Question 1

Phil is a 43-year-old outpatient with a diagnosis of right rotator cuff tear with surgical repair. His insurance will only cover six OT sessions. How could you provide therapy to Phil for the length of time that he needs without exceeding his insurance limits?
A)See Phil for extra-long sessions, so you can get as much done at one time as possible.
B)See Phil once per week. Set him up with a thorough home exercise and modality program to complete between sessions.
C)See Phil at the normal frequency and hope he heals up quickly.
D)Tell Phil to get new health insurance.

Accepted Answer

You could provide therapy to Phil for the length of time he needs by seeing him once per week. Also, set him up with a thorough home exercise program, including any modalities that Phil can administer himself. Phil can complete these tasks on his own between therapy sessions. If therapy is provided this way, Phil will receive six weeks of therapy, and you will be better able to monitor his progress.

Question 2

Lester will be discharged from the nursing home in one week. He lives alone, and you have concerns regarding Lester's ability to follow through with the adaptive dressing and housekeeping techniques you have taught him during his nursing home stay. What do you and your OT department decide to do to insure that Lester will be able to follow through with the techniques you have taught him?
A)Ask his daughter to check on him every day, even though she lives an hour away.
B)Tell Lester's physician that he must have home health services to insure he follows through with dressing and housekeeping techniques.
C)Complete a home visit with Lester and have him demonstrate dressing and housekeeping techniques while you are there.
D)Tell Lester that he must stay in the nursing home another two weeks.

Accepted Answer

To insure that Lester will be able to follow through with dressing and housekeeping techniques at home, you decide to complete a home visit. Have Lester demonstrate dressing and housekeeping techniques while you are at his home. If Lester can complete the techniques in his own surroundings, he is more likely to follow through with them once he is home for good.

Question 3

Norman has left hemiplegia from a right CVA. His Medicare Part A coverage has run out, and his wife wants to take him home rather than pay for a longer nursing home stay. Norman is developing spasticity in his affected arm and has been issued a resting pan splint. What training will his wife need before she takes Norman home?
A)How to position Norman's arm while he is resting.
B)How to perform passive range of motion exercises to Norman's affected arm.
C)How to apply Norman's resting pan splint, and what his wearing schedule is for the splint.
D)All of the above.

Accepted Answer

Before he goes home, you will need to train Norman's wife in how to position Norman's arm while he is resting, how to perform passive range of motion exercises to Norman's affected arm, and how to apply Norman's resting pan splint according to the prescribed wearing schedule. Norman's wife will need to assist him with all of these activities to prevent him from developing contractures in his affected arm.

Question 4

Angel is a 26-year-old outpatient who is recovering from multiple fractures in the carpal bones of her right hand. You have issued a home exercise program, but you can tell that Angel is not following through with the program. When you ask her, she tells you that she is very busy and has not had time to complete the exercises. What could you do to encourage Angel to follow through with her exercise program?
A)Split up Angel's exercises into smaller sets, so she can complete a few at a time during short breaks in her busy day.
B)Emphasize to Angel that she will not regain full use of her hand if she does not complete her exercises.
C)Give Angel only one or two exercises to complete at a time, so she will have time to complete them every day.
D)Tell Angel's doctor that she is not progressing because she is not completing her home exercise program.

Accepted Answer

To encourage Angel to follow through with her exercise program, you could split up her exercises into smaller sets and tell her to complete a few at a time during short breaks in her busy day. If Angel can complete a few exercises here and there, rather than having to sit down and do them all in one session, she is more likely to follow through with them. Follow through works best if the exercise program is designed to fit into the patient's lifestyle.

Question 5

John and his wife Lavinia have been married for 63 years. John is being discharged from the nursing home. You have worked hard at teaching him how to complete ADLs himself, but he insists that Lavinia help him with everything once he gets home. Lavinia has severe osteoarthritis and has trouble completing her own ADLs. What do you tell John to encourage him to complete ADLs himself?
A)"John, you are lazy. You must complete your own self-care tasks.
B)"John, your doctor will not let you out of this nursing home until you can complete your own self-care tasks."
C)"John, I know Lavinia is very willing to help you do everything at home. But she is in a lot of pain, and she has trouble completing her own self-care tasks. Don't you think that if you could complete your own self-care tasks, you would make life easier for Lavinia?"
D)"John, I will not allow Lavinia to do everything for you. You must complete your self-care tasks yourself!"

Accepted Answer

You would tell John that you know his wife, Lavinia, is very willing to help him with everything at home. But she is in a lot of pain and has trouble completing her own self-care tasks. You would appeal to John that the act of completing his own self-care tasks would make life easier for Lavinia. Elderly people are often motivated by the fact that if they can complete a task themselves, they will not be a "burden" to their loved ones.

Question 6

What does the term, "Flat affect" mean?
A)The person's face is flat.
B)The person exaggerates emotions with large fluctuations in facial expressions.
C)The person does not change facial expressions, giving the face a consistently neutral appearance.
D)The person cries all the time.

Accepted Answer

Flat affect means that the person does not change facial expressions, giving the face a consistently neutral appearance. Flat affect is a symptom of depression.

Question 7

Your patient, Mark, has a diagnosis of schizophrenia. He repeatedly talks to you about the voices he hears from other realms. How do you respond when Mark starts talking about these voices?
A)You divert his attention with a functional activity that has solid basis in real time.
B)You tell Mark that the voices are a part of his illness, and he should ignore them.
C)You discuss the voices with Mark, so you can determine what they are telling him.
D)You notify nursing staff that Mark needs a medication adjustment.

Accepted Answer

You respond to Mark's attempts to talk to you about the voices by diverting his attention with a functional activity that has solid basis in real time. By focusing Mark's attention on a real-time activity, you will force his mind to attend to real life - rather than the voices.

Question 8

Sandy is a 32-year-old client of the community program where you work. She has a diagnosis of Down syndrome with cognitive delay. Sandy completes her own basic self-care tasks, simple meal preparation, and housekeeping. Her case manager asks you for a recommendation for a supported employment placement. What do you recommend?
A)Cashier at Wal-Mart.
B)A housekeeping position at a local hotel.
C)Receptionist at the therapy clinic.
D)Packaging parts at the sheltered workshop.

Accepted Answer

You recommend a housekeeping position at the local hotel for Sandy. Since Sandy completes her own housekeeping tasks at home, you know that she is capable of completing the tasks required to work in housekeeping at the local hotel. Packaging parts at the sheltered workshop is below Sandy's capabilities, while cashier and receptionist jobs involve tasks that Sandy cannot complete on her own.

Question 9

Dorothy has Stage 2 Alzheimer's disease. She expresses her concerns to you about her memory problems and worries about becoming more forgetful in the future. She asks you for ideas to help her remember things at home. What do you recommend to Dorothy?
A)Use a wall calendar to write down appointments and events.
B)Store frequently used phone numbers in the one-touch dial function of the telephone or keep a list of frequently used phone numbers next to the phone.
C)Use a kitchen timer to time everything she cooks.
D)All of the above.

Accepted Answer

You recommend to Dorothy that she uses a wall calendar to write down appointments and events, programs her phone with frequently used phone numbers or keeps a list of phone numbers by the phone, and uses a kitchen timer every time she cooks something. These are all simple adaptations to compensate for mild memory loss.

Question 10

Sasha is your 24-year-old inpatient in the eating disorders unit. She has a diagnosis of anorexia nervosa and must have everything organized and perfect to feel comfortable. How do you approach a craft activity with Sasha?
A)Have her mold messy, wet clay.
B)Allow her to choose an activity, and let her take her time organizing her materials.
C)Give her a flower arranging task, and then purposely mess up all the flowers.
D)Give her a cross-stitch activity, and set a timer to limit the amount of time she can spend organizing the threads.

Accepted Answer

You would give Sasha a cross-stitch activity, and set a timer to limit the amount of time she can spend organizing the threads. People who have eating disorders often overly focus on having control of a situation, to the point that they overly focus on organizing an activity rather than completing it. You would choose an organized activity such as cross-stitch for Sasha to complete, so the activity itself is not threatening to her. But you would limit the amount of time she can spend organizing the threads, so Sasha can move on to completing the cross-stitch task.

Question 11

You must arrange a game for a small group of nursing home patients, all diagnosed with various stages of senile dementia. What game do you select?
A)Charades
B)Bingo (with large numbered cards and microphone to call the numbers)
C)Trivia (with the questions taken from an era when the patients were young adults)
D)Basketball

Accepted Answer

You would select a trivia game with questions taken from an era when the patients were young adults. Long-term memory usually remains intact when a person has senile dementia, so participants of your group should be able to successfully answer questions about events that occurred when they were young adults.

Question 12

You are setting up your cooking activity for your group of psychiatric patients. Two of the patients have obsessive compulsive disorder (OCD). What must you look out for with these two patients while completing the cooking task?
A)You must watch to make sure these two patients do not become belligerent with the other patients in the group.
B)You must watch to make sure these two patients add ingredients correctly and cook the food for the appropriate amount of time.
C)You must watch to make sure these two patients do not hide the cooked food in their pockets.
D)You must watch to make sure these two patients sequence the recipe correctly.

Accepted Answer

While completing the cooking task, you must watch to make sure these two patients add ingredients correctly and cook the food for the appropriate amount of time. People with OCD may become so focused on their obsessions during an activity that they neglect the task they are doing or deviate from the instructions to accommodate their obsessions.

Question 13

What activity would be appropriate for an independent living skills group of outpatient psychiatric patients?
A)Grocery shopping in the community.
B)Playing softball.
C)Making yarn dolls.
D)All of the above.

Accepted Answer

Grocery shopping in the community would be an appropriate activity for an independent living skills group of outpatient psychiatric patients. This activity teaches community mobility, product selection, budgeting and money management, and food preparation.

Question 14

Your OT department has asked you to develop a sensory group for the clients who have autism and work at the sheltered workshop. What activity could you include for these clients, who range in age from 23 to 56?
A)Riding on scooter boards.
B)Swinging at the local park.
C)Sitting on therapy balls to play catch.
D)Dancing under a strobe light.

Accepted Answer

You could include sitting on therapy balls to play catch as an activity for this group. Due to the age of the clients, riding on scooter boards or swinging at the local park might not be appropriate. Dancing under a strobe light would probably irritate their sensory issues.

Question 15

You are asked to lead an exercise group for cognitively disabled adults. How do you present the exercises to this group?
A)Keep the exercises simple, and demonstrate the steps of each exercise until each member of the group can follow the task.
B)Play a video demonstrating the exercises, and tell the participants to follow along.
C)Ask each member of the group to come up with an exercise and teach it to the group.
D)Run the exercise group just like you would any other exercise group, as you expect this group of adults to participate independently in the community.

Accepted Answer

You present exercises to this group by keeping the exercises simple and demonstrating the steps of each exercise until each member of the group can follow the task. Adults with cognitive disabilities take longer to learn smaller pieces of information. For all of the adults to be able to follow the exercises, you would want to select exercises with fewer steps and take extra time teaching those steps.

Question 16

Your client Stephanie is a 31-year-old woman with autism. She has undergone medication changes, and her tactile defensiveness has exacerbated. How do you help Stephanie to manage her tactile defensiveness?
A)Teach Stephanie the full Wilbarger brushing protocol; and expect her to follow the full protocol independently.
B)Introduce the Wilbarger brushing protocol to Stephanie, and ask her if she would like to try it.
C)Introduce the Wilbarger brushing protocol to Stephanie and only complete brushing to her arms. As she becomes used to the procedure, expand it to her legs and back.
D)Wrap Stephanie up in a weighted blanket.

Accepted Answer

You help Stephanie manage her tactile defensiveness by introducing her to the Wilbarger brushing protocol. Since Stephanie may view brushing as threatening, you only complete brushing to her arms, a non-threatening part of the body. As she becomes used to the procedure, you expand brushing to her legs and back.

Question 17

Dawn is a 36-year-old cognitively disabled woman in your community activity program. She has not developed the emotional skills of sympathy and empathy. Lately, Dawn has been bossing the other clients of the program around and threatening them if they do not do what she says. How do you address Dawn's behavior?
A)Ask Dawn how she would like it if someone did that to her.
B)Make Dawn do the things she has been demanding that the other clients do.
C)Ignore Dawn's behavior to discourage her from seeking attention by engaging in it.
D)Tell Dawn that she will need to move to another part of the room if she does not stop threatening other clients.

Accepted Answer

You would tell Dawn that she will need to move to another part of the room if she does not stop threatening other clients. Because Dawn has not developed the skills of sympathy and empathy, she will not understand an intervention that involves her thinking about or experiencing what the other clients are experiencing. She will need the concrete consequence of being separated from the other clients to understand that what she is doing is not acceptable.

Question 18

Ruth is a 75-year-old woman with memory loss due to old age. She cannot remember her address and phone number. How do you help Ruth remember this information?
A)Have Ruth memorize her address and phone number until she can state them back to you.
B)Have Ruth keep her address and phone number on a piece of paper in her wallet where she can easily access it.
C)Have Ruth use associative memory tricks to help her remember her address and phone number.
D)Tell Ruth she should not live alone because she cannot remember her address and phone number.

Accepted Answer

You would help Ruth by having her keep her address and phone number on a piece of paper in her wallet, so she can easily access it. Since Ruth's memory loss is due to old age, she is not likely to respond to regular memorization or memory tricks. But she will respond to the ability to look up the information quickly from a convenient place.

Question 19

Waverly must take six medications each morning. He tells you he often forgets to take one or more of his medications because he just can't keep them organized. What do you recommend for Waverly?
A)Pill organizer
B)Prescription bottle holder
C)Review of medications (make sure they are all necessary)
D)Bigger medicine cabinet

Accepted Answer

You recommend a pill organizer for Waverly. A pill organizer uses smaller compartments of a larger container to organize medication doses according to the days of the week. This adaptation would help Waverly organize his medications and take them as prescribed - by simply opening the appropriate compartment when it is time to take medications.

Question 20

Maureen, your inpatient in the psychiatric unit, is afraid to go outside. How do you encourage Maureen to go outside?
A)Introduce going outside to Maureen in steps, including showing her pictures of the outdoors, looking out the window, standing by the door, opening the door, and finally stepping through the door. Practice each step until Maureen is no longer afraid before you proceed to the next step.
B)Have Maureen watch movies of the outdoors to get her used to the outdoor environment.
C)Plan an activity for outdoors that will take Maureen's mind off of the fact that she is outside.
D)All of the above.

Accepted Answer

To encourage Maureen to go outside, you would introduce the idea in steps, including showing her pictures of the outdoors, looking out the window, standing by the door, opening the door, and finally stepping through the door. You would practice each step with Maureen until she is no longer afraid before proceeding to the next step. This method of approaching the task follows the principles of cognitive behavioral therapy.

Quiz 2: Implementing Interventions

Phil is a 43-year-old outpatient with a diagnosis of right rotator cuff tear with surgical repair. His insurance will only cover six OT sessions. How could you provide therapy to Phil for the length of time that he needs without exceeding his insurance limits?

What does the term, "Flat affect" mean?

Your patient, Mark, has a diagnosis of schizophrenia. He repeatedly talks to you about the voices he hears from other realms. How do you respond when Mark starts talking about these voices?

Dorothy has Stage 2 Alzheimer's disease. She expresses her concerns to you about her memory problems and worries about becoming more forgetful in the future. She asks you for ideas to help her remember things at home. What do you recommend to Dorothy?

Sasha is your 24-year-old inpatient in the eating disorders unit. She has a diagnosis of anorexia nervosa and must have everything organized and perfect to feel comfortable. How do you approach a craft activity with Sasha?

You must arrange a game for a small group of nursing home patients, all diagnosed with various stages of senile dementia. What game do you select?

You are setting up your cooking activity for your group of psychiatric patients. Two of the patients have obsessive compulsive disorder (OCD) . What must you look out for with these two patients while completing the cooking task?

What activity would be appropriate for an independent living skills group of outpatient psychiatric patients?

Your OT department has asked you to develop a sensory group for the clients who have autism and work at the sheltered workshop. What activity could you include for these clients, who range in age from 23 to 56?

You are asked to lead an exercise group for cognitively disabled adults. How do you present the exercises to this group?

Your client Stephanie is a 31-year-old woman with autism. She has undergone medication changes, and her tactile defensiveness has exacerbated. How do you help Stephanie to manage her tactile defensiveness?

Ruth is a 75-year-old woman with memory loss due to old age. She cannot remember her address and phone number. How do you help Ruth remember this information?

Waverly must take six medications each morning. He tells you he often forgets to take one or more of his medications because he just can't keep them organized. What do you recommend for Waverly?

Maureen, your inpatient in the psychiatric unit, is afraid to go outside. How do you encourage Maureen to go outside?