NBCOT Test Prep A_ Questions & Answers.

Document Content and Description Below

NBCOT Test Prep A_ Questions & Answers A1. An older adult with peripheral neuropathy resulting from the chronic effects of diabetes expresses concern over the ability to have a satisfying sexual re... lationship with a partner. Which is the most beneficial recommendation for the occupational therapist to make to the older adult? a. Experiment with different positions during sexual expression activities. b. Focus on intact senses and areas of intact sensation. c. Schedule sexual expression activities after rest periods. d. Advise the older adult to accept decreased abilities in sexual expression as a normal part of aging. A2. An individual with amyotrophic lateral sclerosis requires the use of an environmental control unit (ECU) to access electrical devices and a personal emergency response system. The individual lives alone and self-directs personal care attendants to perform personal activities of daily living. During instruction to the individual on the capabilities and use of the ECU, which is most important for the occupational therapist to discuss with the client? a. The ECU's back-up power source and charging instructions. b. Additional assistive technology available. c. Augmentative alternative communication options. d. Funding for the ECU and assistive technology. A3. A nine-year-old child identifies the assembly of a model as the most desired play activity. The occupational therapist determines that the child would have difficulty completing the selected model. Which action is most effective for the therapist to take during the next intervention session? a. Allow the child to work on the model and provide maximum assistance as the child completes the project. b. Explore with the child why completing the model is desired by the child and provide alternative project choices. c. Break the project down into accomplishable segments and instruct the child to complete one segment at a time. d. Explain to the child several reasons why the selected model is not the best choice for the child and provide alternative project choices. A4. A child with myelomeningocele meets the short-term goals of achieving functional gross grasp and lateral pinch. After several additional weeks of occupational therapy, the child does not meet the goals of demonstrating pincer grasp and three jaw chuck. Consequently, the therapist modifies the child's intervention plan. Which intervention is best to include in the revised plan? a. Increase strength of lateral pinch as a basis to develop pincer grasp and three jaw chuck. b. Teach the child to use gross grasp and lateral pinch for functional activities. c. Teach the child to use ulnar grasp for functional activities. A5. An individual attends an outpatient parenting skills group. The person has a history of serious recurrent depression and is taking Nardil. The client complains of recurrent headaches and difficulty focusing during the day (e.g., when helping children with their homework). Which action is best for the occupational therapist to make in response to the client's expressed concerns? a. Instruct the client in stress reduction techniques. b. Ask the group for suggestions on how to deal with the parenting stress of homework. c. Suggest that the individual consult with a nurse practitioner for headache relief strategies. d. Tell the client you will be notifying the psychiatrist of these complaints. A6. A religious congregation obtained private funding to build a ramp so that members with disabilities can attend services. The entrance to the congregation's building has six steps with a rise of 7 inches each. Which is best for the occupational therapist hired by the congregation to recommend for construction of this ramp? a. 42 feet long with a 3′ × 3′ landing at the ramp's midpoint. b. 48 feet long with a 3′ × 3′ landing at the ramp's midpoint. c. 42 feet long with a 5' × 5' landing at the ramp's midpoint. d. 48 feet long with a 5' × 5' landing at the ramp's midpoint. A7. A child with juvenile rheumatoid arthritis wears bilateral night resting splints with wrists in 0° of extension, MPs and IPs flexed, ulnar deviation of 10°, and thumbs in opposition. The child complains of pain in the wrists upon awakening. No redness is noted upon removing splints. Range of motion (ROM) measurements show ulnar deviation of 5°. Which action should the occupational therapist take in response to this complaint and these observations? a. Modify the splints at the wrist. b. Pad the ulnar aspect on the inside of the splints. c. Discontinue the splints and monitor the status of pain for two weeks. A8. A 15-year-old with asymptomatic HIV attends an outpatient clinic. The occupational therapy protocol for patients diagnosed with HIV includes presentation of information on safe sex. The adolescent's parents refuse to allow this information to be presented to their child. Which is the best action for the therapist to take in response to this situation? a. Ask the adolescent's opinion and act on their refusal or consent. b. Document that the parents refuse the intervention for their child. c. Refer the family to the social worker for counseling. d. Have the parents sign a waiver that they refused the intervention for their child. A9. An individual who has Parkinson's disease presents with poor trunk rotation during ambulation and while performing ADL. According to neurophysiologic approaches, which is the most effective therapeutic intervention for the occupational therapist to use with this person? a. Facilitation of trunk rotation using neurodevelopmental handling techniques. b. Slow rolling with the person supine with knees and hips flexed. c. Engagement in ADL using diagonal patterns. d. Provision of a rolling walker to compensate for limited rotation and enhance mobility. A10. An individual who incurred a cerebrovascular accident (CVA) six months ago is receiving outpatient occupational therapy to address residual cognitive-perceptual deficits (i.e., unilateral inattention and spatial relations impairments). The individual drives daily despite strong suggestions from family members to discontinue this activity. The family members share their concerns about the person's capabilities to drive safely with the occupational therapist. Which is the best action for the therapist to take in response to these expressed concerns? a. Report the individual to the department of motor vehicles. b. Suggest that the individual attends a driver training program. c. Report the information to the physician. d. Validate the family members' concerns about the individual's driving risk. A11. Following a left CVA, an individual receives OT services at a sub-acute rehabilitation facility. The patient's personal goal is to be independent in dressing. The patient demonstrates decreased memory, poor sequencing skills, and ideational apraxia. Which of the following is most effective for the therapist to provide when teaching one-handed dressing techniques to this patient? a. Step-by-step verbal instructions. b. Sequenced photographs of the steps in dressing. c. Physical prompts to initiate the steps in dressing. d. A full length mirror for the client to observe self-dressing performance. A12. An elementary school teacher has been recently diagnosed with multiple sclerosis (MS). Which adaptation is best for the occupational therapist to recommend the teacher use to accommodate for the effects of MS on classroom teaching? a. The use of anchoring techniques to compensate for scanning deficits. b. A daily list of tasks to compensate for cognitive deficits. c. A motorized scooter to compensate for decreased endurance. d. A high stool to compensate for lower extremity weakness. A13. An occupational therapist conducts an initial home visit to a family with a premature infant who, at four months and 5 lbs., has just been discharged from the hospital. The child has multiple developmental disabilities. Which is most important for the therapist to do during this first session with the family? a. Communicate effectively to develop a therapeutic relationship with the family. b. Teach the family proper body mechanics for lifting the child. c. Teach the family assertiveness training to develop advocacy skills. d. Determine whether adaptive aids or positioning equipment is needed. A14. A 3-year-old child with left spastic hemiplegia due to cerebral palsy is evaluated for early intervention services. During the evaluation the occupational therapist observes behaviors that seem to indicate the presence of visual deficits. Based on these observations, which action should the occupational therapist take? a. Completion of a motor-free visual perceptual assessment. b. Completion of a developmental vision assessment. c. Refer the child to an optician. d. Refer the child to an optometrist. A15. An occupational therapist constructs a splint for a person who incurred full thickness facial and anterior neck burns. In which position should the therapist splint the neck? a. Extension. b. 15° flexion. c. 15° lateral flexion. d. 15° hyperextension. A16. An occupational therapist reviews the use of the occupational therapy department's resources to determine medical necessity and cost efficiency. Which service management task is the therapist performing? Utilization review. Retrospective peer review. Total quality management. Risk management. A17. A 6-year-old has thumb weakness that is most evident in the child's poor ability to perform thumb opposition. During evaluation, which activity will the therapist most likely observe the child having difficulty performing? Rolling a piece of clay into a ball. Turning a pencil over to erase. Picking up coins. Separating two pieces of paper. A18. Questions A18 to A22 are based on the following information. A private practice comprised of five occupational therapists provides home-based services to a variety of adult clients in a two-county area. They are expanding their practice to include home-based services in another county. This private practice has also recently been awarded the early intervention service provider contract for all three counties. The practitioners plan to hire three entry-level occupational therapists and two certified occupational therapy assistants (COTA®s) to fill the service needs of their growing practice. The COTA®s have extensive experience in home-based service provision. The private practitioners plan to provide all of their new employees with a comprehensive orientation program and the shadowing of an experienced therapist for two weeks. A18. To ensure the provision of best practice, the new entry-level occupational therapists will be provided with supervision of their caseloads. At what level should this supervision be provided? a. Routine. b. General. c. Close. d. Minimal. Questions A18 to A22 are based on the following information. A private practice comprised of five occupational therapists provides home-based services to a variety of adult clients in a two-county area. They are expanding their practice to include home-based services in another county. This private practice has also recently been awarded the early intervention service provider contract for all three counties. The practitioners plan to hire three entry-level occupational therapists and two certified occupational therapy assistants (COTA®s) to fill the service needs of their growing practice. The COTA®s have extensive experience in home-based service provision. The private practitioners plan to provide all of their new employees with a comprehensive orientation program and the shadowing of an experienced therapist for two weeks. A19. The private practitioners pay for their newly hired occupational therapists' registration for an advanced course on pediatric assessment. Which is the most important outcome of attending this course for the occupational therapists? Networking with other pediatric professionals. Improving their professional skills and competence. Keeping up-to-date on current trends in occupational therapy. Questions A18 to A22 are based on the following information. A private practice comprised of five occupational therapists provides home-based services to a variety of adult clients in a two-county area. They are expanding their practice to include home-based services in another county. This private practice has also recently been awarded the early intervention service provider contract for all three counties. The practitioners plan to hire three entry-level occupational therapists and two certified occupational therapy assistants (COTA®s) to fill the service needs of their growing practice. The COTA®s have extensive experience in home-based service provision. The private practitioners plan to provide all of their new employees with a comprehensive orientation program and the shadowing of an experienced therapist for two weeks. A20. The supervising occupational therapists meet to plan the workload of the recently hired COTA®s. Which task is best for them to assign to the COTA®s? The in-home evaluation of the adult clients' instrumental activities of daily living. The determination of long-term goals to include in the adult clients' OT home care intervention plan. The design of home-based sensory integration protocols for infants and toddlers with sensory processing disorders. The administration and interpretation of the Hawaii Early Learning Profile (HELP) to infants and toddlers. Questions A18 to A22 are based on the following information. A private practice comprised of five occupational therapists provides home-based services to a variety of adult clients in a two-county area. They are expanding their practice to include home-based services in another county. This private practice has also recently been awarded the early intervention service provider contract for all three counties. The practitioners plan to hire three entry-level occupational therapists and two certified occupational therapy assistants (COTA®s) to fill the service needs of their growing practice. The COTA®s have extensive experience in home-based service provision. The private practitioners plan to provide all of their new employees with a comprehensive orientation program and the shadowing of an experienced therapist for two weeks. A21. The private practitioners meet with their accountant to plan fiscally for their expanded practice. How would the accountant classify the fees that the practice receives from their early intervention contract? Accounts payable. Capital assets. Productivity standards. Accounts receivable. Questions A18 to A22 are based on the following information. A private practice comprised of five occupational therapists provides home-based services to a variety of adult clients in a two-county area. They are expanding their practice to include home-based services in another county. This private practice has also recently been awarded the early intervention service provider contract for all three counties. The practitioners plan to hire three entry-level occupational therapists and two certified occupational therapy assistants (COTA®s) to fill the service needs of their growing practice. The COTA®s have extensive experience in home-based service provision. The private practitioners plan to provide all of their new employees with a comprehensive orientation program and the shadowing of an experienced therapist for two weeks. A22. The accountant asks the private practitioners to present their budget for anticipated direct expenses of their growing practice. Which is the most appropriate item to include in this budget request? The rent and utilities of the practice's primary office. An integrated computer system for paperless documentation by all staff. Staff vacation and sick time. Supplies of items used in in-home therapy sessions. A23. A young adult with a diagnosis of schizophrenia is scheduled to be discharged from an inpatient setting to a halfway house and psychosocial clubhouse. The occupational therapist is assisting the team with the discharge plan. Which is the most important information for the therapist to provide to the team about this person? The person's instrumental ADL skills. The person's vocational potential. The person's social interaction skills. A24. Following the performance of a home exercise program prescribed one week ago, an individual with bilateral upper extremity muscle weakness reports experiencing pain in both shoulders and elbows. The pain persists for up to five hours. The individual's occupational therapist is on vacation for two weeks and a recently hired entry-level therapist has been assigned to cover the vacationing therapist's caseload. In response to these reported symptoms, which is the best action for the covering therapist to take in response to this individual's reporting symptoms? Recommend the person stop exercising completely until the primary therapist returns and can re-evaluate the person's status. Reduce the intensity of exercise by 50% and reassess the person during the next intervention session. Continue with the current exercise program to develop tolerance. Advise the individual to take a pain relief medication 30 minutes prior to exercising. A25. A child with spinal muscle atrophy can no longer reach beyond 90° of shoulder abduction and 90° of shoulder flexion. The parents state that the child can no longer don or doff a T-shirt. Which is the best approach for the occupational therapist to recommend the child use for dressing? Place the T-shirt directly on the child's lap, have the child don the arms first, then don the head of theT-shirt. Have the child learn to don and doff front-opening shirts instead of T-shirts. Have the child support the elbows on a table at chest height to don the T-shirt over arms, then don over the head. Have the child sit with the trunk well-supported, lean to the right and don the right arm, repeat to the left, and then don the head of the T-shirt. A26. An individual recovering from a CVA has received extensive motor learning intervention. The client can now transfer a learned motor skill to different contexts. The client also demonstrates the ability to successfully problem-solve during motor activities in different contexts. In documenting the client's progress, which stage of motor learning is most accurate for the occupational therapist to document the individual has achieved? Skill acquisition. Skill transfer stage. Skill retention. A27. An occupational therapist provides consultation services to members of a town chamber of commerce who have expressed interest in improving their businesses' accessibility. Which is the minimum door width that the occupational therapist should recommend to the chamber members as accessible and not requiring modification? 28 inches. 32 inches. 30 inches. 34 inches. A28. A client expresses an interest in playing a computer game with another group member during a leisure skills group. The occupational therapist reviews the client's cognitive evaluation and agrees that the game is a good choice for the client's cognitive level. After 15 minutes of engaging in the computer game, the client rubs both eyes, looks around, and reports trouble focusing. Which should the therapist do in response to these observations and client statements? Provide verbal encouragement for the client to complete the game before taking a break. Suggest the client and the other member play a different video game that is easier for the client. Discontinue the session and advise the client to select a different leisure activity to do with the othermember. Suggest the client and the other member pause the game to talk about the game's progress after significant plays. A29. A 19-year-old with a diagnoses of persistent depressive disorder attends a vocational rehabilitation program. When the client arrives for the work adjustment group, the therapist notes that the client demonstrates an unsteady gait and slurred speech. The client's breath smells of alcohol. Which is the best action for the therapist to take in response to these observations? Follow program procedures to arrange for transportation to bring the client home. Introduce the topic of alcohol's effect on work performance as the focus of the scheduled group session. Have the client meet with the social worker to discuss treatment options for potential alcohol abuse. Contact the client's parents to pick the client up to bring the client home. A30. A toddler with spastic quadriplegic cerebral palsy demonstrates a consistent tonic bite reflex. Which technique should the occupational therapist use to help inhibit this reflex? Move a spoon from side to side on the tongue. Walk a spoon down the tongue, from proximal to distal. Press a spoon down firmly on the center of the tongue. Stroke the tongue in a circular motion with a firm object. A31. A child with a tactile defensive sensory modulation disorder attends a private early intervention clinic. The occupational therapist collaborates with the child's parents to develop strategies and guidelines to help the child handle the symptoms of this disorder at home. Which is the best recommendation for the therapist to make to the parents? Avoid the use of swings and other moving equipment during play activities. Encourage the use of swings and other moving equipment during play activities. Soften the child's clothing by repeated laundering and remove clothing tags. Provide a variety of textures in the clothing the child wears. A32. A newly hired COTA® is instructed by the director of rehabilitation to supervise two hospital volunteers as they learn how to assist patients in safely completing bed to wheelchair transfers. The COTA® informs the supervising occupational therapist of the director's request. Which is the first action the occupational therapist should take in response to this request? Advise the COTA® to comply with the request. Advise the COTA® to refuse the request. Observe the COTA® to assess service competence in transfer training. Explain to the director of rehabilitation why the request is inappropriate. A33. A single parent is hospitalized for an exacerbation of schizophrenia. Actively psychotic upon admission, the client has been stabilized on medication. The client is currently not demonstrating hallucinations or delusions. Residual deficits include several negative symptoms and decreased cognitive skills. At the team meeting, the psychiatrist decides to discharge the client within 48 hours. The client lives with their elementary-school aged children. Which is the best recommendation for the occupational therapist to make during this team meeting? An extension of hospitalization to further evaluate cognitive skills. A family meeting to discuss the need for the children to assume home management tasks. A home visit to assess the client's safety skills within the home environment. A referral to social services to explore foster care for the children. A34. An individual recovering from hip replacement surgery prepares for discharge home. The client has a secondary diagnosis of gastric esophageal reflux disease (GERD). Which is the best bed position for the occupational therapist to recommend to this client? Supine with elevation of the shoulders and head. Sidelying with the neck in neutral. Sidelying with elevation of the shoulders and head. Supine with elevation of the hips. A35. An occupational therapist designs a dynamic splint for an individual recovering from tendon repair. At which angle should the therapist position the outrigger? 45° to the joint. 90° to the joint. 60° to the joint. 110° to the joint. A36. The transition plan for a high school senior with developmental delay includes a referral to a vocational rehabilitation workshop job setting. The student has set a goal to live independent of family. Which is the best living environment for the occupational therapist to recommend for this student? An apartment in a subsidized housing project. A group home with case managers available on-call. A supported apartment with a roommate. A group home with daily on-site supervision. A37. The parents of a two-year-old child with unilateral congenital upper extremity amputations express concern to the home-care occupational therapist about their child's complete disinterest in toilet training. At which point should the occupational therapist advise the parents to begin toilet training? When the child indicates discomfort with being wet or soiled. Immediately, because toileting is a developmentally appropriate task. When the child is 3 years old, as this is the typical developmental age for toilet training. A38. A school-aged child who is right-hand dominant complains of numbness and tingling after writing for more than 15 minutes. A neurological exam shows no reason for the numbness and tingling. Which action would be most beneficial for the occupational therapist to recommend to the child? Use a pencil held in a universal cuff to complete writing activities. Elevate the right upper extremity at night and whenever possible during the day. Stretch the right upper extremity every 15-20 minutes during writing activities. Use a custom-molded pencil grip made of splinting material when writing. A39. An occupational therapist leads a transitional planning group for high school students with conduct disorders. The school fire alarm goes off five minutes before the group's scheduled termination. There have been six false alarms during the past three days at the school. Several of the students laugh and say, "There it goes again." Which is the occupational therapist's best response to this situation? Call the school's main office to determine the validity of this alarm. Immediately escort the students to the nearest fire exit. Conclude the group with a discussion about the implications of false alarms. Escort the students back to their homeroom classrooms to await directions. A40. A clubhouse program hires an occupational therapist as a consultant. The clubhouse board of directors requests that the OT consultant focus on the development of evening and weekend leisure activities. Which recommendations should the therapist make for the selection and completion of the group activities? Activities to be selected and completed by clubhouse members according to guidelines provided by the therapist. Activities to be selected by the therapist with written instructions provided to the group attendees foractivity completion. Activities to be selected by clubhouse members with activity completion led by the clubhouse members. A41. A 2-year-old child is placed in foster care due to child abuse and neglect. The child was frequently beaten and locked in a dark closet. The child is fearful and suffering from sensory deprivation. Which sensory input is best for the occupational therapist to recommend the foster parents provide for the child? Slow rocking. Fast rocking. Bright lights. Upbeat music. A42. An occupational therapist advises the parent of an 18-month-old with developmental delays on techniques to facilitate feeding. The child has a reflexive bite. Which utensil is most beneficial for the therapist to recommend the parent use when feeding the child? A deep-bowled soup spoon. A narrow shallow coated spoon. A traditional teaspoon. A plastic spork. A43. During a wheelchair evaluation, an individual with limited functional mobility expresses concern about the ability to continue volunteer work at a local church. The church's doorways are 31 inches wide. The client knows (from a recent home remodeling project) that 32 inches is the minimum width recommended for wheelchair access. Which recommendation should the occupational therapist make to the client to most effectively address their concerns and functional mobility needs? Have the church widen its doorways to comply with ADA requirements. Order a wheelchair with wraparound armrests. Have the client explore alternative volunteer activities in accessible locations. Order a customized narrow adult wheelchair. A44. An occupational therapist provides home-based services to a person recovering from a recent CVA. The individual lives alone and receives home care Medicare Part A benefits. The therapist arrives at the client's house at the scheduled session time, but there is no response to the knocking on the door. A neighbor reports seeing the client leave with a friend. Which is the best action for the therapist to take in response to this situation? Document that no one answered the door and that the appointment will be rescheduled. Call the nurse case manager to report the missed appointment and the need to reschedule. Document that no one was home and that the appointment will be rescheduled. Document that the client is engaged in community mobility activities and should be evaluated fordischarge. A45. A client with a diagnosis of schizophrenia is participating in an initial evaluation session at a psychiatric day treatment program. Halfway through the completion of an activities configuration, the client states the referral to this day program is inappropriate and unnecessary because it was made by an incompetent psychiatrist. The client becomes visibly upset and loud when talking about the unfounded referral and the psychiatrist's incompetence. Which is the best initial action for the occupational therapist to take in response to the client's statements? End the evaluation session and tell the client to call to re-schedule when feeling better. Assure the client of the referring psychiatrist's competence and advise the client to discuss concerns with the doctor. Acknowledge that the client appears upset and ask if the client is able to focus on the remaining evaluation. Contact the day program's chief psychiatrist to report the client's stated concerns about the referring psychiatrist's competence. A46. An occupational therapist measures the active range of motion of an individual's index finger. The measurements are MCP 0-45, PIP 10-60, and DIP 10-40. Which is most accurate for the therapist to document as the finger's total active motion (TAM)? 62.5°. 125.0°. 72.5°. 145.0°. A47. The family of an individual being admitted to a rehabilitation center offers the occupational therapist a cash gift. The therapist refuses the money but the family continues to insist that the therapist take the cash gift. After thanking the family for their generous gesture, which is the therapist's best response? Donate the money to the hospital. Donate the money to charity. Use the money to purchase an item for the OT department. Decline the gift and explain the setting's no-gift policy. A48. An individual who successfully completed an inpatient drug rehabilitation program returns to the setting to thank staff members for their assistance with recovery. The individual offers to share personal insights and experiences with the members of the OT values clarification group scheduled for the next hour. After thanking the individual, which is the best response for the occupational therapist to make in response to this offer? Welcome the individual as a guest to the group to share personal perspectives on recovery and inspire group members. Inform the individual that former clients cannot visit the group due to the need to maintain memberconfidentiality. Ask the individual to prepare a presentation on how values clarification aided in recovery for the nextscheduled group session. Tell the individual that the therapist will discuss this offer with the group and afterwards inform theindividual regarding the group decision. A49. A 21-month-old child with severe spastic quadriplegia is evaluated by an occupational therapist. The therapist determines that the child is cognitively intact, exhibiting age-appropriate cognitive skills despite major sensorimotor deficits. The therapist recommends a play activity to enhance these cognitive abilities and provide the child with a fun and pleasurable experience. Which is the best object for the therapist to recommend? A multi-colored mobile of objects of interest placed over the child's stroller. A mechanical toy with a chin controlled on/off switch. A shape sorter with foam squares, triangles, and circles. A battery controlled hammock swing. A50. An individual recovering from a traumatic brain injury is assessed to be at Level VI of the Rancho Los Amigos Levels of Cognitive Functioning Scale. Which should the occupational therapist use to implement treatment? Sensory stimulation activities such as moving to music. Repetitive self-care tasks such as brushing hair. Community re-entry activities such as taking a bus. Simple meal preparation tasks such as making a sandwich. A51. An individual with hemiplegia has inadequate ankle dorsiflexion on the affected side. Which of the following equipment is best for the occupational therapist to recommend the person use to compensate for this deficit and facilitate safe and effective ambulation? An ankle-foot orthosis (AFO). A wide-based quad cane (WBQC). A narrow-based quad cane (NBQC). A knee-ankle-foot orthosis (KAFO). A52. The parent of two elementary-school-aged children receives home care hospice services due to metastasized bone cancer. The client is in pain and has poor endurance and decreased muscle strength. The client requires moderate assistance with self-care and dressing. Which is the best intervention for the occupational therapist to incorporate into sessions with this parent? Training in energy conservation techniques for self-care and dressing. Training in joint protection techniques for self-care and dressing. Using biofeedback to reduce the client's pain. Exploring play activities for the parent to do with the children. A53. An occupational therapist working in a school has been asked to recommend technological devices for a student with severe spastic quadriplegia and dysarthria. Which action should the therapist take prior to recommending specific equipment? Determine access capabilities in collaboration with the speech language pathologist. Identify funding source(s) in collaboration with the social worker. Obtain family support in collaboration with the psychologist. Determine intervention goals in collaboration with the student. A54. A patient with a complete injury of the spinal cord at the C5 level completed inpatient rehabilitation which concentrated on increasing independence in ADL. In the discharge documentation, which is most likely for the occupational therapist to state the client is able to do? Button buttons using a button hook. Use mobile arm supports for feeding. Tie shoes using thick shoelaces. Brush teeth using a tenodesis splint. A55. An individual has intention tremor, dysmetria, decreased equilibrium and nystagmus caused by a cerebellar lesion. The person expresses difficulty with routine tasks. Which intervention is best for the occupational therapist to provide? A cone and pegboard activity with wrist weights to control tremors. Upper extremity weightbearing during self-care activities at a sink. Quick stretch to lateral trunk muscles during a functional activity. A56. A middle-school-aged child with osteogenesis imperfecta reports feelings of low self-esteem, social isolation, boredom, and lethargy. The occupational therapist collaborates with the child to identify resources for after-school leisure activities to promote socialization and community participation. Which of the following activities is best for the therapist to explore with the child? Team sports. Therapeutic horseback riding. Scouting programs. Computer clubs. A57. An occupational therapist interviews a COTA® for a position at a high school for gay and lesbian youth. The position involves the provision of transitional vocational programming and life skills training. The COTA® uses a wheelchair for mobility and has dysarthric speech. Which of the following is most relevant for the occupational therapist to ask the COTA® about during the interview? Verbal group leadership skills. Sexual orientation. Personal beliefs about homosexuality. Accommodations needed due to the evident disabilities. A58. A nine-year-old girl with the diagnosis of cystic fibrosis is hospitalized in a small rural hospital. Currently, there are no other children in the hospital and the hospital does not have a pediatric play area. The head nurse asks the occupational therapist to suggest appropriate play activities that hospital volunteers can provide for the child. Which is the most age appropriate activity for the therapist to suggest? Dressing paper dolls. Coloring in coloring books. Playing card games. Cutting and pasting pictures onto cards. A59. After evaluating a client with right-sided weakness and decreased motor control an occupational therapist decides to use interventions based on the PNF approach. When applying PNF principles, which of the following actions should the therapist have the client do during an intervention session to increase use of the right upper extremity and hand? Reach overhead with the right hand to retrieve a dish out of a higher cabinet and set it down on the countertop in front. Reach to the right side to retrieve an item out of the refrigerator at hip height and place it into the left hand to set it on the countertop to the left. Use both hands together to pour juice out of a heavy pitcher into a glass on a countertop. Take items out of a dishwasher on the right side and reach across the body to place them in the upper cabinet on the opposite side. A60. A teenage girl with juvenile rheumatoid arthritis (JRA) identifies a goal of applying her own makeup. Which adaptation is most beneficial for the therapist to recommend? Silver ring splints to hold makeup applicators. Enlarged soft foam handles on makeup applicators. Long thin handles on makeup applicators. A universal cuff to hold makeup applicators. A61. An occupational therapist conducts a satisfaction survey to evaluate the quality of OT services in an outpatient program. The questionnaire developed by the therapist asks respondents to rate their responses to quality statements according to a 4-point Likert scale of agreement. Which statement best reflects an adequate measure of satisfaction? "The amount of time devoted to stress management was adequate." "Setting my own goals was important to me." "My experience in occupational therapy helped me." "The OT staff was respectful and fair to me." A62. An occupational therapist working on an acute psychiatric inpatient unit conducts a series of groups for clients newly admitted to the unit. Which group leadership style is most effective for the therapist to assume when leading these groups? Advisory. Facilitative. Laissez-faire. Directive. Questions A63 to A66 are based on the following information. An individual with degenerative joint disease (DJD) incurred an injury to the right hand. The client is referred to occupational therapy due to complaints of severe pain, stiffness, and extreme temperature changes in the hand. The occupational therapy referral states that the person has pitting edema and blotchy, shiny skin. Based on a screening, the occupational therapist determines that the client's presenting symptoms are consistent with the diagnosis of complex regional pain syndrome (CRPS) Type I. A63. The occupational therapist evaluates the client's pain by asking the client which movements or activities elicit pain. Which of the following is the therapist assessing? The quality of pain. The location of pain. The intensity of pain. The triggers of pain. Questions A63 to A66 are based on the following information. An individual with degenerative joint disease (DJD) incurred an injury to the right hand. The client is referred to occupational therapy due to complaints of severe pain, stiffness, and extreme temperature changes in the hand. The occupational therapy referral states that the person has pitting edema and blotchy, shiny skin. Based on a screening, the occupational therapist determines that the client's presenting symptoms are consistent with the diagnosis of complex regional pain syndrome (CRPS) Type I. A64. The occupational therapist completes the pain evaluation. What additional evaluation methods should the therapist use to assess this client? Vigormeter. Dynamometer. Volumeter. Sphygmomanometer. Questions A63 to A66 are based on the following information. An individual with degenerative joint disease (DJD) incurred an injury to the right hand. The client is referred to occupational therapy due to complaints of severe pain, stiffness, and extreme temperature changes in the hand. The occupational therapy referral states that the person has pitting edema and blotchy, shiny skin. Based on a screening, the occupational therapist determines that the client's presenting symptoms are consistent with the diagnosis of complex regional pain syndrome (CRPS) Type I. A65. The occupational therapist plans intervention to address the client's goals to engage in meaningful occupations. Which physical agent modality (PAM) should the occupational therapist use in preparation for functional activity? Transcutaneous electrical nerve stimulator (TENS). Contrast baths. Whirlpool. None; PAMs are contraindicated for this diagnosis. Questions A63 to A66 are based on the following information. An individual with degenerative joint disease (DJD) incurred an injury to the right hand. The client is referred to occupational therapy due to complaints of severe pain, stiffness, and extreme temperature changes in the hand. The occupational therapy referral states that the person has pitting edema and blotchy, shiny skin. Based on a screening, the occupational therapist determines that the client's presenting symptoms are consistent with the diagnosis of complex regional pain syndrome (CRPS) Type I. A66. Which is the most appropriate activity for the occupational therapist to recommend for the person to complete at home? Doing light craft work. Playing a table-top game. Performing relaxation exercises. Manually washing a car. A67. An individual with advanced Huntington's chorea is newly admitted to a skilled nursing facility. The resident weighs 280 pounds and cannot independently transfer. What is the best recommendation for the occupational therapist to make to the resident's direct care staff to ensure a safe transfer? A mechanical lift transfer. A two-person lift transfer. An assisted sliding board transfer. A68. The staff of an acute inpatient medical unit consists of an occupational therapist and an entry-level COTA®. The admission rate has increased and the occupational therapist is having difficulty completing evaluations in a timely manner. Which is the best action for the therapist to take in response to these practice realities? Evaluate patients screened by nursing staff as appropriate for occupational therapy. Plan intervention based on the physical therapy evaluation. Train the COTA® to independently complete the evaluation process. Redesign the program to allow more time for evaluation. A69. An occupational therapist receives a referral to construct a splint for an individual with a brachial plexus injury with full arm involvement. Which orthosis would be most effective for this condition? A flail arm splint. A figure-of-eight splint. A deltoid sling. A70. Following medical treatment for a brain tumor, a client is referred to OT home care services for a functional evaluation. During the initial interview, the client reports difficulty locating desired items. For example, at lunchtime the client could not find a can of soup in the pantry. Based upon this self-report, which functional ability should the occupational therapist evaluate? Visual scanning. Visual acuity. Spatial relations. Topographical orientation. A71. A patient has been discharged from a rehabilitation facility six months ago. A staff therapist who works at the facility sees the former patient and the senior therapist who treated the patient in a dating situation. The senior therapist confirms involvement in a personal relationship with the former patient. Which is the staff therapist's best response to this situation? Report the therapist to the NBCOT®. Advise the facility director. Do nothing. Report the therapist to the OT supervisor. A72. An adult is hospitalized in the recovery phase of Guillain-Barré syndrome. The patient complains of tingling, aching and weakness in both hands, causing difficulty in grasping grooming supplies. The patient requests relief from the hand symptoms. Which action should the occupational therapist take to address the patient's concerns? Provide soft tissue massage to both hands prior to grooming activities. Apply hot packs to both hands and complete stretching exercises prior to grooming activities. Refer the client to a neurologist for follow-up of possible condition regression. Educate the patient about sensory deficits and related adaptive ADL strategies. A73. A child with attention deficit with hyperactivity disorder (ADHD) and conduct disorder attends an afterschool program that utilizes sensory-integrative and behavioral management approaches to achieve intervention goals. Snacks are provided and occasionally used as rewards. A parent insists that a child not be given any foods containing sugar because these will increase the child's hyperactive behaviors. Which is the occupational therapist's best response to this request? Discontinue providing sugary snacks but continue their use as rewards in the behavioral management program. Provide the parent with recent research that refutes the link between sugar and hyperactivity. Discontinue providing sugary snacks for the child to comply with the parent's request. Inform the parent that the therapist will discuss the issue with the program's administrator to determine the best course of action. A74. An individual with myasthenia gravis is being discharged home after a hospitalization for the treatment of pneumonia. The person's spouse has expressed concern about caregiving responsibilities and the client's ability to function in the home. Which is the most beneficial recommendation for the occupational therapist to make to address the spouse's concerns and the client's needs? The extension of client's length of stay to allow for caregiver training. The extension of client's length of stay to provide intervention to develop ADL skills. A referral for the client to an adult day care program to relieve caregiver stress. A referral to a home care agency for a functional evaluation and home assessment. A75. An occupational therapist becomes aware of the practice of a colleague who conducts an outpatient energy conservation class for persons with arthritis. This colleague has been sending the names of class participants to a vendor who sells adaptive equipment. Which action is best for the occupational therapist to take in response to the situation? Ignore the situation for it does not harm anyone. Speak to the therapist privately and tell them this action is unethical. Advise the therapist to disclose this practice and, if they refuse, report the therapist to the outpatient program. Report the therapist's unethical behavior to the state regulatory board. A76. An occupational therapist providing home-based occupational therapy services implements a bed positioning plan for a person recovering from a cerebral vascular accident. The person is receiving care from family members and personal care assistants employed by a home care agency. Which action should the therapist take to ensure the accurate implementation of this plan by the client's caregivers? Provide verbal step-by-step directions of the desired positions to the client's caregivers. Post written step-by-step directions of the desired positions on the wall by the client's bed. Post pictures of the desired positions next to the headboard of the client's bed. Require each caregiver to demonstrate the replication of the desired positions. A77. A young adult with a ten-year history of bulimia nervosa participates in an outpatient vocational exploration group and completes a vocational interest inventory. This evaluation identifies four possible areas for a career. Which career choice is best for the occupational therapist to advise the client to explore further? Web designer. Dietitian. Athletic trainer. Fashion designer. A78. An occupational therapist develops a task group for the newly admitted patients of a psychiatric inpatient unit of a busy city hospital. The therapist considers several activities to use for the group's first session. Which activity is best for the therapist to present to the group members? Planning a weekend pizza party for the patients and their visitors. Decorating styrofoam cups and planting cuttings in them. Publishing a weekly newsletter about city attractions for patients on the unit. Painting a large mural to cover one wall of the day room. A79. An individual is evaluated for a repetitive stress disorder. The individual complains of numbness and tingling of the thumb, index, middle, and radial half of the ring finger and aching pain in the proximal forearm. The client states that these symptoms are not evident at night. The occupational therapist notes a positive Tinel's sign. Which site should the therapist document as the location of this sign for this client? The wrist. The Guyon's canal. The elbow. The forearm. A80. A client with a right below-elbow amputation begins prosthetic training with a body-powered myoelectric prosthesis. The occupational therapist collaborates with the client to begin training in the use of the terminal device to grasp and release objects. Which elbow position is best for the therapist to place the client's elbow in during grasp and release activities? Flexed at 90° with neutral degrees of pronation/supination. Flexed at 90° and pronated 60°. Flexed at 120° and with neutral degrees of pronation/supination. Flexed at 90° and supinated 60°. A81. During an early intervention planning meeting, an occupational therapist explains the results of a play assessment to the parents of an 18-month-old toddler with multiple developmental disabilities. The child has been assessed as delayed by 6-8 months in all developmental parameters. Which intervention approach is most effective for the therapist to recommend using first to develop the toddler's play skills? The use of toys that encourage creative and imaginative play. The use of toys that are visually and auditorily stimulating. Participation in a small parallel play group with other toddlers. Engagement in activities that use sensorimotor skills prerequisite to play. A82. A 2-year-old child receives home care early intervention services. The occupational therapy intervention plan includes a goal to develop the child's pincer grasp. Which is the most appropriate activity for the occupational therapist to work on with the child during an intervention session? Finger-feeding of O-shaped cereal. Picking up marbles. Drawing with jumbo crayons. Stacking 1-inch cubes. A83. An occupational therapist works with an individual with chest and upper extremity burns. During the intervention session, the client expresses vague fears about personal safety at home and asks the therapist to advocate for an extension in the discharge date. According to the medical record, the client had incurred the burns during a cooking accident. Which is the therapist's best initial response to the client's stated concerns? Encourage the client to speak to the social worker about discharge plans. Assure the client that pre-discharge fears are normal and expected. Document the client's concerns and recommend an extension of the length of stay. Invite the client to expand upon the nature of these concerns. A84. The occupational therapist employed at a day treatment center for clients with psychiatric disorders is conducting a leisure planning group. The members of the group decide to take a day trip to the local sculpture garden. Which side effect of psychotropic medications is most important for the therapist to discuss preventative precautions for with the group? Orthostatic hypotension. Akathisia. Photosensitivity. A85. A child with mild spastic diplegia wants to participate in neighborhood activities with peers. The family's main goal for the child is to ride a bicycle. Which bicycle is best for the occupational therapist to recommend? A hand-propelled bicycle with hand brakes. A foot-propelled bicycle with hand brakes. A foot-propelled bicycle with foot brakes. A86. An occupational therapist receives a referral from a physician that outlines a specific course of treatment. Following the evaluation of the person, the therapist believes that a different course of treatment would be more beneficial. Which course of action is best for the therapist to take? Contact the physician and discuss the alternative treatment. Provide the prescribed treatment on a three to four-week trial. Combine the prescribed treatment with the therapist's preferred treatment. Provide the treatment the therapist believes would be more beneficial for the person. A87. A woman with a complete spinal cord injury at the C-5 level has given birth to her first child. The client seeks suggestions on methods to facilitate independent and safe parenting. Which of the following is most beneficial for the occupational therapist to recommend the mother use to help her independently feed her child? A pillow to support the mother's arms during breast-feeding. Bottles with pre-measured formula. Bottles that have molded easy to grip shapes. A sling to support the infant's head during breast-feeding. A88. During a classroom screening, an 8-year-old is observed holding a pencil with a tight grip. The student appears to rely heavily on visual cues to assist during both fine and gross motor tasks. During gross motor activities, the student moves in an uncoordinated manner. The occupational therapist uses a sensory integrative frame of reference to interpret evaluation data. Which impairment should the therapist document as needing further evaluation? Vestibular processing dysfunction. Proprioceptive system dysfunction. Hyporesponsive tactile system. Hyperresponsive tactile system. A89. An individual with borderline personality disorder is admitted to the hospital following a suicide attempt. After attending an occupational therapy orientation group, the patient tells the occupational therapist, "You are the only therapist who has ever been really helpful." The patient asks to meet with the therapist privately on a regular basis instead of the assigned primary individual therapist. Which action is best for the therapist to take in response to the patient's request? Refer the patient to the assigned primary individual therapist. Agree to meet with the patient since a positive therapeutic connection has been expressed. Tell the patient that an occupational therapist provides only occupation-based group treatment. Explain that this type of manipulative behavior is not acceptable. A90. An occupational therapist plans a task-oriented activity group for adolescent girls recently diagnosed with anorexia nervosa. Which is the best activity for the therapist to include in the initial session of this group? Making cards to send to veterans in a local hospital. Baking cookies for the residents in a homeless shelter. Performing low impact aerobic exercises. Composing lyrics and melody for a group song. A91. An occupational therapist completes an early intervention screening of an 8-month-old child. The results indicate that the child is able to sit independently by propping forward on both arms. Which is the best action for the occupational therapist to complete next? Evaluate the child's sensorimotor skills using a standardized evaluation. Inform the parents that the child exhibits typical behavior. Develop goals to improve sitting balance. Provide play activities to develop sitting balance. A92. An entry-level occupational therapist is hired to work on an acute psychiatric unit. The occupational therapy supervisor orients the therapist to hospital policies and procedures. Which are the most important policies and procedures for the supervisor to include in the initial orientation session? Crisis intervention. Reimbursement. Employee benefits. Group program scheduling. A93. An occupational therapist evaluates a client using the Allen Cognitive Level (ACL) Screen. The client successfully completes three running stitches. Which step should the therapist take next? Demonstrate the whip stitch and ask the client to imitate this and complete three stitches. Demonstrate the single cordovan stitch and ask the client to imitate this and complete three stitches. Document that the person demonstrates a cognitive level consistent with Level 3 of the Cognitive Disabilities model. A94. During an occupational therapy session, a veteran recovering from bilateral traumatic lower extremity amputations expresses several concerns about having a changed body and questions its sexual appeal. Which response is best for the therapist to take in response to client's concerns? Refer the client to the primary care physician. Ask open-ended questions to explore the concerns further. Reassure the client that the concerns are a normal part of the recovery process. Explain that positioning can compensate for changes in functional mobility. A95. An older adult who is recovering from a cerebral vascular accident attends occupational therapy two times per day. The intervention environment is highly structured and not over-stimulating, yet the occupational therapist observes that the client's mood often changes abruptly. Within one session, the client will laugh and then become tearful with no apparent precipitant. Which is most accurate for the occupational therapist to document the client may be exhibiting in the client's daily progress note? Early Alzheimer's disease. Anhedonia. A response to auditory hallucinations. Emotional lability. A96. A large general hospital in an urban area initiates several quality improvement committees that include occupational therapists. Which of the following does participation in these committees provide to the occupational therapists? The ability to develop personal performance skills. The capability to enhance leadership skills. The power to promote occupational therapy services. The opportunity to improve overall service delivery. A97. An adolescent student with Duchenne muscular dystrophy and depression is being evaluated for a power wheelchair. Which is the most important area to be considered during the occupational therapy evaluation of the student to determine the student's readiness for the wheelchair? Fine motor skills. Cognitive skills. Postural control. A98. An individual incurred a spinal cord injury at the C-5 level. During an occupational therapy session focused on developing the ability to feed independently using adaptive equipment, the occupational therapist notes that the client is flushed and sweating excessively. The client requests that the session end early due to a pounding headache. Which action is best for the occupational therapist to take first in response to this situation? End the session and call the transporter to return the client to the client's room. Empty the client's filled catheter bag and maintain the client's upright position. Return the individual to the unit and report symptoms to the head nurse. Stop the session and recline the individual in the wheelchair for a rest break. A99. An occupational therapist and a COTA® co-lead a work adjustment group. One member has become progressively more dependent on the COTA® for directions, praise, and input throughout the group activities. Which action should the group leaders initially take in response to these behaviors? Schedule several individual sessions with the COTA® and group member to examine the issues of dependency and transference. Inform the attending psychiatrist that the group member is exhibiting signs of dependency and transference. Have the COTA® work with the person during group sessions to develop independence in task completion. Have another therapist co-lead the group with the occupational therapist and reassign the COTA® to another group. A100. The parents of an 8-month-old child bring their child to a free community health developmental screening program. The occupational therapist evaluates the oral motor development of the child and determines that the child's development is within normal limits. When documenting this determination, which is most likely for the therapist to state the child demonstrates? Rotary chewing. Diagonal jaw movements. Effective mastication. Cup drinking with a firm jaw. A101. An older adult diagnosed with a major neurocognitive disorder was recently admitted to a skilled nursing facility (SNF). The COTA® working with the resident reports to the occupational therapist that during the morning care session, the COTA® observed bruises on the resident's back and upper arms. Which action is best for the occupational therapist to initially take? Talk to the resident to obtain more information. Follow facility procedures for investigating resident safety. Contact the resident's family to obtain more information. Contact the state office for adult protective services. A102. An occupational therapist assesses a retired carpenter and war veteran who was recently admitted to an acute psychiatric unit due to an exacerbation of post-traumatic stress disorder. The individual is observed to initiate interactions with others during structured tasks but is withdrawn when not engaged in a task. Which activity is best for the therapist to recommend to the individual? Writing thoughts and feelings in a daily journal. Engaging in meditation when alone in a hospital room. Assisting another patient with a woodworking project. Writing about personal experiences in the unit's newspaper. A103. Upon evaluating a client for a wheelchair, the occupational therapist determines that a standard narrow adult chair would be suitable for the individual. Which dimensions most accurately identify this chair? 18" wide × 18" deep × 20" high. 16" wide × 16" deep × 20" high. 16" wide × 16" deep × 18.5" high. 14" wide × 16" deep × 18.5" high. A104. An adult is referred to occupational and physical therapy for treatment of chronic back pain that hinders the satisfactory performance of home maintenance tasks. The occupational therapists in the department have little experience with back pain, while the physical therapists in the rehabilitation department have extensive experience in this area. Which action is the best choice for the occupational therapist to take in response to this situation? Refer the patient to physical therapy. Co-treat the person with a physical therapist. Give the patient the option to work in occupational or physical therapy. Review a continuing education video on treatment of back pain. A105. A 6-year-old child with difficulties in figure-ground perception is being discharged from occupational therapy services. In the discharge plan, which should the therapist recommend for this child? Use a different solid-colored folder to hold materials for each class subject. Use a toothbrush and comb that are the same colors as the counter. Wear clothing with bold colors and loud patterns. Place all school books and handouts on the desk while completing homework. A106. An occupational therapist is working with a child presenting with sensory-seeking behaviors and under reactivity to touch and movement. The child has an unusually high activity level, inability to self-calm, motor impulsivity, and frequent touching and handling of items in the environment. Using Ayres classic sensory integrative (SI) approach which would be most effective for the therapist to use with this child to facilitate an adaptive response? A pre-determined schedule of sensory activities designed by the occupational therapist. The child's passive participation in a variety of vestibular and proprioceptive experiences. Use of a sensory void environment to promote self-regulation. Individualized therapeutic activities based on the interests of the child. A107. A non-English speaking individual with a recent left-sided CVA comes to occupational therapy for the first evaluation session. The assigned therapist cannot communicate verbally with the person. Which action is best for the therapist to take first? Perform a screening to determine the specific areas to evaluate. Seek out a translator to assist with the evaluation. Communicate with the individual using non-verbal communication. Evaluate the individual according to established protocols. A108. An occupational therapist provides services to members of a psychosocial clubhouse. Which is the mosteffective approach for the therapist to use when giving directions for a task to an individual with schizophrenia who is experiencing auditory hallucinations? Written directions for making vanilla pudding. Verbal step-by-step directions for making a leather link belt. General verbal directions for the completion of a group collage. Demonstration of steps during a swing dance class. A109. As the result of a trauma ten months ago, a 13-year-old incurred a unilateral below-elbow amputation. Due to a recent growth spurt, the adolescent is being re-evaluated for a new prosthesis. During the evaluation, the adolescent angrily tells the occupational therapist that a prosthesis is "annoying to have to wear every day." The adolescent reports not liking "the claw" and as a result often takes off the current prosthesis. However, the adolescent acknowledges that the prosthesis is "needed sometimes" to perform desired bilateral activities. Which action is best for the therapist to take in response to this adolescent's statements? Refer the adolescent to the child psychologist to deal with adjustment to disability. Work on developing unilateral skills for completion of meaningful activities. Refer the adolescent to a prosthetist for a prosthesis with a cosmetic hand. Recommend the adolescent attend a teen amputee support group. A110. An occupational therapist conducts an after-school transition skills group with adolescents with a diversity of disabilities. One of the student's behaviors is very different than in prior groups (e.g., difficulty focusing when typically serving as the group initiator, making statements that are irrelevant to the topic at hand). The therapist smells a strong alcohol scent on the student's breath. Which action should the therapist take in response to this situation? Directly ask the student if the student has been drinking. Initiate a group discussion about the effects of substance abuse on occupational performance. Proceed with the group and report suspicions of alcohol use at the next transition planning team meeting. Call for a school aide to escort the student to the school's on-site health care facility. A111. An occupational therapist uses behavior modification techniques to help shape the behavioral responses of students with behavioral disorders. Which action is most consistent with this intervention approach? Provide frequent positive reinforcement for all desired behaviors. Reprimand the students every time an undesirable behavior occurs. Allow each student enough time for self-correction of the behavior. Encourage the teaching staff to tell the students which behaviors are correct and incorrect. A112. During a home visit, a client who had incurred a CVA reports difficulty finding objects during BADL and IADL. The client reports that the directions family members provide (e.g., look on the refrigerator's door, look in the medicine cabinet) are not helpful. Which cognitive perceptual ability should the occupational therapist further evaluate? Stereognosis. Organization. Spatial relations. Visual closure. A113. An occupational therapist is treating an 8-month-old child with mild developmental delay. The child exhibits normal cognitive development. The child has developed adequate static sitting balance but has poor dynamic sitting balance. The therapist implements intervention by positioning the child and having the child find a toy that is covered with a cloth. Which positioning and toy placement are most beneficial for the therapist to use with this child? Sit the child between the therapist's extended legs and alternate placing the covered toy to the child's right and left side. Sit the child in a child seat and alternate placing the covered toy to the child's right and left side. Lay the child in a prone position and place the covered toy in front of the child. Lay the child in on the right side and place the covered toy to the left of the child. A114. A child with moderate spastic cerebral palsy works on ambulation with a walker in physical therapy. The occupational therapy evaluation reveals problems in lower extremity dressing, transitional skills, self-feeding, and grasp and release skills. To facilitate the attainment of the child's ambulation goal, which activity is best for the occupational therapist to include in OT intervention session? Rolling in and out of prone and supine while on a mat, with minimal hands-on facilitation. Donning and doffing shoes and socks in bench sitting with one leg externally rotated and placed on the opposite knee. Practicing grasp and release of small objects while wearing bilateral soft splints to support a more functional hand position. A115. A co-worker in the therapy department complains excessively during working hours of personal problems. The co-worker does not respond to colleagues' statements that this is disruptive to their work. Which action is best for the occupational therapist to take in response to this situation? Call the employee assistance program for the co-worker. Talk with the co-worker using a client-centered approach. Tactfully and firmly redirect the co-worker to work issues. Inform the department supervisor of the situation. A116. A 5-year-old is referred to occupational therapy. Upon the completion of a standardized test evaluation, the occupational therapist determines that the child demonstrates age-appropriate cognitive and fine motor skills. Which activity would the child be able to complete at this developmental level? Cutting long thin strips with scissors. Holding and snipping with scissors. Cutting simple figure shapes with scissors. Opening and closing scissors in a controlled fashion. A117. An occupational therapist provides recommendations for play activities that a parent with a complete spinal cord injury at the C7 level can do with children, aged 8 and 10. Which is the best adapted activity for the therapist to recommend? An arts and crafts project using a mouthstick brush to paint. A woodworking project using a universal cuff to hold tools. A board game using a tenodesis grasp to move game pieces. A computer game using a typing stick to keyboard. A118. An individual recently lost significant functional abilities due to post-polio syndrome. The occupational therapist works with the individual to develop compensation skills for performing daily tasks. During a meal preparation session, the person angrily throws all of the adaptive equipment onto the floor. At the next team meeting, which defense mechanism should the therapist report the individual appears to be demonstrating? Acting out. Passive-aggressive behavior. Reaction formation. Displacement A119. An occupational therapist works with a patient with diabetes and a below-knee (BK) amputation to learn how to effectively perform home management tasks while wearing a BK prosthesis. When taking laundry from a front-loading washer and placing it into a top-loading dryer, the patient reports feeling weak, dizzy, and somewhat nauseous. The occupational therapist notices that the patient is sweating profusely and is unsteady when standing. Which is the best immediate course of action for the therapist to take in response to the patient's complaints and these observations? Return the person to the unit of care due to an insulin reaction. Administer orange juice for developing hypoglycemia. Call a nurse to administer an insulin injection for developing hyperglycemia. Have the patient sit down until the orthostatic hypotension resolves. A120. A child with spastic quadriplegic cerebral palsy has increased tone and flexor synergies in both upper extremities. The child receives Botox injections into both biceps. In designing play activities to use during intervention, which is most important for the occupational therapist to include as an activity performance characteristic? Reaching overhead and to both sides in supine. Bilateral upper extremity weight-bearing in sitting and in prone. Grasp and release of objects in supported sitting. Transitions into and out of sitting, supine, and prone. A121. A person recovering from hip replacement surgery wants to begin meal preparation. The client refuses to use the walker that was ordered by the physician. The physician is unavailable for consultation. Which is the best initial action for the occupational therapist to take in response to this situation? Work on meal preparation activities with the client sitting at a table. Work on meal preparation activities with the client standing without the walker. Delay working on meal preparation activities until the physician can be contacted. Tell the client the walker must be used until the physician changes the order. A122. The occupational therapist administers the Allen Cognitive Level (ACL) Screen to an individual. During this evaluation, the most complex behavior the individual can perform is to do the three running stitches, imitating the therapist's example. Based upon these results, the therapist selects an activity to use for intervention that is consistent with the individual's functional level. According to the Cognitive Disabilities model, which activity is best for the therapist to use when implementing intervention with this patient? Exercises that require the imitation of another's posture. Sorting laundry by matching the colors of clothing items. Sanding wooden bookends. Planning a three-course meal. A123. A skilled nursing facility (SNF) wants to provide an activities program to meet the needs of each resident. The occupational therapy supervisor has been asked to write a job description for the position of an activities program director and delineate the qualifications needed for that position. Which should the occupational therapist recommend for this position? A COTA® who receives general supervision from an occupational therapist. A COTA® who receives close supervision from an occupational therapist. A COTA® who receives routine supervision from an occupational therapist. A COTA® who does not require the supervision of an occupational therapist. A124. An occupational therapist works with adolescents who are survivors of child abuse. Treatment can be carried out in groups or on an individual basis. Which of the following would indicate to the therapist that intervention should be provided to an adolescent on an individual basis rather than in a group? The adolescent wants more socialization experiences. The adolescent could benefit from feedback from peers. The adolescent desires greater control over the environment. The adolescent needs an opportunity to gain situational perspective. A125. A house painter is referred to occupational therapy after a reoccurrence of rotator cuff tendinitis. The physician prescribes a conservative intervention approach. Which recommendation is best for the occupational therapist to make to the individual? Continue performing above shoulder activities to build rotator cuff strength. Use an extension handle in the paint roller when painting ceilings. Sleep with the shoulder extended and adducted. Sleep with the shoulder fully flexed and adducted. A126. An occupational therapist implements intervention in a preschool program for children who are overresponsive to touch. In the prior intervention session, the children had responded favorably when the therapist had rolled a large ball over their bodies as they lay supine on a mat. Which intervention method should the therapist use next? Roll the large ball with increased pressure across the children's bodies. Bounce the ball across the children's bodies. Have the children jump into a pool filled with small balls. Roll the large ball, as in the prior session, with the children prone. A127. The parent of a newborn infant has bilateral shoulder weakness and is referred to occupational therapy for training in energy conservation techniques for the performance of parenting and home management tasks. Which adaptation(s) is/are most effective for the occupational therapist to recommend the parent use? A top-loading washer and dryer for clothing care. A steamer, steamer basket, and/or slow cooker for meal preparation. A front pack carrier for holding the infant. Cloth diapers and the use of a weekly diaper care service. A128. A 14-year-old with spastic quadriplegia cerebral palsy and mild intellectual disability begins high school. The occupational therapist determines that the adolescent's academic needs are being adequately addressed by the use of the equipment and strategies that the adolescent had acquired during the middle school years. Which recommendation is best for the therapist to make to the individualized education planning team? Adaptation of the middle school strategies and equipment to the adolescent's high school classes. The development of a transition plan with the adolescent for a desired post-secondary education life. The development of peer relationships through engagement in extracurricular activities. A referral to the local center for independent living for community-based activities. A129. An occupational therapist provides services to a homeless shelter that includes residents who are HIV positive. The therapist conducts several activity groups. Which should the therapist do while working with this population? Wash hands before and after each group session. Always wear latex gloves during groups. Wear latex gloves when handling food. Implement transmission-based precautions. A130. A client with a major depressive disorder and a spouse attend a discharge meeting with the occupational therapist following the client's two-week hospitalization for a major depressive episode. They state that they have few activities in common and spend little time together. The client retired two months ago, and the spouse continues to work full time. Which of the following should the therapist encourage this couple to do first to address this concern? Immediately participate in one activity together. Become involved in their own individualized activities during the day. Explore activities enjoyed together and alone. Delay planning activities until the depression is totally resolved. A131. Two months ago a person received full thickness circumferential burns of both upper extremities. The person shows progressively decreasing ROM of the right elbow with a 25° loss to date with a stiff endpoint. The person complains of increased pain in the elbow. Which action should the occupational therapist take first in response to this change in status? Begin use of a continuous passive motion device. Apply heat prior to active ROM. Contact the person's physician. Splint the person's elbows in static splints. A132. An occupational therapist conducts a communication skills group in a wellness program for a large accounting company. In this mature level group, what should the therapist do? Help to develop the group norms. Participate as a member. Actively resolve group conflicts. Maintain a leader role. A133. When performing a chart audit for an on-site accreditation visit, an occupational therapist realizes that a date of service was documented wrong. Which actions are best for the therapist to take? Use whiteout to remove the incorrect date, write the correct date of service, and then initial and date the correction. Write the correct date over the incorrect date and then write the rehabilitation department director's initials. Put a single line through the incorrect date, write the correct date of service, and then initial and date the correction. Meet with the rehabilitation department director to discuss the need to correct this documentation. A134. A patient incurred a traumatic upper extremity amputation. During pre-prosthetic treatment, the occupational therapist molds the contours of the residual limb to shape it in preparation for a prosthesis. Which method is most effective for the occupational therapist to use? Wrapping. Percussion. Shrinking. Massage. A135. An individual receives treatment for a major depressive disorder on an inpatient psychiatric unit. The patient has received an electroconvulsive treatment (ECT) treatment at 8 am. At 2 pm, the patient walks into the occupational therapy department stating a desire to participate in the leisure skills group. Which is the occupational therapist's best response? Encourage the client to select one of three structured leisure activities to complete. Call nursing staff to escort the client back to the client's room so that the client can rest. Commend the client's motivation but remind the client that rest is recommended for 24 hours after ECT. Have the client complete a leisure history questionnaire to enable individualized treatment. A136. An occupational therapist designs an activity group program for 12 adults with multiple physical disabilities and/or illnesses who attend a day hospital family respite program. Which method is most effective for the therapist to use to determine the members' needs upon which to base the program? Interview family caregivers. Interview each member. Interview day hospital staff. Research the program's population characteristics. A137. An occupational therapist leads a work group at a vocational rehabilitation program for persons with traumatic brain injuries. One member begins to make sexually suggestive comments to other group members. The therapist redirects the client to the work in progress but the member continues to make sexually suggestive statements. Which is the therapist's best initial response to this situation? Explain to the client that such statements are not tolerated at work and call security to have the client removed from the group. Explain to the client that such statements are not tolerated at work and the client must stop or leave the group. End the group before the situation escalates and reschedule the group to meet without the disruptive client. Set the client up at a different work station so the client is not in contact with other group members and cannot disrupt the group's work. A138. A carpenter recovering from injuries incurred during a fall from a ladder has decreased strength in the triceps, bilaterally. The most recent manual muscle test indicated that the triceps muscle strength is 3. The occupational therapist provides the individual with a tabletop wood project to complete. To develop triceps muscle strength, how should the therapist position the tabletop when the person sands the project? At a 45° incline angled so that the individual's hands are above the elbows when the elbows are flexed. At the individual's waist height so that the individual's hands and elbows are on the same plane when the elbows flex. At the individual's chest height so that the individual's hands and elbows are on the same plane when the elbows flex. At a 45° incline angled so that the individual's hands are below the elbows when the elbows are flexed. A139. An occupational therapist provides home-based early intervention evaluations. A referral for an 18-month-old child notes that the child is able to finger feed effectively but is not able to use a spoon or suck from a straw. The occupational therapist puts together supplies to bring to the child's home and plans activities to use during the developmental evaluation. Which developmental age is most important for the therapist to consider when selecting objects and activities to bring to the evaluation session? 6-9 months. 9-12 months. 12-18 months. 18-20 months. A140. An occupational therapist is instructing a patient who had a left CVA on how to lock the brakes on a wheelchair. The patient is right-handed and the right upper extremity has partial paralysis. Based on motor learning theory, which is the best intervention approach for the therapist to use when instructing the person to lock the right brake? Practice with the left hand first and then with the right. Show the person how to use an extension brake. Practice the locking motions with both hands simultaneously. Have the patient use the left hand to assist the right hand. A141. An occupational therapist develops a protocol for a topical group to be implemented on an acute inpatient unit for individuals recovering from substance abuse. Which intervention focus is best for the occupational therapist to identify for this topical group? The improvement of self-esteem. The development of coping skills. The identification of leisure pursuits. The practice of assertive behaviors. A142. An adult incurred severe lacerations to the extrinsic flexor tendons in Zone V of the hand. The tendons were surgically repaired and have healed. The surgeon's most recent orders have upgraded the patient to active ROM without restrictions. The occupational therapist is preparing for discharge and performs a final evaluation, which reveals limitations in active finger flexion 10°-20° of full active ROM of the MCP, PIP and DIP joints of all fingers. The therapist collaborates with the patient to prepare a home program. Which intervention is most important for the therapist to include in this program? Use of a resting splint. Tendon gliding exercises. Weight-bearing activities. Home management tasks. A143. A child with moderate Klumpke's paralysis on the right side wants to cut meat. The child holds the fork with the right hand and the knife in the left hand, and practices with therapy putty. To begin cutting, which is the best way to configure the therapy putty? Flattened and placed directly on the table. Rolled and placed on a plate on the table. Flattened on a plate that rests on a non-skid mat. A144. During an occupational therapy intervention session, a client with a left CVA demonstrates extinction to the right and a tendency to ignore items on the right side. When documenting this behavior what should the therapist report? Agnosia. Unilateral inattention. Poor right/left discrimination. Poor visual scanning. A145. An individual with post-polio syndrome receives an occupational therapy reevaluation of functional status. How should the therapist initiate sensory testing with this client? Demonstrate the test with the individual's vision occluded. Proceed proximal to distal. Demonstrate the test with the client's vision not occluded. Proceed distal to proximal. A146. An occupational therapist is working with a preschool student who was born with congenital cytomegalovirus (CMV) infection. As a result, the child has difficulty seeing. The child enjoys playing with classmates but has difficulty when the play activity is highly dependent on vision. Which of the following actions is best for the therapist to recommend for improving the child's play experiences with classmates? Train a personal assistant to provide verbal cues during play activities. Have the child read books in Braille aloud to the classmates. Train a classmate to guide the child during play activities. Incorporate three-dimensional objects into play activities. A147. Upon screening, an 8-month-old child demonstrates a positive downward parachute reflex. Which action should the occupational therapist take next in response to this observed behavior? Document that the child exhibits normal reflex development. Document that the child exhibits a developmental delay. Evaluate the protective extension downward reflex. Evaluate the standing tilting reflex. A148. The occupational therapist wishes to compare the results of an evaluation of lateral pinch to the norms. Which is the best positioning for the therapist to place the individual in when using the pinch meter? Forearm in neutral and the pinch meter placed on the DIP joint. Forearm in neutral and the pinch meter placed on the middle phalanx. Forearm in pronation and the pinch meter placed on the DIP joint. Forearm in pronation and the pinch meter placed on the middle phalanx. A149. An elementary-school-aged child is referred to occupational therapy by a pediatrician. The pediatrician has ruled out attention deficit disorder and notes that the child demonstrates poor school performance and unexplained clumsiness. The occupational therapist screens the child and determines that the child is a candidate for a sensory processing evaluation. Which skills are most likely to have been observed to be intact during the screening and needing no further evaluation? Fine motor coordination. Sequencing motor tasks. Initiation of activities. Ocular pursuits. A150. A 7-year-old with complete spina bifida at the T10 level attends outpatient OT weekly. The child's parent reports that the child is losing bladder control. Upon reevaluating the child, the occupational therapist notes that the child shows a minimal decrease in strength of bilateral lower and upper extremities and an increase in the equinovarus position of the feet. The therapist contacts the physician to report that the child's change in status may indicate which of the following? Shunt malformation. A recent growth spurt. Arnold-Chiari formation. Tethered cord. A151. A COTA® recently attended a two-day splinting workshop. The COTA® asks the supervising occupational therapist for a caseload that includes more clients that require splinting interventions. Which action is best for the occupational therapist to take in response to this request? Decline the request because splinting is an advanced practice skill. Ask the COTA® to give a splinting in-service to demonstrate acquired knowledge. Establish the COTA®'s service competency in splinting. Distribute the department's caseload to meet the COTA®'s request. A152. An occupational therapist works with the new foster parent of a 2-year-old child diagnosed with major developmental delays and severe hypotonia. The therapist advises the foster parent to position the head in midline during feeding. Which additional positioning recommendations for feeding are best for this child? Sitting with hips and knees at 90° flexion, neck in neutral. Sitting with hips and knees at 90° flexion, neck in extension. Semi-reclined with neck in neutral. Semi-reclined with neck in extension. A153. During an intervention session focused on developing home management skills, a client made a grocery list. The client grouped needed items together to make shopping easier and listed eggs separately from all of the other items. When explaining how the list was composed, the client stated, "Eggs break, they should be on top." Which of the following is the most accurate for the occupational therapist to report that the client's approach to this task represents? Diminished insight. Concreteness. Anosognosia. Poor sequencing. A154. A client with a traumatic below-elbow amputation of the dominant right arm has participated in occupational therapy for prosthetic training. The therapist prepares a discharge plan that incorporates recommendations to facilitate independence in meal preparation and feeding. Which method is best for the therapist to recommend the client use to cut meat? Hold a regular knife in the terminal device and hold a regular fork in the left hand. Hold a knife with a built-up handle in the terminal device and hold the plate with the left hand. Use a one-handed technique with a rocker knife in the left hand and hold the plate with the terminal device. Hold a regular fork in the terminal device and hold a regular knife in the left hand. A155. An occupational therapist working for a psychiatric partial hospital program arranges the seats for a topical group. The room is small and there are eight people in the group. Which is the best arrangement of the room for this group composition? Nine chairs placed in a circle with no assigned seats for the patients or the therapist. Two semicircles of four chairs with no assigned seats facing the therapist's chair placed at the front of the room. Eight chairs placed around a table with no assigned seats and the therapist at the head of the table. A156. A client exhibits residual difficulties in a variety of perceptual skills. Which procedure should the therapist include in the evaluation of the client's proprioception? The therapist positions one extremity with the patient's vision occluded and asks the patient to duplicate the position with the contralateral extremity. The therapist moves one extremity with the patient's vision occluded and asks the patient to duplicate the movement with the contralateral extremity. The therapist demonstrates the desired position and asks the person to replicate the position in mirror fashion. The therapist shows the client a picture of a position and asks the client to replicate the position with each extremity. A157. An occupational therapist implements a transitional program for a high school student with a history of numerous school-related failures. Which is the most important principle of intervention for the therapist to use with this student? Utilize activities that are typically at the developmental level of a middle school student to ensure successful completion. Grade an activity of interest into achievable steps to facilitate successful completion. Introduce several activities during each session and change them frequently to decrease boredom. Terminate the activity during a treatment session when there is difficulty with activity completion to eliminate frustration. A158. An elementary-school-aged child incurred burns, lacerations, and a femur fracture in a motor vehicle accident and was hospitalized for 3 weeks. During outpatient occupational therapy sessions, the parent expresses concern that the child has begun wetting the bed daily. Which professional is most relevant for the occupational therapist to advise the parent to contact? A rehabilitation nurse to develop a bladder control program. A child life therapist for intervention for developmental delays. A psychiatric occupational therapist for behavior management strategies. A clinical social worker to explore potential regression issues. Questions A159 to A163 are based on the following information. A single parent of two children, a 4-year-old and a 6-year-old, is referred to occupational therapy services in a rehabilitation center. The client had a brain tumor removed one month ago. The referral states that the client has residual cognitive-perceptual deficits. Screening indicates that the client's sensorimotor abilities are within functional limits. A159. The occupational therapist administers a standardized cognitive-perceptual assessment to the client. The client demonstrates difficulty performing the first two tasks of the evaluation. Which is the most appropriate action for the therapist to take? Continue the evaluation and provide verbal cues during task performance. Continue the evaluation and model each evaluation task. Continue the evaluation according to the established administration protocol. Discontinue the evaluation to avoid frustrating the client. Questions A159 to A163 are based on the following information. A single parent of two children, a 4-year-old and a 6-year-old, is referred to occupational therapy services in a rehabilitation center. The client had a brain tumor removed one month ago. The referral states that the client has residual cognitive-perceptual deficits. Screening indicates that the client's sensorimotor abilities are within functional limits. A160. During the evaluation, the occupational therapist observes that the client has difficulty dealing with increasing amounts of stimuli. This is observed in all modalities. Based on this observation, which cognitive perceptual dysfunction does the therapist record as present when reporting the client's evaluation results? Inability to abstract. Poor organizational skills. Poor semantic memory. Generalized attention deficit. Questions A159 to A163 are based on the following information. A single parent of two children, a 4-year-old and a 6-year-old, is referred to occupational therapy services in a rehabilitation center. The client had a brain tumor removed one month ago. The referral states that the client has residual cognitive-perceptual deficits. Screening indicates that the client's sensorimotor abilities are within functional limits. A161. The occupational therapist uses a neuro-functional approach to remediate the client's cognitive dysfunction. Which is most appropriate for the occupational therapist to include in the intervention program? Functional activities in their real contexts. Client education on strategies to compensate for deficits. Tabletop activities to practice remediation strategies. Computer games to develop performance component skills. Questions A159 to A163 are based on the following information. A single parent of two children, a 4-year-old and a 6-year-old, is referred to occupational therapy services in a rehabilitation center. The client had a brain tumor removed one month ago. The referral states that the client has residual cognitive-perceptual deficits. Screening indicates that the client's sensorimotor abilities are within functional limits. A162. During an intervention session using a transfer of training approach, the occupational therapist gives the client a list of items commonly found in a closet and asks the client to separate the items into grooming and dressing items. Which skill is the occupational therapist working on? Categorization. Sequencing. Problem solving. Memory Questions A159 to A163 are based on the following information. A single parent of two children, a 4-year-old and a 6-year-old, is referred to occupational therapy services in a rehabilitation center. The client had a brain tumor removed one month ago. The referral states that the client has residual cognitive-perceptual deficits. Screening indicates that the client's sensorimotor abilities are within functional limits. A163. The occupational therapist reevaluates the client prior to discharge from the rehabilitation center. The client exhibits residual cognitive deficits in problem-solving. To develop requisite problem-solving skills for independent functioning at home, which ability should the occupational therapist work on with the client during OT intervention? Performing routine morning self-care. Making a shopping list of grocery staples. Washing the family's laundry. Reading a bedtime story to the client's children. A164. An older adult has lost significant functional vision over the last four years and complains of blurred vision and difficulty reading. The patient frequently mistakes images directly in front, especially in bright light. When walking across a room, the patient is able to locate items in the environment using peripheral vision when items are located on both sides. Based on these findings, which visual deficit should the occupational therapist report the client is exhibiting? Glaucoma. Presbyopia. Hemianopsia. Cataracts. A165. The director of an occupational therapy driver rehabilitation program must determine if the program is meeting its objectives. Which of the following is most important for the director to measure during the evaluation of the program outcomes? Participants' satisfaction with program services. Family members' satisfaction with program services. The effect of program participation on participants' automobile insurance premiums. The percentage of participants who successfully return to driving. A166. An individual with an incomplete C6 spinal cord injury has a secondary diagnosis of thromboangiitis obliterans. The occupational therapist conducts a predischarge home evaluation of the client's rented apartment. Which is the most important area for the therapist to assess? The apartment's electrical capacity for an environmental control unit. The apartment's electrical capacity for an emergency call system. The apartment's water temperature. The landlord's willingness to modify the bathroom. A167. An occupational therapist receives a referral to evaluate an individual's executive functioning following a mild cerebral vascular accident. Which are the most relevant foci for this evaluation? The person's attention and memory. The person's job interests and efficacy. The person's spatial relations and praxis. The person's initiation and planning. A168. An occupational therapist is evaluating a child with developmental delay characterized by hypotonicity. According to the Rood approach, which is the first stability pattern that the therapist should facilitate during intervention? Roll over. Quadruped. Neck co-contraction. Prone on elbows. A169. A person recovering from skin grafting due to full-thickness burns is prescribed splints to immobilize the grafted areas in anti-deformity positions. Which splint wearing schedule is best to include in the splinting protocol for the first 72 hours post-surgery? One hour on, with 10 min off. Four hours on, with 20 min off. Eight hours on, with 30 min off. On at all times, except for dressing changes. A170. A child with tactile defensiveness is receiving intervention from an occupational therapist using a sensory integrative approach. Which method is most effective for the therapist to use when introducing tactile stimuli to the child? Provide deep touch and firm pressure where the child can see the stimuli. Apply the stimuli in the direction opposite of hair growth with vision occluded. Apply light touch across the face and abdomen with vision occluded. Provide light brushing across the palmar surfaces of the extremities with the child watching. [Show More]

Last updated: 1 year ago

Preview 1 out of 39 pages