Excel with Confidence: Ultimate NBCOT
True Learn Test Prep.
A child is referred to occupational therapy to address poor handwriting skills. The OTR
observes the child holding the pencil with a lateral grasp, the paper moves on the desk
when writing, and the child's posture is slumped over the desk. What is the most
appropriate INITIAL activity to address this child's handwriting?
A) Playdoh activities to strengthen hands and prehension
B) Teaching the child to hold the paper more firmly with the non-dominant hand
C) Using a slant board during the writing process in the classroom
D) Prone activities on the scooter board to build core strength -
\D) Prone activities on the scooter board to build core strength
Reasoning: Activities in prone build core strength to create stability for upper extremity
use. These core strengthening activities are most appropriate to address initially to
prepare the child for use of upper extremities, including fine motor tasks. Building
strength and coordination proximally allows the child to gain precise motor movements
and coordination distally in the body.
Bottom Line: In order to improve handwriting skills in a child with poor posture, the OTR
must initially provide activities that address proximal strength. Building strength and
coordination proximally allows the child to gain precise motor movements and
coordination distally in the body.
Which of the following movements allows the OTR to evaluate the strength and control
of the client's trunk flexors
A) The client is instructed to sit upright, maintain an erect spine, and lean forward
B) the client leans backwards and holds the position, then forward to sit upright
C) the client is instructed to sit and lean forward, then lean back to sit upright -
\B) The client leans backward and holds the position, then forward to sit upright
Reasoning: To accurately assess trunk control, the therapist must evaluate strength and
control in four muscle groups including:
trunk flexors
extensors
lateral flexors
rotators
To test trunk control, the client is encouraged to sit in an upright position on a mat table
with feet supported on the floor. To determine the client's strength and control of the
trunk flexors, the client is asked to move the shoulders behind the hips, utilizing an
,eccentric contraction of the trunk flexors when leaning slightly backward. The client is
then asked to return to the initial seated position, requiring isotonic muscle contraction.
Bottom Line: The client uses eccentric contraction of the trunk flexors when leaning
backward, then isotonic control when moving back to an upright seated posture.
An individual recovering from a dislocated shoulder is receiving OT services. Which is
the MOST APPROPRIATE exercise program for the OTR to recommend?
A) Isokinetic exercise program
B) Isotonic resistive exercise
C) Isotonic active assist exercise
D) Machine resistive exercise -
\Isotonic active assist exercises allow the client to move the joint as far as possible, with
assistance from the therapist to move the joint through the rest of the range. Isotonic
active assist exercises require trace, poor minus, or fair minus muscle strength and
have no precautions for use.
Bottom Line: Isotonic active assist exercises allow the client to move the joint as far as
possible, with assistance from the therapist to move the joint through the rest of the
range
A client is receiving OT services in an outpatient rehabilitation setting. The client asks
the OTR to review the most current note from a mental health provider and asks for a
printed copy of the medical documentation from that visit. How should the OTR respond
to this client's request for documentation by another provider?
A) Print a copy of the provider's note and give it to the client directly
B) Ask the client to contact the insurance company for documentation
C) Open up the note on a computer and allow the client to read the information
D) Request the client to follow up with the provider or the medical records department -
\D) Request the client to follow up with the provider or the medical records department
Reasoning: In order to provide consistency in care, the client should be referred back to
the provider or medical records department that can assist with accessing the
appropriate medical records.The Health Insurance Portability and Accountability Act
(HIPAA) provides protection for the disclosure of health information. Although the client
is requesting his or her own documentation, clients' do not have an automatic right to
access his or her entire medical record. Often psychotherapy or mental health
documentation may not be disclosed if the provider feels the client is at risk.
Bottom Line: In order to provide consistency in care, a client who requests medical
record documentation should be referred back to the provider or medical records
department that can assist with accessing the appropriate medical records.
Therapeutic Exercise Program
, Isotonic Active Assistive Exercise -
\Client moves the joint as far as possible
Outside force such as a practitioner assists with moving the joint through the rest of the
range of motion
Appropriate for muscle grades trace, poor minus, fair minus
Therapeutic Exercise Program
Isotonic resistive exercise -
\Client completes an isotonic contraction against resistance
Resistance is provided by weights, elastic bands, springs, etc.
Appropriate for muscle grades fair plus and good
Therapeutic Exercise Program
Isokinetic Exercise -
\Client relies on a machine that controls the speed of contraction within the range of
motion
Resistance controlled by machine and is variable
Appropriate for muscle grades fair plus and good
Therapeutic Exercise Program
Machine Resistive Exercise -
\Provides isokinetic exercise
A 62-year-old client with rheumatoid arthritis is seen in an acute inpatient rehabilitation
facility for recent "flare-up." The client is employed as a certified public accountant
(CPA) and has at least 3 more years of work to reach retirement age. When teaching
the client ergonomic principles, what strategy is MOST BENEFICIAL for the OTR to
recommend?
A) Distribute load over smaller joints only
B) Modify daily schedule to alternate heavy and light tasks throughout the day
C) Remain in one position for extended periods of time
D) Reduce muscle strength and ROM -
\B) Modify daily schedule to alternate heavy and light tasks throughout the day
Reasoning:
An important ergonomic principle is balancing daily work (and home) schedules in order
to strive to balance activities with rest. Light and heavy tasks should alternate
throughout the day to minimize fatigue and impact on joints for individuals with
conditions such as rheumatoid arthritis (RA).
True Learn Test Prep.
A child is referred to occupational therapy to address poor handwriting skills. The OTR
observes the child holding the pencil with a lateral grasp, the paper moves on the desk
when writing, and the child's posture is slumped over the desk. What is the most
appropriate INITIAL activity to address this child's handwriting?
A) Playdoh activities to strengthen hands and prehension
B) Teaching the child to hold the paper more firmly with the non-dominant hand
C) Using a slant board during the writing process in the classroom
D) Prone activities on the scooter board to build core strength -
\D) Prone activities on the scooter board to build core strength
Reasoning: Activities in prone build core strength to create stability for upper extremity
use. These core strengthening activities are most appropriate to address initially to
prepare the child for use of upper extremities, including fine motor tasks. Building
strength and coordination proximally allows the child to gain precise motor movements
and coordination distally in the body.
Bottom Line: In order to improve handwriting skills in a child with poor posture, the OTR
must initially provide activities that address proximal strength. Building strength and
coordination proximally allows the child to gain precise motor movements and
coordination distally in the body.
Which of the following movements allows the OTR to evaluate the strength and control
of the client's trunk flexors
A) The client is instructed to sit upright, maintain an erect spine, and lean forward
B) the client leans backwards and holds the position, then forward to sit upright
C) the client is instructed to sit and lean forward, then lean back to sit upright -
\B) The client leans backward and holds the position, then forward to sit upright
Reasoning: To accurately assess trunk control, the therapist must evaluate strength and
control in four muscle groups including:
trunk flexors
extensors
lateral flexors
rotators
To test trunk control, the client is encouraged to sit in an upright position on a mat table
with feet supported on the floor. To determine the client's strength and control of the
trunk flexors, the client is asked to move the shoulders behind the hips, utilizing an
,eccentric contraction of the trunk flexors when leaning slightly backward. The client is
then asked to return to the initial seated position, requiring isotonic muscle contraction.
Bottom Line: The client uses eccentric contraction of the trunk flexors when leaning
backward, then isotonic control when moving back to an upright seated posture.
An individual recovering from a dislocated shoulder is receiving OT services. Which is
the MOST APPROPRIATE exercise program for the OTR to recommend?
A) Isokinetic exercise program
B) Isotonic resistive exercise
C) Isotonic active assist exercise
D) Machine resistive exercise -
\Isotonic active assist exercises allow the client to move the joint as far as possible, with
assistance from the therapist to move the joint through the rest of the range. Isotonic
active assist exercises require trace, poor minus, or fair minus muscle strength and
have no precautions for use.
Bottom Line: Isotonic active assist exercises allow the client to move the joint as far as
possible, with assistance from the therapist to move the joint through the rest of the
range
A client is receiving OT services in an outpatient rehabilitation setting. The client asks
the OTR to review the most current note from a mental health provider and asks for a
printed copy of the medical documentation from that visit. How should the OTR respond
to this client's request for documentation by another provider?
A) Print a copy of the provider's note and give it to the client directly
B) Ask the client to contact the insurance company for documentation
C) Open up the note on a computer and allow the client to read the information
D) Request the client to follow up with the provider or the medical records department -
\D) Request the client to follow up with the provider or the medical records department
Reasoning: In order to provide consistency in care, the client should be referred back to
the provider or medical records department that can assist with accessing the
appropriate medical records.The Health Insurance Portability and Accountability Act
(HIPAA) provides protection for the disclosure of health information. Although the client
is requesting his or her own documentation, clients' do not have an automatic right to
access his or her entire medical record. Often psychotherapy or mental health
documentation may not be disclosed if the provider feels the client is at risk.
Bottom Line: In order to provide consistency in care, a client who requests medical
record documentation should be referred back to the provider or medical records
department that can assist with accessing the appropriate medical records.
Therapeutic Exercise Program
, Isotonic Active Assistive Exercise -
\Client moves the joint as far as possible
Outside force such as a practitioner assists with moving the joint through the rest of the
range of motion
Appropriate for muscle grades trace, poor minus, fair minus
Therapeutic Exercise Program
Isotonic resistive exercise -
\Client completes an isotonic contraction against resistance
Resistance is provided by weights, elastic bands, springs, etc.
Appropriate for muscle grades fair plus and good
Therapeutic Exercise Program
Isokinetic Exercise -
\Client relies on a machine that controls the speed of contraction within the range of
motion
Resistance controlled by machine and is variable
Appropriate for muscle grades fair plus and good
Therapeutic Exercise Program
Machine Resistive Exercise -
\Provides isokinetic exercise
A 62-year-old client with rheumatoid arthritis is seen in an acute inpatient rehabilitation
facility for recent "flare-up." The client is employed as a certified public accountant
(CPA) and has at least 3 more years of work to reach retirement age. When teaching
the client ergonomic principles, what strategy is MOST BENEFICIAL for the OTR to
recommend?
A) Distribute load over smaller joints only
B) Modify daily schedule to alternate heavy and light tasks throughout the day
C) Remain in one position for extended periods of time
D) Reduce muscle strength and ROM -
\B) Modify daily schedule to alternate heavy and light tasks throughout the day
Reasoning:
An important ergonomic principle is balancing daily work (and home) schedules in order
to strive to balance activities with rest. Light and heavy tasks should alternate
throughout the day to minimize fatigue and impact on joints for individuals with
conditions such as rheumatoid arthritis (RA).
