Determining & managing context/activities
An OT is working with a client 4 weeks post–CVA who is participating in ADL retraining. The client demonstrates increasing frustration and fatigue during grooming tasks and begins refusing to continue halfway through each session. What should the OT do FIRST to support the client’s progress?
A. Keep the same activity plan to promote endurance
B. Modify the task setup and add rest breaks as needed
C. End the session early whenever fatigue occurs
D. Assign additional self-care tasks for home practice
B. Modify the task setup and add rest breaks as needed
A client recovering from a mild TBI is using attentional strategies to prepare for returning to work. What must the client demonstrate before discharge from OT?
A. Self-awareness of needs and ability to advocate for self in the workplace
B. Implementation of self-management strategies
C. Memorization of work tasks
B. Implementation of self-management strategies
Why? Before discharge, the most important indicator of readiness for returning to work after a mild TBI is the client’s ability to independently apply self-management strategies (e.g., pacing, use of reminders, environmental modifications, rest breaks). These strategies enable the client to self-monitor, regulate performance, and optimize participation in daily and work activities.
A middle-aged client with lumbar spondylosis and recent myocardial infarction presents with weakness, fatigue, SOB, chronic pain, and unsteady gait. During a discharge planning meeting, what is the most important recommendation the OT should contribute?
A. Recommend a home evaluation to assess safety and functional performance in the home environment
B. Recommend social services including meal-on-wheels
C. Recommend mobility devices such as rolling walker or scooter for the home
A. Recommend a home evaluation for safety and functional performance in the home environment.
Why? It ensures the client’s safety, independence, and successful transition home by addressing environmental barriers and functional performance in context.
An OT is working with a client 3 days post–open-heart surgery on basic ADL retraining. During toileting, the client begins to lean heavily on both arms to push up from the commode. What should the OT do FIRST?
A. Allow the client to continue to build upper-body strength
B. Stop the movement and remind the client of sternal precautions
C. Continue the task and monitor for discomfort
D. Immediately contact the nurse and end the session
B. Stop the movement and remind the client of sternal precautions.
It is the OT's priority to keep this client safe, breaking precautions puts the client at risk for re-injury and wound separation. Immediate correction and education is necessary.
A small group has been assigned to determine the plans and proposals for a new clinic. The group is experiencing friction and conflict amongst themselves, with personalities and preferences clashing. Which stage of group development is the group experiencing?
A. Norming B. Storming C. Performing D. Adjourning
A client with COPD shows increased fatigue, poor sleep, loss of appetite, and decreased motivation to complete home exercises. What might these symptoms indicate, and how should the OT respond based on their observation and client report?
These symptoms align with depressive symptoms; the OT should reassess the client through interview and a standardized depression assessment.
An OT is providing a 1:1 session to a kindergarten student focusing on FM tasks, pencil grasp, and sitting posture. The student is using a digital pronate grasp while coloring. Which remedial approach should the OT incorporate?
A. Practice stacking small cubes while seated
B. Use a small crayon (1inch) for coloring, to be completed in prone
C. Provide the student with pencil grips and slant boards
B. Use a small crayon (1inch) for coloring, to be completed in prone
Why? Correcting this grasp would encourage a tripod pattern and improve proximal stability to allow for distal mobility!
An OT is leading a 6-week upper extremity group for clients recovering from distal radius fractures. At the midpoint of the program, several members report less pain but still have difficulty opening jars and lifting objects. What is the BEST way for the OT to monitor the effectiveness of the intervention plan?
A. Ask participants if they feel stronger each week
B. Review attendance records for consistency
C. Reassess grip and pinch strength using a dynamometer
D. Increase the intensity of exercises to promote faster results
C. Reassess grip and pinch strength using a dynamometer
A client with HIV reports multiple falls and difficulty with IADLs. The OT provides education on adaptive strategies to prevent future falls. What type of prevention is this?
A. Positive prevention B. Primary C. Secondary D. Tertiary
D. Tertiary prevention – provided after the onset of disability or disease to reduce complications and restore function.
The client has HIV and is receiving OT to address balance deficits impacting IADLs, focusing on rehabilitation and preventing further decline.
An occupational therapy practitioner determines that a client has made significant progress and needs an updated intervention plan. Which type of documentation should the practitioner complete?
Reevaluation (intervention review); reassessing progress and revising the intervention plan
A 6-year-old child with autism is participating in a sensory integration–based OT program. Initially, the child required significant support to stay on task, but now independently chooses activities and transitions with minimal redirection. What is the OT’s NEXT best action?
A. Discontinue therapy because progress is evident
B. Increase the challenge of sensory-motor activities to promote further development
C. Keep the same level of activity for consistency
D. Shift focus to academic performance instead of sensory skills
B. Increase the challenge of sensory-motor activities to promote further development
why? As the child shows improved self-direction and regulation, the OT should grade activities to maintain the “just-right challenge” and continue supporting sensory-motor skill growth.
Which medication could cause excessive bleeding if the client cuts their skin while shaving?
A. Atenolol B. Lopressor C. Warfarin D. Digoxin
C. Warfarin
Why? Warfarin is an anticoagulant (blood thinner) that increases bleeding risk if the skin is cut or injured.
A client with a T4 spinal cord injury reports a sudden severe headache, anxiety, and increased sweating during therapy. What should the OT do first?
Answer: Stop the activity, sit the client upright, and check for causes of autonomic dysreflexia (e.g., blocked catheter, tight clothing), then notify medical staff immediately.
An OT is leading a group focused on stress management. To monitor the effectiveness of the intervention, what is the most appropriate method?
A. Ask clients to verbally share how they feel at the end of each session
B. Review client-reported outcome measures to assess changes over time
C. Increase the group size to enhance social participation
D. Provide education about additional coping techniques
B. Review client-reported outcome measures to assess changes over time
Why? Client-reported outcome measures provide objective data to evaluate progress and the overall effectiveness of the intervention.
A client diagnosed with paranoid schizophrenia was admitted to an inpatient psychiatric unit following the exacerbation of symptoms with increased agitation and aggression towards others. During a cognitive intervention task, the client becomes agitated and frustrated. How should the OT address this?
Prioritize safety, well-being and therapeutic engagement while addressing acute exacerbation of symptoms. This may include assessing for triggers, providing de-escalation techniques, and collaborating with the multidisciplinary team.
An occupational therapy practioner is planning an intervention for a client experiencing lower back pain. The clients medical history includes a pacemaker and a history of cariac conditions. Which physical agent modalities is CONTRAINDICATED for this client?
TENS because it delivers a continual low impulse stimulation to a large part of the body. The TENS unit simulation may affect the functioning of the pacemaker and may result in irregular heart function.
During pulmonary rehab, a client shows dyspnea. The OTR has them stop, sit, and lean forward with forearms supported. What is the MOST important factor to document to show that the client was safe and the intervention was effective?
A. Cause of the dyspnea
B. Vital signs at symptom onset
C. Client’s response to positioning and symptom relief
D. Exercise intensity before symptom onset
C. Client response to the positioning and symptom relief
Documenting the client’s response and the effectiveness of the intervention highlights safe symptom management and supports progress toward independent self-management.
An OT working with a client recovering from a stroke wants to determine whether current interventions are helping the client achieve functional goals. What should the OT do?
A. Continue current interventions for several more sessions before reevaluating
B. Reassess client performance using standardized reevaluation tools
C. Ask the client’s family if they notice improvement at home
D. Focus sessions on new goals to promote motivation
B. Reassess client performance using standardized reevaluation tools
Why? Reevaluation using standardized tools allows the OT to measure progress toward goals and determine if the intervention plan should be modified.
An OTR is working with a 6-month-old with hypotonia in prone, reaching for dangling toys. What is the OT’s primary reasoning for this activity?
A. Encourage rolling
B. Build UE strength for crawling
C. Promote trunk and neck extension against gravity for proximal stability
C. Promote trunk and neck extension against gravity for proximal stability
Why? Trunk stability and control are the building blocks for all movement patterns from infancy forward. Building strong core strength will ensure a good foundation for stability and control.
Which type of modality is contraindicated for clients with Raynaud phenomenon?
Thermal modalities, specifically the use of cold, are contraindicated for clients with impaired vascular structures.
Why? Clients with Raynaud's experience vasospasm of the blood vessels in the distal extremities, especially the fingers and toes, in response to cold temperatures and stress. It leads to reduced blood supply to the fingers and toes. Clients may experience numbness, cold, or pain as blood vessels constrict causing throbbing, redness or pain as blood flow returns.