MV, Trombly-Latham, C (2008). Occupational Therapy for Physical Dysfunction (6th ed.). Baltimore, MD: Lippincott, Williams and Wilkins. Pages 1092-1096, 445 Question 1: What care coordination task should the OTR complete FIRST based on the results of the screening? OTR Exam Prep 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 Correct Answer: 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. A, B, C: These steps are completed after behavioral and environmental factors are identified. Classification: Domain 03 Task 06 Knowledge 01 Reference: Jacobs K, McCormack G (eds). (2011). The Occupational Therapy Manager (5th ed.). Rockville, MD: AOTA Press. Pages 319-320 Fazio L. (2008). Developing Occupation-Centered Programs for the Community (2nd ed.). Upper Saddle River, New Jersey: Pearson Prentice Hall. Pages 101-125 OTR Exam Prep 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 clients 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 Correct Answer: C Rationale: Soft tissue changes due to immobilization should be considered as the primary cause of the clients elbow ROM deficits. 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: Volkmanns 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. Classification: Domain 02 Task 01 Knowledge 02 Reference: Radomski, MV, Trombly-Latham, C (2008). Occupational Therapy for Physical Dysfunction (6th ed.). Baltimore, MD: Lippincott, Williams and Wilkins. Pages: 124, 1113 OTR Exam Prep Question: An OTR has completed a manual muscle test of a client. Results indicate the client has Poor minus (2-/5) functional strength of the dominant upper extremity. What is the MOST EFFECTIVE method for grading an activity to improve the clients muscular strength? A. Increasing the number of repetitions while maintaining the same resistance B. Decreasing the resistance and increasing the number of repetitions C. Increasing the amount of time an isometric contraction is held D. Completing movements through a full arc of motion against gravity

Correct Answer: C Rationale: This client is very weak as noted in a muscle grade of Poor minus (2-/5). For clients with this amount of weakness, the most effective method for increasing strength is to increase the amount of time an isometric contraction is held. A: This grading method is best for increasing endurance. B, D: This may be too difficult for a client with Poor minus (2/5) strength. Classification: Domain 03 Task 05 Knowledge 04 Reference: Radomski, MV, Trombly-Latham, C (2008). Occupational Therapy for Physical Dysfunction (6th ed.). Baltimore, MD: Lippincott, Williams and Wilkins. Page: 127,362 & Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages 433-434, 471-476

May 25, 2012 OTR Exam Prep Question: A client has moderate hemiplegia, dysarthria and diplopia secondary to having had a CVA several weeks ago. An OTR and COTA in an outpatient setting are collaborating to initially evaluate the client using an ecological model. Records indicate the client is a single parent of an

adolescent. The client plans to return to work as a librarian. MC Question 1: What is the FIRST step the OTR should take when evaluating this client? A. Assess deficits related to the clients performance skills and patterns. B. Observe specific client factors during a typical BADL task. C. Perform a standardized assessment of motor and process skills. D. Identify the areas of occupation the client wants or needs to do.

Correct Answer: D Rationale: The practitioner should begin the evaluation process by learning what the client wants or needs to do. This information can then be used to help determine the type and focus of the remainder of the evaluation. A, B, C: These could be included as part of the initial evaluation but only after learning about the clients wants

and needs. Classification: Domain 01 Task 01 Knowledge 01 Reference: "American Occupational Therapy Association (2008). Occupational Therapy Practice Framework: Domain & Process (2nd ed.). American Journal of Occupational Therapy, 62(6), 649. Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Page 38

MC Question 2: Which task-oriented approach would be MOST BENEFICIAL to include as part of the intervention plan for maximizing the clients physical abilities? A. Augmentative communication B. Constraint-induced movement therapy C. Dominance retraining activities D. Visual attention and scanning exercises

Correct Answer: B Rationale: Constraint-induced movement therapy is a taskoriented approach to motor control acquisition. This approach focuses on facilitating use of the affected arm during activities and helping the client overcome learned nonuse. A, C, D: These will not help the client maximize physical abilities. Classification: Domain 02 Task 03 Knowledge 01 Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages 38,793-798 MC Question 3: Which type of activity should be included as part of the INITIAL intervention to remediate the clients motor impairment? A. Repetitive practice of an occupational performance skill in context B. Training on the use of adaptive equipment to support an area of occupation C. Weight bearing through the affected upper extremity prior to an activity

D. Dominance retraining during a variety of writing and drawing tasks

Correct Answer: A Rationale: Evidence indicates that repetitive practice of a skill in context will help with cortical map reorganization for regaining functional use of the affected extremity. B, C, D: These are not remediation activities. Classification: Domain 03 Task 01 Knowledge 05 Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages 793-798, 815, 576 & Gillen G. (2009). Cognitive and Perceptual Rehabilitation: Optimizing Function. St. Louis, MO: Elsevier Mosby. Pages 38-42

MC Question 4: Which assessment should be included as part of the initial evaluation and can be administered by the COTA? A. Functional Independence Measure (FIM)

B. Bay Area Functional Performance Evaluation (BaFPE) C. Canadian Occupational Performance Measure (COPM) D. Allen Diagnostic Module (ADM)

Correct Answer: C Rationale: The ecological model looks at the unique and dynamic relationship between people, environments, and occupations. The COPM is a client-centered tool that supports this model by addressing a clients perception of their performance in areas of occupation and their satisfaction with this performance across 3 key areas: selfcare, productivity and leisure skills. This is a standardized assessment that a service competent COTA could administer. A: This tool is designed for collecting information about a client to generate group data and analyze functional outcomes in inpatient rehabilitation settings. B, D: These tools are designed primarily for clients who have a psychiatric diagnosis or cognitive deficit. Classification: Domain 01 Task 02 Knowledge 01 & Domain 04 Task 02 Knowledge 09

Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages 38, 813

OTR Exam Prep Question: Scenario: "A client has 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, splint as indicated. ROM of the involved digit is as follows: A client has a middle finger PIP joint dislocation of the nondominant 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, splint 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 clients primary insurance company requires copies of the initial evaluation prior to authorizing OT visits beyond the first visit. The client is concerned that wearing a splint will interfere with work activities." MC Question 1: At a minimum, what information should the OTR document to increase the likelihood of additional authorized visits?

A. Five setting grip strength measurements of the involved hand B. Functional problem statements indicating the need for skilled services C. Calculation of the total active motion for each digit on the affected hand D. Expected number of times the client will need to have the splint modified Correct Answer: B Rationale: Third-party payors typically based authorization for visits on medically necessity for skilled care based on evidence of a clients functional limitations. A: Although the five setting grip strength measurement may indicate weakness, there is no comparison to the nondominant hand and no indication about the impact this has on function. C: The total active motion calculations may indicate joint restriction but this alone does not indicate a functional deficit. D: Splint modification provides an indication of skilled services need, but does not address the functional limitations and additional client needs. Classification: Domain 04 Task 03 Knowledge 02 Reference: Borcherding S. (2005). Documentation Manual for Writing SOAP Notes in Occupational Therapy (2nd ed.). Thorofare, NJ: SLACK Inc. Page: 5 _________________________________________________ _____________

MC Question #2: Based on the information presented, which deformity BEST describes the clients finger injury? A. Boutonniere deformity with joint stiffness B. Swan-neck deformity with ligament laxity C. Jersey finger with ligament tightness at the DIP joint D. Mallet finger with lateral band disruption Correct Answer: A Rationale: Boutonniere deformity is described as posturing of the digit in PIP joint flexion with DIP joint hyperextension. B, C, D: These conditions are not consistent with the clients current active and passive ROM measurements. Classification: Domain 02 Task 01 Knowledge 01 Reference: Cooper C. (2007). Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity. St. Louis, MO: Elsevier Mosby. Pages: 305307 _______________________________________________ ______________

MC Question #3: In addition to considering the use of serial casting, which of the following splints should the OTR consider when deciding which type of splint would be MOST BENEFICIAL for the clients middle finger?

A. Dorsally-based static PIP and DIP joint extension gutter splint secured with self-adhering elastic wrap B. Volar-based static DIP joint gutter splint that permits PIP joint active motion C. Circumferential neoprene tube splint that extends the entire length of the finger D. Finger-based dynamic PIP joint extension splint extending from the MCP joint crease to the DIP joint crease

Correct Answer: D Rationale: This splint promotes PIP joint extension while allowing DIP joint flexion. A, B, C: These splints do not adequately target the structures/joints needed to address the specific deformity. Classification: Domain 03 Task 01 Knowledge 09 Reference: Coppard BM, Lohman H. (2008). Introduction to Splinting: A Clinical-Reasoning & Problem Solving Approach (3rd ed.). St. Louis, MO: Elsevier Mosby. Pages: 260264 _______________________________________________ _____________

MC Question #4: How should the OTR respond to the clients concerns about splinting? A. Listen empathetically and remind the client that wearing the splint is temporary.

B. Advise the client to avoid use of the injured hand to promote the healing process. C. Encourage full participation in daily tasks by collaborating on ways to modify typical daily activities. D. Provide the client with a few assistive devices that require the use of only one hand. Correct Answer: C Rationale: The OTR use a clientcentered strategy to determine the clients needs and priorities based on the clients daily activity schedule. A, B, D: 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. Classification: Domain 02 Task 02 Knowledge 02 Reference: "Radomski, MV, Trombly-Latham, C (2008). Occupational Therapy for Physical Dysfunction (6th ed.). Baltimore, MD: Lippincott, Williams and Wilkins. Pages: 424-425 Cooper C. (2007). Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity. St. Louis, MO: Elsevier Mosby. Page: 19 ________________________________________________ _________________ MC Question #5: What type of exercise should be included as part of the clients 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 D. Composite PIP joint and DIP joint passive flexion with the MCP joint supported in extension

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. B, C, D: These exercises do not effectively target the structure impacted by this injury. Classification: Domain 03 Task 01 Knowledge 04 Reference: Burke S, Higgins J, McClinton M, Saunders R, Valdata L. (2006). Hand and Upper Extremity Rehabilitation: A Practical Guide (3rd ed.). St. Louis: Elsevier Churchill Livingstone. Page: 304

OTR PREP QUESTION An OTR working in an outpatient clinic is using a 360 degree goniometer to measure client's active shoulder internal rotation. The client is sitting upright with the shoulder abducted to 90 degree and the elbow flexed to 90 degree. 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 movable arm of the goniometer? Correct Answer A: Rationale: The stationary arm should be positioned parallel to the forearm B,D: The stationary arm should be perpendicular to the floor, which will be parallel to the midline of client's torso C: This is the position for the movable arm when measuring other shoulder motions such as horizontal abduction and horizontal adduction

OTR Exam Prep Question: A client has moderate hemiplegia, dysarthria and diplopia secondary to having had a CVA several weeks ago. An OTR and COTA in an outpatient setting are collaborating to initially evaluate the client using an ecological model. Records indicate the client is a single parent of an adolescent. The client plans to return to work as a librarian. - REPEAT MC Question 1: What is the FIRST step the OTR should take when evaluating this client? A. Assess deficits related to the clients performance skills and patterns.

B. Observe specific client factors during a typical BADL task. C. Perform a standardized assessment of motor and process skills. D. Identify the areas of occupation the client wants or needs to do.

MC Question 2: Which task-oriented approach would be MOST BENEFICIAL to include as part of the intervention plan for maximizing the clients physical abilities? A. Augmentative communication B. Constraint-induced movement therapy C. Dominance retraining activities D. Visual attention and scanning exercises MC Question 3: Which type of activity should be included as part of the INITIAL intervention to remediate the clients motor impairment? A. Repetitive practice of an occupational performance skill in context B. B. Training on the use of adaptive equipment to support an area of occupation C. C. Weight bearing through the affected upper extremity

D.

prior to an activity D. Dominance retraining during a variety of writing and drawing tasks

MC Question 4: Which assessment should be included as part of the initial evaluation and can be administered by the COTA? A. Functional Independence Measure (FIM) B. Bay Area Functional Performance Evaluation (BaFPE) C. Canadian Occupational Performance Measure (COPM) D. Allen Diagnostic Module (ADM) MC Question 1: What is the FIRST step the OTR should take when evaluating this client? Correct Answer: D Rationale: The practitioner should begin the evaluation process by learning what the client wants or needs to do. This information can then be used to help determine the type and focus of the remainder of the evaluation. A, B, C: These could be included as part of the initial evaluation but only after learning about the clients wants and needs. Classification: Domain 01 Task 01 Knowledge 01 Reference: "American Occupational Therapy Association (2008). Occupational Therapy Practice Framework: Domain & Process (2nd ed.). American Journal of Occupational Therapy, 62(6), 649. Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.).

St. Louis, MO: Elsevier Mosby. Page 38 ________________________________________________ ____________ MC Question 2: Which task-oriented approach would be MOST BENEFICIAL to include as part of the intervention plan for maximizing the clients physical abilities? Correct Answer: B Rationale: Constraintinduced movement therapy is a task-oriented approach to motor control acquisition. This approach focuses on facilitating use of the affected arm during activities and helping the client overcome learned nonuse. A, C, D: These will not help the client maximize physical abilities. Classification: Domain 02 Task 03 Knowledge 01 Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages 38,793798 _______________________________________________ ________________ MC Question 3: Which type of activity should be included as part of the INITIAL intervention to remediate the clients motor impairment? Correct Answer: A Rationale: Evidence indicates that repetitive practice of a skill in context will help with cortical map reorganization for regaining functional use of the affected extremity. B, C, D: These are not remediation activities. Classification: Domain 03 Task 01 Knowledge 05 Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages 793-798, 815, 576 & Gillen G. (2009). Cognitive and Perceptual Rehabilitation: Optimizing Function. St. Louis, MO: Elsevier Mosby. Pages 3842 ________________________________________________ _______________ MC Question 4: Which assessment should be included as part of the initial evaluation and can

be administered by the COTA? Correct Answer: C Rationale: The ecological model looks at the unique and dynamic relationship between people, environments, and occupations. The COPM is a client-centered tool that supports this model by addressing a clients perception of their performance in areas of occupation and their satisfaction with this performance across 3 key areas: selfcare, productivity and leisure skills. This is a standardized assessment that a service competent COTA could administer. A: This tool is designed for collecting information about a client to generate group data and analyze functional outcomes in inpatient rehabilitation settings. B, D: These tools are designed primarily for clients who have a psychiatric diagnosis or cognitive deficit. Classification: Domain 01 Task 02 Knowledge 01 & Domain 04 Task 02 Knowledge 09 Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages 38, 813

OTR Prep Question: A 15-year-old adolescent inpatient has renal disease. The patient has been socially isolated as a consequence of the multiple medical procedures. One of the patients goals is to be with other kids. During an OT session, the patient begins to work on a simple task, but suddenly moves to a corner of the clinic to be alone, stating "the other kids can always do things better." Which intervention strategy would be MOST BENEFICIAL for meeting the patients emotional and social needs during task completion?

A) Have the patient engage in a simple but competitive game with just one peer. B) Provide a group task experience with two or three peers of a similar skill level. C) Allow the patient to find a safe place in the clinic to work alone. D) Assist the patient to successfully complete key steps with the current task. Correct Response: B Classification Code: Domain 03, Task 05, Knowledge 01 Reference: Case-Smith J, OBrien. (2010). Occupational Therapy for Children (6th ed.). St. Louis, MO: Elsevier Mosby. Page: 38-39, 409-410 Rationale: The OTR should grade the demands of the intervention to accommodate the patients current ability to deal with social isolation due to a chronic medical condition. This option allows the patient to participate in a social activity with peers of equal skill level in order to promote successful task completion. Incorrect Responses: A: Engaging the patient in a competitive game does not address current emotional needs.

C: This option does not support the patients goal of interacting with peers. D: Assisting the patient to complete key steps does not address the patients need to socialize with peers.

OTR Exam Prep Question: A patient who had a myocardial infarction 2 days ago 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. Sit on a chair at the bathroom sink to complete grooming tasks. C. Measure perceived exertion during personal hygiene activities. D. Complete isometrics and gentle stretching prior to lower body dressing.

Correct Answer: D Rationale: Isometric exercises can affect the cardiovascular

system by causing a rapid and sudden increase in blood pressure. This physiological response is contraindicated during this phase of cardiac rehabilitation. Incorrect Rationale: A, B, C: These activities are typically included in the OT intervention during phase I cardiac rehabilitation. Classification: Domain 01 Task 01 Knowledge 01 Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages: 674, 1145-1147

OTR Exam Prep Question: An inpatient sustained an incomplete cervical spinal cord injury 2 months ago. The patients upper extremity functional strength is Trace (1/5) on the left and Poor Minus (2-/5) on the right. The patients goal is to eat meals independently. Which factor MUST be considered when determining if this patient is a candidate for a mobile arm support? A. Amount of time needed to set up the device for each use B. Amount of upper extremity passive joint mobility C. Type of wheelchair the patient currently uses

D. Presence of upper extremity athetoid movements

Correct response: B Rationale: A patient must have adequate passive mobility to be able to operate the MAS. Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages: 719-724 Classificaiton Code: Domain 03, Task 01, Kownledge 09 A: This should not influence the decision as to whether a patient is a candidate for using this device. C: Mobile arm support mounts are adjustable to fit a variety of wheelchairs. D: Athetoid movements are typically associated with lesions of the basal ganglia.

OTR Prep Question: An inpatient is diagnosed with central cord syndrome. One of the patients goals is to be independent with

ADL when discharged to live at home. Which assessment represents a biomechanical approach that can be used as part of the evaluation to determine the patients progress toward this goal? A. Upper extremity manual muscle test B. Functional Independence Measure C. Canadian Occupational Performance Measure D. Structured self-care checklist

Correct Response: A Rationale: The biomechanical approach emphasizes basic client factors related to strength, ROM, and sensation. Manual muscle testing is a means of assessing muscle strength and can be used to reflect the clients abilities to engage in ADL at home. Classification Code: Domain 01, Task 02, Knowledge 01 Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages: 39, 664

Incorrect responses: B, C, D: These do not relate specifically to the biomechanical approach

OTR Prep Question: What is the PRIMARY purpose for completing a dysphagia screening for an inpatient who had a right CVA several days ago? A. To detect silent aspiration and identify foods that are safe for the patient to eat B. To identify causes for aspiration and the need for referral to speech therapy C. To observe the patient's oral motor control and determine a need for further evaluation D. To determine the patient's tolerance to various food textures prior to requesting a modified diet

Correct Response: C A screening is not used for diagnostics or treatment planning. A screening allows the OTR to quickly detect the

presence of a deficit. It is used to determine if an in-depth evaluation is indicated. Reference: Gutman SA, Schonfeld AB. (2009). Screening Adult Neurological Populations: A Step-by-step Instruction Manual (2nd ed.). Rockville, MD: AOTA Press. Page: 238 Classification Code: Domain 01, Task 01, Knowledge 02 Incorrect Responses: A, B, D: These require an in-depth evaluation and/or a collaborative team approach

OTR Prep 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

Correct response: 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. Classificaiton code: Domain 03 Task 01 Knowledge 07 References: Crepeau EB, Cohn ES, & Schell BAB. (2009). Willard & Spackman's Occupational Therapy (11th ed.). Baltimore, MD: Walters Kluwer, Lippincott, Williams & Wilkins. Page 676-677 Bracciano A. (2008). Physical Agent Modalities: Theory and Application for the Occupational Therapist. Thorofare, NJ: SLACK Inc. Pages 101-104, 112-114, 139-141 Incorrect responses: A: Fluidotherapy is a thermal modality that uses forced air that is typically heated between 105118o 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.

OTR Prep Question: A client who has a C7 spinal cord injury has been admitted to an inpatient rehabilitation facility and is beginning OT. One of the clients goals is to be able to prepare family meals. After identifying the clients typical family mealtime routines and habits, what should the OTR do NEXT to most effectively promote progress toward the clients goal? A. Observe the client during a standardized meal preparation task. B. Assess current physical skills and abilities during a kitchen task. . Discuss the lay-out and type of appliances in the clients home kitchen. E. Provide assistive devices typically used by clients who have quadriplegia.

Correct response: B Rationale: After identifying the clients typical mealtime habits and routines, the OTR should conduct a screening by observing the client perform a kitchen task. This will assist the therapist to generate hypotheses regarding performance

deficits. Reference: Radomski, MV, Trombly-Latham, C (2008). Occupational Therapy for Physical Dysfunction (6th ed.). Baltimore, MD: Lippincott, Williams and Wilkins. Page: 56 Classification code: Domain 02, Task 03, Knowledge 05 Incorrect responses: A: This stage would occur after generating hypotheses regarding performance deficits in order to quantify impairments or deficits flagged during a screening. (OBSERVATION IS FOR SCREENING) C: This information is typically gathered during the initial interview as part of the process in identifying the clients typical meal preparation routines and habits. D: The OTR should collect information about the habits, routines, and environments the client is used to prior to providing assistive devices.

OTR Prep 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 clients 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

Correct response: A Rationale: HD is a disorder characterized by progressive neurodegeneration. Symptoms typically include choreoathetoid 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 Classification code: Domain 03, Task 01, Knowledge 01 Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby PG165,887 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

OTR Prep Question: During which home maintenance tasks would symptoms related to constructional apraxia be MOST EVIDENT? A. Washing the interior sides of single pane windows B. Using a roller brush to paint an interior wall of the home C. Vacuuming floors in the main living area of the home D. Following written instructions for installing curtain rods Classification Code: Domain 01, Task 01, Knowledge 06

Correct response: D Reference: Reference: Zoltan B. (2007). Vision, Perception, and Cognition: A Manual for the Evaluation and Treatment of the Adult with Acquired Brain Injury (4th ed.). Thorofare,

NJ: SLACK Inc. Pages 123-128, 184. Rationale: Individuals who have constructional apraxia have difficulty constructing/assembling objects; as in following instructions for installing curtain rods. Incorrect Responses: A, B, C Rationale: These tasks require motor planning, but they do not require the detailed attention required to follow instructions for installing the curtain rods.

OTR Prep Question: A 10-year-old child has cerebral palsy with moderate athetosis and age-appropriate cognition. The child currently requires moderate assistance with BADL. One of the childs goals is to be more independent with dressing. The OTR plans to use a cognitive approach during a dressing session with this child. Which method exemplifies this approach? A. Employing a top-down approach to encourage the child to problem solve when difficulties are encountered during the dressing task B. Incorporating a bottom-up method to enable the child to learn dressing tasks in a developmentally appropriate sequence C. Allowing the child to select preferred clothing in

preparation for learning an age-appropriate dressing task D. Adapting the child's clothing and teaching compensatory strategies to use during a dressing task

OTR Prep 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 patients 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

Classification code: Domain 01, Task 02, Knowledge 03 Correct response: C

Reference: Cara E, MacRae A (2005). Psychosocial Occupational Therapy: A Clinical Practice (2nd ed.). Thomson Delmar. Pages: 456-457 Rationale: Based on the patients account, the dependence on cocaine use appears to be in direct relation to the patients 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.

OTR Prep Question: An OTR is facilitating a group for clients with polysubstance use. During the first group session, the OTR describes how trigger events and irrational thinking can lead to substance misuse. Which theoretical model does this approach exemplify? A. Cognitive-behavioral B. Psychodynamic C. Motivational D. Human occupation

Correct Response: A Rationale: The premise behind cognitive-behavioral therapy is that the individual can change their behavior (substance misuse) by first challenging their negative assumptions (cognitions) relating to trigger events. Reference: Cara E, MacRae A (2005). Psychosocial Occupational Therapy: A Clinical Practice (2nd ed.). Thomson Delmar. Page: 453 Incorrect responses: B: The premise behind psychodynamic models is that the individuals substance misuse has resulted from earlier psychological conflicts C: Motivational strategies encourage the individual to consider change through exploration and feedback on alternative options. D: The Model of Human Occupation emphasizes exploration, competence, and achievement as related to a clients areas of occupation. An OTR is completing a self-care assessment with a resident in a long term care facility. Nursing staff referred the resident to OT after observing a decline in the residents function following an exacerbation of COPD one month ago. Medical hx is also significant for residual cerebellar symptoms secondary to an excision of a brain tumor5 years ago. The client has Fair Plus (3+/5) functional strength of bilateral upper extremities. During the assessment, the OTR asks the resident to pick up your shirt from the night stand. When reaching for the shirt, the resident has to stabilize the arm to prevent reaching beyond or short of the shirt. When documenting the session what term should the OTR use to BEST describe the residents action? A. Decreased motor planning B. Generalized weakness

C. Dysmetria D. Dysdiadochokinesia

Incorrect: A:The resident has the ability to plan the motor components needed for picking up shirt B:Clients functional strength is adequate to pick up shirt w/o resulting in these movements D:Dysdiadochokinesia is the ability to perform rapidly alternating movements. These movements are not required for picking up a shirt Rationale: Dysmetria is a common-side effect of cerebellar dysfunction. It is characterized as overshooting or undershooting an intended target Classification: Domain 02 Task 01 Knowledge 03

OTR Exam Prep Question: Review this: http://www.nbcot.org/index.php?option=com_content&view=articl e&id=241

An OTR is evaluating the ROM of a client who has rheumatoid arthritis. Goniometric measurements of the long finger are as follows:
Active Motion Long Finger MCP Joint PIP Joint DIP Joint Extension Flexion (in degrees) 0-90 -50-90 +30-40 Passive Motion Extension Flexion (in degrees) 0-90 0-95 +30-50

What do these finding indicate? A. Dorsal subluxation of the MCP joint B. Rupture of the flexor digitorum superficialis tendon C. Lengthening of the lateral slips of the extensor digitorum communis tendon D. Rupture of the central slip of the extensor digitorum communis tendon

Correct Answer: D

Rationale: "When documenting ROM measurements, a loss of full extension is represented by a minus sign. In this case, the -50 90 measurement for the PIP joint indicates a loss of 50 degrees extension (extension lag) and the ability to flex the PIP joint to 90 degrees. Hyperextension is documented using the plus sign (+): +30 40 degrees of DIP joint motion indicates there is 30 degrees of hyperextension and the joint is able to flex from 30 degrees of hyperextension to 40 degrees of flexion. These ROM measurements indicate a boutonniere deformity. This is characterized by flexion of the PIP joint and hyperextension of the DIP joint. It is typically caused by rupture or lengthening of the central slip of the extensor digitorum communis tendon. Incorrect Rationale: A: Dorsal subluxation of the MCP joint is not typically associated with the deformity described. B: Rupture of the flexor digitorum superficialis tendon may result in a swan neck deformity C: Lengthening of the lateral slips of the extensor digitorum communis tendon results in a swan neck deformity Classification: Domain 01 Task 01 Knowledge 04 References: "Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Pages: 961-963 Cooper C. (ed.) (2007). Fundamentals of Hand Therapy:

Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity. St. Louis, MO: Elsevier Mosby. Pages: 82, 305-307"

OTR Exam Prep 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 90 degree angle

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

Incorrect Rationale: A, B, C: These options will not reduce ulnar-directed forces against the MCP joints when cutting. Classification: Domain 03 Task 01 Knowledge 09 References: "Radomski, MV, Trombly-Latham, C (2008). Occupational Therapy for Physical Dysfunction (6th ed.). Baltimore, MD: Lippincott, Williams and Wilkins. Pages 1222-1225 Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Page 973-975."

OTR Exam Prep Question: A client had a repair of the median nerve on the dominant upper extremity after sustaining a work-related laceration of the wrist 6 weeks ago. The client has been undergoing rehabilitation and resumed light work as a warehouse stocker several days ago. During a follow-up appointment, the OTR observes several blisters on the clients index finger. What INITIAL action should the OTR take based on this observation? A. Advise the client to file an incident report with the employer B. Teach the client protective sensory re-education strategies C. Contact the case manager to modify the clients job tasks D. Recommend strategies for minimizing the use of the index finger

Correct Answer: B Rationale: It is important for the client to learn visual compensation techniques to reduce secondary injury or trauma due to the loss of sensation. Incorrect Rationale: A: The clients blisters may not be due to a work-related injury. C, D: The client should continue with daily routines using visual compensation and other protective sensory reeducation techniques. Classification Code: Domain 03 Task 05 Knowledge 05 References: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Page 848 Cooper C. (2007). Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity. St. Louis, MO: Elsevier Mosby. Page 242-243 2013 without answers
An OTR has completed an initial evaluation of an 18-month-old child who has hypotonicity. The childs 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 would accurately reflects the childs current motor skills? COTA Exam Prep: An inpatient has a right transtibial amputation secondary to complications associated with type II diabetes mellitus. The patient uses a wheelchair for mobility and will be discharged to live at home with family. What education is MOST IMPORTANT to include as part of the patients pre-discharge sessions from acute care?

OTR Exam Prep: 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? COTA Exam Prep: A COTA is planning a cooking group for several residents of a brain injury unit who are functioning at Allen Cognitive Level 4 (Goal-Directed Actions). What is the BEST way for the COTA to provide activity instructions considering the residents level of cognitive function?

COTA Exam Prep: A 7-year-old child has a shunt to control hydrocephaly secondary to spina bifida. The child uses a wheelchair for mobility. During a school-based gross motor activity the child begins to feel ill, complains of a pounding headache, and appears flushed. Which action should the COTA take immediately after stopping the activity? Ly supine call 911 OTR Exam Prep: 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? Rocker knife COTA Exam Prep: A young adult client has a transhumeral amputation of the dominant extremity and has been fitted with a prosthetic. The client has full use of the non-dominant arm and does not want to use the prosthetic during BADL. Which devices would maximize the client's performance during self-care tasks?

OTR Exam Prep: A client has difficulty swallowing secondary to multiple sclerosis. The OTR manually assists the client in performing a chin tuck prior to the client swallowing a bite of food. What is the PRIMARY benefit of facilitating this position?