NBCOT exam prep-Therapy Ed book – Flashcards

C. Continue with the planned activity and file an occurrenc report upon return to the group home. Rationale: Upon determination that the client has not been injured there is no need to cancel the planned activity. It is standard policy to file a report about any incidents that involve clients but occurrence reports about minor events do not have to be done immediately There is no information in the scenario provided to indicate a need to call an ambulance. Asking the client to report any symptoms related to the fall is appropriate, but it is not the most important action for the OTA to take. Proper documentation is a professional and legal requirement that must be met.

A. The hospital wellness program's wellness program's yoga group Rationale: The yoga and stretching program put the least amount of pressure on the pulmonary and cardiovascular systems. Also, the program is monitored by hospital personnel. All of the other activities can stress the cardiovascular and pulmonary systems too much. Also, they are not monitored by health care professionals familiar with COPD.

D. paraphrase the consumers' statements about past difficulties to help clarify feelings Rationale: The focus of client-centered therapy is to be directed by the consumer. The goal is to encourage awareness of feelings and exploration of possible consequences of future actions. Offering suggestions is not a component of client-centered therapy. The OTA should use techniques to encourage the consumers to generate such suggestions. In the client-centered approach, the OTA should withhold judgment on self-deprecating comments. The best approach is to accept the consumer unconditionally. To foster self-esteem, the OTA does best to focus on the consumers' ability to discover positive feelings independent of what other people may say.

D. Directive Rationale: Directive leadership involves the provision of structure, clear directions, and immediate and consistent feedback. These qualities are needed in a group whose members are acutely ill with psychiatric disorders. The other choices do not provide the structure or organization needed for individuals whose symptoms often include decreased attention span, distractibility, poor social skills and/or thought disorders.

B. Provide hand-over-hand assistance to brush the child's teeth. Rationale: In providing hand-over-hand assistance, the OTA is using tactile, proprioceptive, and movement stimuli to cue the child. The somatosensory system is inclusive of these sensory systems. providing auditory, tactile, or visual input does not provide sufficient input for the child to learn the task.

A. a mechanical lift transfer Rationale: A mechanical lift transfer is the safest for both the resident and the staff. The other transfers require motor and cognitive abilities that are beyond the capacity of an individual with advanced Huntington's chorea. Huntington's chorea, an autosomal dominant neuromuscular disease, is characterized by choreiform movements, progressive intellectual deterioration, and psychiatric disturbances. The individual's movement disorder combined with potential confused and/or agitated behaviors requires the use of a mechanical lift for safe and efficient transfers.

D. shunt malfunction Rationale: These identified symptoms, along with seizures, are all symptoms of shunt malfunction. Shunt malfunction is a medical emergency. Stomach flu might be a possible reason for several of these symptoms, but given the clustering of the symptoms, the child should be checked for shunt malfunction. The signs of tethered cord include difficulties with bowel and bladder, gait disturbances, and/or foot deformities. A child may have a tendency to complain of stomach aches and other complaints to avoid school, if anxious. However, school anxiety would not include physical evidence of illness such as sunken eyes.

A. C7-8 Rationale: These skills correspond to the C7-8 level. Individuals with SCIs at the other levels do not have the fine motor control to perform the skills independently.

D. Encourage the members to explore alternative methods to resolve the conflict. Rationale: In a cooperative group, the OTA acts an an advisor. Group members are mutually responsible for giving feedback and meeting group needs. The OTA's interventions should facilitate group problem-solving rather than direct the course of actions or decisions. Waiting until a group is deadlocked would not be beneficial to group cohesion.

A. the strap provides passive ROM to the index finger Rationale: The buddy strap provides passive ROM to the injured finger. The buddy strap can also help to improve a deformity that has been caused by immobilization due to injury, weakness, or casting. Elevation of the finger, retrograde massage, and contrast baths are techniques that help to reduce edema. Sometimes the strap on the finger can actually restrict circulation and increase edema. The strap mobilizes the finger and limits active ROM.

A. hypotension Rationale: Persons with hypotension can be included in a rehab group that includes IADL's. Engagement in these activities would be contraindicated for patients with the other conditions. Unstable angina is a coronary insufficiency with risk for myocardial infarction or sudden death. The person's pain is difficult to control and it is present with low level activity or rest. Venous thrombosis and uncontrolled atrial arrhythmia must be monitored closely and a person with these diagnoses would be better candidates for OT services that are provided bedside.

C. determine a destination Rationale: The firs step is to determine a desired destination. Map reading skills would be the next step in determining the subway route(s) to take to arrive at the desired destination. Purchasing a fare card and taking the subway as a group comes after planning a route.

A. provide deep touch and firm pressure where the child can see the stimuli Rationale: Deep touch and firm pressure help to decrease tactile defensiveness. The decrease defensiveness, the child needs to see the stimuli. The self application of stimuli can also increase tolerance. Light touch, brusing across the face and abdomen, and application of stimuli in the direction opposite of hair growth are all aversive to a person with tactile defensiveness. Stimuli should be applied in the direction of hair growth for this is less aversive.

B. prone on elbows Rationale: According to Rood there are eight different patterns which occur in the following sequence: 1) supine withdrawal 2) rollover 3) prone extension 4) neck co-contraction 5) prone on elbows 6) quadruped 7) standing 8) walking

B. redirect the child's energy into acceptable and safe play activities Rationale: Redirecting the child's energy to activities can be an effective management of the child's aggressive behavior. It would also be appropriate to have the parents observe and record the precipitants to these behaviors to determine potential environmental modifications. This is not an option provided. Allowing the child to vent aggression onto a stuffed animal or doll would not provide the structure the child needs to learn appropriate, safe behaviors. Also, aggressive behaviors are not always coupled with aggressive feelings. Sometimes the hyperactivity of a child simply asserts itself in socially unacceptable ways, such as when a child pushes a sibling very hard in an effort to get the sibling to play "chase". Punishing the child or removing the child from the family does not address the child's needs. Taking punitive actions towards the child can increase feelings of resentment and promote a decrease in feelings of self-worth, which are typically already low in children with ADHD, which can fuel aggressive behavior.

C. return the person to the w/c and immediately recline it Rationale: Individuals with SCI are at risk for orthostatic hypotension. C/O of dizziness and nausea are indications of orthostatic hypotension and require an immediate response. Reclining the individual in his/her w/c will return blood pressure to a normal range. The other choices do not address the need for imeediate remediation of this crisis.

B. verbally reinforce the goals and norms of the group Rationale: The most effective choice is to verbally reinforce the goals and norms of the group. This helps to direct the focus of the members and to address difficulties in keeping that focus. Inspirational phrases can be helpful to instill a positive attitude but they do not address the need to develop group cohesion. Writing in a journal can help develop personal insights but it would not increase group cohesion. Asking for self-disclosure in a group with decreased levels of trust will decrease cohesion. Also, the topic of what members do not like about the group is not likely to facilitate trust, openness, and willingness to share.

A. modify the splints at the wrist Rationale: The splints should be adjusted by use of heat to accommodate to the current position of ulnar deviation. Padding is frequently used to attempt to modify the position of the splint, but it does not correctly allow distribution of pressure. Discontinuing the splints will serve to increase deformities and pain. The child might benefit from day splints, but this does not address the issue of the night resting splints causing pain and being set an an incorrect angle for the child's ulnar deviation measurement.

D. a joystick control Rationale: At the level of C-8, the teenager can independently use a joy stick control. A chin switch woul be indicated for a C-3, C-4 level lesion; a tenodesis splint is indicated for a C-6 level lesion; and a dorsal splint with a universal cuff is indicated for a C-5 level lesion

B. use of an abductor pillow between the lower extremities Rationale: An abductor pillow will prevent adduction of the operated hip, which is an important post-surgery precaution. Using a hospital bed to elevate the lower extremities to flex the hips to 90 degrees is contraindicated bc a major hip precaution is not to flex beyond 90 deg. Changing position from supine to prone requires rolling which can result in internal rotation of the hip. External rotation should be avoided if an anterolateral approach is used. This is contraindicated for it can result in dislocation.

B. organization of a list of daily activities Rationale: A transfer of training approach is a remedial/restorative approach that focuses on restoration of components to increase skill. It is deficit specific and utilizes tabletop and computer activities as treatment modalities. According to this approach, the activity of organizing a list of daily activities will help with the ability to formulate a schedule in one's home environment. Preparing a meal, composing a shopping list, and completing an interest checklist are each discrete activities that would develop skills related to the performance of these activities, but they do not address the skills needed to schedule the multiple activities of a typical day.

B. competence Rationale: Competence means practicing correctly. In this scenario, the colleague is incorrectly performing or administering the therapeutic activity. Judgment refers to decision-making skills in implementing services and is not an ethical principle of practice. Autonomy refers to having the pt. involved in the decisions of therapy to reflect personal goals, values, and interests. Justice refers to complying with the laws of the profession as well as legality of local, state, and federal laws. While not practicing competently is a violation of state practice regulations and licensure laws, there is not law specifically against providing fluidotherapy for a person with an insensate hand.

B. denial Rationale: During the psychosocial adjustment to disability/illness, denial is characterized by unrealistic expectations of recovery and minimizing one's difficulties. Shock is characterized by emotional numbness, depersonalization and reduced speech and mobility. Acceptance is reflected in the acknowledgement of the situation and the development of a new self-concept reflective of one's assets and potentialities. Acting out is a term used to describe behavior that challenges societal norms.

A. shaving and crafts Rationale: Shaving and crafts meet the 1.4-2.0 MET criteria of stage II of cardiopulmonary recovery. Self-feeding, reading, deep breathing and table top games are at a 1.0-1.4 MET level and would be appropriate for an individual in stage I. Showering is at the MET level of 2.0-3.0 and would be appropriate for an individual in stage III of recovery. Isometrics are contraindicated during stage II.

B. focusing on the group tasks rather than the feelings of the participants Rationale: The egocentric-cooperative group tends to focus on the tasks to be completed with little attention devoted to the feelings of the participants. At this level, members do not actively assume diverse group roles. A mature group would require little or not supervision and performs at the 15 to 18 year old developmental level. An egocentric-cooperative group performs at the five to seven year developmental level.

D. guide the person into a sidelying position on the bed Rationale: An aura is the brief warning stage before the tonic phase of an epileptic seizure. During an aura, changes in tactile, gustatory, olfactory, or other sensations are experienced (e.g., numbness, unexplained smells). After this brief stage, a tonic-clonic seizure will occur. The tonic phase includes a loss of consciousness, stiffening of the body, heavy and irregular breathing, drooling, skin pallor, and occasional bladder and bowel incontinence for a few seconds before the clonic phase begins. The clonic phase includes alternating ridigity and relaxation of muscles. since a person could fall and harm him/herself during a seizure, the OTA must immediately ensure the client's safety. Therefore, the best action for the OTA to take is to place the person in sidelying on the bed. If there are bed rails these should be raised. this will prevent the client from falling or choking. Providing reassurance, having the client remain seated, and ending the session does not effectively deal with the immediate need to provide interventions for the impending seizure. The OTA does not need (nor should wait for) the input of the OT.

C. a chilled dental exam mirror Rationale: The use of a cold stimulation to the inferior faucial arches via a chilled dental examination mirror will elicit a swallow reflex. The others will not.

A. finger feeding of o-shaped cereal Rationale; Picking up O-shaped cereal to finger feed will facilitate the use of a pincer grasp. While picking up marbles also uses a pincer grasp, this activity presents a potential choking hazard, as two year olds frequently put items they pick up into their mouths. Drawing with a jumbo crayon uses a gross grasp. Stacking cubes uses a radial digital grasp.

D. the child's ability to indicate when the diaper is wet or soiled. Rationale: The first toileting skill that must be developed is the child's recognition of being wet or soiled. This typically occurs at 12 months. Subsequent toileting skills such as sitting on the toilet with supervision and indicating the need to go to the bathroom can develop after this initial recognition of being wet or soiled.

D. Boutonniere deformities Rationale: A boutonniere deformity is caused by a lengthening or rupture of the extensor digitorum communis tendons and is expressed by DIP hyperextension and PIP flexion. A swan-neck deformity can result from the rupture of the lateral slips of the extensor digitorum communis or flexor digitorum superficialis tendon and results in DIP flexion and PIP hyperextension. A trigger-finger deformity results from a thickening of the flexor digitorum superficialis tendon at the flexor tunnel, also called a tendon sheath. The affected joint tends to stay open upon attempt to close or fist the hand. Synovitis of the MP joints can cause damage to the MP ligaments with palmar dislocation in conjunction with, or independent of, ulnar drift.

A. crisis intervention Crises can occur at any time in any acute facility. All employees must immediately learn the policies and procedures for dealing with crises to ensure the safety of patients and staff. Reimbursement issues and group program scheduling can be reviewed during regular supervisory sessions. These issues are not immediate concerns. Employee benefits are the responsibility of the personnel/human resources department.

A. to the side of the person, with no direct lighting Rationale: An individual with cataracts loses central vision first; therefore, presenting evaluation materials directly in front of the person will be ineffective. Peripheral vision gradually decreases with cataracts, so presenting materials to the side will enable the person to use his/her residual vision. Individuals with cataracts have increased difficulty with glare, so indirect lighting is indicated.

D. generalized attention deficit Rationale: Attention requires the ability to focus on a specific stimulus without being distracted by external or internal stimuli. The other options describe deficits with different manifestations. (The ability to abstract requires the person to see relationships between concepts, ideas and events. Organization is the ability to structure thoughts and actions. Semantic memory is the general knowledge shared by groups of people, such as social norms).

A. A re-evaluation of the client be completed Rationale: The most important action to take after noticing a change in the functional status of a person with a progressive condition is to re-evaluate. Based on the results of the eval, interventions can be planned. These interventions can include orthotics, powered mobility and/or a strengthening program; only the results of a re-evaluation can appropriately determine intervention needs. The OT would perform the re-evaluation.

B. A steamer, steamer basket, and/or crock pot for meal prep Rationale: A steamer, steamer basket and crock pot eliminate the need to move and lift heavy pans and pots; tasks which require intact bilateral UE strength. A top-loading washer and dryer require more work than frontloading machines. The extra lifting required for top-loading appliances would be difficult with shoulder weakness. A front pack infant carrier has straps which cross the shoulders so this would be contraindicated in this case. The child's weight in the carrier could contribute to shoulder strain. While a weekly diaper service can provide clean diapers each week, cloth diapers require additional care (i.e. rinsing) which can consume the client's time and energy. Lifting the week's load of wet diapers to bring to the door and picking up the week's allotment of clean diapers can be difficult with shoulder weakness.

D. use full-length mirrors or wallpaper to camouflage exit doorways Rationale: Camouflaging the doorways is often an effective intervention to decrease wandering behavior in individuals with dementia or other cognitive deficits. One cannot open a door if one does not see a door. There are many additional intervention options to explore to decrease wandering prior to placing an individual in a SNF (e.g., the use of personal alarms, Velcro doors, and/or diversional activities, and/or the rearrangement of furniture). The use of bed guard rails can be dangerous as the individual may attempt to climb over the rails and fall. The installation of a deadbolt lock on the person's bedroom door is very dangerous for it can prevent timely rescue in the event of a fire or accident.

B. supine to side-lying Rationale: Developmentally, rolling from supine to side-lying starts at about two months. Rolling from prone to supine is the next stage that begins at about four months. The other options begin at about seven months. Supine to side-lying is the first skill to develop, therefore the OTA should initiate mobility with this skill first.

A. To facilitate the generalization of learning Rationale: A major principle in contemporary approaches in neurorehabilitation is the use of multiple contexts to facilitate the generalization of learning. This generalization can then make it easier for an individual to transfer his/her learning to new situations which increases performance consistency, decreases confusion, and helps the person perform effectively in diverse situations. *Practice in different contexts can facilitate the generalization of learning.

B. static tripod with a pencil Developmentally, the best way to progressively grade the grasp is to work on static tripod with a thinner object before going to work on dynamic tripod. A lateral pinch is not an effective grasp for holding a thick marker.

C. spatial perception while in the ADL apartment Rationale: Difficulties in spatial perception are typically related to a right CVA. With a left CVA, these abilities would remain intact. The other options are all typically affected by a left CVA.

B. Utensils with wide textured grips Rationale: Wide textured grips will provide augmented sensory feedback to the individual and will be easier to grip than narrow smooth handles. Somatosensory changes associated with aging include decreased tactile sensation, decreased proprioception, and increased pain thresholds. A rocker knife and dycem pads would not address these deficits. A rocker knife is suitable for one-handed cutting and dycem pads are used to provide stability to an object.

B. walk a tongue depressor from the front of the tongue to its back Rationale: Walking a tongue depressor from the front of the tongue to the back can desensitize a hyperactive gag reflex. The other interventions do not address a hyperactive gag reflex. Sipping on a straw can increase the sucking reflex. Quick icing is a traditional Rood technique that theoretically stimulates a muscle group. Stimulating the neck muscles would not influence a gag reflex.

A. The child exhibits normal reflex development Rationale: A downward parachute reflex is normal from four months and persists throughout one's lifetime unless neurological damage occurs. It is also called the protective extension downward reflex. The onset of the standing tilting reflex is from 12 to 21 months, so an evaluation of this reflex is premature

D. at hip level Rationale: w/c seat belts are to extend across the hips and into the lap at a 45 degree angle

A. the ulnar aspect of the forearm and hand Rationale: cubital tunnel syndrome is an ulnar nerve compression at the elbow. Its presenting symptoms are numbness and tingling along the ulnar aspect of the forearm and hand, pain at the elbow with extreme elbow flexion, weakness of power grip, and a positive Tinel's sign at the elbow.

B. sitting at the kitchen table Rationale: MS is characterized by fluctuations in abilities. The best choice for an activity that will be performed frequently is to perform the activity in an adequately supported position. The avoidance of fatigue is important in the management of MS. Doing meal prep while sitting at the kitchen table achieves these aims and uses the person's natural context. There is no need indicated in this scenario for the use of a w/c and a tray. The client can do meal prep activities with readily available supports. Standing might require using too much energy and does not provide good support or stability for performing the fine motor aspects of meal prep. Leaning against the counter or a stool requires more energy, and does not provide good support or stability for performing the fine motor aspects of meal prep, and may not be safe.