NBCOT Registered Occupational Therapists (OTR) Quiz: Adl Iadl Interventions
20 questions · exam conditions
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Adl Iadl InterventionsQuestion 1 of 20

An OTR is planning discharge for a 78-year-old client who was hospitalized for a fall and is now diagnosed with moderate dementia, likely Alzheimer's type. The client is returning home with their 75-year-old spouse. The client is physically ambulatory but has short-term memory loss, poor sequencing, and safety awareness. The spouse is concerned about the client's ability to safely use the bathroom independently, especially regarding hygiene after toileting.

What is the MOST effective intervention to promote safe and effective toilet hygiene for the client?

Create a detailed, step-by-step checklist with pictures for the client to follow for completing toilet hygiene and post on the bathroom wall.
Recommend the spouse provide verbal cues for each step of the hygiene process every time the client uses the toilet.
Recommend the installation of a bidet toilet seat with a simple remote and color-coded buttons for 'wash' and 'dry' functions.
Train the client in a backward chaining approach, where the spouse performs all steps except the last one, to rebuild the hygiene routine.
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NBCOT Registered Occupational Therapists (OTR) Quiz

NBCOT Registered Occupational Therapists (OTR) Quiz: Adl Iadl Interventions

Practice Adl Iadl Interventions in NBCOT Registered Occupational Therapists (OTR) with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

What this quiz covers

This quiz focuses on Adl Iadl Interventions, giving you a quick way to practice the rules, question types, and explanations that matter most for NBCOT Registered Occupational Therapists (OTR).

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

All questions

Question 1

An OTR is planning discharge for a 78-year-old client who was hospitalized for a fall and is now diagnosed with moderate dementia, likely Alzheimer's type. The client is returning home with their 75-year-old spouse. The client is physically ambulatory but has short-term memory loss, poor sequencing, and safety awareness. The spouse is concerned about the client's ability to safely use the bathroom independently, especially regarding hygiene after toileting.

What is the MOST effective intervention to promote safe and effective toilet hygiene for the client?

  1. Create a detailed, step-by-step checklist with pictures for the client to follow for completing toilet hygiene and post on the bathroom wall.
  2. Recommend the spouse provide verbal cues for each step of the hygiene process every time the client uses the toilet.
  3. Recommend the installation of a bidet toilet seat with a simple remote and color-coded buttons for 'wash' and 'dry' functions. (correct answer)
  4. Train the client in a backward chaining approach, where the spouse performs all steps except the last one, to rebuild the hygiene routine.
Explanation: The correct answer is C. For a client with moderate dementia, procedural memory often remains intact longer than declarative memory. A bidet automates the task of cleansing, reducing it to a simple, repeatable button press. This capitalizes on procedural memory and significantly reduces the cognitive demands of sequencing, judgment, and fine motor control required for using toilet paper. It is the most effective long-term solution for ensuring adequate hygiene and reducing caregiver burden. Distractor A is unlikely to be effective because the client with moderate dementia will likely fail to initiate looking at the chart or will be unable to follow the sequence. Distractor B creates significant caregiver dependency and may not always be feasible. Distractor D (backward chaining) is a learning technique that is less effective for clients with moderate dementia who have difficulty learning new multi-step routines.

Question 2

A client with chronic right-sided hemiparesis and aphasia following a left CVA several years ago communicates a desire to be more involved in simple meal preparation. They have fair dynamic standing balance but poor coordination and sensation in their right hand. They can follow demonstrated instructions but have difficulty with verbal commands. During an assessment, they attempt to stabilize a cutting board with their affected right hand, but it repeatedly slips.

What is the MOST effective ADAPTIVE strategy for the OTR to introduce for one-handed cutting tasks?

  1. Provide a cutting board with a non-slip backing, such as Dycem, and teach the client to use their body to brace it against the counter edge.
  2. Instruct the client in bilateral integration activities to improve their ability to use the affected hand as a functional assist during cutting.
  3. Train the client to use a rocker knife in their left hand while providing hand-over-hand assistance to stabilize the food with their right hand.
  4. Introduce a cutting board with two stainless-steel spikes to hold food items and suction-cup feet to secure the board to the counter. (correct answer)
Explanation: When you encounter questions about adaptive equipment for clients with hemiparesis, focus on strategies that provide maximum independence while compensating for specific deficits. This client has poor coordination and sensation in their affected hand, making it unreliable for stabilization tasks. Answer D is correct because it addresses both stabilization needs simultaneously. The suction-cup feet eliminate the need for the client to stabilize the cutting board with their impaired right hand, while the stainless-steel spikes securely hold food items in place during cutting. This solution provides complete independence for one-handed cutting tasks and compensates directly for the client's coordination and sensory deficits. Answer A is incorrect because it still requires the client to use their affected hand with poor coordination and sensation to brace the board, which the passage shows is unsuccessful. Answer B focuses on remediation rather than adaptation – bilateral integration activities would be a treatment approach, not an adaptive strategy for immediate meal preparation needs. Answer C is problematic because it relies on the impaired right hand for stabilization through hand-over-hand assistance, which doesn't promote independence and still depends on the affected limb's unreliable function. For NBCOT questions about adaptive strategies, remember to distinguish between remediation (improving function) and compensation (working around deficits). True adaptive strategies should maximize independence while bypassing, not relying on, impaired body functions. Look for solutions that eliminate the need to use compromised abilities rather than trying to improve or assist them.

Question 3

A client with low vision due to advanced macular degeneration wants to continue managing their medications independently. They take five different pills at various times of the day. They have difficulty distinguishing the small pills from one another and have made two errors in the past month. The client has good hearing, tactile sensation, and cognition. They are comfortable with low-tech solutions.

Which intervention is the MOST appropriate to enhance the safety and independence of this client's medication management?

  1. Teach the client to use a high-powered optical magnifier to read the labels on the prescription bottles each time they take a dose.
  2. Recommend a family member fill a standard 7-day pill organizer for the client each week to reduce the chance of error.
  3. Set up an auditory reminder system on a smart speaker and train the client to identify pills by shape and size using tactile skills.
  4. Provide talking prescription labels obtained from the pharmacy and organize the bottles on a tray with tactile markers indicating time of day. (correct answer)
Explanation: The correct answer is D. This is a multi-faceted, low-tech solution that leverages the client's strengths (hearing, touch) to compensate for their primary deficit (central vision loss). Talking labels provide clear auditory identification of each medication, and tactile markers create a system for organization that does not rely on vision. This combination provides multiple layers of verification and promotes the highest level of independence. Distractor A is not ideal because macular degeneration affects central vision, making it very difficult to use magnifiers effectively for reading small print. Distractor B reduces independence, which is contrary to the client's goal. Distractor C is a partial solution; while tactile identification is a good skill, it can be unreliable with similarly shaped pills, and an auditory reminder doesn't help identify which pill to take.

Question 4

An OTR in a skilled nursing facility is treating a 90-year-old resident with severe osteoarthritis in her hands and kyphosis of the thoracic spine. The resident requires assistance with lower body dressing, specifically with donning socks and shoes. She can no longer reach her feet due to the kyphosis, and her painful, weakened grip prevents her from pulling on socks. She values her appearance and wants to wear her preferred footwear.

What is the MOST appropriate combination of adaptive equipment and technique for this resident?

  1. A sock aid for donning socks and elastic shoelaces to convert her preferred lace-up shoes into slip-ons. (correct answer)
  2. A long-handled shoe horn and recommending that the resident switch to wearing only slip-on slippers.
  3. A dressing stick to push socks on and pull up shoes, combined with caregiver assistance for tying laces.
  4. Strengthening exercises for grip and back extensors, followed by practice of traditional sock and shoe donning.
Explanation: The correct answer is A. This combination directly addresses both of the client's primary limitations. A sock aid compensates for the inability to reach the feet due to kyphosis. Elastic shoelaces allow her to continue wearing her preferred shoes while eliminating the need for fine motor control and grip strength to tie laces, effectively turning them into slip-ons. This solution respects her values and maximizes her independence. Distractor B is only a partial solution and forces her to give up her preferred footwear. Distractor C is incorrect because a dressing stick is generally ineffective for pulling on snug-fitting socks. Distractor D is unrealistic; strengthening is unlikely to reverse the functional limitations caused by severe, chronic conditions like osteoarthritis and kyphosis.

Question 5

An OTR is treating a 62-year-old client with rheumatoid arthritis (RA) that severely affects the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of both hands, resulting in pain, ulnar deviation, and decreased grip strength. The client is an avid gardener but has stopped this leisure IADL due to pain when using standard hand tools. The client's goal is to resume simple container gardening.

Which intervention is MOST appropriate to enable the client to resume gardening while protecting their joints?

  1. Provide the client with paraffin wax bath treatments for their hands before and after gardening to manage pain and stiffness.
  2. Instruct the client in using ergonomic gardening tools with extended, padded handles and pistol grips, and teach principles of joint protection. (correct answer)
  3. Fabricate bilateral resting hand splints for the client to wear during gardening to maintain joint alignment and prevent further deformity.
  4. Design a therapeutic exercise program using therapy putty and hand grippers to increase the client's grip strength for holding tools.
Explanation: The correct answer is B. This is the most functionally relevant and evidence-based approach. Ergonomic tools are designed to reduce deforming forces and stress on joints. A pistol grip maintains a more neutral wrist and reduces ulnar deviating forces. Padded, extended handles distribute pressure over a larger surface area. Combining this adaptive equipment with education on joint protection principles (e.g., using larger joints, avoiding tight grip) directly addresses the client's goal in a safe manner. Distractor A is a useful preparatory/postparatory modality for pain, but it doesn't enable the task itself. Distractor C is incorrect because resting splints are non-functional and would prevent the client from participating in the activity. Distractor D is contraindicated; resistive exercises like using putty and grippers can exacerbate joint inflammation and deformity in active RA.

Question 6

An 8-year-old child with Level 2 Autism Spectrum Disorder (ASD) and sensory processing difficulties is beginning to learn personal hygiene. The child's parents report that toothbrushing is a major source of conflict. The child screams and resists when a standard toothbrush and mint-flavored toothpaste are used. The parents' goal is to establish a consistent, independent morning hygiene routine.

Which intervention should the OTR implement FIRST to address the toothbrushing challenges?

  1. Create a visual schedule that incorporates toothbrushing into the morning routine and provide a token board for reinforcement upon completion.
  2. Introduce a variety of toothbrush types (e.g., vibrating, three-sided) and unflavored or differently flavored toothpastes to find a tolerable sensory combination. (correct answer)
  3. Implement the Wilbarger Protocol for deep pressure and proprioceptive input immediately before attempting toothbrushing to decrease oral defensiveness.
  4. Use a social story explaining the importance of dental hygiene and model the correct toothbrushing sequence for the child to imitate.
Explanation: The correct answer is B. The primary barrier described is sensory-based (resistance to the specific brush and toothpaste). Therefore, the first step is to address the sensory aversion by modifying the task's sensory properties. Exploring different types of toothbrushes and toothpastes allows for identifying a combination that the child can tolerate, which is a prerequisite for establishing a routine. Distractor A is a valuable strategy for routine-building but will be ineffective if the sensory experience of the task itself remains aversive. Distractor C, while addressing sensory modulation, is a preparatory method that should be used in conjunction with, not before, adapting the task itself. Distractor D is a cognitive approach that is unlikely to be effective on its own when the core issue is a negative sensory reaction.

Question 7

A 40-year-old client with multiple sclerosis (MS) experiences significant fatigue and intention tremors that worsen as the day progresses. The client is a parent of two young children and identifies managing the family's laundry as a critical but overwhelming IADL. They struggle with carrying the heavy laundry basket, bending to load the front-loading washer and dryer, and folding clothes due to the tremors.

Which combination of strategies would be MOST effective for the OTR to recommend?

  1. Recommend the family hire a laundry service to manage the task and conserve the client's energy for childcare.
  2. Instruct the client to do all laundry in one large batch on a weekend morning when their energy is highest.
  3. Suggest using a rolling laundry hamper, sitting on a low stool for loading/unloading, and using a laundry folding board. (correct answer)
  4. Teach the client proprioceptive loading techniques and provide wrist weights to dampen tremors during folding tasks.
Explanation: The correct answer is C. This option provides a comprehensive solution using energy conservation, work simplification, and adaptive strategies. A rolling hamper eliminates heavy lifting and carrying. Sitting on a stool addresses the difficulty with bending and conserves energy. A folding board provides an external structure that can help manage the intention tremors and produce a consistent result, simplifying the fine motor demands of folding. Distractor A relinquishes the client's role completely, which may not be desired. Distractor B is poor advice for MS-related fatigue; doing a large batch would be excessively fatiguing, violating energy conservation principles. Distractor D is a remedial approach; while wrist weights can sometimes help with tremors, it doesn't address the significant fatigue associated with carrying and bending, which are the larger issues.

Question 8

A 25-year-old client is in an outpatient setting following a moderate traumatic brain injury (TBI). The client exhibits significant deficits in executive functions, including initiation, planning, and follow-through. A primary IADL goal is for the client to independently manage paying their monthly rent and utility bills on time.

Which intervention strategy is MOST appropriate to support the client's goal of independent bill payment?

  1. Provide worksheets for practicing money-counting and budgeting skills.
  2. Assist the client and their family in setting up automatic online bill payments and digital calendar alerts. (correct answer)
  3. Conduct a role-playing session where the client practices writing checks and addressing envelopes.
  4. Recommend a conservator be appointed to manage all of the client's finances.
Explanation: The correct answer is B. Setting up automatic payments and digital alerts is a high-tech compensatory strategy that bypasses the client's primary deficits in initiation and memory. It creates a sustainable system for independence that reduces the cognitive load required for the task. A is incorrect because the problem is not a lack of basic math skills, but rather executive dysfunction. C is incorrect because while it practices a component of the task, it doesn't address the core issues of initiation and remembering to do it on time. D is incorrect because it is the most restrictive option and should only be considered after all other strategies to promote independence have failed.

Question 9

A 68-year-old client with severe chronic obstructive pulmonary disease (COPD) is being seen by a home health OTR. The client reports significant dyspnea and fatigue during ADLs, particularly bathing. They use a standard tub-shower combination with no grab bars and report feeling exhausted for hours after showering, which they now do only twice a week. The client's priority is to bathe more frequently without becoming so fatigued.

Which set of recommendations is the MOST critical for the OTR to implement to address the client's goal?

  1. Instruct the client in diaphragmatic breathing techniques and recommend they shower in the evening when they have more energy.
  2. Recommend installation of a tub transfer bench and a long-handled sponge, and teach the client to pace the activity by bathing in stages. (correct answer)
  3. Suggest the client use no-rinse body wipes on non-showering days and perform upper body strengthening exercises with light weights.
  4. Advise the client to use a pulse oximeter during showering to monitor oxygen saturation and to increase their supplemental oxygen flow rate beforehand.
Explanation: The correct answer is B. This combination of energy conservation, work simplification, and adaptive equipment directly targets the activity of bathing. A tub transfer bench eliminates the high-energy task of stepping over the tub ledge and allows the client to sit, conserving significant energy. A long-handled sponge reduces bending and reaching. Pacing by stages (e.g., washing upper body, resting, then washing lower body) is a core energy conservation strategy for clients with COPD. Distractor A is helpful, but breathing techniques alone are insufficient without modifying the task itself. Distractor C provides an alternative to showering but does not help the client achieve their goal of showering more frequently. Distractor D involves monitoring, which is important, but advising a client to alter their oxygen flow rate is outside the OT scope of practice and must be directed by a physician.

Question 10

An OTR is treating a 60-year-old client with amyotrophic lateral sclerosis (ALS) in a multidisciplinary clinic. The client is in the middle stages of the disease, with significant distal weakness and moderate proximal weakness in the upper extremities, but maintains good trunk control. The client wants to continue feeding themself independently despite hand weakness and fatigue. They have difficulty scooping food and bringing it to their mouth without spilling.

Which combination of adaptive equipment would BEST support this client's goal of independent feeding?

  1. A mobile arm support (MAS) or suspension sling and a lightweight, built-up handle spoon. (correct answer)
  2. A universal cuff with a standard spoon and a plate with a raised edge (plate guard).
  3. An electronic self-feeder (robotic feeder) to provide maximum assistance with the task.
  4. A weighted spoon to dampen tremors and a dycem mat to stabilize the plate.
Explanation: When treating clients with progressive neuromuscular conditions like ALS, you need to match adaptive equipment to their specific pattern of weakness while supporting their functional goals. ALS typically presents with distal weakness progressing proximally, so understanding the client's current level is crucial for appropriate interventions. Option A is correct because it addresses this client's primary deficits perfectly. The mobile arm support (MAS) or suspension sling compensates for the moderate proximal weakness by supporting the weight of the arm during feeding motions, reducing fatigue and enabling smoother movement patterns. The lightweight, built-up handle spoon addresses the significant distal weakness by making the utensil easier to grip without adding unnecessary weight that would increase fatigue. Option B fails because a universal cuff is designed for clients with no grip strength (like those with spinal cord injuries), but this client still has some hand function that should be preserved and utilized. This approach doesn't address the proximal weakness that's causing difficulty bringing food to the mouth. Option C represents over-compensation. Electronic feeders are typically reserved for clients with severe proximal weakness or complete loss of upper extremity function. This client wants to maintain independence and still has functional capacity that should be supported, not replaced. Option D incorrectly assumes tremor is the primary issue. ALS primarily causes weakness and fatigue, not tremor, so weighted utensils would actually increase fatigue and worsen function. Remember: In progressive conditions, always match intervention intensity to current function level—support what's weak while preserving remaining abilities.

Question 11

A 16-year-old with a new diagnosis of Type 1 diabetes is struggling with the IADL of blood glucose monitoring. The client has a significant needle phobia, which leads to avoidance of the task and poor glycemic control. The client is also concerned about performing the task discreetly at school. The client's goal is to manage their diabetes independently and consistently.

What intervention strategy should the OTR prioritize to address the client's avoidance of blood glucose monitoring?

  1. Work with the client and medical team to transition to a continuous glucose monitoring (CGM) system with a sensor worn on the body. (correct answer)
  2. Educate the client and their parents on the long-term health consequences of poor glycemic control to increase motivation for adherence.
  3. Implement a systematic desensitization program, starting with handling the lancing device and progressing to actual finger pricks.
  4. Provide the client with a smaller, more discreet monitoring kit and role-play how to perform the task quickly in the school bathroom.
Explanation: When addressing avoidance behaviors in IADL performance, occupational therapists must consider both the underlying barriers and available alternatives that can eliminate or minimize those barriers while maintaining functional independence. Option A is correct because a continuous glucose monitoring (CGM) system directly addresses the root cause of the avoidance behavior—needle phobia—by eliminating the need for frequent finger pricks. The sensor is applied once every 7-14 days (depending on the system) and provides continuous readings via a smartphone app or receiver. This solution maintains the client's goal of independent diabetes management while addressing both the phobia and discretion concerns, as readings can be checked silently on a phone. Option B focuses on education about consequences, but this doesn't address the underlying phobia. Fear-based motivation often increases anxiety rather than improving compliance, especially in adolescents who may already understand the risks but cannot overcome the phobic response. Option C suggests systematic desensitization, which is a valid behavioral intervention but would be time-intensive and may not fully resolve the school discretion issue. While this could work long-term, it doesn't provide immediate relief for poor glycemic control. Option D addresses the discretion concern but completely ignores the needle phobia—the primary barrier to task performance. A smaller kit still requires finger pricks, so avoidance would likely continue. Study tip: When clients have strong phobic responses to essential IADL components, prioritize interventions that eliminate or bypass the phobic trigger while maintaining functional independence, rather than interventions that require the client to overcome the phobia first.

Question 12

An OTR in an outpatient hand clinic is treating a 38-year-old chef who sustained a partial flexor tendon injury to the index and middle fingers of their dominant right hand. The client is 8 weeks post-op and has clearance to begin strengthening and resuming light IADLs. The client is anxious to return to work and wants to practice meal preparation. They have limited grip strength and are restricted from forceful gripping or lifting items over 5 pounds.

Which IADL intervention is MOST appropriate for the OTR to introduce at this stage of the client's recovery?

  1. Simulate heavy-duty chopping tasks using dense foam and a weighted knife to begin building functional strength for work.
  2. Have the client practice kneading bread dough for 10-minute intervals to improve intrinsic hand strength and endurance.
  3. Instruct the client in using built-up handles on utensils and a one-handed rocker knife to prepare a simple, cold meal like a salad. (correct answer)
  4. Engage the client in opening various sizes of screw-top jars and cans to grade resistive grip strength in a functional context.
Explanation: The correct answer is C. At 8 weeks post-op from a flexor tendon repair, the focus is on light functional activity while carefully avoiding excessive force that could rupture the repair. This option is the safest and most appropriate. Built-up handles reduce the required force of grip, and a rocker knife allows for chopping with a neutral wrist and minimal finger flexion force. Preparing a cold meal avoids lifting pots. This activity allows for engagement in the valued IADL while adhering to surgical precautions. Distractors A, B, and D all involve forceful gripping, heavy resistance, or repetitive strenuous motions that would place the tendon repair at significant risk of rupture and are contraindicated at this stage.

Question 13

An OTR in a community mental health setting is working with a 35-year-old client with schizophrenia and significant negative symptoms, including avolition and anhedonia. The client lives in a supported apartment and has a goal to improve their health. A primary IADL issue is inconsistent meal preparation, leading to a diet of processed snack foods. The client reports feeling "too overwhelmed" to cook and has poor initiation for the multi-step task.

Which intervention strategy is the MOST effective for this client to begin participating in meal preparation?

  1. Provide the client with a cookbook of complex, healthy recipes to promote interest and develop advanced cooking skills over time.
  2. Use a psychoeducational approach to teach the client about the nutritional benefits of healthy eating and the risks of their current diet.
  3. Structure a group cooking session with peers that focuses on preparing a single, simple meal, with tasks broken down and assigned to each member. (correct answer)
  4. Develop a detailed daily schedule for the client that blocks out one hour each evening for independent meal planning, shopping, and cooking.
Explanation: The correct answer is C. This approach directly addresses the client's core deficits. The group format provides social support and modeling, which can help combat avolition. Preparing a single, simple meal reduces the cognitive load and feeling of being overwhelmed. Breaking down the task and assigning specific roles provides the external structure needed to overcome poor initiation. This creates a successful experience that can be built upon. Distractor A is inappropriate as complex recipes would increase the feeling of being overwhelmed. Distractor B is a cognitive approach that is unlikely to be effective against the powerful negative symptoms of avolition and anhedonia; knowledge does not equal motivation. Distractor D creates a rigid schedule that the client, due to their avolition and initiation deficits, is very unlikely to follow independently.

Question 14

An OTR is working with a 32-year-old veteran who has a dual diagnosis of post-traumatic stress disorder (PTSD) and alcohol use disorder. The client is participating in a transitional housing program. A primary IADL goal is grocery shopping, which the client avoids due to hypervigilance, anxiety in crowded spaces, and difficulty with decision-making when feeling overwhelmed. This leads to poor nutrition and reliance on convenience store food.

Which intervention represents the BEST graded approach to enable independent grocery shopping?

  1. Accompany the client to a large supermarket during peak hours to provide in-vivo exposure and desensitization to the anxiety-provoking stimuli.
  2. Provide the client with a list of healthy foods and instruct them to use a grocery delivery service to avoid the store environment completely.
  3. Have the client create a detailed shopping list at home, practice shopping in a small convenience store during off-peak hours, and use headphones with calming music. (correct answer)
  4. Role-play a grocery shopping trip in the clinic, followed by having the client independently plan, budget, and shop for a week's worth of groceries.
Explanation: The correct answer is C. This intervention provides a 'just-right' challenge by grading multiple aspects of the task. Creating the list at home structures the activity and reduces in-store decision-making. Starting at a small store during a quiet time reduces the sensory and social stimuli. Using headphones is a client-directed coping strategy to manage the environment. This is a systematic, graded exposure approach that builds skills and confidence. Distractor A represents flooding, not graded exposure, and is likely to overwhelm the client and cause a setback. Distractor B avoids the problem rather than building a skill for community integration and does not address the client's goal of shopping. Distractor D is too large a leap from role-playing to full, independent shopping for a week, skipping the crucial in-vivo graded exposure steps.

Question 15

An OTR is working with a 68-year-old client who is 1 week post-stroke with resultant left hemiplegia and moderate left-sided neglect. The client has fair seated balance but poor standing balance. The client's primary goal is to be able to dress independently before being discharged home.

What is the BEST initial intervention for the OTR to implement to help the client achieve the dressing goal?

  1. Provide verbal cues to attend to the left side while the client practices donning a shirt in a standing frame.
  2. Teach the client one-handed dressing techniques for upper and lower body garments while seated on the edge of the bed. (correct answer)
  3. Recommend that the family purchase only loose-fitting pullover shirts and elastic-waist pants.
  4. Have the client perform bilateral upper extremity activities to improve awareness of the left arm before attempting dressing.
Explanation: The correct answer is B. Teaching one-handed dressing techniques while seated is the most appropriate initial intervention. It directly addresses the ADL task, compensates for the hemiplegia, and provides a safe position of function given the client's poor standing balance. This approach prioritizes functional independence using the client's current abilities. A is incorrect because using a standing frame is likely too challenging given the poor standing balance and does not address the hemiplegia motor deficit. C is incorrect because it is overly restrictive and does not teach the client a new skill, limiting their future clothing choices. D describes a preparatory activity; while potentially useful, it is not a direct intervention for the functional task of dressing and should not be the initial focus.

Question 16

An OTR is working with a client who has moderate Parkinson's disease. The client exhibits significant intention tremors, which makes self-feeding difficult and embarrassing for them in social settings. The client has adequate grip strength but frequently spills food.

Which intervention would be MOST effective for improving the client's ability to eat independently?

  1. Provide utensils with built-up foam handles.
  2. Instruct the client in active range of motion exercises for the upper extremities.
  3. Introduce weighted utensils and a scoop dish or plate guard. (correct answer)
  4. Recommend a liquid or pureed diet to minimize the risk of spilling.
Explanation: The correct answer is C. Weighted utensils provide proprioceptive feedback and can help dampen tremors, improving control during movement. A scoop dish or plate guard helps keep food on the plate when the client is scooping, compensating for motor control difficulties. A is incorrect because built-up handles are for compensating for weak or limited grasp, not tremors. B is incorrect because general exercises do not directly address intention tremors during a functional task. D is incorrect as it is an overly restrictive diet modification that is not necessary and negatively impacts the client's quality of life.

Question 17

A client with rheumatoid arthritis (RA) is experiencing a flare-up with significant pain and inflammation in the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of both hands. The client's primary goal is to be able to perform light housekeeping, but they report that opening jars and wringing out sponges is too painful.

Which intervention BEST applies the principles of joint protection to this client's IADL goals?

  1. Instruct the client in hand-strengthening exercises using therapeutic putty to improve grip.
  2. Recommend using an electric jar opener and a sponge squeezer or pressing the sponge on the side of the sink. (correct answer)
  3. Teach the client to use hot packs on their hands for 20 minutes prior to starting housekeeping tasks.
  4. Advise the client to avoid all housekeeping tasks until the flare-up subsides.
Explanation: The correct answer is B. This intervention provides adaptive equipment and alternative techniques that allow task completion while minimizing stress on the inflamed joints. Using larger muscle groups and avoiding tight grasping are core principles of joint protection. A is incorrect because strengthening exercises are contraindicated during an acute inflammatory phase and would likely increase pain and joint damage. C describes a palliative modality that may temporarily decrease pain but does not modify the task to protect the joints from stress. D is incorrect because it is overly restrictive; occupational therapy aims to find ways for clients to participate in meaningful occupations safely.

Question 18

An OTR in a school setting is working with an 8-year-old child with autism spectrum disorder (ASD) and tactile defensiveness. The child consistently refuses to participate in toothbrushing at home and school, leading to poor oral hygiene. The child screams when a standard toothbrush and mint toothpaste are brought near their mouth.

What is the BEST initial approach for the OTR to use to address this ADL?

  1. Implement a sticker chart where the child earns a reward for each time they brush their teeth.
  2. Firmly hold the child's hands and complete the toothbrushing task for them to ensure it gets done.
  3. Systematically desensitize the child by introducing varied textures and flavors, such as a vibrating toothbrush and unflavored toothpaste. (correct answer)
  4. Show the child a social story with pictures of other children happily brushing their teeth.
Explanation: The correct answer is C. The child's refusal is rooted in sensory defensiveness. The best approach is to address this underlying issue by systematically desensitizing the child and offering alternative sensory experiences that may be more tolerable. This approach respects the child's sensory needs and grades the activity to promote success. A is a behavioral approach that may not be effective if the sensory experience is truly aversive; the underlying issue must be addressed first. B is inappropriate, unethical, and would likely increase the child's trauma and aversion to the task. D is a cognitive strategy that may be helpful for understanding the routine, but it does not address the overwhelming negative sensory experience which is the primary barrier.

Question 19

An OTR in a home health setting is working with a client with severe chronic obstructive pulmonary disease (COPD). The client reports becoming exhausted and severely short of breath midway through showering, which is their most fatiguing ADL. The client's priority is to complete the task without needing to rest for an hour afterward.

Which set of recommendations BEST incorporates energy conservation principles for this task?

  1. Take a very hot shower to open up the airways and use pursed-lip breathing.
  2. Complete upper body and lower body bathing on alternate days.
  3. Use a shower chair, keep items within reach, and use a terrycloth robe to dry off instead of a towel. (correct answer)
  4. Perform 10 minutes of upper body exercises before showering to build endurance.
Explanation: The correct answer is C. This set of strategies systematically reduces the energy demands of the task. Sitting on a shower chair eliminates the effort of standing. Keeping items within reach prevents excessive moving and reaching. Using a robe for drying (patting dry or air drying) is less strenuous than vigorous towel drying. A is incorrect because a very hot, steamy shower can actually make breathing more difficult for some people with COPD. B is a valid energy conservation strategy but does not address how to make the act of showering itself less fatiguing. D is incorrect because exercising immediately before a strenuous activity would increase fatigue, not reduce it for the task.

Question 20

A client is hospitalized with full-thickness burns to the dorsum of their dominant right hand. The hand is in a bulky dressing and an antideformity orthosis that positions the wrist in extension and MCPs in flexion, limiting functional grasp and dexterity. The client is ambulatory but requires assistance with toilet hygiene.

To facilitate the client's independence with toilet hygiene, which adaptive device should the OTR introduce and provide training on?

  1. A bedside commode.
  2. A raised toilet seat with armrests.
  3. A bidet attachment or long-handled toileting aid. (correct answer)
  4. A sliding board for transfers.
Explanation: The correct answer is C. The client's primary deficit is the inability to grasp and manipulate toilet paper due to the injury and orthosis on their dominant hand. A bidet or a long-handled toileting aid directly compensates for this fine motor limitation, allowing the client to complete hygiene independently. A is incorrect because the client is ambulatory and does not need a bedside commode. B is incorrect because a raised toilet seat helps with transfers, which is not the identified problem. D is incorrect because a sliding board is used for seated transfers and is not relevant to the client's needs.