Johnson (SIMULATION EXAMINXATION 1)

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1. While performing a hand reassessment, the OT practitioner
notices a deformity developing on the dorsal aspect of the client's
second digit. The client's PIP joint appears flexed, and the DIP
appears to be
(B) Boutonniere deformity. A boutonniere deformity is typically
hyperextended. The OTR can BEST describe this condition as a:
characterized by PIP joint flexion and DIP joint hyperextension.
A. Mallet deformity
B. Boutonniere deformity
C. Subluxation deformity
D. Swan neck deformity
2. An OTR is MOST likely to administer a test of visual motor (A) Copying letters. A test of visual motor integration usually
integration to a child referred to OT for difficulty with: consists of design-copying tasks that can yield information on the
A. Copying letters child's ability to translate a visual image into a motor output. Visual
B. Remembering letters motor integration is defined as "the ability to integrate the visual
C. Recognizing letters image of letters and shapes with the appropriate motor response
D. Sequencing letters necessary".
3. When performing a "naturalistic observation" of dressing skills
with a
(D) Observe the child entering the clinic and taking off his coat
young child diagnosed with developmental delay, an OT practi-
and shoes. "In a naturalistic observation the therapist gathers
tioner should FIRST:
information in the typical or natural setting [in which] the activity
A. Provide oversized clothing to ensure success.
occurs" (p.494). The most reliable information can be gained by
B. Have the child dress and undress in a distraction-free corner
observing the child as he/she normally does the activity: this is
of the clinic.
especially true of children with developmental delay, who may
C. Provide assistance as needed to minimize frustration.
have difficulty generalizing learning from one situation to another.
D. Observe the child entering the clinic and taking off his coat and
shoes.
4. An OT student witnesses a seizure in young client with hydro-
cephalus. The MOST relevant information to document and report (B) Objective signs and duration of the seizure. In order to assess
to the supervising therapist is: the efficacy of antileptic medication or during periods of gradual
A. The child's positioning during the seizure. withdrawal, staff members are often asked to monitor the child
B. Objective signs and duration of the seizure. for seizures activity. Type and duration of seizures should be
C. Responsiveness during the seizure. documented carefully.
D. Facial expression during and after the seizure
5. An OTR is evaluating an individual who has sustained a
left-hemisphere cerebrovascular accident (CVA). After determin-
ing that the person was able to read before the CVA, the thera-
pist's presents a paper with typed letters of the alphabet randomly
dispersed across the page. The individual is then asked to cross (D) Decreased attention. An attention deficit is indicated if the
out all the Ms. The OTR observes that that the individual has individual recognizes the letter and marks it accurately on both
missed letters in a random pattern throughout the page. This the right and left sides of the paper but misses letters in a random
MOST likely indicates: pattern.
A. A left visual field cut.
B. A right visual field cut.
C. Functional illiteracy.
D. Decreased attention.
6. Which of the following assessment methods would an OT
practitioner MOST likely choose to learn about a family's values (A) Interviews. Interviews provide "an opportunity for the par-
and priorities? ents to identify their values and priorities about the skills being
A. Interview evaluated by the therapist" (p.207). Open-ended questions are
B. Skilled observation best for eliciting information about the family's feelings about the
C. Inventory intervention.
D. Standardized test
7. An OT practitioner works on the trauma unit of a hospital and
often sees patients with trauma and disease of the upper extrem-
ity musculoskeletal system that can impact their motor control
function. Assessment of motor control MOST likely include: (B) Assessment of UE function in ADL, work, and leisure activities.
A. Evaluation of developmental factors. Assessment of UE function in ADL, work, and leisure activities is
B. Assessment of upper extremity functions in ADL, work and evaluated both through the involved and uninvolved extremity.
leisure activities.
C. Evaluation of pain, postural control and alignment.
D. Assessment of self-concept and self-awareness.

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8. A young client who will be using a wheelchair after discharge
from the rehabilitation facility is going home. In determining ac-
(C) Steps, width of doorways, and threshold heights. The first area
cessibility of the interior home environment, the FIRST area of
of evaluation would be the steps, width of doorways, and presence
evaluation the OT will be concerned with is:
and height of door thresholds to determine whether the wheelchair
A. Location of telephones and appliances.
user will be able to enter or exit interior spaces in the wheelchair
B. Arrangement of furniture in bedrooms.
or whether structural modifications are required.
C. Steps, width of doorways, and threshold heights.
D. Presence of clutter in the environment.
9. An OT practitioner is working on functional mobility skills with a
child who has a pes Varus deformity of the foot. The OT can BEST
(B) Clubfoot. Pes varus or equinovarus is also called club foot. This
document this as a(n):
deformity involves forefoot inversion and supination, heel varus,
A. Enlarged great toe
equinus through the ankle, and medial deviation of the foot in
B. Club foot
relationship to the knee.
C. Pronated foot
D. Unstable heel
10.The OT practitioner is observing dressing skills in an individ-
ual with chronic obstructive pulmonary disease (COPD). While
putting on his shirt, the individual becomes short of breath and
stops to rest before finishing with the shirt and going on to his (D) Endurance. A deficit in endurance is demonstrated by the per-
trousers. The OTR would recognize this as a deficit in: son's inability to sustain cardiac, pulmonary, and musculoskeletal
A. Postural control exertion for the duration of the activity.
B. Muscle tone
C. Strength
D. Endurance
11.While assessing the motor skills of an 8-month old child, the (B) Normal development. Proximal movement on a fixed distal limb
OT practitioner observes him assume a quadruped position and component - that is, on hands and knees - is an example of the
then begin to rock back and forth. This behavior MOST likely development of mobility superimposed on stability. This stage is
indicates: essential in the development of coordinated antigravity movement.
A. Perseverative tendencies The development of this type of movement in the quadruped
B. Normal development position occurs between the ages of 7 and 12 months. This pattern
C. Low muscle tone is typical of normal development and does not indicate answers
D. Limitation in movement repertoire A, C, or D.
12.While standing and holding onto furniture, a 3-year-old boy
with delayed motor development shifts his weight onto one leg
and steps to the side with the other. This movement pattern is best
described as: (C) Cruising. The described pattern is cruising. Cruising occurs at
A. Creeping approximately 12 months of age and directly precedes walking.
B. Crawling
C. Cruising
D. Clawing
13.An individual who works as a nurse reports difficulty squeezing
the bulb of the sphygmomanometer when taking blood pressures
and difficulty opening pill bottles. Which of the following instru-
(D) Dynamometer. This individual exhibits difficulty in the area
ments would be MOST appropriate for assessing the individual?
of the strength. A dynamometer measures grip strength through
A. Goniometer
gross hand grasp.
B. Aesthesiometer
C. Volumeter
D. Dynamometer
14.A computer programmer arrives at an OT clinic complaining of
pain while on the job. Which of the following are MOST likely to
be considered work-related injuries specifically linked to the age (B) Carpal tunnel and chronic tension. CTS and chronic cervical
of technology? tension are just some of the work-related occurrences secondary
A. Systemic disease to the arrival of visual display terminals and specialized technol-
B. Edema and paresthesia ogy that require repetition and unusual body positioning.
C. Burns and electrocution
D. Carpal tunnel and chronic cervical tension
15.During an initial interview, parents describe their child as hav-
ing severe difficulty in communication and interacting with others. (D) Pervasive developmental disorder of childhood. This disorder
The OT practitioner also observes that the child exhibits many "is characterized by severe and complex impairments in social
repetitive and ritualistic behaviors. The behaviors described are
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MOST likely to be associated with:
A. Attention-deficit hyperactivity disorder (ADHD) interaction, communication and behavior". Children with ADHD
B. Childhood conduct disorder display behaviors of inattention, hyperactivity, and impulsivity:
C. Obsessive-compulsive disorder therefore, answer A is incorrect.
D. Pervasive developmental disorder of childhood
16.In an acute mental health facility, an individual refuses to
participate in OT activities, and the therapist notes the refusal
in the subjective section of documentation note. Which form of
refusal would MOST likely reflect acute depression?
(C) "I'm just too tired." One of the main symptoms of severe
A. "I had an argument with another group member and I'm too
depression is decreased energy: therefore, the response of "I'm
angry"
too tired" indicates fatigue.
B. "I don't want to participate because I don't know how to do the
activity"
C. "I'm just too tired"
D. "I'm waiting for my visitors to come"
(B) Good (4). The individual's "available" range is the range
through which point the joint may be move passively. Therefore, if
17.During evaluation, the OTR asks a client with rheumatoid an individual is able to move the joint actively through the entire
arthritis to raise her arm. The client's range of motion is limited movement that is completed passively and then take maximum
to 90 degrees and she can tolerate moderate assistance in this resistance, the grade is normal (5). Good (4) is the grade given
position. The OTR further observes that passive range of motion when an individual is able to move apart through the available
(PROM) is the same as active range of motion. The manual stage range against gravity and is able to sustain moderate re-
muscle test grade would MOST likely be documented as: sistance. Fair (3) is the grade given when an individual is able to
A. Normal (5) move a part through the full range against gravity but lacks the
B. Good (4) strength for any resistance. Fair minus (3-) is the graded given
C. Fair (3) when an individual moves a part against gravity through less than
D. Fair minus (3-) the full ROM. Fair minus is the last graded range for movement
against gravity. Grades poor and trace are for gravity-eliminated
movements.
(A) Never, because children with flaccid bladders typically cannot
18.A child with spina bifida has a lesion at the lumbar level
be toilet trained. Answer (A) is correct because, "when the lesion
that causes her bladder to be flaccid. At what age should the
is in the lumber region or below, the bladder is flaccid (lower motor
OT practitioner consider lack of bladder control as a delay and
neuron bladder)... the reflex arc is not intact, and the bladder has
institute a toilet training program?
lost all tone... children with a flaccid bladder cannot be trained
A. Never, because children with flaccid bladder typically cannot be
because the bladder has no tone to empty". These children are
toilet trained
commonly provided with some type of catheterization technique
B. At 3 years of age when normally developing children recognize
after medical testing is performed. Typically, nighttime bowel and
the need to urinate
bladder control may not be accomplished until the normally de-
C. At 4 years of age because normally developing children tend
veloping child is 4 or 5 years of age. Other developmental trends
to get toilet trained at this age
in toilet training are that daytime control is usually attained by 30
D. At 4 to 5 years of age
months and that girls may precede boys 2.5 months.
19.An OT practitioner is working with a client who demonstrates
motor limitations when swallowing. Which of the following repre-
sents a motor problem commonly associated with dysphagia?
(A) Coughing or choking. Coughing and choking are motor prob-
A. Coughing or choking
lems that are commonly noted in patients with dysphagia.
B. Disorientation or confusion
C. Pain while swallowing
D. Decreased smell and taste
20.An individual with the goal of increasing attention span is
frequently observed watching the person next to her instead of
performing her assigned task. This behavior MOST likely indi-
cates: (D) Distractibility. Distractibility involves losing one's focus be-
A. Memory deficits cause of other stimuli.
B. Spatial operations
C. Generalization of learning
D. Distractibility
21.An OTR performing a motor skills evaluation observes that a
child is awkward at many gross motor tasks, particularly those (C) Developmental dyspraxia. The motor problem described as
which require relating the body to objects in space. Though able it occurs during the evaluation is characteristic of developmen-
to skip rope in the regular forward pattern of movement, the child

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is unable to skip rope backwards, even after several attempts. This
information would lead the therapist to be particularly observant tal dyspraxia. Children with dyspraxia often learn tasks such as
for additional signs of: jumping rope with great difficulty, effort, and considerable practice.
A. Delayed reflex integration However, when the task is altered, such as in this case by asking
B. Inadequate bilateral integration the child to skip backwards, the child is unable to adapt the task
C. Developmental dyspraxia for a long while.
D. General incoordination
22.In administering an assessment of finger pinch strength, the (A) Thumb against the tip of the index finger. The correct position
OT practitioner would instruct the individual being tested to place for tip pinch is the thumb against the tip of the index finger. The
the fingers in which position? thumb against the side of the index finger describes the posi-
A. Thumb against the tip of the index finger tion for lateral pinch. The thumb of the index and middle fingers
B. Thumb against the side of the index finger describes the test position for three-jaw chuck, or palmar pinch.
C. Thumb against the tips of the of the index and middle fingers The thumb against the tips of all the fingers is not a standard test
D. Thumb against the tips of all the fingers position.
23.After assessing a client who had recently lost his spouse in
a house fire, the psychiatrist classifies the client as having an
anxiety disorder caused by the occurrence of a major life event.
(D) Post-traumatic stress disorder. Posttraumatic stress disorder
Which of the following BEST represents this disorder?
is an anxiety disorder that follows a traumatic event in a person's
A. Cyclothymic disorder
life.
B. Dysthymia
C. Schizophrenia
D. Post-traumatic stress disorder
24.The OT practitioner working with an infant observes the pres-
(C) "The infant is exhibiting ulnar palmar grasp." Ulnar palmar
ence of the first stage of voluntary grasp. Which of the following
grasp precedes the other types of grasp. The infant first grasps on
would be the MOST appropriate statement for documenting this
the ulnar side of the hand against the palm, then with all 4 fingers
behavior?
against the palm (palmer grasp), and finally the grasp moves to
A. "The infant is exhibiting radial palmar grasp"
the radial side of the hand (radial grasp). The highest level of grasp
B. "The infant is exhibiting pincer grasp"
is pincer grasp, in which the pad of the index finger meets the
C. "The infant is exhibiting ulnar palmar grasp"
opposed thumb.
D. "The infant is exhibiting palmar grasp"
25.An OT practitioner has planned to assess group interpersonal
skills in an activity-based group of seven individuals. Shortly be-
fore the group is to begin, the therapist is asked to add two newly
admitted clients to the group. Which of the following actions would
(B) Add the 2 new clients and then divide the members into 2
yield the MOST efficient and effective result?
groups. It is generally not costeffective to run groups less than 3
A. Ask one or two of the original seven members to wait until later
individuals, and it is not effective to have more than 8 in a group.
and include the two new clients in the group.
Maintaining an appropriate group size enables the OT practitioner
B. Add the two new clients and then divide the members into two
to adequately observe the interpersonal skills of the members.
groups.
Using interviews or group with 3 or fewer members.
C. Interview the two new clients separately and continue with the
original evaluation group of seven.
D. Proceed with the group as planned, adding both new clients to
the original seven.
26.An OT practitioner is treating a client who demonstrates pain,
progressive weakness of the thumb, atrophy of the thenar mus-
cles and numbness and tingling in the thumb, index, long, and half
(B) Median nerve. The median nerve passes through the carpal
of the ring fingers. The client is not experiencing proximal upper
tunnel at the wrist. Impingement in this region causes sensory
extremity limitations so the practitioner will MOST likely suspect
changes in the thumb, index finger, long and half of the ring finger.
problems with which of the following?
Prolonged impingement in the carpal tunnel results in atrophy of
A. Ulnar nerve
the thenar eminence and weakness of the opponens pollicis.
B. Median nerve
C. Radial nerve
D. Brachial plexus
27.An OT practitioner is working on morning activities of daily (B) Initiation. The inability to perform the first step of an activ-
living with a young adult who recently sustained a traumatic brain ity without prompting indicates that the individual has initiation
injury. The client requires prompting to apply shaving cream to his problems. Memory deficits could also be evidenced by the per-
face and to pick up his razor. After these cues, to client is then able formance of task steps out of correct sequence. The individual
to complete the activity. This is MOST likely to be documented as with initiation problems may be able to plan or carry out activi-
a deficit in which of the following performance components? ties but be unable to begin until prompted by someone else. An
A. Impulsivity individual who has difficulty with impulsivity, memory, or attention

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B. Initiation
would have no difficulty with beginning the activity but would have
C. Memory
difficulty in completing the task successfully.
D. Attention
28.Using the Model of Human Occupation as a frame of ref-
erence, evaluation of an individual should focus PRIMARILY on
which of the following?
A. Identification of problem and behaviors that need to be extin-
(D) The effect of personal traits and the environment on role
guished
performance. Evaluation according to MOHO would focus on the
B. Clarification of thought, feelings, and experiences that influence
effect of personal traits and the environment on role performance.
the behavior.
C. Cognitive function, including assets and limitations
D. The effect of personal traits and the environment on role per-
formance
29.In screening a child who has been referred to occupational
therapy, the PRIMARY goal of the occupational therapist is to: (D) Determine the need for further evaluation. The purpose of
A. Obtain necessary information for an occupational therapy con- screening is to determine whether further assessments are need-
sultation with teachers and parents. ed and, if so, which test would be appropriate for that child. A
B. Test a wide variety of developmental behaviors screening test is not designed for planning programs (answer C)
C. Establish an information base for the occupational therapy or consultation (answer A), and they do not test any skills (answer
treatment plan B) in a comprehensive way.
D. Determine the need for further evaluation
30.A method that an OT practitioner can use to document total fin-
ger flexion without recording the measurement in degrees would
be to: (B) Measure the distance from the fingertip to the distal palmar
A. Measure the passive flexion at each joint and total the numbers crease with the hand in a fist. The distance from the fingertip to
B. Measure the distance from fingertip to the distal palmar crease the distal palmar crease with the hand fisted may be measured
with the hand in a fist in either inches or centimeters. This measures how close the
C. Measure the active flexion at each joint and total the measure- fingertip comes to the palm. A person who has full flexion would
ments have a measurement of 0.
D. Measure the distance between tip of the thumb and the tip of
the fourth finger
31.The BEST way for the OT practitioner to evaluate the pres- (B) Line bisection. Line bisection is used as a method of determin-
ence of unilateral neglect is by using which of the following pa- ing unilateral neglect. The block assembly (used for constructional
per-and-pencil tests: apraxia) is not a paper-and-pencil task, and the other tests may be
A. Six-block assembly performed with or without the individual writing. Proverb interpre-
B. Line bisection tation (abstraction) may be performed verbally, and overlapping
C. Proverb interpretation figures (figure ground discrimination) testing may be performed
D. Identification of the square on four overlapping fingers by pointing.
32.An individual with schizophrenia who is newly admitted to the
hospital is asked by the therapist to tell about what brought the
person to the hospital for admission. The individual responds by
saying, "I took a cab". In the report, the therapist is MOST likely (C) A concrete response. Literal and concrete responses to gen-
to identify this response is an example of: eral inquiries indicate the difficulty that people with schizophrenia
A. Delusional thinking have in understanding questions with several possible meanings.
B. A distractible response
C. A concrete response
D. An insightful response
33.A child is observed grabbing toys from others, becoming easily
frustrated, and is unable to sit still. This behavior MOST likely
indicates: (A) ADHD. This behavior exemplifies the excessive fidgeting
A. ADHD and restlessness, inattention, and impulsiveness characteristic of
B. Mood disorder; manic episode ADHD.
C. Conduct disorder
D. Anxiety disorder
34.When measuring elbow range of motion with a goniometer, the
OTR must position the axis of the goniometer:
(A) At the lateral epicondyle of the humerus. The lateral epicondyle
A. At the lateral epicondyle of the humerus
of the humerus is the bony prominence on the lateral side of the
B. At the medial epicondyle of the humerus
elbow.
C. Parallel to the longitudinal axis of the humerus on the lateral
aspect
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D. Parallel to the longitudinal axis of the radius on the lateral
aspect
35.A woman experienced repeated sexual abuse by her father as
a child and now describes her father's abusive actions as being
caused by his stress of being fired from a job because of new
management. The defense mechanism she is MOST likely to be (D) Rationalization. Making excuses for or justifying others' be-
using is: haviors that are generally considered to be unacceptable is called
A. Identification rationalization.
B. Projection
C. Denial
D. Rationalization
36.An OTR observes an individual having difficulty trying to find
white socks on a bed with white sheets. The MOST appropriate
(A) Figure-ground discrimination. Figure-ground discrimination is
performance component for the OT to address is:
the ability to distinguish an object from the background. A person
A. Figure-ground discrimination
with impaired figure-ground discrimination would have difficulty
B. Unilateral neglect
finding the sock despite its position on the bed.
C. Position in space
D. Cognitive mapping
37.An individual with myocardial infarction (MI) was transferred
from the acute care unit to a rehabilitation unit. During the initial
interview, he displays good memory of information processed
before the MI but poor recall of the period spent in the acute care
facility. He is able to recall information since the transfer. The OT
(C) Anterograde amnesia. Anterograde amnesia is the inability to
practitioner would be MOST likely to document these behaviors
recall events after a trauma.
as:
A. Orientation problems
B. Long-term memory deficits
C. Anterograde amnesia
D. Retrograde amnesia
38.An OTR requests that the COTA conduct a structured inter-
view. During this type of interview, it is MOST important for the
COTA to:
A. Rephrase the interview question in his or her own words (C) Ask the questions as they are stated on the interview sheet.
B. Ask questions that he or she thinks are pertinent to this patient. A structured interview requires following procedure, order, and
C. Ask additional question as they are stated on the interview wording of the questions to be asked.
sheet
D. Ask additional questions (other than those listed) to gain further
insight into the patient
39.The OT practitioner plans to use a checklist she has designed
for evaluating a child's eating performance skills. Which term (C) Skilled observation. Checklists are simple lists of factors or
BEST describes the type of evaluation the OT practitioner will be behaviors that a therapist thinks are important to observe as a
using? support for referral or screening of a child. Although checklists may
A. Norm referenced appear in a standard format, they are not well developed enough
B. Criterion referenced to include establishment or normative data and other attributes of
C. Skilled observation tests, such as validity and reliability.
D. Valid and reliable
40.In the assessment of individuals in whom the early and middle (C) The ability to engage in superficial social conversation. The
stages of dementia are diagnosed, the functional ability that will onset of most dementias is slow and progressive. Cognitive abil-
MOST likely remain intact for the longest duration is: ities such as reading and writing are most often initially affected.
A. The ability to read the written information Sensorimotor abilities such as dressing tend to follow. Superficial
B. The ability to write basic information social abilities are often preserved until the last stages of de-
C. The ability to engage in superficial social conversation mentia and may often hide the earlier cognitive and sensorimotor
D. The ability to dress and undress oneself. changes.
41.An OT practitioner is performing sensation testing on an indi-
(C) Apply the stimuli to the uninvolved area proximally to distally
vidual with hemiplegia. The therapist should FIRST:
in a random pattern. The general guidelines for sensation testing
A. Apply the stimuli distally to proximally
are that the person's vision should be occluded, the stimuli should
B. Test the involved area then the uninvolved area
be randomly applied with false stimuli intermingled, a practice trial
C. Present test stimuli in an organized pattern to improve reliability
should be performed before the test, and the unaffected side/area
during retesting

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D. Apply the stimuli to the uninvolved area proximally to distally in should be tested before the affected side/area. Also, the amount
a random pattern. of time person has to respond should be established.
42.An OT practitioner observes a 5-year-old child with Down
syndrome who has low muscle tone sitting on the floor exclusively
using a "W" sitting position. This observation MOST likely indi- (C) Demonstrating typical development for a child with Down
cates that the child is: syndrome. Answer C is correct because exclusive "W" sitting is
A. Developing abnormally commonly seen in children with low muscle tone. The child is
B. Using a non-compensatory position to achieve stability compensating for an inability to achieve stability in a variety of
C. Demonstrating typical development for a child with Down syn- positions that require dynamic postural control, depending on
drome. skeletal rather than neuromuscular structures for stability.
D. Using a position normal for a younger child, not for a 5-yearold
child
43.An individual who wears a hip brace is being measured for a
wheelchair. The correct seat dimension for the OT practitioner to
(A) 2 inches wider than the widest point across the individual's
recommend would be:
hips while he/she wears the brace. Measuring the individual with
A. 2 inches wider than the widest point across the individual's hips
the brace on and adding 2 inches, as in answer A, allows the
while he or she wears the brace
individual to easily get in and out of the chair, while preventing
B. 2 inches wider than the widest point across the individual's hips
pressure to the individual's sides. The correct length of the seat
C. 2 inches more that the distance from the back of the bent knee
should be 2 inches shorter than the distance from the back of the
to the buttocks
bent knee to the back of the buttocks.
D. The same as the distance from the back of the bent knee to the
buttocks
44.During morning self-care activities, a client is able to place his
dentures in his mouth but has difficulty applying denture cream to
the appropriate place on the dentures and attempts to place the (A) Constructional apraxia. An individual with constructional
cap on the tube backwards then on the wrong end of the tube. apraxia may have full sensory awareness of the affected side of
This behavior would MOST accurately be reported as: the body but be unable to perform the construction of one or more
A. Constructional apraxia objects onto each other to carry out a verbal command or put on
B. Ideomotor apraxia clothing in the proper sequence or position.
C. Visual agnosia
D. Unilateral neglect
45.A college student has been referred to a day treatment pro-
gram following hospitalization for an acute schizophrenic episode.
The individual is uncomfortable in social settings; has difficul-
ty sustaining conversation, is unable to make eye contact, and
responds with bizarre comments when spoken to. Which of the
(D) Social skills training. Social skills training can be used to de-
following would be the MOST effective treatment approach?
velop the ability to relate appropriately and effectively with others.
A. Vestibular stimulation and gross-motor exercises
B. Modification of the environment
C. Pleasurable activities that don't require conscious attention to
movement
D. Social skills training
46.A flight attendant with a back injury is participating in a work
hardening program. The client can successfully simulate distrib-
uting magazines to all passengers in a plane using proper body (A) Putting blankets in the overhead compartments. When distrib-
mechanics. To upgrade the program gradually, the OT practitioner uting magazines, the flight attendant uses negligible reaching and
should NEXT request that the client simulate: bending. Upgrading the activity increases the degree of reaching
A. Putting blankets in the overhead compartments and bending and adds more resistance than that provided by
B. Distributing meals to the passenger magazines.
C. Distributing magazines to half of the passengers in the plane
D. Putting luggage in the overhead compartments
47.Which of the following intervention is MOST appropriate for
an individual who has recently been diagnosed with rheumatoid (B) Positioning, adaptive equipment, and patient education. Po-
arthritis and is in the acute stage of the disease: sitioning and adaptive equipment are necessary to maintain the
A. Strengthening with restrictive exercises integrity of the musculoskeletal system and prevent deformity;
B. Positioning, adaptive equipment, and patient education patient education about the disease and ways of dealing with its
C. Discharge planning effects can also be started at this point.
D. Preparing the patient for surgical intervention
48.The occupational therapist is a member of the interdisciplinary
team providing transition services for a 17-year-old male with
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moderate learning disabilities. The goal is to help the student
engage in parttime work at a local stationery store. Which of the
following interventions is MOST appropriate: (B) Observe performance at the job site and make recommenda-
A. Have student practice work tasks in the classroom with peers tions to increase productivity. One of the roles of the OT in tran-
B. Observe performance at the job site and make recommenda- sition services includes consulting with the employer on adaption
tions to increase productivity to the job activities to accommodate individuals with disabilities.
C. Teach math and money management skills to help the student The other members of the educational team can provide class-
handle his pay check. room-based instruction as in A, C and D
D. Teach the student interviewing skills to increase the likelihood
of eventually obtaining full-time employment.
(A) Sit straddling a bolster with both feet on the floor. Once
the child has learned to sit independently on the floor, external
49.A young child has just learned to sit independently on the
stabilizing support is in longer necessary (answer D). After having
floor. Which of the following is the NEXT step toward refining her
developed independent postural reactions on a stable surface,
postural reactions in sitting?
that is, the floor, the child can now further refine sitting skills by
A. Sit straddling a bolster with both feet on the floor
learning to maintain posture when placed on an unstable surface.
B. Maintain sitting balance on a scooter while being pulled
At first, the child should be left in control of the movement on this
C. Ride a hippity-hop without falling off
surface, and she should have both feet on the floor for maximal
D. Maintain floor-sitting position with the therapist providing pelvic
stability. Later, these skills can be refined by placing the child on
support
more challenging surfaces, such as on the hippity-hop (answer C)
or on a scooter pulled by another person (answer B).
50.The treatment goal that BEST addresses the psychosocial skill
of self-expression is:
(B) The client will use facial expressions and gestures that are
A. The client will identify and pursue activities that are pleasurable
consistent with stated emotions during assertive, passive, and
to the self
aggressive role-play situations. Self-expression is the use of a
B. The client will use facial expressions and gestures that are
variety of styles and skills to express thoughts, feelings, and
consistent with stated emotions during assertive, passive, and
needs. It is also the ability to vary one's expressions, thoughts,
aggressive role-play situations.
feelings, and needs. Being able to vary one's expression during 3
C. The client will recognize his or her own behavior and possible
different styles of expressing feelings is an example of this.
negative and positive consequences
D. The client will identify his or her own assets
51.The treatment goal for a 4-year-old child with hypotonia is to (C) Weight-bearing on hands. This is the only activity that will
improve grasp. Which of the following activities would be best for facilitate hand function in the preparation phase. Weight-bearing
preparing the childs hand for grasp activities? on the hands gives deep pressure to the surface of the hand and
a. Dropping blocks into a pail facilitates wrist and arm extension, as well as shoulder cocontrac-
b. Placing pegs on a pegboard tion, to prepare the arm for reach and stabilization of the hand for
c. Weight-bearing on hand grasping. The other answers all provide different types of grasp
d. Holding and eating a cookie activities that could be used as therapy.
52."The patient has taken a more active role in the task group,
as evidenced by the willingness to contribute ideas and offer to
assist in designing the unit mural." This statement would MOST (B) Objective. The objective portion of the SOAP note (answer B)
appropriately be documented in which portion of a SOAP note? focuses on measurable or observable data obtained by the OT
a. Subjective practitioner through specific evaluations, observations, or use of
b. Objective therapeutic activities.
c. Assessment
d. Plan
53.A client is working on prehension skills in order to return to
work as a mechanic. Which of the following BEST resembles a
(A) Loosening nuts and bolts. Loosening nuts and bolts is the
prehension activity?
activity that most closely resembles a tip or lateral prehension
a. Loosening nuts and bolts
activity. Prehension is a hand position that permits finger and
b. Removing an air filter
thumb contact while facilitating the manipulation of objects.
c. Cranking a car jack
d. Grasping a hammer
54.An OTR is about to begin working with a 2-year-old child
with hypotonia and extremely poor head control who is unable to
(B) Forward and side-to-side movement with the child sitting on
maintain a sitting position. The FIRST pre-sitting activity the OTR
the therapist's lap. Answer B is correct because the position of
should introduce, while providing stability as needed, is:
the child requires the least resistance to gravity. By tilting the child
a. Forward and backward movement on a ball with the child in a
in this position, the practitioner controls how much the child will
prone position
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 Johnson (SIMULATION EXAMINXATION 1)
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therapist's lap
c. Forward and side-to-side movement on a tilting board with the
work against gravitational pull and assures that the child is well
child in a quadruped position
supported.
d. Placing the child supine on a mat and pulling him or her into a
sitting position
55.A sales executive is participating in a time management pro-
gram. Which of the following would be the expected outcome for
the client? (D) To arrive at work on time consistently. Time management man-
a. To control anxiety when arriving late for a meeting dates that one "recognize one's values and priorities, structure a
b. To take responsibility when late with reports daily routine, schedule one's time, and organize tasks efficiently."
c. To cope with feelings of inadequacy when missing a deadline
d. To arrive at work on time consistently
56.A homemaker is learning how to perform transfers into a
bathtub after a total knee replacement. Despite having surgery
2 weeks ago, the client is still unable to extend or flex the knee
greater than 20 degrees. Which of the following would MOST likely
(C) Use of a tub transfer bench and leg lifter. The use of a tub
allow for safe tub transfers?
transfer bench would allow the client to back up to the tub bench,
a. Wait another 2-4 weeks, because showering and bathing are
sit, and manually lift the leg over the side of the tub, either by using
contraindicated for individuals with total knee replacements for
her own hands or a leg lifter.
4-6 weeks after surgery
b. Use of handrail attached to the side of the tub
c. Use of a tub transfer bench
d. Use of a beach chair in the tub
(C) Have the child roll around in a carpeted barrel. Because
57.Which of the following activities should be introduced FIRST
tactile defensiveness is an area of SI treatment that should be
when treating a child for tactile defensiveness?
approached cautiously, the child-controlled rolling on a textured
a. Gently brush the child's face and neck
surface is less intrusive to the nervous system than gentle brush-
b. Rub lotion on the child's arms
ing or rubbing lotion (answers A and B), when the therapist is
c. Have the child roll around in a carpeted barrel
providing sensory stimulation to the MOST sensitive areas of the
d. Swing the child in a hammock swing
body.
58.A middle-aged client with a diagnosis of reactive depression
is admitted to the hospital following an overdose of sleeping pills.
The client was recently forced to retire from a job in public relations
and his present goals are to increase his sense of competence (C) Copper tooling using a template. When choosing activities to
and encourage development of enjoyable leisure activities. Based address self-competence and self-confidence, it is important first
on the client's OT goals, what is an appropriate FIRST activity to to choose activities that are relatively simple, structured, of short
recommend for this patient? duration, and guaranteed to provide a successful experience to
a. Pouring and glazing chess pieces the patient.
b. Designing and building a doll house
c. Copper tooling using a template
d. Learning how to play bridge
(C) Edema, contracture, muscle tone, and pain. Edema limits
ROM because of the increase of fluid in the extremity. A con-
59.The therapist is performing UE activities for an individual with tracture can result when joint motion is limited by a prolonged
left hemiparesis following a CVA. She observes that active range spasticity or change in the tissues, causing resistance to passive
of motion is limited throughout the LUE. In analyzing this client's stretch. Muscle tone may also be a limiting factor in one's ability to
performance, the therapist is most likely to consider the impact of complete ROM. If an individual is unable to remove a part through
which factors on range of motion: full range against gravity, the therapist may put the individual in a
a. Muscle tone, edema, sensation, and diadokinesis gravity-eliminated position to attempt the same movement. Finally,
b. Edema, proprioception, and muscle tone pain may be a limiting factor. This may particularly be seen in
c. Edema, contracture, muscle tone, and pain individuals with arthritis or changes in joint structure. Pain gen-
d. Contracture, stereognosis, and sensation erally occurs in the end ROM. Other options listed (proprioception
and diadokinesis) may affect the quality of active movement or
coordination but do not limit AROM or PROM.
60.Development of a treatment plan for a child with an under
reactive vestibular system would MOST likely include specific (A) Poor postural responses. Poor postural responses, such as
activities to address: poor balance and postural control against gravity, are often symp-
a. Poor postural responses toms of an under-reactive vestibular system.
b. Discomfort with motion activities

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c. Anxiety when his or her feet are off the ground
d. Gravitational insecurity
61.An individual learning to use an augmentative communication
system has mastered the task of understanding picture symbols
(A) Sequencing of picture symbols. A person needs to use picture
and their use. Next step would be:
symbols to indicate 2 or more part thought or sequence of ac-
a. Sequencing of picture symbols
tivities. For example, pointing to pictures of a shoe and a closet
b. Recognizing letters of the alphabet
would indicate the place to find a shoe in response to a question.
c. Recognizing whole words
d. Spelling letter by letter
62.Which of the following activities would BEST represent an
expected outcome for an individual who completes an energy
(A) Getting dressed without becoming fatigued. Prevention of
conservation program?
fatigue is the primary purpose of energy conversation. Energy
a. Getting dressed without becoming fatigued
conservation techniques may often result in slower, not faster
b. Lifting heavy cookware without pain
(answer D), performance.
c. Doing handicrafts without damaging his or her joints
d. Dusting and vacuuming more quickly
63.An OT practitioner is working with a withdrawn child whose
occupational therapy objectives include increasing the ability to
express feelings and conflicts. Which of the following activities will (A) Drawing a picture titled "This is me". Children who have
MOST effectively promote this skill? trouble expressing their emotions verbally are sometimes able to
a. Drawing a picture titled "This is me" express their feelings in open-ended drawing activities. Among the
b. Playing adapted soccer with a large ball answers given, answer A is the only projective activity.
c. Playing structured board game, such as Monopoly
d. Singing folk songs in a group
64.A therapist is planning a simple meal preparation activity that
will result in success for a patient with cognitive deficits. The (A) A can of soup. Grading activities according to complexity is an
SIMPLEST activity would be preparing: important part of the therapist's selection of appropriate activities
a. A can of soup for each individual. Complexity increases as the number of steps,
b. A casserole number of different ingredients or tools used, and time to complete
c. Brownies from a box mix the task increases.
d. A meal with two side dishes and an entrée
65.An individual with a C6 spinal cord injury has been referred
to OT two days post injury. Immobilized with a Halo brace, the
(C) Wrist splints to promote development of tenodesis. Hand
individual demonstrates fair plus wrist extension and poor minus
splinting to promote tenodesis is implemented in the acute phase
finger flexion. Which of the following interventions should be im-
of rehabilitation. A tenodesis grasp is developed by allowing the
plemented FIRST?
finger flexors to shorten. The person is then able to achieve a
a. Volar resting pan splints to prevent flexion contractures
functional grasp by extending the wrist. This improves the ability
b. Wrist support with universal cuff to promote independence
of an individual with a C6 or C7 SCI to grasp and hold objects.
c. Wrist splints to promote development of tenodesis
d. Instruction in bed mobility techniques to prevent decubiti
66.A pre-schooler has poor visual tracking skills, which affect her
performance on tasks requiring eye-hand coordination. Which of
the following activities is most appropriate for OT practitioner to
recommend to the child's parents in order to promote beginning (B) Catching and bursting soap bubbles. This activity involves
visual tracking skills during summer vacation? visually tracking a slow-moving target and requires minimal fine
a. Tossing and catching a water balloon motor precision to accomplish a successful "hit".
b. Catching and bursting soap bubbles
c. Throwing and catching a beach ball
d. Playing softball
67.An OT practitioner is working with three individuals in a cooking
group. The individuals demonstrate difficulty attending to task,
(D) Each member will remain in the group without disrupting the
frequently ask to leave the room, and do not interact with each
work of others for 15 minutes. Parallel groups are most appropriate
other. Based on the developmental group concept, which of the
for people who do not have the ability to interact successfully with
following is the MOST appropriate goal for this group?
other group members. Participants in parallel groups are involved
a. Each member will take a leadership role within the session
individual task that require minimal, if any, interaction. Therefore,
b. Members will share materials with at least one other group
appropriate expectations for parallel groups focus on remaining in
member
the group and working alongside others.
c. Each member will express two positive feelings about them-
selves with in the group session

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 Johnson (SIMULATION EXAMINXATION 1)
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d. Each member will remain in the group without disrupting the
work of others for 15 minutes
68.A person with peripheral neuropathy exhibits loss of pinprick,
light touch, pressure and temperature sensation. The most ap- (D) Sensory compensation. When protective sensation is severely
propriate form of intervention to address this type of sensory loss decreased or absent, the primary focus of intervention becomes
would be a program of: protection of the insensate part through educational methods to
a. sensory re-education increase awareness of potential injury dangers, teach safety pro-
b. sensory desensitization cedures, and train in the use of vision to compensate for sensory
c. sensory bombardment loss.
d. sensory compensation
(C) Multisensory input. Each of the possible 4 answers describes
appropriate treatment interventions for infants in the NICU. How-
ever, an infant approaching full term or post term is now equipped
with a maturing sensory system tolerant and in demand of a
69.An infant born 15 weeks prematurely has a history of multiple multisensory diet including oral stimulation, vestibular input, and
medical issues including retinopathy of prematurity, mechanical auditory and visual orientation, to assist with age-appropriate
ventilation for 5 weeks, and a poor feeding skills. The infant is motor and behavioral skill acquisition. It is often found that these
now a 43-week-old, medically stable and engaging infant, with a very premature infants are limited in the amount of social in-
G-tube and oxygen supplement of 2 liters by nasal cannula. Which teraction and appropriate sensory stimuli because of necessary
of the following is the MOST appropriate intervention to pursue at medical equipment and procedures: e.g., ventilators, IV catheters,
this time? isolettes, warmers, bililights, and nasogastric tubing. Therefore,
a. Positioning and handling stable, growing post-term premature infants would most benefit
b. PROM of all extremities from a multisensory diet, answer C, to best meet the demands of
c. Multisensory input their maturing sensory system and capitalize and their socializa-
d. Music therapy tion skills. Answers A, B, and D are all possible treatments for the
32 to 35-week-old infant who responds best to unimodal sensory
input and minimal direct intervention, e.g., ROM and positioning,
because of immature sensory systems and compromised respi-
ratory systems.
70.During an evaluation, you learn that a young child is easily
aroused because of a sensory-processing disorder. Which envi-
ronmental adaptation would be MOST effective in assisting this
(B) A noise machine producing white noise at bedtime. For a child
individual to fall asleep?
who is easily aroused, a constant, monotonous auditory input can
a. A mini-trampoline in the bedroom to tire the child out before
be calming to the degree of inducing sleep. The other answers
going to bed
may actually increase arousal.
b. A noise machine producing white noise at bedtime
c. A lightweight, fuzzy blanket, providing light touch
d. Shutters on the windows to produce total darkness
71.A deficit in visual memory is affecting a child's reading skills.
Which would be the BEST game to promote visual memory?
a. Dominoes (B) Concentration. This game requires the player to remember
b. Concentration visual cues.
c. Pickup sticks
d. Checkers
(D) Slicing a prepared roll of sugar cookies at room temperature
72.An individual with weak grip strength and poor endurance and placing them on tray using a spatula. This answer describes
wishes to bake something for family member's birthday. The OTR the lowest level of physical exertion and may be completed within
wants to plan an activity during which a client can work on the time frame designated by the therapist. The sugar cookie
grasp/release for 5 minutes without becoming exhausted. The dough would be soft enough to provide minimal resistance without
MOST appropriate activity for both purposes would be: causing immediate fatigue. In addition, the activity provides for
a. Mixing blueberry muffins from scratch using a hand powered isotonic contractions during the repetitive grasp and release of the
mixer and scooping them into muffin tins with a cup knife and the spatula. While muffin and cake better provide the
b. Mixing an angel food cake from a box mix using an electric mixer least amount of resistance, the hand is using sustained isometric
and pouring into a pan grasp on the electric or hand-powered mixer, which combined with
c. Mixing cold chocolate cookie dough using a spatula with a the minimal resistance of the batter and mixer weight is fatiguing.
built-up handle and dropping dollops onto a tray using an ice The chocolate chip cookie dough is resistive whether it is warm or
cream scoop cold and to maintain an isometric grasp while mixing with a spatula
d. Slicing a prepared roll of sugar cookies at room temperature or scooping with an ice cream scooper would cause the individual
and placing them on a tray using a spatula to fatigue before the activity is finished. If the individual becomes
fatigued while performing any of the activities, only the sugar

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 Johnson (SIMULATION EXAMINXATION 1)
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cookies or the chocolate chip cookies would allow the individual
time to rest without affecting the final product.
73.In a home program to promote beginning symbolic play for a
child with developmental delay, the OT practitioner would MOST
(D) Doll house and dress-up clothes. To encourage symbolic
likely recommend playing with:
play, the child should be exposed to toys offering imaginative,
a. busy box, nesting toys, and blocks
open-ended play opportunities, encouraging formulation of ideas
b. board games
and feelings.
c. craft kits
d. doll house and dress-up clothes
74.The home health OT practitioner is seeing a client in the middle
stages of Alzheimer's disease. The family is very concerned that
the client's memory loss is now interfering with performance of
(C) Instructing caregivers in task breakdown. Instructing the care-
daily activities, even familiar self-care activities. The MOST rele-
givers in task breakdown, or breaking down tasks into simple
vant OT intervention at this point would be:
steps and then providing step-by-step instructions, will allow the
a. memory retraining activities for the client
client to perform activities as capabilities decline.
b. ADL retraining program for the client
c. instructing caregivers in task breakdown
d. leisure activity planning
75.An OT practitioner is transferring a client with hemiplegia from
a wheelchair to an elevated mat. The client is able to place
both feet on the floor and move the buttocks to the edge of the
wheelchair. The therapist then places one hand on the client's
right anterior pelvis and the other hand on the client's left shoulder.
The client is set up so the transfer can be performed toward the
(B) Assisted stand pivot transfer. An assisted stand pivot transfer
client's stronger side. The client then pushes to a standing position
is implemented when the client assists with the transfer.
and pivots with the therapist's guidance. This is most likely an
example of a/n:
a. independent transfer from wheelchair to mat
b. assisted stand pivot transfer
c. pneumatic lift transfer
d. dependent stand pivot transfer
76.An OT is applying PNF techniques for weight shifting during an
activity that requires an individual to use the right hand to remove
groceries from a bag on the floor to the right. The MOST benefit
would be gained from this activity by then placing the groceries: (D) In the upper cabinet to the left side. This pattern of movement
a. on the counter directly in front promotes the greatest degree of weight shift to the affected side.
b. on the counter to the left side
c. in the upper cabinet to the right side
d. in the upper cabinet to the left side
77.The OT practitioner is treating a patient with a standard
above-elbow amputation who is experiencing hypersensitivity of
the residual limb. The OT would most likely perform which of the
(C) Activities which provide tapping, application of textures, and
following interventions in the pre-prosthetic phase of treatment?
weight bearing to the residual limb. Massage, tapping, use of
a. Activities to strengthen the residual limb
textures and weight bearing on the distal end of the residual limb
b. Activities to increase the range of motion of the residual limb
are techniques used to develop tolerance to touch and pressure
c. Activities which provide tapping, application of textures, and
in the hypersensitive limb.
weight bearing to the residual limb
d. Activities for practicing putting on and taking off the UR pros-
thesis
78.A physician has informed an OTR that her client's headache
problem at work is primarily caused by the increased neck and
shoulder tension that the individual experiences while typing on a
(B) Progressive relaxation exercises and autogenic training. Pro-
computer. The BEST stress management approach for the OTR
gressive relaxation exercises, answer B, is the answer most rele-
to suggest in this situation is:
vant to the client's shoulder tension. This technique "involves tens-
a. assertiveness training focusing on increasing the individual's
ing and relaxing muscle groups, one group at a time, from head
assertiveness with his or her boss
to foot", while autogenic training utilizes the concept of mental
b. progressive relaxation exercises and autogenic training
imagery in order to "achieve muscle relaxation and vasodilation."
c. training in cognitive reappraisal to decrease the frequency of the
individual's tendency to generalize and exaggerate the negative
side of work events

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d. teaching the individual more effective problem-solving strate-
gies
79.During an infant's first OT session, the mother reports she
has observed that the baby has difficulty with swallowing and
(B) Head slightly flexed. Postural alignment is important in pro-
frequently chokes. Which of the following feeding positions will
moting oral motor function. The spine and pelvis should be in a
MOST effectively reduce the risk of aspiration and facilitate swal-
neutral position. Normally, the head should be a neutral or slightly
lowing?
flexed (answer A). When a child has difficulty swallowing, however,
a. Head in neutral position
tucking the chin slightly can reduce the risk of aspiration and
b. Head slightly flexed
facilitate swallowing.
c. Head slightly extended
d. Head rotated toward the feeder
80.An individual with strong dependency needs is able to lace
a leather wallet only with consistent verbal cueing. Which is the
BEST way to grade this activity in order to decrease dependency? (B) Ask the individual to try some lacing with distant supervision
a. Provide lacing instructions on lacing techniques and ask the and praise her for what she has been able to do. All of the
individual to continue on her own responses are increments of approaches used for decreasing
b. Ask the individual to try some lacing with distant supervision dependency needs, but answer B is best next step in this case
and praise her for what she has been able to do because it allows the individual to attempt some lacing in the pres-
c. Ask the individual to take the lacing to her room and continue ence of the OT, who in turn offers reassurance that the individual
without the OTs assistance is actually able to do the activity.
d. Tell the individual to complete a small amount of lacing while
the OT assists another patient in the same room
81.An OTR is addressing concerns about sexual activity with
(A) Lying on the left side while propped with pillows. This posi-
a person with left sided hemiplegia with spasticity. The BEST
tioning allows the unaffected right extremities to remain free and
recommendation for positioning during sexual intercourse for this
provides weight bearing to the affected side to assist with tone
person would be:
reduction. The pillows behind the individual allow support and the
a. lying on the left side while propped with pillows
individual may lean against the pillows to also provide pressure
b. lying on the right side while propped with pillows
relief as needed to the affected side because sensation may be
c. lying in a supine position
reduced on that side along with movement.
d. lying in a prone position
82.A woman with a head injury is impulsive during self-feeding
and frequently attempts to place too much food in her mouth at
one time. Which of the following methods would MOST effectively
control her rate of intake during self-feeding?
(C) Have her put the utensil down until she swallows. The individ-
a. Cut her food into smaller pieces
ual needs to learn to pace herself during feeding.
b. Have her count to 10 between bites of food
c. Have her put the utensil down until she swallows
d. Serve the various food items in separate containers on the meal
tray
(C) Altered task method. "When the task method is altered, the
same task objects are used in the same environment, but the
method of performing the task is altered to make the task feasible
83.An OT practitioner is teaching a client who recently sustained given the performance deficits". An example would be substituting
an above-elbow amputation how to dress with one hand. Teaching one-handed techniques for someone who previously used both
a client to perform a familiar activity or skill is called the: hands (i.e., one-handed shoe trying for an individual who recently
a. problem-solving method had an above-elbow amputation). Problem solving is the ability to
b. retraining method organize information from several levels to generate a solution to
c. altered task method a problem. Retraining teaches the same skills of an activity to the
d. compensation method person who previously had mastery of those skills (e.g., having a
person with hand weakness practice tying knots). Compensation
would be avoiding performance of the activity entirely by using an
alternative place equipment or method.
84.An OT practitioner is positioning a child with poor muscle
tone and postural instability into a prone stander to develop head
(C) Position stander at 75 to 90 degrees from the floor. Answer
righting. The child rapidly shows fatigue and associated reactions.
C is most correct because by adjusting the prone stander nearer
How can the therapist BEST adjust the stander to decrease these
to vertical (the least effect of gravity on the head or posture), the
reactions while continuing to address the goal of head righting?
child will be able to tolerate working on head righting.
a. Place the child in prone on the floor
b. Position the stander at 45 degrees from the floor

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c. Position the stander at 75 to 90 degrees from the floor
d. Position the child upright in a prone or supine stander
85.A new client exhibits no awareness of functional limitations
resulting from his recent head injury, and he attempts to per-
form transfers without assistance. He also has expressed that he
(C) Have client predict his performance before an activity, then
doesn't see the need for therapy. The BEST approach to promote
have him self-evaluate the performance. Having the client predict
awareness and insight is to:
his performance before an activity (self-estimation) and compar-
a. have the patient explain why he believes he is impaired
ing his predicted performance with a self-evaluation of the actual
b. provide the client with a checklist of the skills he must have to
performance can provide meaningful self-initiated feedback and
perform various activities and review these
would be the best way to increase awareness.
c. have the client predict his performance before an activity, then
have him self-evaluate the performance
d. disregard the client's perceptions and proceed with therapy
86.An individual with left upper extremity flaccidity is observed
sitting in a wheelchair with his left arm dangling over the side. (D) Arm trough. An arm trough would provide a stable surface that
The FIRST positioning device that should be assessed for this would keep the individual's arm in a safe and appropriate position.
individual is a(n): In addition, the arm trough approximates the humeral head into
a. lap tray the glenoid fossa at a natural angle. If the individual has edema
b. wheelchair armrest in his hand, a foam wedge may be placed in the trough to elevate
c. arm sling the hand.
d. arm trough
87.An OT practitioner is working with a student on handwriting
skills when she instructs the client to stabilize his forearm on the
(D) Incoordination. A person with tremors or poor coordination can
table when writing. The client is MOST likely to be demonstrating:
reduce instability by stabilizing the limb proximally before working
a. decreased vision
distally. Stabilization adds a secure base of support from which to
b. poor endurance
work.
c. limited fine movement
d. incoordination
88.An OT practitioner is planning a group session in which the
group members will be encouraged to participate in a game of
chance. Which of the following would MOST likely be considered
(B) Bingo. Luck is the key element in games of chance. Bingo is
a game of chance?
a game whose outcome depends on the calling out of random
a. collecting baseball cards
numbers.
b. bingo
c. charades
d. balloon volleyball
89.Of the following, which would be MOST effective strategy for
increasing attention to the left for a person who has a diagnosis
of unilateral neglect? (B) Encouraging any available hemiplegic limb movements before
a. encouraging participation in bilateral activities or during a task. Any contralesional limb movement (even shoul-
b. encouraging any available hemiplegic limb movements before der elevation) will activate additional motor units which will then
or during a task increase attention to the left.
c. participation in tasks that do not cross the midline
d. participation in tasks placed on the uninvolved side
90.A school age child has Duchenne muscular dystrophy. Al-
though he is able to use a manual chair for distances between (C) Change to a power wheelchair to reduce effort. Considering
classes, he is tired on arrival. What would be the BEST recom- the progressive nature of the child's disease, as well as strength
mendation the OTR could make for wheelchair use at school? and endurance, the best recommendation would be to change to
a. retain the manual chair to build up strength a power wheelchair. The child would be better able to participate in
b. change to an ultralight sports model because it requires less the cognitive tasks of school if less effort was required for mobility.
strength The team's recommendation should also be integrated with the
c. change to a power wheelchair to reduce effort family's needs and resources.
d. encourage walking with a walker to alternate mobility methods
91.An individual with hand weakness has difficulty holding a fork.
(C) Repeatedly squeeze with the hand against increasing
Using a biomechanical frame of reference, which of the following
amounts of resistance. The biomechanical approach is a treat-
interventions would be MOST appropriate?
ment approach used when a person has a deficit in strength,
a. elicit functional grasp using reflex inhibiting postures
endurance, or ROM but has voluntary muscle control during per-
b. stimulate the hand flexors to promote a functional grasp
formance of activities. The biomechanical approach focuses on
c. repeatedly squeeze with the hand against increasing amounts

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of resistance decreasing the deficit area to improve the person's performance
d. build up utensil handles of daily activities.
92.A client with neurological deficits resulting from a head injury
was performing the task of reaching for her brush on the shelf
of her bathroom cabinet. During this task the OT practitioner ob-
served that the client located the brush but became very distract- (B) Selective attention. The client demonstrated difficulty in at-
ed by the other items on the shelf. As a result of this observation, tending to the activity because the presence of other environmen-
the OT is most likely to provide activities that will improve: tal stimuli was distracting. This suggests a deficit in selective or
a. Learning focused attention.
b. selective attention
c. figure-ground perception
d. problem solving
93.When working with a child who is at risk for shunt malfunction,
it is MOST important for the therapist to observe for: (D) Unexplained sensory loss. The major signs of shunt mal-
a. increased tone function in children are irritability, nausea and vomiting, irritability,
b. headaches changes in behavior or school performance, fever, pallor, visual
c. back pain perceptual difficulties, and headaches.
d. unexplained sensory loss
94.An OT practitioner is planning a community living program for
clients who are to be discharged after an average of 25 to 30years
of hospitalization. One of the goals of this program is to train the
clients to effectively manage their money. Which of the following (C) Use a board game to introduce the concept of receiving and
activities should be used first? spending money. This activity provides an opportunity provides
a. provide each client with $23 to spend during a group trip to the an opportunity for the individuals to experience the value and
local shopping center purpose of money. Although it is important to introduce the actual
b. provide sample of coins and paper money value of coins and paper money, it is essential to combine this with
c. use a board game to introduce the concept of receiving and concrete applications.
spending money
d. establish a hospital-based community store where the clients
can buy clothing
95.An OT practitioner is trying to demonstrate and then involve
a group of individuals in practicing "broken record" behaviors
which of the following intervention BEST encompasses the bro-
(C) Assertiveness training. Broken record is a specific assertive-
ken record technique?
ness skill concerned with repeating your position without losing
a. music therapy activities
control.
b. self-awareness activities
c. assertiveness training
d. psychodrama approaches
96.When instructing the parents of a toddler in the use and care
of a hand splint, the OT practitioner should put MOST emphasis (A) Checking for irritation and pressure problems. Because a
on: toddler cannot communicate discomfort effectively, skin irritation
a. checking for irritation and pressure problems may go unnoticed for too long. A young child, therefore, is at higher
b. avoiding excessive heat exposure risk for developing skin and pressure problems than an older,
c. cleansing the splint regularly more verbal one.
d. adhering strictly to the wearing schedule
97.When leading groups, OT practitioners should demonstrate
consistency from day to day. Inconsistent behavior would most
(C) Anxiety and confusion among group members. It is important
likely result in:
for group leaders to demonstrate consistency by showing the
a. overdependence of group members
same degree of respect, interest, and authority toward every
b. group members knowing what to expect from the group leader
group members.
c. anxiety and confusion among group members
d. group members receiving too much praise
98.An individual with a C6 spinal cord injury is unable to button
his shirt. The OT would be MOST likely to select which type of
(D) A buttonhook attached to a cuff that fits around the palm.
adaptive equipment to assist this client with buttoning?
Individuals with C6 quadriplegia may have a tenodesis grasp or
a. a buttonhook with an extra-long, flexible handle
no grasp at all available to them. Therefore, a buttonhook that fits
b. a buttonhook with a knob handle
onto the palm or a buttonhook with a built-up handle are the only
c. a buttonhook on a 0.5-inch diameter, 5-inch-long wooden han-
appropriate choices.
dle
d. a buttonhook attached to a cuff that fits around the palm

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99.A child with a behavior disorder has an innately difficult tem-
perament. Which of the following treatment approaches is MOST
(B) Help the child develop cognitive strategies for anxiety-produc-
appropriate?
ing activities. Children with innate temperament problems need
a. emphasize limit setting with the child during activities
cognitive strategies to help them to overcome anxiety in order to
b. help the child develop cognitive strategies for anxiety producing
approach and participate in activities. Parents need to understand
activities
the innate temperament problem and the discomfort the child
c. help care providers develop an unpredictable routine for activ-
feels during activities, and limit setting (answer A) will not promote
ities that disorganize the child
understanding.
d. provide a play environment in which the parent and child can
demonstrate conflicts
100. Which of the following is the BEST method to use for encour-
aging problem solving during a craft media group?
a. begin with activities that have obvious solutions and a high
probability of success and then gradually increase the level of (A) Begin with activities that have obvious solutions and a high
complexity probability of success and then gradually increase the level of
b. begin with activities that require gross motor responses and complexity. Beginning with activities that have obvious solutions
then gradually progress to fine motor responses and are successful and gradually increase in complexity is an
c. select activities that require interaction with others and then effective method for developing problem solving skills
provide opportunities
d. gradually increase the time used in the activity by 15-minute
increments
(B) A mobile arm support. A C5 quadriplegic with fair shoulder
flexors and abductors and at least poor minus biceps, upper
trapezius, and external rotators will be able to operate a mobile
101. An OT practitioner is planning a self-feeding session with
arm support for self-feeding and facial hygiene activities. A wrist
an individual with a C5 spinal cord injury. Which piece of feeding
driven flexor hinge splint would be used for a lower level SCI
equipment would be MOST appropriate for the OT practitioner to
(C6-C8) in which the individual has functional use of the shoulder
introduce to the client?
and arm muscles and has fair plus or better wrist extension
a. a wrist driven flexor hinge splint
strength. The splint is indicated for individuals who lack prehen-
b. a mobile arm support
sion power. An electric feeder is indicated for individuals with
c. an electric self-feeder
higher level of involvement (C4) and who demonstrate poor plus
d. built-up utensils
or weaker shoulder strength. Built-up utensils may be indicated
for individuals with C8 or T1 injuries because they may lack the
strength to tightly grasp regular utensils.
(A) Identify options and the consequences of each option. Indi-
viduals are frequently resistive to changes that will affect familiar
102. An individual with emphysema reports recently "having an
home environment, such as moving furniture or adding medically
accident" when unable to make it to the bathroom in time. When
necessary equipment. For them to accept change, their feelings
the home health OT practitioner recommends a bedside com-
and cultural attitudes and beliefs must be recognized. Then the
mode, the idea is immediately rejected. Which of the following
following steps can be implemented to encourage acceptance of
actions should the OT practitioner take FIRST?
change: (1) identify options and the consequences of each option;
a. identify options and the consequences of each option
(2) allow time for reflection and consideration of options (answer
b. decrease the effects of prolonged inactivity
B); (3) practice with a "demo" device (answer C); (4) reassess
c. practice with a "demo" bedside commode
the decision; (5) if acceptable, order the equipment, order the
d. allow time for the individual to think about the bedside commode
equipment; and (6) if rejected, document the steps taken and the
reasons for rejection (answer D).
103. When planning intervention for individuals in the acute phase (B) Decrease the effects of prolonged inactivity. Some of the
of cardiac rehabilitation, it is MOST important for the OT practi- main objectives of inpatient cardiac rehab include decreasing
tioner to select activities that: the effects of prolonged inactivity, such as thromboembolism,
a. can be accomplished without causing fatigue orthostatic hypotension, and muscle atrophy safely providing a
b. decrease the effects of prolonged inactivity program of monitored activity performance to maximize function;
c. promote strength, range of motion and endurance reinforcing cardiac precautions; and providing instruction in ener-
d. can be carried out independently after discharge gy conservation techniques.
104. A young child has a diagnosis of spastic quadriplegia. The
OT practitioner is teaching the child's parents how to effectively
(D) Make sure the child's hips are secured against the back of the
position the child sitting so that participation in family games will
seat. The hips are one of the key points of control when positioning
be facilitated. What is the MOST important point the practitioner
a child. Positioning the hips securely against the back of the seat
can make?
with a seat belt or an abductor wedge (or both) in the correct
a. make sure the child's head is upright
angle serves to break up the extensor pattern and facilitate the
b. make sure the child's arms are on the armrests
c. make sure the child's back is straight
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 Johnson (SIMULATION EXAMINXATION 1)
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d. make sure the child's hips are secured against the back of the positioning of the other body parts (answers A, B, and C), so that
seat the child can participate in family games.
105. An OTR is working on sitting balance with an individual with
C6 quadriplegia. The BEST position for the individual's hands to (B) Flexed at all joints. When weight bearing, the fingers should be
be in when using them for support is to have the fingers: flexed at all joints (the fisted position). This preserves the tenode-
a. extended and adducted sis function by protecting the finger flexors from overstretching.
b. flexed at all joints Another reason for this position is to prevent claw-hand deformity
c. extended and abducted by protecting the intrinsic hand muscles from overstretching.
d. adducted and flexed only at the metacarpal phalangeal joints
106. An OT practitioner, along with the assistive technology team,
has made specific recommendations for electronic assistive tech-
nology for an adult with muscular dystrophy. After the devices
are ordered, and modified as necessary, the NEXT step in the
(C) Train the client in the operation of the AT system and in
process of implementation is for the OT to:
strategies for its use. Training activities in the use of the assistive
a. Evaluate how well the whole system works.
devices are the next critical step after setup of the system, and are
b. Evaluate if the assistive technology devices match the needs
essential because the complex nature of assistive technologies
of the client.
can require many hours of practice to master.
c. Train the client in the operation of the assistive technology
system and in strategies for its use.
d. Determine if funding is available for the assistive technology
recommended.
107. Which of the following is MOST important when using a
remotivation approach with a group of elderly individuals?
a. Use pictures, music, and discussion to encourage discussion (A) Use pictures, music, and discussion to encourage discussion
of memories of memories. Remotivation approaches are used to encourage
b. Discuss an upcoming holiday and base an activity on that the expression of thoughts and feelings related to intact long-term
holiday memories. The topic should be linked to the group's past experi-
c. Adapt the environment to maximize independent functioning ences and be easy to understand.
d. Focus on group activities designed to enhance interpersonal
skills.
108. A child with a diagnosis of ADHD also exhibits perceptual
(D) Blowing cotton balls into a target. Children with ADHD have
deficits. The activity that would be the MOST effective intervention
difficulty with sustained attention and effort. Answers A, B, and C
for this child to train visual attention is:
require sustained visual vigilance and involve delayed gratifica-
a. Playing a game if Memory in which images are matched by
tion. By contrast, blowing cotton balls into a target is a short-term
memory.
activity with immediate reward for successful completion. This
b. Assembling a 200-piece puzzle.
activity is therefore the most appropriate one, responding to the
c. Finding Waldo against a complex visual background
child's dual needs.
d. Blowing cotton balls into a target.
109. An attractive unmarried patient with a spinal cord injury (CSI)
is on a rehab unit and constantly flirts with the OT and PT staff.
(D) Setting personal boundaries appropriate to the therapist-pa-
The staff should reach by:
tient relationship. It is important to acknowledge the individual's
a. Firmly rejecting his advances.
need for sexual expression while supporting the sense of self
b. Flirting back in order to promote his self-esteem.
and identifying acceptable relationship and behaviors. Setting
c. Selecting one team member to discuss the effects of SCI on
boundaries while accepting the individual is the most appropriate
sexual functioning with the patient.
therapeutic response.
d. Setting personal boundaries appropriate to the therapist-patient
relationship.
110. While running a nutrition awareness group, an OY practition-
er observes that one member tends to monopolize the discussion
be frequently interrupting. Which intervention would be NEST to
(B) Comfort the individual's behavior: "Are you aware that you
implement after other, more conservative approaches have been
frequent interruptions prevent others from having a chance to
unsuccessful?
contribute?" In general, the group leader should try answers A,
a. Sit beside the person who is monopolizing and touch his or her
C or D before confronting the individual who is monopolizing the
hand or arm as a reminder not to interrupt others who are talking.
conversation. Answer B, confronting the behavior, is the approach
b. Confront the individual's behavior: Are you aware that your
that would most likely be taken after more conservative attempts
frequent interruption prevents others from having a chance to
have failed the practitioner.
contribute?
c. Redirect the individual: Now let's hear what others have to say
about this.

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d. Restructure the task: Select a group activity that requires se-
quential turn taking.
(A) Ease the patient onto the floor, cushioning his fall. Proper
body mechanics must be used when transferring patients. No one
should "attempt a transfer that seems unmanageable because of
111. In the middle of a wheelchair to bed transfer, an obese patient
the discrepancy between the patient size and her own or because
begins to slip from the grasp of an average-size OT practitioner.
of the patient's level of dependency." Attempting to continue or
The BEST action for the OT practitioner to take is to:
reverse the transfer on an obese patient who has already begun
a. ease the patient onto the floor, cushioning his fall.
to slip (answers B and C) is likely to result in injury to the OT
b. reverse the transfer getting the patient back in the wheelchair.
practitioner and perhaps to the patient as well. Once the patient
c. continue the transfer, getting the patient to the bed.
has started to slip, the OT practitioner should begin easing him
d. call next door for assistance.
to the floor immediately. Although calling for assistance is an
appropriate action, the higher-priority action is to begin easing the
patient to the floor to prevent injury to the individuals involved.
112. A physical education teacher is being treated for osteoarthri-
tis of the upper and lower extremities. Which of the following neu-
romuscular activities would the therapist MOST LIKELY suggest
(D) Low-impact aerobics 3 times a week for 1 hour. The avoidance
to prevent further complications?
of activities that promote hyperextension and resistance to the
a. Lifting weights three times a week for 1 hour
joints best addresses the neuromuscular aspect of preventing
b. Listening to relaxation tapes three times a week before bed-
further damage to arthritic joints.
time.
c. Vocational retraining
d. Low-impact aerobics three times a week for 1 hour
(D) Perform behavioral techniques and developmental positioning
with parental observation and interaction. The NICU environ-
113. Upon arrival to an infant's therapy session in the neonatal in-
ment can often undermine the importance of the family. There-
tensive care unit (NICU), the OT finds the infant's parents present.
fore, implementing and integrating parental involvement with daily
Of The following, which is the OPTIMAL intervention to pursue?
neonatal care becomes of primary importance for the carryover
a. Review the chart to complete birth history information and
of learned techniques to best promote developmental acquisition.
speak to the infant's primary nurse.
Answers B, C, and D are all family-centered strategies and are
b. Introduce yourself as their child's OT, explain and excuse
recommended for NICU intervention. However, D is clearly the
yourself from the situation secondary to limited availability for
optimal strategy for fostering parental observation skills, building
intervention.
positional and handling skills, and developing their ability to inter-
c. Issue written positioning and state regulation and readiness
pret and respond their infant's behaviors. Initial chart interview and
information for the parents to review.
updating with nursing staff (answer A) are essential assessment
d. Perform behavioral techniques and developmental positioning
steps made prior to initial contact with the infant and family and
with parental observation and interaction.
is the least optimal intervention strategy to pursue with the family
present
114. A client is being seen by OT to promote independence in
meal preparation and clean-up activities. The method of structur-
ing activity practice that would BEST promote retention of learning
and transfer of skills is to:
(A) Practice preparing a variety of foods, using different cooking
a. practice preparing a variety of foods, using different cooking
methods and recipes. Recent findings in motor learning suggest
methods and recipes.
that practicing variety of tasks in a nonsystematic but repetitive
b. practice cooking one meal from beginning to end in the same
way (variable practice) can enhance learning retention and trans-
kitchen setting several times.
fer of skills because the novelty introduced into the task engages
c. Practice making a sandwich until that is mastered, then practice
more cognitive effort.
preparing another part of a meal until the person has mastered
that skill, etc.
d. Practice performing each step of the food preparation process,
such as cutting vegetables.
115. An OT practitioner is working with a medically stable client
who sustained bilateral upper extremity partial thickness burns
(D) Encourage independent self-feeding and dressing skills with
3 days ago while frying chicken. Which of the following BEST
minimal use of adapted utensils and tools. Encouraging indepen-
represents a typical ADL intervention?
dent self-feeding and dressing skills with minimal use of adapted
a. Instruct the client to use all adapted equipment.
utensils and tools is the most significant ADL intervention. It is
b. Encourage independent compression garment, application.
important to avoid an overreliance on adapted equipment so the
c. Perform bilateral upper extremity PROM exercises twice a day.
client can experience full active ROM when engaged in ADL.
d. Encourage independent self-feeding and dressing skills with
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116. A student has been working on learning to activate a switch
for a communications device needed in the fourth grade class-
room. The switch is mounted on the wheelchair tray, but the stu-
dent is having difficulty operating it because of excessive muscle
(A) Work on coordinated reach in sidelying position first and then
tone. Despite practicing for extended periods of time, the student
transfer the skill to sitting position. The OT practitioner should
is not making any progress. The OTR decides to:
teach the skill with the child in the position in which the child can
a. work on coordinated reach in side lying position first and then
most easily learn the skill and then teach the child to transfer the
transfer the skill to sitting position
skill to a more functional position.
b. passively stretch the student's upper extremity to increase
range of motion
c. use a brightly colored switch to increase visibility
d. use systematic behavioral reinforcement through shaping
117. A patient diagnosed with Parkinson's disease is being seen
by an OT practitioner to develop a routine for performing self-care
activities. The therapist is MOST likely to begin this process by (A) Are most easily performed if coordinated with consistent timing
instructing the patient that self-care activities: of medications. A patient with Parkinson's needs to learn to use
a. are more easily performed if coordinated with consistent timing the period of reduced symptoms and improved mobility resulting
of medications. from medication use to best advantage for performing ADL. Med-
b. should be performed before medications are taken. ications taken regularly and consistently aid the establishment of
c. should be attempted only with the assistance of others. routines for self-care.
d. should be performed at intervals throughout the day until com-
pleted.
(D) Hold him firmly when picking him up. Holding the child firmly
118. The BEST method for handling a child who exhibits tactile inhibits responses to light touch, which are usually uncomfortable
defensiveness is to: for children with tactile defensiveness. Tickling (answer A) and
a. tickle him during play times. light stroking (answer C) are also uncomfortable or intolerable for
b. play loud music when undressing him. a child with tactile defensiveness. A strong stimulus such as loud
c. lightly stroke his arms and legs during baths. music causes further startling and discomfort during a time when
d. hold him firmly when picking him up. the child is MOST vulnerable to the sensation of light touch (i.e.,
when clothing is being removed).
119. An individual with fine motor incoordination reports difficulty
with self-care. Which of the following options would this individual (C) Toothpaste with a flip-open cap. An individual with fine motor
find MOST beneficial? incoordination would be able to manage a toothpaste cap that
a. Wash mitt flips open much more easily than a cap that must be removed
b. Spray deodorant completely from the tube. Also, toothpaste tubes with flip-open
c. Toothpaste with a flip-open cap caps are larger in diameter, which make them easier to manage.
d. Toothbrush with a built-up handle
120. The spouse of a patient with a progressive disease has come
into the OT department to learn how to help the spouse perform (D) Instruction in how to perform the activities safely. Instructing
functional activities at home. The FIRST focus of caregiver edu- caregivers in methods that promote safe performance of function-
cation for this person should be: al activities, such as locking wheelchair brakes before standing
a. methods for motivating the patient to perform ADLs. up, is the first focus for caregiver training. Answers A, B, and C
b. how to analyze activities to solve problems. are also useful areas of caregiver instruction, however, safety is
c. instruction in how to provide cues to the patient. the first priority.
d. instruction in how to perform the activities safely.
121. An individual complains of perspiration which is causing his
(D) Provide a stockinet for the individual to wear inside the splint.
resting hand splint to be uncomfortable. The BEST action for the
A stockinet liner worn inside the splint keeps the perspiration from
OT practitioner to take is to:
irritating the skin by absorbing the perspiration from irritating the
a. recommend putting talcum powder in the splint.
sin by absorbing the perspiration and keeping the skin away from
b. line the splint with moleskin.
the damp plastic. A stockinet liner is inexpensive enough to have
c. fabricate a new resting hand splint with perforated material.
several, so the individual can always have a clean one available.
d. provide a stockinet, for the individual to wear inside the splint.
122. A child with a diagnosis of mental retardation is currently
learning to independently tie her shoes. The facilitated general- (B) Have the child practice tying her shoes at home as well as in
ization of this skill, the OT practitioner should: school. Children with mental retardation often have difficulty gen-
a. fit the child's shoes with Velcro closures eralizing learning from one setting to another. For instance, they
b. have the child practice tying her shoes at home as well as in learn to tie their shoes in the OT clinic but are unable to perform
school the same skill at home or at school. The ability to generalize is
c. use a backwards-chaining technique essential in making the new skill functional in this child's daily life.
d. provide brightly colored shoelaces

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123. An OT practitioner is training an adult worker with a develop-
mental disability to put a pencil in a box before putting the score
pad in the box for a game packaging task in a sheltered workshop
assembly line. The employee has not done this task before. The (D) Continues reinforcement of correct responses. Continuous
type of reinforcement schedule that will BEST achieve the goal of reinforcement is provided every time the correct behavior occurs.
learning this task sequence is: Continuous reinforcement is helpful with learning of new behav-
a. intermittent reinforcement with correct responses. iors.
b. reinforcement every 10 minutes.
c. reinforcement for every fourth correct response.
d. continuous reinforcement of correct response.
124. A PT practitioner receives a referral to fabricate a splint that
will assist with the maintenance of a functional hand position while
keeping the soft tissue of the hand in a midrange position. Which
(B) A resting pan splint. A resting pan splint is the most appro-
splint would the OTR MOST likely select to address these needs?
priate splint to fabricate for the maintenance of a functional hand
a. A bivalve cast
position.
b. A resting pan splint
c. A dynamic extension splint
d. A wrist cock-up splint
125. An individual with Guillain-Barre syndrome was recently
admitted to a rehabilitation unit and is expected to remain for
3 to 4 weeks. When should the OT practitioner order adaptive
(D) Just before discharge. Because the prognosis for patients
equipment for this individual?
with Guillain-Barre syndrome is usually good, equipment should
a. After the patient and family have accepted the individual's
be ordered just before discharge to accurately determine the
disability
individual's needs.
b. As soon as the insurance provider approves it
c. Within the first week of therapy
d. Just before discharge
126. An OT practitioner is working with a client who has severe
cognitive deficits. Using a functional skill training approach, the
MOST appropriate method to teach the client to brush his or her
teeth is based on: (A) Rots repetition of the task substeps with gradually fading cues.
a. rote repetition of the task sub steps with gradually fading cues. Functional skill training focuses on mastery of a specific task. It
b. practice of fine-motor activities that incorporate motions needed requires the client to repeatedly practice the substeps of a task
in tooth brushing with the number of cues given for each step gradually decreased
c. teaching the caregiver how to set up the task and guide the or faded.
client's performance.
d. use of instructional cards which the client will learn to use to
remind him of how to perform the task.
127. Prevention of cumulative trauma disorders (CTD) in the
primary focus of an OT practitioner who is working as an industry
consultant. The MOST appropriate way to reduce risk of CTD in
an industry where there is heavy keyboard use is to:
(B) Educate employees about ergonomic adaptations including
a. teach employees to identify the symptoms of cumulative trauma
correct typing techniques, posture, hand positioning, and equip-
disorder early.
ment modification. Educating employees on correct positioning
b. educate employees about ergonomic adaptations including
and equipment modification would be an effective way to intro-
correct typing techniques, posture, hand positioning, and equip-
duce this population to a change in in task methods related to
ment modification.
keyboarding which may prevent CTD.
c. provide inexpensive resting splints to employees to rest hands
and wrists at night if symptoms appear.
d. instruct employees in exercise routines to increase strength in
weak upper extremities.
128. While participating in activities to improve strength, an indi-
vidual with multiple sclerosis (MS) who was recently admitted to
the hospital complains of fatigue. Which of the following actions is
the most appropriate for the OT practitioner to take?
(D) Give the individual a rest break. Fatigue may cause additional
a. Instruct the individual to work through the fatigue to complete
structural damage in the acute stage of MS and should be avoid-
the session.
ed. Rest breaks need to be scheduled to avoid fatigue.
b. Instruct the individual to work through the fatigue for another 5
to 10 minutes.
c. Discontinue strengthening activities.
d. Give the individual a rest break
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129. An OT practitioner is showing a parent how to bathe a child
with hypertonic muscle tone. Which of the following approaches
(C) Handle the child slowly and gently. Answer C is correct be-
is MOST appropriate to use?
cause the child with hypertonicity will be most relaxed and easier
a. Avoid the use of adaptive equipment.
to handle if tone is inhibited by the OT practitioner's slow and
b. Avoid explanations of the procedure.
gentle handling of the body.
c. Handle the child slowly and gently.
d. Stand and lean over the tub to support and wash the child.
130. An individual with amyotrophic lateral sclerosis (ALS) has
asked an OT practitioner how to maintain strength in a weak (fair
plus) wrist extensors. Which is the MOST appropriate intervention
for the OT practitioner to recommend? (B) Playing Velcro checkers to tolerance. Gentle, repetitive, resis-
a. Cock-up wrist support tive exercises help maintain strength and endurance in weakened
b. Playing Velcro checkers to tolerance muscles.
c. Active range of motion for wrist daily without resistance
d. Wrist extension exercises several times a day against maximal
resistance
131. An individual with low endurance complains of becoming too
fatigued during sexual activity to enjoy it. The BEST strategy for
(C) Take the bottom, supine position. This position requires the
the therapist to recommend is for the individual to:
least amount of energy expenditure and should be recommended.
a. time sex for the end of the day.
In addition, the therapist may encourage experimentation with a
b. take the top, prone position.
variety of positions (answer D).
c. take the bottom, supine position.
d. experiment with a variety of positions.
132. An OT practitioner working in a sheltered workshop with
adult clients with developmental disabilities is preparing for a
group of clients functioning at Allen's Cognitive Level 4. Which
(C) Provide project samples for clients to duplicate. Individuals
of the following is the BEST method for introducing an assembly
functioning at cognitive level 4 are able to copy demonstrated
activity?
directions presented one step at a time. They find it easier to copy
a. Provide repetitive, one-step activities.
a sample than to follow directions or diagrams.
b. Demonstrate a three-step assembly process.
c. Provide project samples for clients to duplicate.
d. Provide written directions for the individuals to follow.
133. An OT practitioner is working with a client who complains
of pain while completing kitchen cleaning tasks. Which of the
following positions would be MOST effective in alleviating low
back pain when the patient is loading the dishwasher?
a. Place dishes next to dishwasher and load from a standing (D) Place dishes near the dishwasher, bend down on one or both
position. knees, and load. Bending down on one or both knees increases
b. Wash dishes in the sink. balance while reducing the need to bend at the waist.
c. Place dishes next to dishwasher and load from the front of the
dishwasher.
d. Place dishes near the dishwasher, bend down on one or both
knees, and load.
134. An OT practitioner requests that an OT student treat a client
with a condition involving the upper extremity. The OTR suggests
the use of contrasts baths, retrograde massage, and pressure (B) Edema. Contrast baths cause vasodilation and vasoconstric-
wraps. The OT student can consider these interventions a PRI- tion, which facilitate a pumping out of the edema. Retrograde
MARY technique to address: massage assists with the facilitation of blood and lymph move-
a. heterotopic ossification ment. Pressure wraps (coban) are applied distal to proximal to
b. edema address edema issues.
c. wound healing
d. scar management
135. The PRIMARY functions of an OTR leading a therapeutic
group in the beginning stages of group development will be to:
a. set the climate, provide structure, and offer support.
b. leave members to set the climate, provide structure, and offer (A) Set the climate, provide structure, and offer support. Answer
support to each other. A reflects typical leadership involvement in OT groups.
c. aid group members in separation
d. work individually with group members until each is ready to join
group activity.

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136. An OT practitioner is performing discharges teaching with a (B) Temperature and pain. The sensations of pain and temper-
client who sustained a deep laceration of the median and ulnar ature are carried along small, unmyelinated nerve fibers, which
nerves. The practitioner informs the clients that the two tactile recover more rapidly than senses carried by larger, myelinated
senses that are the earliest to recover after a peripheral nerve fibers. The sensations of pain and temperature are also part of the
injury are: protective or primary sensory systems, which are the receivers of
a. vibration and pain simple information. More complex information is carried through
b. temperature and pain the discriminative or epicritic system. The senses carried on this
c. light touch and proprioception system are vibration, light touch, proprioception, and tactile local-
d. tactile localization and proprioception ization.
137. A toddler has feeding difficulties because of deficient
(B) Dry cereals with milk. Foods selected for this child's diet
oral-motor control and oral defensiveness. The child's parents
should reflect the current skill level. To increase oral tolerance and
would like to eat family meals together and include such foods as
control of food, textures are gradually modified from smooth and
meats (cut up), sandwiches, and vegetables. The OT practitioner
consistent (answer C) to smooth and slightly varied (answer A and
explains to the parents that they can start to introduce these foods
D), to increasingly resistive foods and a combination of contrasts,
when their child is able to tolerate which foods?
for example, hard and crunchy mixed with soft or liquid (answer
a. Apple sauce and mashed bananas
B). After the child has mastered this level of control and tolerance,
b. Dry cereals with milk
he/she can safely proceed to an even greater variety of textures,
c. Strained fruits and vegetables
tastes, and temperatures offered at family meals.
d. Scrambled eggs
138. A mother of four teenage children who was diagnosed with a
(C) Folding laundry. Sorting and folding laundry (answer C) chal-
right CVA is receiving home care OT services. The treatment plan
lenges balance and UE function in ways that are more functional
includes "activities" to improve left upper extremity function@ and
than stacking cones or throwing a ball. Rather than seeking con-
activities to improve balance in sitting and standing. Which of the
trived activities (answers A, B, C) that challenge single-component
following activities would be most appropriate?
deficits, the focus of home care is to find ways for the patient
a. Stacking cones
to actually perform the daily activities that are presenting the
b. Door pulley
challenges. Because this patient is the mother of 4, it is presumed
c. Folding laundry
that her occupational role includes homemaking activities.
d. Throwing a ball
139. An OT practitioner is instructing a client with a total hip
replacement how to perform a passenger side car transfer. Which
of the following BEST represents the initial steps of this transfer?
a. Stand the body parallel to the car, hold onto a stable section of
the car, lift and place the left leg into the car, and slowly sit and
follow with opposite leg. (B) Back up the body to the passenger seat, hold onto a stable
b. Back up the body to the passenger seat hold onto a stable section of the car, extend the involved leg, and slowly sit in the
section of the car extend the involved leg, and slowly sit in the car. This is the safest way to perform a car transfer after surgery
car. for a total hip replacement.
c. Back up the body to the passenger seat, hold into a stable
section of the car, flex both legs simultaneously, and slowly sit in
the car.
d. Back up the body to the passenger seat, hold onto a stable
section of the car, flex the involved leg, and slowly sit in the car.
140. An OT practitioner is working on hand function with a
(C) Pencil gripper. These are all adaptive devices that can be
school-age child diagnosed with juvenile rheumatoid arthritis.
used with a child who has JRA for various reasons. However,
Which of the following devices will MOST effectively prevent hand
the correct answer is C because the pencil gripper will probably
fatigue?
make grasping the pencil easier and reduce hand grasp fatigue.
a. Reacher
Because of hand weakness and because printing and handwriting
b. Jar opener
are common tasks for children this age, it is important that fatigue
c. Pencil gripper
be reduced.
d. Plate guard
141. An individual with quadriplegia complains of frequently
slumping to the side when sitting in a wheelchair. The wheelchair
adaptation that would BEST enable this individual to maintain an
(C) Lateral trunk supports. Lateral trunk supports would help
optional position is:
maintain correct alignment of the pelvis and trunk in the wheel-
a. a reclining wheelchair
chair.
b. an arm trough
c. lateral trunk supports
d. lateral pelvic supports
142. An OT practitioner is fabricating a splint for a client who
sustained a low-level ulnar nerve injury. The OTR explains that

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the PRIMARY purpose of an ulnar nerve splint is to:
(B) Block hyperextension of the MCP joints and allow MCP flexion.
a. block hyperextension of the PIP joints and allow PIP flexion.
An ulnar nerve splint's primary purpose is to support the hand
b. block hyperextension of the MCP joints and allow MCP flexion.
secondary to ulnar intrinsic muscle paralysis. This splint also
c. block PIP flexion and allow for PIP hyperextension.
allows for MCP flexion.
d. block MCP flexion and allow for MP hyperextension.
143. A nursing home resident with Alzheimer's disease also has
limitations in shoulder range of motion. The OT goal for this patient
is to improve shoulder motion so that the person can resume
selfcare activities. Which strategy which would be MOST effective
in getting the client actively engaged? (C) Incorporating simple, familiar activities such as hanging up
a. Telling the resident to perform repetitions of active UE range of clothing or catching a ball. Incorporating simple activities would
motion exercises independently. be most effective for gaining active cooperation participation from
b. Training the resident to use long handled adaptive devices to a person with Alzheimer's.
compensate for decreased shoulder motion.
c. Incorporating simple, familiar activities such as hanging up
clothing or catching a ball.
d. Performing PROM exercises on the resident.
144. An OT practitioner is working with a confused patient who is
having difficulty placing both feet into his pants legs. An example (D) Having him place his feet through loops of therapeutic band.
of a pre functional treatment activity would MOST likely be: A prefunctional activity is when an individual is unable to perform
a. pulling up pants during toileting activities. a specific task, so an activity is used that practices the same
b. teaching the individual to use a reacher to pull up his pants to movement as placing his feet into his pants legs. A prefunctional
knee level. activity provides a base to improve a functional activity and may
c. pulling off socks using a dressing stick. be practiced before or at the same time as a functional task.
d. having him place his feet through loops of therapeutic band
145. An OT practitioner is instructing a patient with left hemiplegia
and unilateral neglect to put on a t-shirt. The BEST sequence to
teach the patient would be:

a.
(1) place left had into sleeve and pull up sleeve past elbow;
(2) place right hand into sleeve and pull up sleeve;
(3) pull shirt up over head;
(4) pull shirt down over trunk.
(B) (1) Position shirt on lap; (2) Place left hand into sleeve and
b.
pull up sleeve past elbow; (3) Place right hand into sleeve and
(1) position shirt on lap;
pull up sleeve; (4) Pull shirt up over head. Answer B would be the
(2) place left hand into sleeve and pull up sleeve past elbow;
best sequence because positioning the shirt first on the lap may
(3) place right hand into sleeve and pull up sleeve;
provide cues for patients with unilateral neglect. Starting with the
(4) pull shirt up over head.
left side allows the unaffected right hand to perform the first part
of the task successfully and requires the eyes to then scan to the
c.
left to locate the left arm.
(1) position shirt on lap;
(2) place right hand into sleeve and pull up sleeve past elbow;
(3) place left hand into sleeve and pull up sleeve;
(4) pull shirt up over head.

d.
(1) pull shirt up over head;
(2) place left arm into sleeve;
(3) place right arm into sleeve;
(4) pull down shirt over trunk.
146. An OT practitioner has conducted a home evaluation for a
client with Parkinson's disease whose primary functional prob-
lems are caused by a shuffling gait. The MOST relevant environ-
(D) Remove scatter rugs throughout the house. The client would
mental recommendation the OT could make to address a potential
face the greatest safety hazard from the presence of scatter rugs
safety hazard is to:
in the house, which could cause the client with shuffling gait to trip
a. increase illumination in hallways.
and fall. Persons with Parkinson's disease are at high risk for falls.
b. screen out distracting stimuli in the environment.
c. place door locks higher or lower than eye level.
d. remove scatter rugs throughout the house.

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147. A child with developmental delays has just developed the
strength and stability in his right hand to hold scissors properly
and make snips in the paper. Which of the following would be the
NEXT scissors skill to develop? (D) Cut the paper in 2 following a straight line. Scissors skills
a. Cut cardboard and cloth develop from first cutting snips to cutting a single straight line.
b. Cut along curved lines to cut out a circle
c. Cut along straight lines to cut a triangle
d. Cut the paper in two following a straight line
148. The husband of an individual who is being treated for bipolar
disorder describes his frustration with the ups and downs of his
wife's condition. Which of the following is the BEST support group
(C) National Alliance for the Mentally Ill. This is a support group
to recommend to this husband?
that is open to clients and families and focuses in education and
a. Al-Anon
support related to all mental illness.
b. Family therapy
c. National Alliance for the Mentality III
d. Recovery, Inc
149. An individual with lower extremity paralysis uses a standard
annual wheelchair and is ready to be discharged to home. During
the home evaluation, the OY practitioner notes that the entrance
(B) Raise the toilet. The minimum doorway width that allows a
to the bathroom is 32 inches wide and the toilet is 15 inches high.
standard wheelchair to pass through easily is 32 inches. A stan-
Which of the following recommendations will MOST facilitate use
dard toilet is 15 inches, which is 3 inches lower than the standard
of the bathroom for this individual?
wheelchair seat. Raising the toilet 18 inches would make transfers
a. Widen the doorway
easier for this individual.
b. Raise the toilet
c. Widen the doorway and raise the toilet
d. Widen the doorway and lower the toilet
150. An occupational therapist is discharging a 4-year-old child
with athetoid cerebral palsy from a rehabilitation setting to home.
The MOST appropriate instructions for the OTR to provide to the
(A)"Jaw opening and closing are controlled with your index and
family for maintaining correct jaw control while feeding the child
middle fingers; place your thumb on the child's cheek." The correct
from the side are:
position of the adults hand for jaw control is as described in
a. "Jaw opening and losing are controlled with your index and
Answer A when the child is fed from the side. If the child is fed
middle fingers; place your thumb on the child's cheek."
from the front, the adult's thumb is placed on the chin, with middle
b. "Jaw opening and closing are controlled with your index and
finger under the chin to control opening and closing of the jaw. The
middle fingers; place your thumb on the child's larynx for stability."
index finger then rests on the side of the child's face to provide
c. "Jaw opening and closing are controlled with your whole hand
stability.
on the child's jaw"
d. "Jaw opening and closing are controlled with your index and
middle fingers; place your thumb on the child's ear for stability."
151. An OT practitioner in an acute care hospital is using the
SOAP note format to document information about an individual
with dementia. Which statement is the BEST example of subjec-
tive information?
a. The therapist will establish a daily self-feeding routine using
verbal and physical cues to encourage the individual to pen con-
tainers on the lunch tray.
b. The individual has been able to identify closed liquid-beverage
containers on the meal tray for four of six presentations.
c. The individual is able to identify and drink liquids presented
in cups without lids but leaves beverages in closed containers
untouched.
d. The individual asks for more beverages during meals, but ap-
pears surprised when the therapist indicate beverages in closed
containers are on the meal tray
152. An OT practitioner Is educating the parents of a high school
age patient who is being discharged from the burn center to
his home environment after an 8-month inpatient stay for severe
burns. The therapist is reviewing common psychological reactions
that occur is burn victims. The therapist will MOST likely educate
the client and family about:
a. the possibility of decreased range of motion and sensation.
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b. the potential for depression and low self-esteem.
c. the likelihood of violent behavior and sexual acting out.
d. the potential for delirium and fatigue.
153. An individual being evaluated for meal preparation skills
demonstrates minimal to moderate difficulty when asked to pre-
pare a macaroni and cheese dish. Which of the following is the
MOST appropriate cooking activity to use for the next OT ses-
sion?
a. Making baked chicken and mashed potatoes
b. Making a peanut butter and jelly sandwich
c. Preparing a can of soup
d. Making instant pudding
154. An OT practitioner is determining a third-grader's readiness
for discharge from direct OT as a related service. The essential
criteria which the practitioner needs to assess is:
a. whether the areas of concern to the OT interfere with the child's
education.
b. the degree of functional skills possessed by the child.
c. the level of independence in ADL.
d. the degree of accessibility of the learning environment.
155. An OT practitioner is working in an acute care inpatient
psychiatric facility. Upon admission, the FIRST step in planning
for the discharge of a socially isolated individual is to:
a. provide community re-entry activities introduce the individual to
community resources to use after discharge.
b. evaluate the individual's occupational performance.
c. educate the family about the individual's ability to return home.
d. make a referral to an outpatient socialization program.
156. An individual with ALS swims three times a week to maximize
strength and endurance. Initially able to swim for only 10 minutes,
the individual is now able to swim 20 minutes without becoming
fatigued. The NEXT step is:
a. continue the program of swimming 20 minutes three times a
week.
b. decrease swimming frequency to two times a week.
c. increase swimming time to 25 minutes or to tolerance.
d. provide adaptive equipment that will enable the individual to
swim using less energy.
157. A child who has difficulty with visual perception of "position
in space" will soon be discharged from an outpatient occupational
therapy program and the OT practitioner will be meeting with the
classroom teacher and parents. Of the following, which would be
the BEST activity to promote this type of visual perception?
a. Identifying letters on a distracting page.
b. Finding geometric shapes scattered in a box.
c. Following directions about objects located in front, in back, and
to the side.
d. Making judgements about moving through space
158. A child with limited upper extremity range of motion is being
readied for discharge. The MOST important home adaptation for
the OT practitioner to recommend concerning use of the toilet is:
a. installation of safety bars next to the toilet seat.
b. mounting of a wide base toilet seat.
c. placement of a skid proof stepping stool next to the toilet.
d. installation of a bidet with spray wash and air drying mechanism
159. A long term goal for a 60-year-old client with back pain is to
be able to return to work as an illustrator. The client has achieved
the short-term goal of sitting at a work table for 20 minutes. The
BEST example of a revised short-term goal for this client is:
a. "Client will draw sitting at work table."
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b. "Client will draw 1 hour, taking stretch breaks every 20 min-
utes."
c. "Instruct client in stretching techniques to be performed every
20 minutes."
d. "Instruct client in the use of proper body mechanics that apply
to prolonged sitting."
160. A child with a swallowing dysfunction is being discharged
with a home-feeding program that includes eliminating foods
with consistencies that are difficult to swallow. The OT would
MOST likely recommend that the following type of food texture be
AVOIDED:
a. smooth semisolids (pureed bananas).
b. lumpy semisolids (cottage cheese).
c. liquids and solids combined (minestrone soup).
d. thickened liquids (malted milk).
161. The therapist is re-evaluating and individual's PROM for
elbow flexion by completing three consecutive measurements.
A 10-degree discrepancy exists between the first two measure-
ments and the third. The MOST likely response of the therapist
would be to:
a. check the alignment of the goniometer.
b. use a larger goniometer.
c. use a smaller goniometer.
d. attempt to force the individual's arm further into flexion.
162. Which of the following is the BEST example of "objective"
information as written by an OT practitioner for the objective
section of a discharge summary?
a. "Pt. reports he can work at the computer much longer and more
comfortably than he could initially."
b. "Pt. was initially able to work at the computer for only 10 minutes.
Upon discharge, he can work at the computer for 3 hours with
stretch breaks every 30 minutes."
c. "Pt. has improved significantly in his ability to work at the
computer."
d. "Pt. reports he is now able to work at the computer for 3 hours,
where initially he was only able to tolerate 10 minutes."
163. An OTR and COTA are collaborating on a discharge summa-
ry. Which of the following is the MOST appropriate contribution for
the COTA to make?
a. Describe the treatment received
b. Make the referral for community based services
c. Compare the initial and final status
d. Formulate the OT follow-up plans
164. An individual is about to be discharged to home following a
hip arthroplasty. He is able to ambulance with a quad cane, but his
balance remains slightly impaired. During the home evaluation,
which is the MOST important safety recommendation for the OT
practitioner to make?
a. Remove all throw or scatter rugs
b. Place lever handles on faucets
c. Install a ramp if steps exist
d. Install a handheld shower
165. An OT practitioner is treating a client who has demonstrated
a decrease in paranoid behavior. The BEST way to document this
change is:
a. The patient is no longer as afraid of men.
b. The patient has not accused any men of attacking her this
week.
c. The patient is participating more actively in beauty group.

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d. The patient will tolerate sitting next to a man in group one time
this week.
166. An individual has made gains in fine-motor coordination in
the past week. Which of the following statements belongs in the
assessment section of a SOAP note?
a. Patient performed the Nine Hole Peg Test in 20 seconds.
b. Patient reports being able to button the buttons on most items
of clothing.
c. Patient is demonstrating gradual improvement in fine motor
coordination.
d. Family reports patient is performing more fine motor activities
independently.
167. An OT practitioner has been asked to work on laundry skills
with an adult with cognitive disabilities. Initially, the OT practitioner
recommend that the staff in the group home work with the individ-
ual for 2 months on how to recognize when clothing is dirty and
needs to be laundered. After 2 months, however, the individual
is unable to recognize or judge when clothing is dirty. What is
the NEXT step the OT practitioner should take to maximize the
individual's independence on doing laundry?
a. Instruct the individual to wear clothes for 2 days and to then
launder those items.
b. Assess the individual's ability to recognize dirty clothing.
c. Recommend that the individual take clothes for dry cleaning
rather than wash them at home.
d. Recommend to the staff that they do the individual's laundry
from now on.
168. A COTA and OTR are planning for the discharge of a child
from an early intervention program. What advice to the parents
will MOST likely result in effective carryover of a therapeutic home
program?
a. Set aside a certain time daily to focus on therapeutic activities.
b. Incorporate therapeutic activities into family routines.
c. Provide therapeutic activities on an as needed basis.
d. Do therapeutic activities daily, but vary the time of day
169. An OT practitioner functioning in the role of a consultant in
an adult day care facility would be MOST likely to provide which (D) Providing OT expertise to run the program and solve problems.
of the following services: An OT practitioner could perform all of the functions identified. The
a. evaluating clients to determine OT needs. OT consultant in this setting typically offers information and skill
b. implementing recreational activity groups. knowledge to both OT and non-OT staff and administration to help
c. serving as personal advocate for the client and family liaison. plan programs that meet the needs of the clients.
d. providing OT expertise to run the program and solve problems.
170. An OT is employed by a community health center has deter-
mined that there is a need to provide groups of clients with specific
diagnoses. One group the therapist is recommending starts with
the clients engaging in a game of rhythmic exercises performed (A) Parkinson's disease. People with Parkinson's disease can
to music. The group activity also includes teaching the clients benefit from rhythmic exercises, movement strategies, and hand-
strategies to get up from chair and start walking and specially writing activities. Providing these interventions in a group format
adapted handwriting activities. This is MOST likely and OT group is of particular benefit to this population because of the added
for people with the diagnosis of: advantage of social interaction. From a planning point of view,
a. Parkinson's disease group treatment for this condition is also cost efficient.
b. Guillain-Barre
c. COPD
d. SCI
171. An OT practitioner working in a sheltered workshop with
individuals with mental retardation must be aware of how the
(C) AC MRDD. The AC MRDD stands for Accreditation Council
agency that provides services to the developmentally disable
for services for the Mentally Retarded and other Developmentally
population is accredited. Which of the following is responsible for
Disabled persons.
accrediting these workshops?
a. JCAHO

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b. CARF
c. AC MRDD
d. NLN/APHA
172. An OPT practitioner is providing accessibility consultation
services to a local library. In the back of the library there is a
reference room with a doorway that has a threshold of 1-inch
(C) Removing the threshold altogether. Removing the threshold
height. Concerning the threshold and accessibility according to
altogether would be the simplest and safest solution. Door thresh-
the ADA guidelines, the BEST recommendation would be:
olds may have a maximum height of a half inch and these must be
a. Keeping the threshold as is, place a sign near the door alerting
leveled. The best solution would still be to remove the threshold
people to the threshold.
altogether to provide the most accessible surface.
b. Providing a throw rug which covers the threshold.
c. Removing the threshold altogether.
d. Ramp the threshold.
173. An OT practitioner working in an acute psychiatric facility is
meeting with a client who has mental health issues. The client is
(D) Outpatient counseling. Transitional programs after hospital-
preparing for discharge and is ready for the least restrictive level
ization offer a range or continuum of support to mental health
of care. The facility the BEST represents the least restrictive level
consumers. Outpatient counseling is the least restrictive situation
of care is:
because it provides support through counseling is the least re-
a. a quarter way house.
strictive situation because it provides support through counseling
b. a halfway house.
but does not require any residential treatment.
c. a supervised apartment.
d. outpatient counselling.
174. Which of the following components is MOST essential to (A) Pain management techniques. Work hardening programs fo-
include when designing a work-hardening program? cus on requiring individuals to work in physically appropriate set-
a. Pain management techniques tings as quickly as feasible through reconditioning. As part of that
b. Achieving a balance between work and leisure program, pain management techniques (answer A) are included
c. Energy conservation techniques to assist the person with managing and coping with pain during
d. Vocational counselling work-related activities.
175. An OT wishes to assess the results of a life-skills training
program provided to individuals at a shelter for abused women.
Which of the following methods would be BEST for obtaining this
Information? (C) Program evaluation. Program evaluation is the compilation of
a. Final evaluation of each client involved the intervention results for a population of individuals.
b. Client satisfaction survey
c. Program evaluation
d. Utilization review
176. An OT consults to a vocational instructor in a high school
program for students with moderate mental disabilities. Which of
the following activities would be MOST appropriately provided by
the OT? (D) Meeting the vocational instructor weekly to discuss adapta-
a. Developing an in-house prevocational work program tions to work tasks. Effective consultation involves ongoing com-
b. Bringing in outside speakers from different job settings munication that helps team members problem solve are effective-
c. Teaching the vocational instructor different assessment tools ly.
and scoring procedures
d. Meeting the vocational instructor weekly to discuss adaptation
to work tasks
177. An OTR and COTA share and coordinate therapy for a
caseload. Which of the following jobs would be MOST appropriate (A) Completing the chart reviews. An identified role of the COTA
for the COTA to perform: is to complete data collection records such as a record review,
a. completing the chart reviews. general observation checklist, or behavior checklist. A COTA can
b. completing the no standardized portions of the evaluation. contribute to the development of a treatment plan, but it is not
c. interpreting the results of the no standardized portion of the within the COTA scope of practice to develop treatment plans
evaluation. independently.
d. independently designing a treatment plan for the individual.
178. As health care changes through the next century, the focus
will move more toward health status and away from health care.
This trend focuses on enhancing wellness and health through
activities using various strategies, including education and be-
havioral change efforts. The OT practitioner's role in this trend is
BEST described as:
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a. occupational behavior
(D) Health promotion. Health promotion is the advancement
b. intervention
of healthy lifestyles, which may include educational, behavioral
c. self-efficacy
change, and cultural support.
d. health promotion
179. The OT is working with a patient on an acute care floor when
(B) Rinse the eye with an eye wash or water immediately. It is
the patient's IV equipment disengages, splashing the therapist in
necessary to immediately wash the eye because the "backwash"
the eye with the medication and IV "backwash" fluid. The thera-
fluid in the IV is unidentifiable body fluid and universal precau-
pist's FIRST response should be to:
tions should be followed. It is recommended to flush an exposed
a. rub the eye and continue treatment.
area with warm water or normal saline immediately. Following the
b. rinse the eye with an eye wash or water immediately.
cleansing of the eye, it is recommended to contact the immediate
c. write an incident report.
supervisor and report the exposure through the facility reporting
d. cover the eye with a bandage and contact the immediate
system.
supervisor.
180. An OT practitioner is supervising an OT aide. The MOST
appropriate kinds of activities and level of supervision for the aide (A) Selected tasks in which sides have been trained, with intense
include: close supervision. To maximize efficiency and cost effectiveness
a. selected task in which aides have been trained with intense of therapy services, there has been increasing use of OT aides.
close supervision. Such aides must be closely supervised and are expected to
b. various intervention activities with routine supervision. receive site specific training in selected activities determined by
c. completing ADL training with a patient without supervision. the supervising OT practitioner and must be utilized in accordance
d. selecting adaptive equipment from a catalog with general su- with state regulations.
pervision.
(A) From a home health OTR or COTA. Home health services
181. A patient who has had surgery for a malignant tumor was which may include nursing, OT, PT and speech therapy are pro-
seen once in OT and is being discharged home, though the patient vided in the patient's home. Individuals who require continued
is weak and needs to continue receiving IV chemotherapy with a care following discharge from the hospital may be appropriate for
home health nurse. The MOST appropriate recommendation the home health services if they are unable to travel to the hospital
OT practitioner could make for this patient to receive OT services for outpatient services. If the decision to discharge the person
would be: ] has already been made, recommendation for a continued stay
a. from a home health OTR or COTA in the acute care hospital or transfer to a rehabilitation cancer
b. staying in the hospital a little longer. (answer B and C) are not appropriate. The person's weakness
c. going to a rehabilitation center. and continuing requirement for intravenous drug therapy would
d. coming back for outpatient OT. make it extremely difficult for the patient to return to the hospital
for outpatient therapy (answer D).
182. During a routine transfer, a patient's legs buckle, causing him
and the OT practitioner to fall to the floor. The most appropriate
way for the OT practitioner to document this accident is in a(n):
(A) Incident report. Facilities use incident report to document
a. incident report.
incidents such as this.
b. daily progress note.
c. letter to the department head.
d. verbal report to the department head.
183. While documenting the week's OT sessions in an individual's
chart, an OT practitioner notices that a progress note from 2
weeks ago was not completed. The therapist recalls providing
treatment that week and how the patient responded. The ONLY (B) Document services provided and data the note as a late entry.
appropriate action for the OTR take is to: It is the responsibility of the OT practitioners to document services
a. complete the note using the original date. provided. After the error was found, the OT should document the
b. document services provided and date the note as a late entry. services as she recalled.
c. leave the chart as is without documenting services provided.
d. write a brief note stating that documentation was not completed
for the specified dates.
184. A hospital-based multidisciplinary team meets bimonthly to
monitor their services in regard to the creation of an environment
that meets or exceeds consumer needs. This model is MOST (A) Total quality management. This model "encourages health
appropriately called: care institutions to move away from a focus on compliance to
a. total quality management. standards and refocus on improvement goals in an effort to deliver
b. cost accounting. high quality."
c. employee empowerment.
d. horizontal structuring.

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185. An OT practitioner completing a home assessment has
recommended a hospital bed, lightweight wheelchair, bedside
commode, reachers long-handled sponge, shower chair, and (D) Lightweight wheelchair and hospital bed. Durable medical
handheld shower. The family states they can be billed as durable equipment is defined by Medicare as "that which can withstand
medical equipment. Which of the following can be billed as durable and repeated use, is primarily and customarily used to serve a
medical equipment? medical purpose, and generally is not useful to a person in the
a. Lightweight wheelchair and reachers absence of illness or injury." Depending on the patient's medical
b. Shower chair, hand-held shower and bedside commode condition, a bedside commode may be covered.
c. Hospital bed, shower chair and hand-held shower
d. Lightweight wheelchair and hospital bed
186. An OTR is working with a patient that has Medicare part B.
The OTR informs the patient that Medicare part B will MOST likely (B) Medical necessity. Medicare defines medical necessity as
reimburse for assistive devices, such as a wheelchair, if it meets "necessary and reasonable to treat an illness or an injury or to
the criteria of: improve the functioning of a malformed body member." Medicare
a. increasing functional independence. part B does not typically cover items such as elevated toilet seats,
b. medical necessity. grab bars, or adaptive equipment because they are not considered
c. maintaining patient function. to be medically necessary.
d. reducing deformity.
187. An OT practitioner working in a school based setting is in-
(B) 1 year experience. Fieldwork educators, or supervisors, may
terested in training students in level-II fieldwork. Before accepting
be COTAs or OTRs with a minimum of 1 year of experience.
level-II students, the OT practitioner should have at least:
These individuals should be competent and knowledgeable and
a. 6 months experience
able to function as good role models. There is no similar guideline
b. 1 year experience
indicating the amount of experience needed to supervise level-I
c. 2 years experience
students.
d. 3 years experience
188. According to the Joint Commission on Accreditation of Hos-
pital Organization (JCAHO) an OT managing delivery of therapy
services in a hospital setting would have to review and update (A) Review and update annually. The JCAHO supports a long-term
occupational therapy policies and procedures as follows: ongoing emphasis on quality and therefore recommends that
a. review and update annually. policies and procedures be reviewed and updated annually. Fa-
b. review and update on years in which JCAHO surveys are cilities that attempt to update their manual specifically for JCAHO
performed. surveys will not be able to demonstrate a program of continual
c. review and update when new occupational therapy managers process assessment and improvement.
take over a department.
d. review every other year
189. A home health OT has received a referral for a Medicare (C) A physician's order identifying services to be provided. Within
patient. Which one of the following items is MOST necessary to the home-care setting, the therapist must have a physician's order,
have before the therapist can initiate evaluation or treatment? which identifies the services that are to be provided. Following the
a. Identification of the deficits that impair functional abilities. OT's assessment, identification of deficits as well as short-term
b. Established short-term and long-term goals. and long-term goals (answers A and B) can be established. The
c. A physician's order identifying services to be provided. individual's history of the current illness (answer D) is contained
d. The individual's history of the current illness. within the initial assessment.
(D) All individuals with open wounds. Treating blood and body
substances of all individuals as though they are contaminated is
the concept of universal precautions. There are several strate-
gies to protect employees from potential exposure. Engineering
controls modify the work environment to reduce risk of expo-
190. OT practitioner should PRIMARILY wear gloves when work- sure; for example, using sharps containers, eyewash stations, and
ing with: biohazard waste containers. Work practice controls are policies
a. individuals with open wounds who have been diagnosed with that require a procedure be performed a certain way so that
human immunodeficiency virus. potential for exposure is minimized. Examples of work practice
b. individuals with third-degree burns. controls include the technique for disposal of sharps using only
c. individuals with open wounds who have been diagnosed with one hand and frequent hand washing during and after patient
hepatitis. contact. Personal protective equipment, another strategy is the
d. all individuals with open wounds. use of appropriate gear to prevent contact with blood or identi-
fied bodily substances. Equipment may include goggles, masks,
gowns, and gloves. Answers A, B, and C are all examples of
individuals with open wounds, where exposure to blood is likely.
Both the health-care provider and the patient could be placed at
risk unless gloves are worn.

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 Johnson (SIMULATION EXAMINXATION 1)
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191. At the beginning of fieldwork, a student asks an OTR who
is the clinical supervisor about student objectives. The MOST
(A) Objectives vary in each facility. Objectives are behavioral
accurate statement about student objectives for fieldwork is:
descriptors of the expectations the student will be required to
a. objectives vary in each facility.
achieve. Each fieldwork site is unique in the provision of OT and,
b. objectives are standardized for all facilities.
therefore, the objectives may vary from site to site.
c. are written by the NBCOT.
d. must meet state licensure requirements
192. An OT providing services to a community mental health
program has been asked to examine the effectiveness of the OT
groups that have been provided over the past 6 months. Which of
(D) Program evaluation. Program evaluation is a systematic col-
the following procedures should be used to accomplish this goal?
lection and reporting of outcomes data to document program
a. Quality assurance
effectiveness and cost-efficiency.
b. Peer review
c. Utilization review
d. Program evaluation
193. A new, inexperienced COTA has joined the staff of a reha-
bilitation facility and the OTR is required to provide close "super-
vision" for the first few months. As specified by AOTA, the amount (A) Contact with supervisor once a day. The Guide for Supervision
of supervisory by AOTA, the amount of supervisory contact the of Occupational Therapy Personnel document provides definitions
OTR should provide to the COTA is: for levels of supervision. Close supervision is defined as "daily,
a. contact the supervisor once a day. direct contact at the site of work." Other levels of supervision are
b. contact with supervisor once a week. routine, general, and minimal.
c. contact with supervisor once a month.
d. contact with supervisor as needed.
194. Many COTAs are employed in long-term care facilities and
perform many functions. The function which the OTR MUST per-
form in this setting is:
a. activity programming, environmental adaptations, and caregiv-
(C) Interpreting results of assessments for the purposes of treat-
er and staff education.
ment planning. Interpretation of assessment results for purposes
b. ADL training, and running feeding and leisure activity groups.
of treatment planning must be performed by the OTR.
c. interpreting results of assessments for the purposes of treat-
ment planning.
d. positioning, providing adaptive devices, and instructing in use
of splints.
195. An OT practitioner evaluation a child notices a bruise on the (C) Make a report to appropriate authorities. In many states, the
child's shoulder that looks like an adults' hand and fingerprint. OT practitioner, as a health professional, is in the position of being
Which of the following actions is it MOST critical for the OT a "mandated reporter" who must make a report if there is reason
practitioner to take? to believe a child has been abused. A report of the injury should
a. Discuss this with the family member who picks up the child. be made to appropriate authorities. Answers A, B, and D delay or
b. Observer further additional injuries. prevent proper assistance to a family involved in the occurrence
c. Make a report to appropriate authorities. of child abuse. All agencies serving children have policies and
d. Avoid becoming involved in personal family matters. procedures for reporting injury in these situations.
196. An OT practitioner is asked, "What is the primary emphasis
of occupational therapy services?" by another health professional.
(D) Reinforcement and enhancement of performance. The em-
The MOST accurate response for the OT to give is that the
phasis of OT is on performance: specifically, performance of work,
emphasis is on:
play, or ADLs. As OTs, the focus has been on reinforcing and
a. skill acquisition.
enhancing the execution of these occupations and the activities
b. compensation for deficits.
which are part of the occupations.
c. environmental adaptation.
d. reinforcement and enhancement of performance.
197. An OT practitioner is conducting a research study on the
effects of using a sling with individuals who sustained a stroke with (D) A small group of patients who are representative of the pop-
resultant hemiplegia. If the researcher were to choose a sample ulation, with each individual meeting criteria which validate that
population for his research, he would MOST likely use: they are a representative subset of the population. Answer D
a. the entire population of the facility's stroke patients. is the MOST correct answer because the question asks for a
b. all patients who have had a CA with resulting deficits in upper sample (subset) population (defined group of people). In research,
extremity function. a sample is a small subset of a group or population. The sample
c. a numbers table to select the population. is to be representative of the entire population.
d. a small group of patients who are representative of the popula-

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 Johnson (SIMULATION EXAMINXATION 1)
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tion, with each individual meeting criteria which validate that they
area representative subset of the population.
198. One OT practitioner witnesses another OT practitioner under
the influence of alcohol treating patients. The practitioner decides
to take actions to prevent this practitioner from practicing in the (C) NBCOT. The NBCOT grants certification to OT practition-
United States. Which of the following would be MOST appropriate ers upon successful completion of the certification exam. Only
organization to contact? NBCOT can revoke or suspend certification. An individual may not
a. AOTA practice or call himself/herself an OTR or COTA if certification has
b. State regulatory board been suspended or revoked, regardless of location.
c. NBCOT
d. Administration of the facility
199. Upon completion of a level-II fieldwork placement on a re-
habilitation unit, student is functioning slightly below minimal en- (A) Fail the student. Students should be evaluated at the midpoint
try-level competence. The supervising fieldwork educator should: of each level-II fieldwork experience as well as at the conclusion.
a. fail the student. The purpose of the final evaluation is to provide the student
b. pass the student with the requirement that the student not with feedback regarding performance during fieldwork as well as
practice in a rehabilitation setting. to document that entry-level competence has been achieved. A
c. pass the student and recommend additional training or volun- student who does not demonstrate entry-level competence should
teer work in rehabilitation setting. not be passed.
d. pass the student.
200. OT practitioner spends 15 minutes reviewing a new patient's
chart and talking to the nurse, who indicates that the patient is
preoccupied with finances. As the OT practitioner enters the room,
the patient states that he does not want to be seen by any of the
therapists because his insurance has run out and he cannot afford
(B) Do not treat the individual based on his refusal and document
to pay for the treatment. Which of the following action would be
the interaction in the chart. As stated in principle 1 of the Code
MOST appropriate for the OT practitioner to take?
of Ethics, "the individual shall inform those people served of the
a. Treat the individual per the physician's order and notify the
nature and potential outcomes of treatment and shall respect the
nurse that the man's preoccupation with finances continues.
right of potential recipients of service to refuse treatment.
b. Do not treat the individual based on his refusal and document
the interaction in the chart.
c. Treat the individual but do not charge or document the services.
d. Do not treat the individual and only charge for the time spent
completing the chart review.

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