NBCOT Registered Occupational Therapists (OTR) Quiz: Goal Prioritization
20 questions · exam conditions
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Goal PrioritizationQuestion 1 of 20

A 72-year-old client is 3 weeks post-left CVA with expressive aphasia and right hemiplegia in an inpatient rehabilitation facility. When the OTR attempts to discuss goals, the client becomes frustrated. They are able to say 'No' clearly but little else. They repeatedly point to a photograph of themselves in a large garden. The client's spouse states the client was an avid gardener and it was their 'life's passion.' The FIM score for dressing is 2 (Maximum Assist).

What is the BEST initial approach to collaboratively establish a prioritized, client-centered goal?

Prioritize improving upper body dressing independence since it is a fundamental ADL with a documented low FIM score.
Assume gardening is the primary goal and begin with adaptive gardening tasks in the therapy gym's raised beds.
Use a series of pictures depicting various occupations (e.g., dressing, eating, gardening, reading) and ask the client to point to the one they want to work on first.
Collaborate with the speech-language pathologist (SLP) to establish a reliable yes/no communication system before setting any OT goals.
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NBCOT Registered Occupational Therapists (OTR) Quiz

NBCOT Registered Occupational Therapists (OTR) Quiz: Goal Prioritization

Practice Goal Prioritization 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 Goal Prioritization, 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

A 72-year-old client is 3 weeks post-left CVA with expressive aphasia and right hemiplegia in an inpatient rehabilitation facility. When the OTR attempts to discuss goals, the client becomes frustrated. They are able to say 'No' clearly but little else. They repeatedly point to a photograph of themselves in a large garden. The client's spouse states the client was an avid gardener and it was their 'life's passion.' The FIM score for dressing is 2 (Maximum Assist).

What is the BEST initial approach to collaboratively establish a prioritized, client-centered goal?

  1. Prioritize improving upper body dressing independence since it is a fundamental ADL with a documented low FIM score.
  2. Assume gardening is the primary goal and begin with adaptive gardening tasks in the therapy gym's raised beds.
  3. Use a series of pictures depicting various occupations (e.g., dressing, eating, gardening, reading) and ask the client to point to the one they want to work on first. (correct answer)
  4. Collaborate with the speech-language pathologist (SLP) to establish a reliable yes/no communication system before setting any OT goals.
Explanation: The client has a clear communication deficit but is attempting to express a preference. The most effective approach is to provide a structured, nonverbal method for them to confirm their priorities. Using pictures allows the client to make a choice, confirming if the potent nonverbal cue (pointing to the photo) is indeed their top priority over other essential activities. This respects their autonomy and ensures the goal is client-centered. Choice A prioritizes deficits over client values. Choice B makes an assumption without confirmation. Choice D creates an unnecessary delay, as OT can and should use nonverbal methods for goal setting while the SLP works on communication.

Question 2

A home health OTR is treating a 90-year-old client with advanced dementia. The primary caregiver, her daughter, reports extreme burnout and wants to discuss placement in a long-term care facility. The client's son, who visits weekly, is adamant that his mother must stay at home. The client herself is unable to articulate her goals or preferences due to severe cognitive decline but appears placid in her home environment.

In this complex family situation, the OTR's primary responsibility in prioritizing a direction for care is to:

  1. Objectively assess client function, home safety, and caregiver burden, and then facilitate a family meeting to discuss data-driven, realistic options. (correct answer)
  2. Prioritize the son's goal to keep the client at home by developing a comprehensive caregiver training plan.
  3. Prioritize the daughter's goal for placement, as caregiver burnout is a significant risk factor for client safety.
  4. Focus interventions on maintaining the client's current function to enhance quality of life at home, avoiding involvement in the family conflict.
Explanation: When you encounter questions about complex family dynamics and care planning, remember that OTRs must balance multiple ethical principles: client autonomy, beneficence, and professional boundaries. The key is gathering objective data before facilitating informed decision-making. Answer A is correct because it follows proper ethical practice. You must first assess the actual situation objectively—evaluating the client's functional status, home safety risks, and caregiver capacity. This data-driven approach respects all parties by providing concrete information rather than assumptions. Facilitating a family meeting allows for collaborative decision-making based on facts, which is essential when the client cannot advocate for herself. Answer B is wrong because it automatically sides with the son without assessing whether home care is actually safe or feasible. You cannot ethically commit to a care plan without evaluating its viability. Answer C is wrong because it automatically sides with the daughter. While caregiver burnout is serious, you need objective assessment to determine if placement is truly necessary or if other supports could address the burden. Answer D is wrong because it avoids your professional responsibility to address safety concerns and family dynamics that directly impact care outcomes. Ignoring family conflict doesn't make it disappear—it often worsens care quality. Remember this pattern: When families disagree about care decisions, your role is to be the objective professional who gathers data, presents realistic options, and facilitates informed decision-making. Never automatically side with one family member over another without proper assessment.

Question 3

A 28-year-old client is in acute rehabilitation following full-thickness burns to their face, neck, and bilateral hands. The surgeon has prescribed an aggressive protocol for range of motion (ROM) and splinting to prevent contractures. The client is medically stable but demonstrates signs of depression, refusing to participate in self-care or look at their reflection. They state, 'It's pointless. I don't want anyone to ever see me like this.'

Which approach BEST prioritizes the client's immediate psychosocial needs while respecting the urgent medical necessity of contracture prevention?

  1. Prioritize the prescribed ROM and splinting protocol, clearly explaining the severe functional loss that will occur if contractures form.
  2. Defer physical goals until the client engages with a psychologist to address body image and trauma.
  3. Collaborate with the client to identify one controllable aspect of their daily routine, such as choosing the scent of their lotion for hand massage during ROM. (correct answer)
  4. Focus on long-term goals like community reintegration and peer support to provide hope for the future.
Explanation: This approach demonstrates expert clinical reasoning by integrating the psychosocial and physical needs. It acknowledges the client's distress and need for control (a core issue in trauma) by offering a small, manageable choice. This 'hooks' the client into participating in the medically necessary ROM by embedding it within a more palatable, client-directed activity. Choice A ignores the psychosocial barrier and uses a fear-based tactic that can damage rapport. Choice B inappropriately delays critical OT intervention and compartmentalizes care. Choice D focuses on long-term goals, which may be too overwhelming for a client in the acute phase of recovery.

Question 4

A 45-year-old client with bilateral carpal tunnel syndrome works as a data entry clerk and is a single parent to two young children. Their insurance plan has authorized only four sessions of outpatient OT. The client reports significant pain and difficulty with work tasks, meal preparation, and helping their children with fasteners on clothing.

Given the severe time constraint, which goal should the OTR prioritize to provide the MOST lasting benefit?

  1. Client will report a 2-point decrease in pain on a 10-point scale through the use of modalities within the four sessions.
  2. Client will receive custom-fabricated wrist orthoses and demonstrate correct application of ergonomic principles for work and home tasks. (correct answer)
  3. Client will demonstrate mastery of a full nerve and tendon gliding exercise program to be performed independently.
  4. Client will identify three pieces of adaptive equipment to assist with meal preparation and dressing tasks.
Explanation: With a very limited number of visits, the priority must be on interventions that provide durable, long-term benefits and empower the client for self-management. Fabricating orthoses provides symptom relief and protection, while education on ergonomics addresses the root cause of the problem across multiple life roles (work and home). This combination offers the most significant and lasting impact. Choice A focuses on short-term pain relief that will not last beyond the sessions. Choices C and D are useful but are secondary to the foundational interventions of orthotics and ergonomic education in this case.

Question 5

An 80-year-old client living in a rural area with no public transport is referred for a driving evaluation by his physician following a minor accident. Clinical tests show slowed reaction time and reduced neck rotation. The client is defensive, stating, 'I have to drive to stay independent. My only goal is to pass this test so my doctor will leave me alone.'

What is the MOST important initial step in the goal-setting process for the OTR to take?

  1. Explain that the primary goal is an objective fitness-to-drive determination based on standardized assessment results.
  2. Frame the evaluation as a collaborative effort to explore strategies for safe driving, while concurrently exploring transportation alternatives as a backup plan. (correct answer)
  3. Prioritize interventions to remediate deficits in reaction time and neck ROM before scheduling the on-road assessment.
  4. Begin by exploring alternative transportation options, since the clinical signs strongly suggest the client is an unsafe driver.
Explanation: The client's driving role is deeply tied to their identity and independence, leading to defensiveness. The best approach is to reframe the process from a pass/fail test into a collaborative partnership focused on safety and maintaining community mobility. By exploring strategies to enhance safety and discussing alternatives as a parallel plan rather than a consequence of failure, the OTR reduces the client's anxiety and defensiveness, fostering a therapeutic alliance. This allows for a more open conversation about the ultimate goal: continued participation in the community, whether by car or other means. Choices A and D are confrontational. Choice C may provide false hope and delays a necessary comprehensive assessment.

Question 6

A 6-year-old child with Autism Spectrum Disorder, Level 3, is non-verbal and uses a picture exchange system for basic requests. During the evaluation, the child persistently lines up toy cars and becomes highly distressed when this routine is interrupted. The parents' stated priority is toilet training, as it is a major source of family stress and limits community outings.

In establishing the initial intervention plan, which foundational goal must the OTR prioritize?

  1. Implement a timed voiding schedule and behavioral reward system to address the parents' primary concern.
  2. Use the child's interest in cars to establish a reliable method for communicating emotional states (e.g., 'all clear' vs. 'roadblock') and choices. (correct answer)
  3. Introduce sensory integration techniques designed to reduce the child's restrictive and repetitive behaviors with the toy cars.
  4. Work on bilateral coordination and motor planning skills needed to manage clothing for toileting.
Explanation: Successful participation in a complex ADL like toilet training requires foundational skills in communication, emotional regulation, and interoception. The child's repetitive behavior is not just a 'symptom' to be extinguished; it is a source of comfort and a potential key to communication. By leveraging this high-interest activity, the OTR can build a communication and regulation system that is meaningful to the child. This foundation is essential before tackling a stressful, sensory-rich, and emotionally laden task like toileting. Choice A ignores these underlying needs and is likely to fail. Choice C views the behavior negatively instead of using it therapeutically. Choice D focuses on motor skills, which are secondary to the primary sensory, communication, and regulation barriers.

Question 7

A 68-year-old man is in inpatient rehabilitation following a right CVA with resulting left hemiparesis. He lives with his wife in a single-story home. Prior to the stroke, he was an avid woodworker. During the initial interview, the client states, "I just want to walk out of here and get back to my workshop." His wife expresses significant concern about his safety, stating, "I'm so afraid he is going to fall when we get home." Evaluation findings indicate the client requires minimal assistance for transfers and moderate assistance for dressing.

When collaborating with the client and his wife to establish initial intervention goals, which goal should the OTR prioritize?

  1. Modifying woodworking tools for one-handed use.
  2. Improving dynamic standing balance for ambulation.
  3. Achieving independence in safe transfers to various surfaces. (correct answer)
  4. Providing comprehensive caregiver training for all ADLs.
Explanation: The correct answer is C because achieving independence in safe transfers is a foundational skill that directly addresses both the client's desire for mobility (a precursor to walking and workshop activities) and the wife's primary concern about fall prevention. It is a critical prerequisite for safe discharge and participation in other meaningful occupations. Choice A is premature as basic mobility and safety must be established first. Choice B focuses on a performance component (balance) rather than a whole occupation (transfers), and safe transfers are a more immediate priority for discharge planning. Choice D is important, but the primary goal should focus on restoring the client's function first, with caregiver training supporting that goal.

Question 8

An OTR is participating in an initial IEP meeting for a 7-year-old boy with Autism Spectrum Disorder (ASD). The teacher reports that the student has difficulty with handwriting and often disengages during group activities. The parents' primary concern is that he has no friends and is always isolated during recess. When asked about his favorite things, the child talks extensively about dinosaurs and enjoys drawing them.

Which of the following goals BEST reflects a collaborative prioritization of the concerns of the student, parents, and teacher?

  1. Student will improve handwriting legibility on classroom worksheets using a pencil grip.
  2. Student will participate in a structured social skills group to learn conversational turn-taking.
  3. Student will initiate and engage in a drawing activity with one peer during a structured recess period. (correct answer)
  4. Student will tolerate sitting in a group of peers for 10 minutes without disengaging.
Explanation: The correct answer is C because it masterfully integrates the primary concerns of all parties in a client-centered way. It addresses the parents' goal of peer interaction and social participation, incorporates the teacher's goal of engagement, and leverages the student's intrinsic motivation (drawing dinosaurs). This approach makes the therapeutic process meaningful and more likely to succeed. Choice A addresses only the teacher's concern and ignores the primary social goal. Choice B is a generic approach that isn't tailored to the student's specific interests. Choice D focuses on tolerance rather than active, meaningful participation.

Question 9

A 45-year-old administrative assistant is attending outpatient therapy following a carpal tunnel release surgery on her dominant hand. She is a single mother of two school-aged children. She tells the OTR, "I have to be able to type to keep my job, but right now I can't even make dinner for my kids without pain." Assessment reveals decreased grip strength, pain with wrist extension, and difficulty with fine motor coordination.

In collaborating with the client to set initial goals, which of the following should be the FIRST priority?

  1. Increase grip strength to within functional limits to allow for typing.
  2. Simulate meal preparation tasks using ergonomic principles and adaptive equipment. (correct answer)
  3. Educate the client on proper ergonomic setup of her computer workstation.
  4. Achieve full active range of motion of the wrist and fingers.
Explanation: The correct answer is B because it directly addresses one of the client's two primary concerns (making dinner for her children), which is a crucial daily role. By focusing on a meaningful occupation and introducing ergonomic principles and adaptive equipment, the OTR can provide immediate solutions, build rapport, and address functional limitations that will also translate to her work-related goals. Choices A and D are biomechanical goals (bottom-up approach) and are less client-centered than focusing on the functional task itself. Choice C is important but addresses only one of the client's stated problems, while meal preparation is a more immediate daily need.

Question 10

A 32-year-old member of a community mental health clubhouse program, who has a diagnosis of schizophrenia, tells his OTR case manager, "I want to get a job, maybe working with animals, but I'm terrified of interviews." The member has been medication-compliant and his symptoms are stable. His daily living skills are adequate, but he presents with significant social anxiety and has not worked in over five years.

What is the MOST appropriate initial goal to establish with the member to support his vocational aspirations?

  1. Complete a vocational interest inventory to identify potential jobs.
  2. Develop a professional resume and write a cover letter.
  3. Secure a volunteer position at the local animal shelter for 4 hours per week. (correct answer)
  4. Practice job interview skills through role-playing scenarios.
Explanation: The correct answer is C because it provides a graded, real-world experience that directly aligns with the client's stated interest (working with animals) while addressing his primary barrier (social anxiety) in a less-threatening context than a formal job interview. Volunteering allows him to explore the work environment, build confidence, and develop work habits. Choice A is unnecessary as the client has already identified an interest. Choices B and D are important steps in job seeking, but they are premature given the client's significant anxiety and lack of recent work experience. A successful volunteer experience should be the foundational first step.

Question 11

An 85-year-old woman is in a skilled nursing facility (SNF) for rehabilitation following surgery for a hip fracture. She has non-weight-bearing precautions on the affected leg. She lives alone in a two-story house and her primary goal is to "go home as soon as possible." An assessment reveals that she requires moderate assistance for bed mobility and transfers, and maximal assistance for lower body dressing.

Which goal is the HIGHEST priority to facilitate a safe discharge to home for this client?

  1. Mastering safe transfers and bed mobility while maintaining hip precautions. (correct answer)
  2. Navigating stairs independently to access the second floor of her home.
  3. Preparing a simple meal in the therapy kitchen using a walker.
  4. Educating the client's family on how to assist with all ADLs.
Explanation: The correct answer is A. For a client with a hip fracture who lives alone, mastering safe bed mobility and transfers is the most critical and foundational goal. These skills are essential for preventing falls, maintaining precautions, and performing virtually all other ADLs. Without this, a safe discharge home is not possible. Choice B is a more advanced goal that would be addressed after foundational mobility is established. Choice C is an important IADL, but secondary to fundamental safety and mobility. Choice D is important, but the primary focus of rehabilitation is to restore the client's independence as much as possible, not to create dependence on family.

Question 12

A 25-year-old man who sustained a moderate traumatic brain injury (TBI) six months ago is attending outpatient OT. He lives with his parents and is eager to return to his college studies. Evaluation results show significant executive functioning deficits, particularly in initiation, planning, and memory. He is easily overstimulated in busy environments.

Which of the following is the MOST realistic and appropriate initial goal to collaborate on with the client?

  1. Enroll in and attend one online college course with accommodations.
  2. Develop and use a weekly schedule to manage two home-based responsibilities. (correct answer)
  3. Independently research and select a new major for his college studies.
  4. Learn and apply three different note-taking strategies for academic lectures.
Explanation: The correct answer is B because it addresses the client's underlying executive functioning deficits in a structured, graded, and contextually relevant manner. Mastering the management of a few home-based tasks (e.g., laundry, taking out trash) builds the foundational skills of planning, initiation, and follow-through in a low-stakes environment. This success is critical before tackling the highly demanding cognitive load of a college course. Choice A is likely too advanced and could lead to failure and frustration. Choices C and D target specific aspects of college life but are not appropriate until the foundational executive functions are more stable.

Question 13

A 55-year-old construction manager is in the acute care unit two days after a myocardial infarction (MI). His vital signs are stable, but he has low activity tolerance, within a 2-3 MET level range. He appears anxious and tells the OTR, "I have to get back to my crew. My business can't run without me." He attempts to get out of bed without assistance.

When establishing goals with the patient for this acute phase of recovery, what should be the OTR's PRIMARY priority?

  1. Developing a graded return-to-work plan for construction management.
  2. Increasing upper body strength to meet the physical demands of his job.
  3. Educating the patient on energy conservation and adherence to cardiac precautions during basic ADLs. (correct answer)
  4. Practicing functional mobility, such as getting in and out of a simulated work truck.
Explanation: The correct answer is C. In the acute phase post-MI, the highest priority is patient safety and medical stability. The goal must focus on educating the patient about their current limitations (MET levels), teaching them how to conserve energy, and ensuring they can perform basic self-care without putting undue stress on the heart. This directly addresses his unsafe behavior (getting up alone) and begins the education process necessary for recovery. All other choices (A, B, D) are completely inappropriate and unsafe for the acute phase of cardiac recovery; they represent long-term goals for later stages of rehabilitation.

Question 14

A 10-year-old fourth-grader with ADHD is being evaluated for OT services. The teacher reports the student rushes through written work, leading to careless errors, and his desk is extremely disorganized. His parents state that morning routines are chaotic and he frequently forgets his homework and lunchbox. The student says, "I just want to finish my work fast so I can go play."

Which IEP goal BEST synthesizes the needs of the student, teacher, and parents?

  1. Student will improve handwriting legibility by 25% on a standardized assessment.
  2. Student will use a visual checklist to pack his backpack and organize his desk with minimal cues. (correct answer)
  3. Student will decrease off-task behaviors during independent work time.
  4. Student will use a timer to learn to pace himself during written assignments.
Explanation: The correct answer is B because it addresses the underlying executive functioning issue (organization, working memory, initiation) that is impacting performance in all contexts (home and school). A visual checklist is a concrete strategy that can be used for packing a backpack (parents' concern), organizing a desk (teacher's concern), and ensuring all parts of an assignment are complete (student's goal to finish). It builds a transferable skill. Choice A focuses narrowly on handwriting. Choice C is a behavioral goal, not a skill-building one. Choice D is a useful strategy but is less comprehensive than the checklist, which addresses the organizational component that is a root cause of his difficulties.

Question 15

A 30-year-old chef is in the acute care burn unit following a full-thickness burn to his dominant hand, which has just received a skin graft. He is anxious and repeatedly asks the OTR, "Will I ever be able to hold a knife again? My career is over." The surgeon has ordered OT for an orthosis and to begin therapy.

In this acute phase of recovery, which goal is the MOST important to prioritize with the client?

  1. Fabricating a custom orthosis to protect the graft and maintain a functional hand position. (correct answer)
  2. Beginning gentle active range of motion exercises to prevent stiffness.
  3. Exploring adaptive cutting tools and one-handed kitchen techniques.
  4. Initiating scar management techniques including massage and compression.
Explanation: The correct answer is A. Immediately following a skin graft, the highest priority is to protect the fragile graft to ensure it takes. An orthosis is critical for immobilization, preventing contractures, and positioning the hand for optimal future function. This medical necessity directly aligns with the client's long-term vocational goal by preserving the anatomical structures he will need. Choice B is likely contraindicated in the immediate post-grafting phase. Choice C is premature and may undermine the client's hope for recovery. Choice D is important but is implemented after the graft is stable and wounds have healed.

Question 16

An OTR is working in palliative care with a 62-year-old man in the late stages of ALS. He is dependent for all care, uses a power wheelchair with a head array, and communicates via an eye-gaze device. During a session, he communicates, "I want to be in my garden. I want to direct my own care." His family is focused on managing his physical comfort and repositioning schedule.

In collaborating with the client and family, which goal BEST prioritizes the client's expressed wishes?

  1. Train the family in passive range of motion to prevent contractures and reduce pain.
  2. Establish a consistent turning and repositioning schedule with the family.
  3. Adapt the client's wheelchair and communication systems to allow independent access to his outdoor garden patio. (correct answer)
  4. Provide a sensory stimulation program including nature sounds and floral scents.
Explanation: The correct answer is C because it directly and actively addresses the client's stated goals of autonomy ('direct my own care') and meaningful participation ('be in my garden'). This goal focuses on enabling the client to use his remaining abilities to control his environment and engage in a cherished occupation, which is central to quality of life in palliative care. Choices A and B are important for physical comfort (the family's focus) but do not honor the client's specific request for autonomy and engagement. Choice D is a passive alternative that does not fulfill his desire to actually be in his garden.

Question 17

A 70-year-old man with moderate Parkinson's disease recently stopped driving. He was accustomed to meeting friends for coffee every morning but now relies on his wife for all transportation. He tells the OTR, "I feel like a prisoner in my own home." His wife adds, "I want him to get out, but I'm worried about him falling if he tries to use the bus." Assessment reveals shuffling gait and mild postural instability.

What is the MOST appropriate initial community mobility goal to set with the client and his wife?

  1. Complete a comprehensive driving evaluation to see if he can resume driving.
  2. Client will perform daily balance and coordination exercises to reduce fall risk.
  3. Client will research and compare the costs of various ride-sharing services.
  4. Client will plan and complete one round trip to the coffee shop using public transit with supervision. (correct answer)
Explanation: The correct answer is D. This goal is client-centered as it directly addresses his desire to return to his valued social routine. It is collaborative because it incorporates the wife's safety concerns by including supervision. It is a functional, occupation-based goal that allows for the real-world practice of problem-solving, navigation, and physical management in the community. Choice A contradicts the fact that he has already stopped driving. Choice B is a decontextualized exercise program, not a community mobility goal. Choice C is a passive task and does not address the client's desire for active participation.

Question 18

An OTR in a school setting is working with a 9-year-old girl with diagnoses of dyslexia and dysgraphia. The child expresses extreme frustration with writing, stating, "I'm dumb," and often refuses to complete assignments. Her parents are focused on improving her grades on written reports. Assessment indicates strong verbal reasoning skills but significant deficits in the mechanics of writing.

To address both academic needs and the child's self-esteem, which initial goal should be prioritized?

  1. Child will improve handwriting legibility using a multisensory writing program.
  2. Child will use voice-to-text software to compose a short paragraph on a topic of interest. (correct answer)
  3. Child will verbally dictate her reports to a scribe, such as a parent or teacher's aide.
  4. Child will increase her typing speed on a standard keyboard to 20 words per minute.
Explanation: The correct answer is B because it utilizes a compensatory strategy (assistive technology) to allow the child to bypass her area of greatest difficulty (dysgraphia) and experience immediate success in written expression. This directly addresses her poor self-esteem by showing her she is not 'dumb' and has good ideas. It also meets the parents' goal of producing written work. This approach builds confidence, which can then increase her motivation to work on remedial skills. Choice A focuses on a remedial approach that may increase her frustration initially. Choice C promotes dependence rather than independent skill development. Choice D is a valid long-term goal but is a slower process that won't provide the immediate success this child needs.

Question 19

A 79-year-old widow living alone is seen by a home health OTR. She has diagnoses of congestive heart failure (CHF) and depression. She reports, "I have no energy for anything," and spends most of her day in a recliner. She states she has not been cooking or cleaning and misses attending her garden club. Her home is cluttered, and her personal appearance is disheveled.

Given the client's fatigue and low motivation, what is the MOST important initial goal for the OTR to establish?

  1. Client will prepare a simple, no-cook lunch for herself 3 days a week.
  2. Client will perform one preferred morning self-care task while seated at the sink. (correct answer)
  3. Client will sort through one pile of mail while sitting at her kitchen table.
  4. Client will identify transportation options to resume attending her garden club.
Explanation: The correct answer is B. This goal focuses on re-engaging the client in a basic, foundational ADL. It is achievable ('one' task), accounts for her low energy by suggesting she remain seated, and addresses basic self-worth and hygiene. Successfully completing a small, routine task can combat the inertia of depression and introduce energy conservation principles. This creates a foundation for tackling more complex tasks. Choices A and C are slightly more complex IADLs. Choice D is a much longer-term goal that is too ambitious for her current state of fatigue and depression.

Question 20

A 75-year-old man who is a long-term resident in a skilled nursing facility had a CVA six months prior, resulting in expressive aphasia and right hemiparesis. The OTR observes that he has stopped attending the daily resident card game, which he previously enjoyed. Using a communication board, he is able to express that he feels "sad" and points toward the other residents playing cards. Nursing staff notes he has been less cooperative with therapy.

When revising the plan of care, which goal BEST prioritizes the resident's psychosocial needs and motivation?

  1. Resident will use an assistive device to participate in a modified card game with a peer. (correct answer)
  2. Resident will independently propel his wheelchair to the activity room daily.
  3. Resident will demonstrate increased active range of motion in his right wrist and hand.
  4. Resident will use his communication board to make a request to a staff member once per day.
Explanation: The correct answer is A because it directly targets the loss of a valued, meaningful social occupation that is the likely source of the resident's sadness and decreased motivation. By adapting the activity to allow for success, the OTR addresses his quality of life and reason for participation, which can in turn improve his cooperation with other aspects of therapy. Choices B, C, and D are all reasonable therapy goals, but they do not address the specific, client-identified reason for his distress—his inability to participate in his preferred card game.