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Clinical Procedures
Final Exam
| Question | Answer |
|---|---|
| True/False: After washing your hands at the sink with soap and water, you should turn off the water then dry your hands. | False |
| How many trials of each assessment should you complete when testing strength? | 3 Trials |
| What are the 3 types of pinches that are assessed using the pinch gauge? | Lateral, 2-point, 3-point |
| How do you use a volumeter to measure edema? | |
| Which arm(s) should you use for blood pressure readings with a new client? | Both arms |
| Describe how you would position your patient to measure grip strength. | |
| List the 6 situations in which it is necessary to perform hand hygiene. | |
| Swelling is a normal tissue response to an injury that includes all of the following EXCEPT: | An increase in WBC's, inflammatory response, deeply pitting fluid that rebounds quickly, NOT vasoconstriction. |
| True/False: Hand hygiene is the number one way to prevent the transmission of infection from healthcare workers to clients? | True |
| What are the 8 keys to good body mechanics? | |
| Your client had a BKA of his R LE 3 days ago. You have just completed your initial evaluation and your client has requested you help settle him back in bed with a pillow under both knees for comfort. What would you do? Choose the BEST answer. | Educate your patient on the risk of placing a pillow under his knees and position him in a manner that promotes hip and knee extension. |
| What is the somatosensory receptor that responds to cell damage? | Chemoreceptor |
| When testing 2-point static and moving touch, what area of the hand should you test? | Finger Tips |
| Name & Instructions for Assessments | |
| What end feel is defined as ROM limited by soft tissue? | Soft End Feel |
| What end feel is defined as ROM limited by bone touching bone? | Hard End Feel |
| What end feel is defined as 'no resistance is felt, or full ROM is not achieved due to pain'? | Empty End Feel |
| What end feel is defined as ROM limited by normal muscle or joint capsule stretch? | Firm End Feel |
| When assessing upper extremity function, you should observe what? | All of the above - posture of the cervical spine and shoulders, skin condition, presence of odor. |
| Mildred fell resulting in a pelvic fracture. She has transferred to the acute rehab facility. Mildred is able to complete full AROM against gravity. However, they are unable to withstand any additional resistance. What is her MMT score? | Fair: 3/5 |
| What type of neurons carry information from the PNS to the CNS? | Afferent |
| True/False: When testing sensation, your patient should never have their vision occluded. | False |
| When completing a stand pivot transfer, where should your client’s heels be pointing? | Toward where the patient is transferring |
| You are walking with a patient, and they suddenly feel faint and tell you they think they will pass out. You notice that their skin color has changed, they are sweating, and their skin is cool to the touch. Which is the BEST step to take next? | Lower the patient onto your flexed knee as if they are sitting in a chair, and then down to the floor. |
| According to the Assistive Technology Act, which of the following is considered to be assistive technology? A pencil grip on a pencil d/t decreased hand strength. A sock aide for a client with a THA. A page magnifier for a client's reading. | All of the above. |
| The Functional Independence Measure (FIM) defines Moderate Assistance as: | Level 3: Subject completes 50% or more of the task. |
| What is the best way for a therapist to walk with a client who may or may not need assistance. How would you position yourself when walking, sequence to move legs, and what part(s) of the client’s body you would want to place a gait belt to hang on to. | |
| During T-shirt dressing, the steps include threading his right arm in the shirt, threading his left arm, pulling the shirt over his head, and pulling it down. You help to pull the shirt down only. What level of assistance is this? | Minimal Assistance |
| The Timed Up and Go (TUG) Assessment is a simple tool that does not require much equipment to administer when you are assessing balance. When do you begin your stop watch when administering the assessment? | When you say 'Go'. |
| You are going to evaluate a new patient on the rehab unit today. The PT competed the evaluation yesterday and had documented the patient to have Poor + dynamic standing balance. What does that mean? | |
| Walking into the bathroom to use the toilet is an example of: | Functional Ambulation |
| True/False: W/C management includes users' ability to manage parts of the W/C and complete mobility both inside and outside on multiple surfaces. | True |
| What is the purpose of the box and blocks test? | Gross/Manual Dexterity |
| How do you score the box and blocks test? | Number of blocks in 1 minute. |
| What is the procedure for the box and blocks test? | Scripted (and demonstrate) 15 second trial Place hands on the sides of the box. Dominant hand first. |
| What is the purpose of the grooved pegboard test? | Manipulative dexterity, finger speed |
| How do you score the grooved pegboards test? | (# of seconds) + (# of drops) + (# of pegs) If time gets to 5 min, stop and count pegs, otherwise # of pegs is always 25 |
| What is the procedure for the grooved pegboard test? | Scripted Pegboard placed at midline. Dominant hand first R hand places pegs L to R, top to bottom (L hand R to L) |
| What are the 3 types of UE tests? | Grip Strength - Dynamometer Pinch Strength - Pinch Gauge Edema - Volumeter or Measuring Tape |
| How do you score the 9-hole pegboard test? | Time # of seconds to place and remove pegs (Start time when they touch the first peg, stop time when the last peg is returned to the container) |
| What is the procedure for the 9-hole pegboard test? | Scripted (while demonstrating): Dominant arm first- Pegs on the dominant side, The script has place for practice trial (15 secs). Place pegs in any order. Then repeat with non-dominant hand. |
| What is the purpose of the Purdue peg board test? | Dexterity |
| How do you score the Purdue Pegboard test? | # of pins placed in 30 seconds R hand L hand Both Hands Add up R + L + Both Assembly score - # of individual parts placed in 1 minute 8 assemblies is 32 parts |
| What is the procedure for the Purdue Pegboard test? | |
| What is the purpose of the hand tool dexterity test? | Dexterity and manipulation of tools, screws, and other household or workplace items. |
| How do you score the hand tool dexterity test? | Amount of time to move all bolts to opposite side Start time as soon as they pick up the wrench Stop time as soon as last bolt is tightened |
| What is the procedure for the hand tool dexterity test? | Remove bolts on left side top to bottom Loosen with tools, then fingers Mount bolts on right side bottom to top Tighten with fingers, then tools On both sides, the bolt head goes on the inside, long skinny part on outside |
| How many pins per hole in O'Conner's finger dexterity test? | 3 pins/hole |
| What does the Minnesota dexterity test contain? | 5 subtests, round blocks, scripted |
| What does the Jebsen hand function test contain? | Printing a short, grade 3 reading lvl sentence. Turning over notecards (simulated page turning). Picking up objects (ex. pennies) and placing in a container. Stacking checkers (H/E coordination). Simulated feeding. Moving large empty & weighted cans |
| What is the procedure for pain testing? | Sharp/dull Check unaffected side for how much pressure is required to elicit pain response, and use that pressure on the testing side Then test with eyes closed, random pattern and timing They respond with either “sharp” or “dull” |
| How do you score pain testing? | Protective Sensation - Intact: Correct response to both sharp and dull Impaired: Incorrect response to both sharp and dull Absent: Inability to perceive being touched Hyperalgesic: Heightened pain reaction to the stimulus |
| What is the procedure for temperature testing? | One tube at 40 deg and one at 110 deg. Alternate touching them long enough for them to feel it, NO PATTERNS, total of 10 attempts The respond with either “hot” or “cold” |
| How do you score for temperature testing? | Intact temperature awareness: correct response to both hot and cold Impaired temperature awareness: incorrect response to either hot or cold |
| What is the procedure for the 2 pt static touch test? | Demonstrate first on different body part with eyes open Test radial & ulnar aspects of each finger tip Random 1 or 2 Parallel to long axis Press enough for skin to blanch Begin with 5 mm They respond “one,” “two,” or “I don’t know” |
| How do you score the 2 pt static touch test? | 7/10 correct responses Normal: 1-5 mm Fair: 6-10 Poor: 11-15 1 point perceived: protective sensation only No points perceived: anesthetic area |
| What is the procedure for the 2 pt moving touch test? | Start with 8 mm Move proximal to distal, parallel to long axis |
| How do you score the 2 pt moving touch test? | 7/10 correct 2-4 mm normal for ages 4-60 4-6 mm normal for ages 60+ Pressure |
| What is the procedure for using monofilaments to test pressure? | Start with smallest Enough pressure to bend Hold for 1-1.5 seconds |
| How do you score pressure testing using monofilaments? | If felt, that is their score. If not, go to next one. Green (2.83) = norm. light touch Blue (3.62) = dim. light touch Purple (4.31) = dim. protect. sense Red (4.56 and 6.65) = loss of protect. sense Unable to feel largest size (6.65+) = untestable |
| What is the procedure for proprioception testing? | Hold lateral part of elbow, wrist, digit Move it into flex or extension They respond with “up” or “down” Could also say in and out for ulnar/radial deviation |
| How do you score proprioceptive testing? | Accurate response = Intact proprioception |
| what is the procedure for Kinesthesia testing? | Put unaffected side in a position, they copy on the other side |
| What is the procedure of stereognosis testing? | Moberg pickup test (ours might not be specifically moberg) Screw, nickel, dime, paper clip, etc. Feel with eyes closed Agree on labeling terms beforehand |
| How do you score the stereognosis test? | how many items they get right. |
| What is the procedure for localization of touch testing? | The smallest monofilament they can feel Poke hand with their eyes closed They can open their eyes and point to where they felt a touch then record by placing a dot where they touch and an arrow where you touched on the hand grid. |
| How do you score localization of touch tests? | Correct identification of the area w/i 1 cm = intact touch localization |
| What is the procedure for the TUG test? | clients start seated, then when the therapist says go they walk 10 ft forward turn around and walk back 10 ft and sit back down, timer starts when Go is said and stops when the client sits back down |
| How do you score the TUG test? | Comparing the client's times to averages for individuals of their age and sex |
| What is the procedure of the single leg stance test? | have the client stand with their eyes open and feet together and time how long they can balance then have them do the same thing with their eyes closed and time it. |
| How do you score the single leg stance test? | Comparing the client's times to averages for individuals of their age and sex |
| What is the procedure for functional reach test? | have the client stand and then extend their arm closest to the wall then have them reach hinging at the hips feet flat on the floor and measure 3 times (can be modified for wheelchair users- side to side reach and then forward in the wheelchair) |
| How do you score the functional reach test? | Average the 2nd and 3rd reach lengths |
| What is the procedure for the bergs balance test? | 14 parts, demonstrate and verbal instructions |
| How do you score the bergs balance test? | Each of the 14 parts is given a score 0-4 |
| What is the procedure for the Tinetti balance assessment? | Balance section - 9 parts score 0-1 or 0-2 Gait section - 8 parts scored 0-1 or 0-2 |
| What is the definition of cleaning? | The activity of removing the contaminant |
| What is the definition of disinfecting? | Spraying down surface and wiping it down using a chemical or germicide |
| What is the definition of sterilization? | Destruction of all microbial life, using steam at a high pressure |
| What is the definition of 'contaminated'? | It's not sterile anymore and anything that comes into contact is at risk. |
| Define hand hygiene. | General term that involves hand washing, using antiseptic (soap) or to clean hand and remove contaminants. |
| What is the definition of nosocomial infection? | Acquired infection you get while in the hospital while being treated for something else. |
| Define personal protection equipment (PPE). | Gloves, gowns, masks, face shields. |
| What is the definition of 'source'? | The person who is ill or object that is contaminated. |
| Define 'host'. | Someone who does not have the illness. |
| Define 'transmission'. | The way that the illness is given to another person from an object or different individual. |
| Define 'contact'. | Touching the object or person (direct or indirect). |
| Define 'in/direct contact'. | Touching the person directly. Indirect touching occurs when touching an object that was touched by someone that is sick. |
| Define 'droplet'. | Sick person coughs, sneezes and the particle lands in a mucosal surface of another person. |
| Define 'airborne'. | The particles remain in the air, dispersed by air current can infect when it lands on mucosal membranes. |
| Define 'common vehicle'. | Contaminated water, food, common equipment or something many people have access to |
| Define 'vectorborne'. | Insect transmitted. |
| What are standard precautions? | Standard hand hygiene, use of gloves and injection measures. |
| What are contact precautions? | PPE required before entry and removal before exit of the room, sterilize the equipment before and after, or use disposable equipment. |
| What are droplet precautions? | Masks, face shield, distance. |
| What are airborne precautions? | Preventing agents through air, reverse pressurized room, PPE required, respirator, n95 fitted mask |
| What are the steps of hand washing? | 1. turn on the water 2. use soap and warm running water 3. rub hands vigorously for 20 seconds 4. rinse hands 5. dry hands 6. turn off water |
| When should you perform hand hygiene? | when visibly dirty/soiled, after touching patient equipment, after touching patient, before touching patient, when moving from contaminated body suit to clean body suit, after removing gloves |
| What is the sequence for donning PPE? | Gown, mask, face shield, gloves |
| What is the sequence for doffing PPE? | Gloves, goggles, gown and respirator separately. Then wash hands or gown and glove together. Then shield, mask, washing hands after both. |
| What unit is used for heart rate? | Beats per minute. |
| What are the heart rate norms? | Adults: 60-100 BPM Kids: 60-205 BPM |
| What heart rate is associated with bradycardia? | HR less than 60 BPM |
| What heart rate is associated with tachycardia? | HR greater than 100 BPM |
| What equation is used to determine a person's maximum heart rate? | 220 - age = Max Heart Rate |
| What is the equation used to determine a person's target heart rate? | (0.60) x (220 - age) = heart rate to (0.8) x (220 - age) = heart rate |
| Define 'blood pressure'. | Resistance of blood flow. Determines vascular resistance. |
| What is systolic pressure? | Measure of pressure exerted by blood against arterial walls during heart contraction. |
| What is diastolic pressure? | Measure of pressure exerted by arterial walls against blood when the heart is not contacting. |
| What are the BP norms? | Normal: <120/80 Hypertension: 120-130/80-89 Stage 1 hypertension: 140-159/90-99 Stage 2 hypertension: 160+/100+ |
| What is respiratory rate? | Measuring 1 inspiration and the following expiration in 1 minute. |
| What are the respiratory rate norms? | Even & quiet breaths. adult: about 12 breaths per minute. kids: about 20 breaths per minute. |
| What are the temperature norms? | Norm: 98.6 Oral >100 - febrile hyperthemia: >106 hypothemia: <94 |
| Why would you assess grip and pinch strength? | Hand function, ability to complete functional tasks, and assess function prior to physical measures. |
| Define 'swelling'. | Normal response to injury, vasodilation, and increase in white blood cells. |
| What is edema? | Excessive swelling and abnormal accumulation of interstitial fluid |
| What is lymphedema? | Permanent mechanical obstruction to the lymph system. |
| What is acute edema? | 2-5 days of swelling |
| What is considered subacute and chronic edema? | > 3 months of swelling |
| How does edema effect function? | Decreased ROM, decreased sensation, decreased coordination |
| How would you assess edema? | Observation, palpation, volumetric measurements |
| What neurons move along a pathway away from the brain? | Efferent Neurons |
| What are mechanoreceptors? | Give us touch input, mechanical change - stretch, sharp, dull |
| What do thermoreceptors sense? | Sense change in temperature - cold and hot. |
| What are the types of sensory testing? | Pain, temperature, touch, pressure, proprioception, stereognosis, localization of touch |
| What are good body mechanics for therapy? | keep the object/client close, maintain a wide base of support, push before pulling and pull before lifting, and lift with your legs, smooth pacing, turn your whole body don't twist |
| What are the keys to positioning a patient? | Consider comfort, change positions frequently, and maintain alignment. |
| What are the keys to draping a patient? | Maintains modesty and warmth, protects clothing, obtain permission, clean linens. |
| What are the causes behind ROM deficits? | Tissue changes, muscle weakness, and joint changes. |
| Define 'burden of care'. | We, as OTs, let the client do as much as possible on their own including through struggling rather than helping. |
| What are the levels for functional independence measurements (FIM)? | 7 - independent, 6- modified independent, 5 - Supervision set up assistance standby assistance, 4 - Contact guard &minimum assistance, 3 - Moderate assistance 2 - maximum assistance, 1 - dependent |
| What are the levels for CARE and GG? | 6-independent & modified independent, 5 - supervision & stand by assistance & set up assistance, 4- stand by assistance & contact guard assistance, 3 - minimum assistance & Moderate assistance, 2 - maximum assistance, 1 - dependent |
| What does balance require? | Postural control, center of gravity and base of support. |
| What is the fall recovery process? | Roll over onto side get up on hands and bring both knees up, crawl to a stable surface, move to side of chair pull one leg in front and place foot on ground using one hand and legs push yourself up and place one cheek on the seat then slide into the chair |
| Which of the following symptoms typically indicates that a client who has been on prolonged bed rest is experiencing orthostatic hypotension? | |
| a client has persistent pitting edema of the hand secondary to mild hemiplegia. Which method would be the most reliable for monitoring the client's edema over time? | |
| A 3rd-party payer has denied reimbursement of pre-authorized OT services based on "insufficient information to substantiate payment." the OTR is writing a letter to appeal the denial. What type of info related to the client is most important to include? | |
| An OTR has completed the initial evaluation of a pt with cancer. The OTR plans to work with the patient on a daily basis prior to the patient's discharge to home in one week. What info is most important to include in the initial evaluation report? | |
| Client w/ chronic low back pain is in a program. The focus is for the client to learn pain coping mechanisms and reduce work-related injury. The client has been making progress. What info is most important to report about progress at next meeting? | |
| An OTR in a SNF often teaches residents how to use AE during BADL. The OTR wants to evaluate her effectiveness in improving resident's functional performance. Which method would be most effective for gathering this info? | |
| An OTR is teaching stand pivot transfers to a client with stage 2 PD, using a w/c for mobility. After instructing the client to properly position the chair in relation to the transfer surface and asking them to lock the w/c breaks, what is next? |
Created by:
hannahruby
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