Purple Book NBCOT, Complete answered/rationales Test Bank

An OT is preparing to evaluate a toddler who has UE orthopedic concerns. How will the OT MOST likely obtain the majority of the initial assessment data? a. measurement tools that assess visual-motor skills. b. dynamometer and pinch meter readings. c. Observation of a child during activities in the child-care center. d. Functional independence measures. - correct answer C. observation of a child during activities in the child-care center. Through observation of the child, the OT can collect information about the child's motor performance skills and participation in activities that require UE/hand skill. Naturalistic observation is a method of ecologic assessment which is a "primary mechanism for obtaining data relevant to the child's performance context." The other answer choices are all appropriate choices after the child is old enough for these assessments. During an initial eval, the OT suspects that a child has somatodyspraxia. In what area should the OT focus on the eval? a. ability to print or write b. reading competency c. math calculations d. new motor task planning - correct answer D. New motor task planning Somatodyspraxia is described as a deficit in learning new motor skills, planning new motor actions, and generalizing motor plans. Inability to print or write is termed dysgraphia. Dyslexia means dysfunction in reading, and dyscalculia is the term for inability to perform mathematics. An OT working in a long-term care facility needs to eval the long-term memory of a resident. Which of the following methods is BEST for evaluating memory of personally experienced events (declarative memory). a. show the person a series of objects and ask him to recall the objects within 60 seconds b. ask the individual how he spent New Years. c. have the individual state the place, date, and time. d. ask the client to remember to bring a specific item to the next therapy session. - correct answer B. ask the individual how he spent New Years Declarative memory is one aspect of long term memory and includes conscious memory of events, knowledge, or facts. It is commonly assessed through verbal interviews and informal testing such as asking a question about a persons recall of personal events. Working memory refers to the temporary storage of information while one is attending to it (answer A). Prospective memory involves the ability to remember intentions or activities that will be required in the future (answer D). Knowing time, date, and place is orientation. A child avoids playground equipment that requires her feet to be off the ground. What does this behavior MOST likely indicate? a. difficulty modulating proprioception b. somatodyspraxia c. gravitational insecurity d. bilateral integration/sequencing deficits. - correct answer C. Gravitational insecurity. gravitational insecurity is described as fear response to movement. Tactile defensiveness (answer A) is a term used to describe discomfort with various textures with unexpected touch. Somatodyspraxia interferes with development of bodyscheme and awareness. Bilateral integration relates to ability to coordinate, sequence, and execute motor actions quickly and efficiently. When the OT suspects tactile defensiveness as a rational for a child's challenges, in what area of participation should the OT focus on FIRST? a. play behavior b. dressing habits c. social skills d. leisure interests - correct answer b. dressing habits Children with tactile defensiveness are bothered by tactile aspects of ADLs including specific types of clothing. The child may avoid wearing certain clothes. Conversely, some children may never take their shoes off to avoid tactile stimulation. Play behavior and social skills could be affected secondarily as a result of intolerance to certain textures or human touch. Knowledge of the child's dressing habits will give the OT key information at the start of the evaluation process. An OT is working with an individual with schizophrenia who is in the process of preparing to move from a state hospital to a group home. During a baking group, the client becomes agitated and leaves the room when another client uses the electric hand mixer to mix the cake batter, and again when two clients begin to argue loudly about which type of icing to use. How would the OT BEST describe this behavior? a. low registration b. sensory avoiding c. sensory seeking d. a hearing impairment - correct answer b. sensory avoiding The individual's actions are indicative of sensory avoiding behavior, characterized by low threshold to stimuli perceived as noxious, followed by an active response such as leaving the room. Individuals with sensory avoiding behavior may become distressed in situations in which they cannot control the environment. An individual with low registration, sensory seeking behavior, or a hearing impairment would not have difficulty with the auditory stimulation. During a self-care eval of an individual who recently sustained a brain injury, the OT instructs the individual to comb his hair immediately after he washes his face. The individual washes his face quickly, but then the therapist must give him several reminders to comb his hair. The OT is MOST likely to identify this as a deficit in what area? a. working memory b. judgement c. hearing d. abstraction - correct answer a. working memory working memory is the temporary storage of information while one is working with it or attending to it. It includes the ability to recall information immediately after exposure. It also allows one to focus conscious attention and keeps track of information as one is performing an activity. Judgment is the ability to make realistic and safe decisions and would not be needed for this task. Because the person performed the first request, hearing would seem intact. Abstraction is the ability to extrapolate information from an idea to generalize to another situation and would not be needed to follow this direction. A supermarket employee with OCD takes an hour to stock 24 soup cans on the shelf because once he has placed the cans on the shelf, he removes them and starts over stating "all the labels were not lined up exactly in the same direction." Which of the following methods would be MOST effective to evaluate this individual's work performance? a. on-site observation of performance skills b. formal cognitive assessment c. verbal interview focusing on the requirements of the job. d. task evaluation using a "clean" medium such as a puzzle. - correct answer A. on-site observation of performance skills Individuals with OCD often experience difficulties with work. Observation in situational context is likely to be more useful in fully understanding their behavioral success and is the preferred approach for assessing work function of people with psychiatric disabilities. There is nothing to suggest the individual has a cognitive deficit or need for cognitive evaluation. Interview is more useful for assessing an individual's readiness for work, occupational development, and interests. Task evaluation with a clean medium may be indicated for individuals with OCD of the washing type. However, this individual has OCD of the checking type. An OT has been working with an individual who is recovering from a TBI. A standard pivot transfer has been successfully demod in the gym. The MOST appropriate way to assess generalization of this new learning would be to have the patient perform which activity? a. identify potential hazards in the patient's bathroom at home that could make transferring unsafe. b. select an appropriate tub bench and nonskid mat for the patient's bathroom at home. c. attempt a standard pivot transfer from wheelchair to bed in the patient's hospital room. d. attempt a sliding board transfer from wheelchair to tub. - correct answer C. Attempt a standard pivot transfer from the wheelchair to bed in the patient's hospital room. Giving the individual a functional task, then changing it, and observing the response will tell the therapist how well the patient can transfer learning to new situations. Generalization of skill is seen when the learner is able to spontaneously perform the task in different environments. None of the other answers assess the ability to transfer learning. An OT is working with an individual with depression who is cognitively intact but demoing difficulty carrying out self-care and other ADL tasks. The OT, who has no advanced certifications, would like to identify a standardized assessment to measure ADL performance. Which is the MOST appropriate tool for this purpose? a. Bay Area Functional Performance Eval. b. Routine Task Inventory- Expanded. c. Kohlman Evaluation of Living Skills. d. Assessment of Motor and Process Skills. - correct answer c. Kohlman Evaluation of Living Skills the KElS combines interview items with simulated performance to obtain information about 17 living skills in the areas of self-care, safety and health, money management, transportation, telephone use, and work and leisure. The AMPS assesses motor and process skills, sometimes embedding a task that is in an ADL category. In order to administer the AMPS, one must have special training. Therefore, the OT could not use this immediately. The routine task inventory uses observation to assess 14 different ADL aspects and is based on the cognitive disabilities model which would not be appropriate for this client. The bay area functional performance eval was designed to measure performance skills such as memory, organization, attention, motivation, and frustration tolerance. Although it can help the OT develop conclusions about ADL performance, it is not actually an ADL evaluation tool. An OT is conducting a perceptual function screening with an individual who has had a CVA. Which of the following informal screening activities would the therapist ask the individual to perform in order to identify the presence of agnosia? a. demonstrate common gestures such as waving. b. name objects through touch only c. identify or demonstrate the use of common household objects. d. read a paragraph and explain its meaning. - correct answer c. identify or demo the use of common household objects visual agnosia is the inability to recognize common objects and demo their use in an activity. Asking the individual to demo common gestures such as waving is a technique to screen for apraxia or the inability to perform purposeful movement on command. Answer B is asking the individual to perform stereognosis. Asking the individual to read a paragraph an explain its meaning would be a screening method for alexia, or the inability to understand written language. An individual with an L4 SCI wishes to become independent in driving an automobile. The MOST appropriate piece of AE for this individual is: a. palmar cuff for the steering wheel b. spinner knob for the steering wheel c. pedal extensions for acceleration and breaking. d. hand controls for acceleration and breaking. - correct answer d. hand controls for acceleration and breaking. An L4 SCI would result in paraplegia. Hand controls use hand motions to control the accelerator and brake mechanisms, limiting the need for LE function. answers A and B are options for individuals who need to steer single-handedly. Pedal extensions can be installed for individuals with limited LE reach. What is the MOST important aspect of administering and scoring a standardized test? a. judgment to determine how best to administer the test. b. previous experience as a way to gauge test results c. adherence to specific instructions for administration and scoring. d. practice in administering the test items. - correct answer c. adherence to specific instructions for administration and scoring. In standardized assessments, the instructions are detailed and fixed so that procedures are followed consistently. Following these instructions assures the highest level of reliability and validity possible. Subjective judgment and previous experience may be factors in administration of nonstandardized tests. Although practice of a attest can help determine competence in the use of a test, it would not influence how to administer and score the test. During an initial interview, parents describe their child as having difficulty communicating and interacting with others. The OT observes him repeatedly gazing upward and scanning the ceiling or quickly patting his hip. These behaviors described are MOST likely to be associated with what disorder? a. ADHD b. Childhood conduct c. Obsessive compulsive d. autism spectrum disorder - correct answer d. autism spectrum disorder. ASD is characterized by severe and complex impairments in reciprocal social interaction and communication skills, and by the presence of stereotypical behavior, interest and activities. Children with ADHD display behaviors of inattention, hyperactivity, and impulsivity. Children with childhood conduct disorder display severe forms of chronic misbehavior such as physical aggression or lying. OCD is characterized by intrusive thoughts and repetitive behaviors that have little or no functional purpose beyond decreasing tension. A toddler with spina bifida has been referred for assessment. When collecting the initial data during interview with the child's parent, what should the OT focus on PRIMARILY? a. parent's concerns and goals for the child. b. Childs medical management c. equipment needs d. physical layout of the home. - correct answer A. parents concerns and goals for the child. Interviews enable the OT and parent to develop rapport and provide opportunity for the parents and children to identify and discuss issues that are important to them. The other answers are important issues as well but can be addressed at a later time. When evaluating an individual with coronary artery disease for controllable risk factors, what is MOST important for the OT to include as part of the assessment? a. determine the individual's age and gender b. assess the individual's lifestyle and dietary habits. c. observe the individual for obesity and cholesterol levels. d. determine whether the individual has a family history of heart disease. - correct answer b. assess the individual's lifestyle and dietary habits. controllable risk factors include smoking, cholesterol, hypertension, sedentary lifestyle, obesity, diabetes, and psychological stress. OTs have expertise in working with individuals to address goals associated with lifestyle performance and dietary habits that can help prevent heart disease. Age, gender, and family history are all uncontrollable risk factors. A doctor would address the other three answer choices. The OT has been working with an individual with deficits in the area of executive functioning postsurgery. When the OT asks about scheduling a therapy appointment after discharge and transportation to the outpatient clinic, the client is unable to identify how to obtain the clinic's phone number or where to park. When the OT points out these missing areas, the client appears perplexed, then laughs it off, stating that someone else would be calling to schedule appointments and providing transportation. Attempting to subtly hint about cognitive deficits is no longer working, and the OT is concerned because despite repeated efforts, the individual is not retaining safety precautions. This patient's behavior indicates a problem in what area? a. denial b. self-awareness c. emotional regulation d. sequencing - correct answer b. self-awareness Problems that contribute to deficits and self awareness include recognizing errors, inability to use feedback, and false beliefs about abilities. Whereas an individual who lacks self-awareness may be surprised or confused when given feedback regarding limitations an individual who is in denial may demonstrate anger or resistance when given feedback. Deficits in emotional regulation may be characterized by uncontrolled anger, laughter, or crying. Deficits in sequencing may be characterized by difficulty planning or enacting the steps of an activity. An OT is evaluating two-point discrimination in an individual who sustained a median nerve injury. What is the BEST way to administer this test? a. apply the stimuli beginning at the little finger and progress toward the thumb. b. start with the thumb area first, then progress toward the little finger. c. present stimuli in an organized pattern to improve reliability during retesting. d. allow the individual unlimited time to respond. - correct answer a. apply the stimuli beginning at the little finger and progress toward the thumb. The purpose of these principles is to eliminate non-tactile cues and to ensure that the responses from the patient accurately reflect actual sensation. General guidelines for sensation testing are that an individual's vision should be occluded, stimuli should be randomly applied with intermingled false stimuli (opposite of answer C), a practice trial should be performed before the test begins, and the unaffected side should be tested first (opposite of answer B). With a median nerve injury the ulnar side of the hand is the unaffected side. and thus should be tested first. Also the individual should be given a specific time in which to respond. An OT is initiating an eval of a preschool child diagnosed with autism spectrum disorder. What is the OT MOST likely to include in the evaluation process? a. one-to-one interview with the child b. observation of the child in a social, gross motor, and self-feeding task. c. the Peabody Developmental Scales-2 d. Assessment of the child's performance skills while outside on the playground. - correct answer b. Observation of the child in a social, gross motor, and self-feeding task. Recommended practices suggest that OTs conduct observations of clients with ASD before selecting and administering formal assessments because of the wealth of knowledge that is gained through observation. Answer A would not be the most valuable choice as communication difficulties are a core feature of ASD. It would be more helpful to combine an interview of the child in conjunction with parent-teacher interview. The Peabody may be something the therapist administers based on the recommendations following review of the observation data. Answer D is something the OT might consider, but a more comprehensive picture can be drawn from observing multiple areas of occupation. A high school teacher diagnosed with a right CVA is given a paper with letters of the alphabet displayed in a random order across the page and is instructed to cross out every "M". The individual misses half of the "M"s in a random pattern. What type of deficit would cause such a response. A. left visual field cut b. right visual field cut c. functional illiteracy d. decreased attention - correct answer D. decreased attention selective attention is the ability to attend to relevant stimuli while inhibiting distractions and irrelevant information. Because the errors were random, it does not reflect a visual field cut. Illiteracy is unlikely because the individual is a high school teacher. A college student with a history of substance abuse has been admitted to the hospital following an accidental overdose at a party. He states his goal is to return to school as soon as possible so that his GPA does not drop below 3.0. What is the MOST important area for the OT evaluation to focus on. a. leisure skills b. ADLs. c. academic/study skills d. family education - correct answer a. leisure skills in this situation, the college student appears to be having more difficulty with healthy use of leisure time than with academic skills. In this case, it is particularly evident that leisure is affected, with the individual's primary leisure activity being substance use. Skills required to accomplish ADLs or IADLs are rarely severely impaired. Family education is an important element, however, it would not be the focus of an evaluation. What are the MOST important items to assess when evaluating motor control after a traumatic injury? a. developmental factors and primitive reflexes b. muscle tone, postural tone, reflexes and coordination. c. BP, HR, endurance, and confusion d. self-concept and self-awareness - correct answer b. muscle tone, postural tone, reflexes, and coordination. After observing functional performance, the OT usually will find it necessary to assess the performance components that underlie motor control. Answer C, evaluation of vital signs is associated with the evaluation of cardiopulmonary function. Answer D, assessment of self-concept and self-awareness is related to the psychological impact of trauma. Answer A is related to an individual's life experiences and how those experiences relate to coping with the musculoskeletal disorder. A new parent recently returned to work and reports difficult concentrating at work because of thoughts about the baby. When at home, the individual feels distracted by thoughts about work. This MOST likely suggests the need to help the individual in what area? a. parenting skills b. attention span c. assertiveness d. role performance. - correct answer d. role performance Role performance involves identifying, maintaining, and balancing functions one assumes in society. Changes in important roles may result in feelings of anger, frustration, confusion, boredom, and fear. OTs help people construct or reconstruct their roles when they have experienced dysfunction. This individual is having difficulty balancing roles and is feeling stressed and conflicted. This stress may result in difficulty maintaining attention; however, the larger issue is related to the role performance. Evaluation by an OT could include assessment of parenting and assertiveness skills to determine whether these are areas of need, and if so, interventions could be designed to address these areas to support role performance. However, these have not been identified as areas of need in the scenario. An OT is beginning to work with individuals in recovery in a community-based program. The OT needs an evaluation tool that can be administered in less than 20 minutes, identifies occupational performance limitations, can be used to establish goals based on client priorities, and measure outcomes. Which is the BEST tool for this purpose? a. Occupational Performance History Interview 2 b. Role checklist c. COPM d. Occupational self-assessment - correct answer d. occupational self-assessment This is a self report measure that identifies client's problem areas in occupations, their competence in the occupations, and the importance they assign to them. It takes 10-20 minutes to administer, and goals can be based on the results. It can also be used as an outcome measure. The OPHI-II is a semistructred interview focused on occupational adaptation in three areas: occupational identity, occupational competence, and impact of occupational environment. It takes about an hour to complete and generates a narrative of the individual's life history allowing the therapist to compare performance over time. The role checklist takes approximately 15 minutes to complete, however it does not provide a way to measure occupational performance. The COPM takes about 30-40 minutes to complete. It is a semistructured interview of self-care, productivity, and leisure. It can be useful for goal setting, intervention planning, and measuring outcomes, but it takes longer than the occupational self-assessment. While making brownies, an individual is able to obtain all the supplies from the cabinet and check the oven temperature periodically. However, when the TV is turned on halfway through the activity, she becomes involved with the program and burns the brownies. This individual is showing signs of a deficit in which area? a. sustained attention b. detecting and reacting c. shifting of attention d. mental tracking - correct answer d. mental tracking Mental tracking is the ability to simultaneously keep track of two or more stimuli during an ongoing activity. Sustained attention is the ability to consistently engage in an activity over time. Detecting and reacting is the ability to detect and react to gross changes in the environment such as the phone ringing or name being called. Shifting attention is the ability to alternate attention between tasks with different cognitive or motor requirements. In preparation for an annual individualized Family Service Plan (IFSP) meeting, the OT is developing ideas for intervention to develop a child's fine motor performance for independent play participation. To match the principles of Part C early intervention programs, what would be the OTs BEST recommendation? a. family encouragement of the child to engage in play with toys he has at home, without concern for normal development. b. a periodic reassessment using the Peabody fine motor subtest to measure progress in fine motor skill achievement. c. home visit, during which OT will identify and encourage opportunities for fine motor practice within the family's preferred routines. d. increased weekly home visits so OT can implement therapy activities to promote child's fine motor skill development, using a remedial approach. - correct answer c. home visit, during which OT will identify and encourage opportunities for fine motor practice within the family's preferred routines. C is correct as it reflects the use of the natural environment. A is vague and does not help the parent identify toys most matched to the child's specific fine motor needs. B is incorrect as it describes an evaluation rather than an intervention. D is incorrect as it is counter to the principles of IEP programs designed to support learning and development within the context of children's everyday activities and routines. An adolescent with a history of shoplifting and gang violence has been hospitalized with a diagnosis of conduct disorder. During a task group, what are the most important performance skills for the OT to evaluate? a. perceptual motor performance b. leisure and vocational interest c. attention span and social interaction skills d. interest in performing and ability to perform multiple roles. - correct answer c. attention span and social interaction skills. Conduct disorders often involve aggression towards people or animals and destruction of property. The individual with conduct order violates rules, age appropriate norms, or the rights of others, evidenced by acts of aggression against people or animals, property destruction, lying, or theft. These symptoms cause impairment in job, school, or social life. When working with this population, the OT typically addresses areas of attention, impulse control, and social skills. Children with developmental delays typically require intervention for perceptual motor skills. Multiple role performance is more developmentally relevant to adulthood than adolescence. Although leisure and vocational interests may be relevant, the other issues will be more significant for a person with this diagnosis. An OT is evaluating an individual who has undergone a total hip replacement to determine awareness and adherence to hip precautions prior to discharge. What can the OT conclude when the individual is observed leaning forward and stopping at 90 degrees of hip flexion to use the long-handled shoe horn while donning shoes? a. demonstrates independence with precautions b. requires verbal cueing to observe precautions c. needs a longer assistive device d. demonstrates cognitive deficits - correct answer a. demonstrated independence with precautions precautions following total hip replacement include no hip flexion past 90 degrees, no IR, and no adduction past midline. Individuals with poor short-term memory, impulsivity, or poor judgement may require verbal cuing to remember these precautions. A long shoe horn may be necessary for an individual who cannot put on shoes safely with a shorter shoe horn.