Workbook simulation test 1

Question 1

Shunt malfunction symptom/Signs

Answer 1

• The major signs of shunt malfunction in children are irritability, nausea, and vomiting. Additionally, the therapist may observe changes in behavior or school performance, fever, pallor, visual perceptual difficulties and headaches.

Question 2

OT observes an individual who is able to place dentures in his mouth, but has difficulty applying dentrue cream to the approprate place on the dentures and attempts to place the cap on teh tube backwards or on the wrong end of the tube.

The OT will interpret this as …

Answer 2

• Constructional apraxia - because of difficulty with object use. May have sensory awareness of the affected side.

if it were ideomotor apraxia and dressing apraxia, the sequencing of the activity would have been impaired.

Question 3

Innervation of the median nerve

Answer 3

The median nerve passes throught the carpal tunnel at the wrist. Impingement in thei region causes sensory changes in the thumb. index finger, long, and half the ring finger. Prolonged impingement results in atrophy of thenar eminence and weakness of the opponens pollicis.

Question 4

Which strategy for modifying the environment is most effective for an initial eval for an individual with Obsessive-compulsive disorder

Answer 4

• Limit the time available to answer each question - Individuals with OCD frequently experience time consuming compulsive thoughts and actions. Conduct interviews only in highly structured situations/may not be appropriate for an interview.
• Open ended questions are more difficult to limit time than closed ended questions.
• Limiting environmental distractions is effective for individual with attention deficits.

Question 5

Types of memory loss

• Anterograde amnesia
• Retrograde amnesia
• Longer memory deficits
• Disorientation

Answer 5

• Anterograde amnesia - inability to recal events after a trauma
• Retrograde amnesia - inability to recall events prior to trama
• Longer memory deficits - storage of information for recall at a later time
• Disorientation - a problemm with awaremess of person, place and time.

Question 6

It is observed that a 10 month old child is able to sit alone by propping himself forward on his arms, but consistently loses his balance when reaching for a toy

This behavior indicates …

Answer 6

• A developmental delay
  
  • Typically developing children should be able to sit unsupported for several minutes by the age of 8-9 months

Question 7

An individual who sustained deep laceration of the median and ulnar nerves resulting in sensory loss should expect the return of which sensations first?

Answer 7

• temperature and pain - the sensations of pain antemp are carried along small unmyelinatd nerve fibers. They recover more rapidly than senses carred by larger myelinated fibers. Also the sensation of pain and temp are protective sensory systems which recieve simple info.
• more complex information is carred throught the discriminative system or epicritic system such as the senses of vibration, light touch, proprioception, and tactile localization.

Question 8

A woman who has suffered a stroke tries but is unable to don a blouse using a one-handed technique. she states “i can do it, I’m just not trying hard enough”

The OT recognizes this as….

Answer 8

• Denial - person may be having difficulties accepting her stroke and is using denial to avoid dealing with it.
• Wrong answers:
  
  • Projection - process in which a person attributes th eunacceptable thought and feelings on to another person
  • Rationalization - makes excuses for unacceptable behavior
  • Regressions - an individual reverts to infantile or childlike behavior as a way of dealing with a difficult situation.

Question 9

A child with partial thickness burns 3 days ago. How should the OT approach ADL intervention initially?

Answer 9

• Encourage independent ADLs with minimal reliance on adapted utensils and tools. It is impoartant to avoid an overreliance on adapted equipment so the child can experience full active range of motion when engaged in ADL.
• Compression garments are contraindicated for open wound closure.

Question 10

When developing play activities for a child with Juvenile Rheumatoid arthritis,

the OT has to consider…..(contraindications)

Answer 10

• avoid resistive materials - For JRA, the OT should use tecnhiques for joint portection and energy conservation. resistive materials cush as clay, leather should be avoided to prevent pressure being applied to the joints, which can exacerbate the condition.

other contraindications

• light touch - is precaution for children with tactile defensiveness
• rapid vestibular stim - contraindicated for a child who is prone to seizures
• above body temperatures - avoided for clietns with multiple sclerosis because high temp exacerbate the syptoms.

Question 11

An intelligent person diagnosed with paranoid schizophrenia hospitalized in acute care psychiatric setting.

best type of activite to engage the patient ….

Answer 11

• assempling a complex airplane model requiring the use of detailed directions - it is complicated enought to engage the person intellectually and sustain his interests. it uses controllable materials and requires organization to complete
  
  • avoid competition that can be threatening to a person with this diagnosis

Question 12

Type of exercise to maintain strength in an intividuals arm after an upper extremity fracture.

Answer 12

• Isometric muscle contractions - it is exercise where without joint movmeent or change in muscle length
• Wrong answers:
  
  • A person who has a castobstructing movement sould be unable to perform exercises requireing change in muscle length
  • Isotonic contracitons shorten the muscle length with joint movment

Question 13

Group programming that is most appropriate in an acute care psychiatric setting for clients who display disorganized thinking

Answer 13

• Directive groups - are highly structured approach. used for patients with psychoses who display disorganized thinking and disturbed functioning.

Question 14

Goal of assertiveness training

Answer 14

• Process of gradually empowering clients to make their own decisions, request assistance, avoid beign taken advantage of, and provide constructive criticism. Activities to assist in this process need to be graded for success by starting with situations that are less threatening to the client.

Question 15

Most appropriate splint for a low-level ulnar nerve injury

Answer 15

• Prevents hyperextension fo the MCP joints and allows for MCP flexion.

Question 16

During a clean-up portion of a cooking activity, an elderly woman with a diagnosis of depression and dementia begins to dry the plates an dutensils she has already dried.

The OT should …

Answer 16

Put the dried dishes away and begin to hand her wet dishes - Compensating for mistakes helps to increase the sense of self-worth and integrity of individuals with dementia. Avoid drawing attention to errors, especially in situations in which safety is not an issue.

Question 17

When working with a child with low tone who has difficulty engaging in activities against gravity, what is the best position to place the child

Answer 17

• side lying on a mat - side-lying positions give children a stable, midline head position and keep their hands in their line of vision
  
  • long sitting, supine and prone on a bolster all require the child to work against gravity and would be difficult for a child to maintain while engaging in play actvities.

Question 18

Knowing How to grade an activity for a individual on a cardia rehabilitation unit

• stop the activity
• upgrade the activity
• modify the activity to make less challengeing

Answer 18

OT will need to recognize subtle signs of fatigue: frustration, slowing down, hurrying to finish, heart rate increase of more than 20 bpm, failure to return to resting heart rate after 5 min rest.

• stopping the activity - necessary if the individual experiences symptoms of dyspnea, chest pain, lightheadedness, or diaphoresis(sweating).
• upgrade activity - when the individual is able to perform the activity without signs of fatigue or cardiac symptoms
• modify activity to make less challenging - when showing signs of fatigue, such as slwing down, lessening range of motion and use of substitution movements.

note: isometric exercises interfere with blood flow through the muscles and create heighted demand on the cardio vascular system. Isometric exercises should NEVER be used with individuals with cardiac conditions.

Question 19

How to approach a suggestion rejection by the client

Answer 19

Approach in the following order:

1. identify options and the consequences of each option
2. allow time for reflection and cinsiderations of options
3. practice with a demo device
4. reassess the decision
5. order the equipment
6. if rejected, document the steps taken and the reasons for rejection

Question 20

A young individual with neurological deficits has been unable to carry over skills learned previously in therapy and exhibits in ability to learn new information

Answer 20

• When unable to exhibit new learning, use compensatory strategies for ADL performance.
  
  • they will be unable to benefit form interventions that require the ability to transfer learning such as repetative practice, ADL training in a fimilar environment, or forward or backward chaining.

Question 21

An individual exhibits no awareness of funcitoinal limitation resulting from a recent head injury.

How should the OT promote awareness and insight…

Answer 21

• have the individual predict his performance before an activity, then have him self-evaluate the performance. By comparing the 2, it will encourage self-initiated feedback thus increasedd awareness.
  
  • simply discussing performance, would not provide concrete feedback about performance

Question 22

What design elements need to be present in a dynamic radial nerve injury splint

Answer 22

• provide wrist extension, MCP extension and thumb extension. the purpose of the splint is to prevent the extensor tendons from overstretching as well as prvide proper positioning of the hand for funcitonal use
• a low level radial verve injury results in decreased extension of the MP joints of the thumb and fingers

Question 23

A homebound individual has been recieved OT for self-care and home management training and PT for ambulation and stair training, following a stroke. The individual reported to the OT practitioner on teh last visit and she walk ed to the bus stop alone

This statement is significant in that it indicates that the indivdual….

Answer 23

• is no longer homebound - In order to recieve home care services, the recipient must be confined to home, a condition referred to as homebound (not bedridden but leaving the residence must require a considerable or taxing effort). after the individual is able to leave the residence, the individual cannot continue to receive home care services and would be referred to outpatinet services