Dysphagia
An OTR is developing an oral motor feeding program for a client with dysphagia. During the evaluation, the OTR observes that the client has reduced lingual control, resulting in difficulty manipulating and moving a food bolus to the back of the mouth for swallowing.
Which food is the SAFEST to include in the client's diet?
A. Chopped meat with gravy
B. Cooked pasta with melted cheese
C. Dry oat cereal with milk
D. Toasted bread with butter
✅ Correct Answer: A. Chopped meat with gravy
Rationale:
Clients with reduced lingual control have difficulty:
Chopped meat with gravy provides moisture that helps the food form a cohesive bolus, making it easier for the tongue to manipulate and transport during swallowing.
A speech therapist recommends Level 4 Pureed foods.
Which food is MOST appropriate?
A. Mashed potatoes
B. Toast
C. Crackers
D. Mixed salad
Correct Answer: A. Mashed potatoes
An OTR is evaluating three clients with low vision conditions. Which client presentation is MOST consistent with glaucoma?
A. A client reports increasing difficulty recognizing faces and reading medication labels because of a blurry dark spot in the center of vision.
B. A client reports cloudy vision and significant glare while driving at night and reading under bright lights.
C. A client reports bumping into objects at the sides of hallways and difficulty noticing obstacles in crowded environments.
✅ Correct Answer: C. A client reports bumping into objects at the sides of hallways and difficulty noticing obstacles in crowded environments.
Rationale:
Glaucoma typically causes a gradual loss of peripheral vision, resulting in:
Why the Other Answers Are Incorrect:
A. Difficulty recognizing faces and reading due to a blurry dark spot in the center of vision
B. Cloudy vision and significant glare while driving at night
NBCOT Tip:
Match the vision loss pattern:
A client with COPD becomes increasingly short of breath during a grooming activity at the bathroom sink. The client begins using accessory muscles and reports difficulty catching their breath.
Which position should the OTR instruct the client to assume FIRST to reduce dyspnea?
A. Lie supine with the head flat.
B. Sit upright and lean forward onto crossed forearms.
C. Stand and perform shoulder flexion exercises.
D. Lie on the left side with hips flexed.
✅ Correct Answer: B. Sit upright and lean forward onto crossed forearms.
Rationale:
This position is known as the forward-leaning (tripod) position, a commonly taught breathing strategy for individuals with COPD.
Benefits include:
This is typically the first intervention when a client experiences shortness of breath during activity.
A client is participating in Phase II cardiac rehabilitation following a myocardial infarction. The physician has prescribed activities that do not exceed 3 METs.
Which activity is MOST appropriate?
A. Running on a treadmill at 6 mph
B. Vacuuming the living room
C. Sitting and folding laundry
D. Carrying heavy grocery bags upstairs
✅ Answer: C. Sitting and folding laundry
Rationale:
Folding laundry while seated is typically a low-energy activity (<3 METs).
An OT working in a pediatric outpatient clinic is asked to provide feeding therapy for a 4-year-old with Down syndrome, but has never received formal training in pediatric dysphagia management. Which is the MOST professional response?
A. Accept the referral and learn on the job while observing therapy sessions.
B. Seek mentorship or additional training in pediatric feeding and collaborate with an SLP before initiating treatment.
C. Refer immediately to another OT without further assessment.
Answer: B. Seek mentorship or additional training in pediatric feeding and collaborate with an SLP before initiating treatment.
Rationale: Domain 4 emphasizes maintaining competency and using evidence-based practice. Accepting a referral without proper training risks harm; immediate referral without assessment may unnecessarily delay care.
A client is prescribed Level 0 Thin Liquids.
Which beverage is MOST appropriate?
A. Water
B. Honey-thick juice
C. Pudding
D. Nectar-thick milk
✅ Answer: A. Water
A patient who has been diagnosed with low vision lives alone in a two-bedroom, single-story home. An OTR is completing a home evaluation to provide recommendations that will help the patient compensate for visual impairments and maintain independence.
What would be the MOST appropriate INITIAL recommendation for this patient?
A. Purchase a video magnification system for reading mail and medication labels.
B. Install contrasting colored tape on the edges of stairs, thresholds, and frequently used household items.
C. Begin training in the use of a white cane for all community mobility.
D. Rearrange furniture to create a more aesthetically pleasing environment.
✅ Correct Answer: B. Install contrasting colored tape on the edges of stairs, thresholds, and frequently used household items.
Rationale:
The question asks for the INITIAL recommendation. For clients with low vision, the first priority is typically to improve safety and environmental accessibility using simple, low-cost modifications.
Increasing contrast helps the client:
Why the Other Answers Are Incorrect:
A. Purchase a video magnification system
C. Begin training in the use of a white cane
D. Rearrange furniture
NBCOT Tip:
For low-vision home evaluations, think "safety first." Initial interventions often include:
✅ Increasing contrast
✅ Improving lighting
✅ Reducing glare
✅ Labeling important items
✅ Maintaining clear pathways
Before recommending specialized equipment, start with simple environmental modifications that improve function and safety.
An inpatient had an acute anterolateral myocardial infarction (MI) 3 days ago and is beginning Phase I cardiac rehabilitation. Which evaluation component is CONTRAINDICATED at this time?
A. Measuring the patient's upper extremity strength
B. Monitoring the patient's vital signs during activity
C. Determining the patient's average daily energy expenditure
✅ Correct Answer: A. Measuring the patient's upper extremity strength
Rationale
During Phase I cardiac rehabilitation (acute inpatient phase), the primary goals are to:
Manual muscle testing (MMT) or formal strength testing of the upper extremities is contraindicated shortly after an acute MI because maximal or resistive muscle contractions can:
Therefore, measuring upper extremity strength is not appropriate during the early acute phase of recovery.
A client recovering from CABG surgery is cleared to participate in activities requiring up to 4 METs.
Which activity should the OTR recommend FIRST?
A. Walking on level ground at a moderate pace
B. Shoveling snow
C. Carrying furniture
D. Jogging outdoors
✅ Answer: A. Walking on level ground at a moderate pace
Rationale:
Walking is generally 3–4 METs and is appropriate for early cardiac rehabilitation.
An OTA implements an OT plan for a client with mild dysphagia. The OTR designed positioning strategies and adaptive utensils. Which task is MOST appropriate for the OTA?
A. Conduct a videofluoroscopic swallow study
B. Prescribe thickened liquids
C. Provide supervised feeding using adaptive utensils and proper positioning
Correct Answer: C. Provide supervised feeding using adaptive utensils and proper positioning
Rationale: OTA can implement interventions under supervision. A and B are SLP responsibilities.
An OTR reviews a diet order of Level 6 Soft & Bite-Sized.
Which meal is MOST appropriate?
A. Pureed peaches
B. Chicken cut into bite-sized pieces with soft vegetables
C. Steak
D. Trail mix
✅ Answer: B. Chicken cut into bite-sized pieces with soft vegetables
An OTR is evaluating a client with cataracts who reports difficulty completing grooming tasks in the bathroom early in the morning. The client states that vision seems blurry when shaving and applying makeup, particularly when sunlight enters through the bathroom window.
Which environmental modification is MOST appropriate?
A. Install brighter task lighting around the bathroom mirror and reduce glare from nearby windows.
B. Teach the client to use lighthouse scanning techniques during grooming tasks.
C. Provide colored visual anchors on the left side of grooming supplies.
✅ Correct Answer: A. Install brighter task lighting around the bathroom mirror and reduce glare from nearby windows.
Rationale:
Clients with cataracts often experience:
Improving task lighting while minimizing glare provides the best support for grooming tasks that require visual detail.
Why the Other Answers Are Incorrect:
B. Teach the client to use lighthouse scanning techniques
C. Provide colored visual anchors
NBCOT Tip:
For cataracts, think:
✅ Increase lighting
✅ Reduce glare
✅ Improve contrast
An OTR is treating a client with a history of atrial fibrillation (AFib) who is taking warfarin for stroke prevention. During a transfer training session, the client reports feeling dizzy, loses balance, and strikes the forearm against the armrest of the wheelchair. The client denies pain and there is no visible bleeding.
What is the MOST important action for the OTR to take?
A. Continue the session while monitoring for bruising because there is no visible bleeding.
B. Instruct the client to apply ice to the arm after therapy and continue transfer training.
C. Stop the activity, assess the client for injury and signs of bleeding, and notify nursing staff of the incident.
D. Document the incident at the end of the session and educate the client on fall prevention.
✅ Correct Answer: C. Stop the activity, assess the client for injury and signs of bleeding, and notify nursing staff of the incident.
Rationale:
This question combines two high-risk factors:
Although there is no visible bleeding, clients taking anticoagulants can develop:
The OTR's priority is to stop the activity, assess, and report the incident before continuing treatment.
A patient had a coronary artery bypass graft (CABG) one week ago. The patient will be discharged from the inpatient rehabilitation unit to live at home with family. One of the patient’s goals is to resume homemaking and childcare tasks.The cardiologist is allowing the patient to resume an activity level of no more than 1.5 metabolic equivalent (METs) units.
Which activity represents a MAXIMUM allowable MET-level activity for this patient?
A Moving laundry from the washer to the dryer
B Assisting a young child with bathing and dressing
C Grooming while seated at a bathroom sink
D Standing under warm water in the shower
Correct Answer: C. Grooming while seated at a bathroom sink
Rationale: Seated Grooming (≤1.5 METs)
Grooming while seated is the SAFEST activity because it minimizes cardiac workload through energy conservation.
Conserves energy by eliminating standing demand.
Requires minimal exertion for upper extremity tasks.
Strictly adheres to the 1.5 MET limit post-CABG.
A patient who has critical illness polyneuropathy and is at risk for aspiration is participating in OT to increase independence with self-feeding. During a session, the OTR notes that after several bites of food, there is a change in the patient’s vocal quality that can be described as wet phonation. Based on this observation, what is the BEST statement that describes why the OTR should inform the physician about the patient’s wet phonation after swallowing?
A. Possible weak laryngeal elevation with reduced closure of the epiglottis over the airway
B. Concern for reduced esophageal motility and incompetence of the upper esophageal sphincter
C. Reduced strength of the jaw, lips, and tongue musculature that interfere with a safe swallow
✅ Correct Answer:
A. Possible weak laryngeal elevation with reduced closure of the epiglottis over the airway
NBCOT Rationale
The key clue is:
"Wet phonation after swallowing"
A wet or gurgly vocal quality after eating suggests that food, liquid, or secretions are remaining on or near the vocal folds because the airway was not adequately protected during swallowing.
This indicates a problem with airway protection during the pharyngeal phase of swallowing, often due to:
Because the patient already has critical illness polyneuropathy and is at risk for aspiration, the OTR should report this finding to the physician.
A client aspirates thin liquids but safely swallows mildly thick liquids.
Which IDDSI liquid level is MOST appropriate?
A. Level 0
B. Level 1
C. Level 2
D. Level 7
✅ Answer: C. Level 2
An OTR is evaluating a client who recently sustained a traumatic brain injury. During a grooming task at the bathroom sink, the client reports seeing two images of the toothbrush and frequently reaches to the wrong location when attempting to grasp grooming items. The client states that symptoms worsen when looking at objects across the room.
Which intervention is MOST appropriate for the OTR to recommend initially?
A. Increase task lighting and contrast around the sink area.
B. Teach the client to scan the environment using lighthouse scanning techniques.
C. Apply an eye patch to one eye during grooming tasks as recommended by the vision specialist.
D. Place brightly colored tape on the left side of grooming items.
✅ Correct Answer: C. Apply an eye patch to one eye during grooming tasks as recommended by the vision specialist.
Rationale:
The client is experiencing diplopia (double vision), which commonly occurs after neurological injury due to impaired eye muscle coordination. An eye patch or partial occlusion prescribed by a vision specialist can eliminate one of the images, allowing the client to perform functional tasks more safely and accurately.
An outpatient client who recently experienced a myocardial infarction is participating in a Phase II cardiac rehabilitation program. During a meal preparation activity, the OTR monitors the client's heart rate and notes the following responses:
What can the OTR conclude based on the client's cardiac response to activity?
A. This is an abnormal response to activity; the supervising physician should be alerted immediately.
B. This is an unexpected response to activity; modify the session to avoid use of the upper extremities.
C. This is an expected response to activity; proceed with the session as planned.
✅ Correct Answer: C. This is an expected response to activity; proceed with the session as planned.
Rationale
During Phase II cardiac rehabilitation, clients participate in progressively challenging functional and exercise activities while their physiological response is monitored.
Small increases in heart rate during activity are expected because:
In this scenario:
represent a normal physiological response to activity and do not indicate cardiac distress.
A client enrolled in Phase II cardiac rehabilitation has been cleared to participate in activities requiring up to 4 METs. The client wants to resume household responsibilities.
Which activity is MOST appropriate?
A. Preparing a simple meal in the kitchen
B. Mowing the lawn with a push mower
C. Carrying a full basket of laundry upstairs
D. Moving furniture to clean behind it
✅ Correct Answer: A. Preparing a simple meal in the kitchen
Rationale
Simple meal preparation is generally 2–4 METs and is appropriate for a client cleared for activities up to 4 METs.
NBCOT Clue
When you see 4 METs, think:
Avoid:
A resident in a skilled nursing facility has dysphagia and poor oral control. During a self-feeding session, the OTR observes that the resident pockets food in the cheek, and food remains in the mouth between bites. The OTR strokes the outside of the cheek where the pocketing occurs and instructs the resident to check the inside of the cheek for food. However, the resident is unable to swallow the remaining food.
What is the NEXT action the OTR should take to facilitate swallowing of the pocketed food?
A. Have the resident clear the throat immediately after the next successful swallow.
B. Encourage the resident to use a straw to drink small sips of room-temperature water.
C. Touch the resident's lip with an empty eating utensil to facilitate another swallow.
✅ Correct Answer: C. Touch the resident's lip with an empty eating utensil to facilitate another swallow.
Rationale:
The resident has already received verbal cues and external cheek stimulation but is still unable to clear the pocketed food. The next step is to provide an additional sensory cue to trigger the swallowing response.
Touching the lip with an empty utensil is a common dysphagia intervention that:
During a meal assessment, a client is prescribed Level 5 Minced & Moist. Which food should the OTR remove from the tray?
A. Finely minced meat with gravy
B. Moist scrambled eggs
C. Peanuts
D. Soft cooked vegetables
✅ Answer: C. Peanuts
An OTA is working with a patient who has mild vision loss. One of the patient's goals is to independently read books and magazines while sitting in a recliner in the living room.
Which interventions would be BEST to introduce to support the patient's reading performance? Select 3 answers.
A. Position an adjustable gooseneck lamp to direct light onto the reading material.
B. Encourage the patient to hold reading materials closer to the eyes or use a handheld magnifier.
C. Recommend high-contrast reading materials with large print.
D. Reduce all lighting in the room to minimize visual distractions.
E. Encourage reading while watching television to improve visual attention.
F. Place reading materials on a low-gloss surface to reduce glare.
✅ Correct Answers:
Rationale
A. Adjustable task lighting
✔️ Improves illumination of the reading material without increasing overall room glare. Task lighting is one of the most effective low-vision interventions.
C. Large print and high contrast
✔️ Enhances visual discrimination and readability for individuals with mild vision loss.
F. Reduce glare
✔️ Glare can significantly interfere with reading performance. Positioning materials on low-gloss surfaces and controlling reflected light improves visual comfort.
A client is 5 days post-Coronary Artery Bypass Graft Surgery and is participating in OT on a cardiac step-down unit. The client is following sternal precautions and wants to transfer from a chair to standing to complete morning grooming tasks at the sink.
Which method is MOST appropriate for the client to use during the sit-to-stand transfer?
A. Push up forcefully from both armrests to stand.
B. Pull on a walker positioned in front of the chair.
C. Cross the arms over the chest and use the legs to rise from the chair.
D. Place one hand on the armrest and one hand on the walker to assist with standing.
✅ Correct Answer: C. Cross the arms over the chest and use the legs to rise from the chair.
Rationale
Following median sternotomy, sternal precautions are implemented to protect healing sternal tissues and reduce stress on the sternum.
Clients are generally instructed to:
Crossing the arms over the chest while using the legs to stand minimizes stress on the sternum and follows sternal precautions.
A client is participating in Phase II cardiac rehabilitation following a myocardial infarction. The physician has cleared the client for activities requiring up to 5 METs. During a discharge planning session, the client asks which household activity would be appropriate to resume independently.
A. Walking briskly around the neighborhood for 20 minutes
B. Carrying multiple bags of mulch around the yard
C. Shoveling snow from the driveway
D. Moving a refrigerator to clean behind it
✅ Correct Answer: A. Walking briskly around the neighborhood for 20 minutes
Rationale
A brisk walk is generally within the 4–5 MET range, making it appropriate for a client cleared for activities up to 5 METs.
This activity: