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Answer Key for Scenario Set Untimed Quiz


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Clinical Simulation 1

Scenario Set 1
Opening Scene
An OTR® and COTA® work together in a small rural school district which is in an impoverished area with a high unemployment rate. The school consists of one building, with a kindergarten and elementary school positioned at one end and a middle/high school at the other end. Due to limited space, the room that the OT practitioners use for therapy, is in a sectioned off portion adjacent to the kindergarten section. This space is not ideal as the dividers for the therapy space do not reach the ceiling and they, therefore, do not block out sound.

Scenario item 1 of 4

The OTR® and the COTA® are employed to cover 3 different school districts. To comply with supervision regulations, they decide to meet monthly to discuss all the students on their caseloads. The OT practitioners usually meet at this school because it is the most central and fits in with both their schedules. During their monthly meeting, the OTR® and the COTA® typically discuss all the students on their caseloads, including the students from the other 2 schools. On one occasion, while the OTR® and COTA® are meeting, the children from the kindergarten class unexpectedly rush into their classroom as their playtime has been cut short. In this situation, what should the OTR® and COTA® do NEXT?


Your Response
Yes    No		 Answer Key Action
Yes 1.
Yes 2.
No 3.
No 4.
No 5.
Yes 6.

Rationale

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Scenario Set 1
Opening Scene
An OTR® and COTA® work together in a small rural school district which is in an impoverished area with a high unemployment rate. The school consists of one building, with a kindergarten and elementary school positioned at one end and a middle/high school at the other end. Due to limited space, the room that the OT practitioners use for therapy, is in a sectioned off portion adjacent to the kindergarten section. This space is not ideal as the dividers for the therapy space do not reach the ceiling and they, therefore, do not block out sound.

Scenario item 2 of 4

The occupational therapy caseload at this school has been increasing due to a large number of new referrals being made by the county’s birth to three agency. The special education director of the school approaches the OTR® about the high number of students being referred to OT and asks the OTR® if any of the students can be discharged from OT as the school budget is not able to support the level of occupational therapy services currently being provided. How should the OTR® respond?


Your Response
Yes    No		 Answer Key Action
Yes 1.
Yes 2.
Yes 3.
No 4.
No 5.
No 6.

Rationale

As the OTR® should respond to the special education director in a professional manner that is beneficial to the school while at the same time looking out for the best interests of the students, the OTR®'s response to this request must be carefully considered to observe the principles of Beneficence, Nonmaleficence, Justice, Fidelity and Veracity. Beneficence- Occupational therapy practitioners shall demonstrate concern for occupational therapy patients. This includes providing a plan of intervention for recipients of occupational therapy services to address their specific needs, and occupational therapy services should only be terminated when no longer beneficial. Nonmaleficence- Do not abandon the service recipients and attempt to facilitate appropriate transitions when unable to provide services for any reason. Fidelity- Occupational therapy practitioners shall treat patients and other healthcare professionals with respect. This includes keeping communication with colleagues professional and respectful and encouraging collaborative efforts between professionals. Justice- Occupational therapy practitioners shall provide occupational therapy services in a fair and objective manner. Veracity- Occupational therapy practitioners shall represent the profession in a thorough, objective, and accurate manner.

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Scenario Set 1
Opening Scene
An OTR® and COTA® work together in a small rural school district which is in an impoverished area with a high unemployment rate. The school consists of one building, with a kindergarten and elementary school positioned at one end and a middle/high school at the other end. Due to limited space, the room that the OT practitioners use for therapy, is in a sectioned off portion adjacent to the kindergarten section. This space is not ideal as the dividers for the therapy space do not reach the ceiling and they, therefore, do not block out sound.

Scenario item 3 of 4

To reduce the time spent on individual therapy sessions, the OTR® and the COTA® have decided to work together with a small group of children who have the same OT goals. During a group session, the COTA® begins telling the OTR® that they heard one of the kindergarten teachers is getting divorced. How should the OTR® respond in this situation?


Your Response
Yes    No		 Answer Key Action
Yes 1.
Yes 2.
No 3.
No 4.
Yes 5.
No 6.

Rationale

1.
2.
3.
4.
5.
6.

Scenario Set 1
Opening Scene
An OTR® and COTA® work together in a small rural school district which is in an impoverished area with a high unemployment rate. The school consists of one building, with a kindergarten and elementary school positioned at one end and a middle/high school at the other end. Due to limited space, the room that the OT practitioners use for therapy, is in a sectioned off portion adjacent to the kindergarten section. This space is not ideal as the dividers for the therapy space do not reach the ceiling and they, therefore, do not block out sound.

Scenario item 4 of 4

One of the students who is receiving OT services at the school is a 10-year-old girl who has been diagnosed with an Intellectual Disability. While the COTA® is working with the student, she tells the COTA® that her uncle touched her private parts. As this student has a history of making comments that are not always true, how should the COTA® respond?


Your Response
Yes    No		 Answer Key Action
No 1.
Yes 2.
Yes 3.
No 4.
No 5.
Yes 6.

Rationale

1.
2.
3.
4.
5.
6.

Scenario Set 2
Opening Scene
Amber is a 3-year-old girl with Down’s Syndrome who is transitioning from an early intervention program to an inclusive preschool. She has been receiving OT services since birth and an updated assessment is now necessary as part of the transition process.

Scenario item 1 of 4

In order to determine baseline scores for the skills that need to be addressed in the IEP, the OTR® is required to evaluate Amber using standardized assessments. Which assessments would be appropriate for the OTR® to administer?


Your Response
Yes    No		 Answer Key Action
No 1.
No 2.
No 3.
Yes 4.
Yes 5.
Yes 6.

Rationale

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3.
4.
5.
6.

Scenario Set 2
Opening Scene
Amber is a 3-year-old girl with Down’s Syndrome who is transitioning from an early intervention program to an inclusive preschool. She has been receiving OT services since birth and an updated assessment is now necessary as part of the transition process.

Scenario item 2 of 4

The OTR® meets with the IEP team to provide feedback on Amber’s performance in the OT evaluation. While setting goals for Amber’s IEP, her parents ask the OTR® for advice on how they can make sure there is carry over from what is being addressed at school. They specifically want to know what activities they should encourage Amber to participate in. Which activities are the MOST appropriate for the OTR® to recommend for Amber, and are there any precautions her parents should be aware of when she is playing?


Your Response
Yes    No		 Answer Key Action
Yes 1.
Yes 2.
No 3.
No 4.
No 5.
Yes 6.

Rationale

1.
2.
3.
4.
5.
6.

Scenario Set 2
Opening Scene
Amber is a 3-year-old girl with Down’s Syndrome who is transitioning from an early intervention program to an inclusive preschool. She has been receiving OT services since birth and an updated assessment is now necessary as part of the transition process.

Scenario item 3 of 4

Information gained from Amber's Sensory Profile indicates that she is: 1. Under-responsive to proprioceptive, vestibular, and oral stimuli. 2. Experiencing difficulty with tactile discrimination. 3. Hypersensitive to visual and auditory stimuli. Amber's Individualized Education Program (IEP) has been established and goals to incorporate sensory modulation accommodations in the classroom have been incorporated into her IEP. What specific school-based interventions should the OTR® recommend to achieve the goal of providing appropriate sensory modulation accommodations?


Your Response
Yes    No		 Answer Key Action
Yes 1.
Yes 2.
No 3.
Yes 4.
No 5.
No 6.

Rationale

Sensory Processing Disorder (SPD), exists when sensory signals are either not detected or don't get organized into appropriate responses. A child with SPD misinterprets everyday sensory information, such as touch, sound, and movement. They may feel bombarded by information, they may crave intense sensory experiences, or they may be unaware of sensations that others feel. There are six subtypes of SPD. Almost all individuals with SPD have a combination of symptoms from more than one subtype. Sensory processing disorders are addressed by treatments and adaptations which must be carried over both at home and in the school environment. Occupational therapists work with parents, caregivers, teachers, and paraprofessionals to educate them on why children behave the way they do when they have sensory processing difficulties and how they can make changes to help a child adapt and develop sensory processing . • Proprioceptive under responsiveness- Stimulate by using heavy work and activities which compress the joints together or stretch them apart. • Vestibular under responsiveness- Stimulate with movement. • Tactile discrimination- Awaken the sense of touch • Auditory defensiveness- Decrease the amount of auditory input to reduce a child’s distress when around loud noises or in crowded areas. • Visual sensitivity - Block or filter light to offset frequencies • Oral under-responsive- Awaken the mouth by using strong flavors, chewable foods/toys and facilitate the oral musculature to work harder.

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Scenario Set 2
Opening Scene
Amber is a 3-year-old girl with Down’s Syndrome who is transitioning from an early intervention program to an inclusive preschool. She has been receiving OT services since birth and an updated assessment is now necessary as part of the transition process.

Scenario item 4 of 4

Included in Amber's IEP are goals to improve her pre-writing skills. What specific adaptations should the OTR® include in Amber's IEP which would help her achieve these goals?


Your Response
Yes    No		 Answer Key Action
Yes 1.
Yes 2.
No 3.
Yes 4.
No 5.
No 6.

Rationale

Pre-writing skills are the fundamental skills children need to develop before they are able to write. These skills contribute to the child’s ability to hold and use a pencil, and the ability to draw, write, copy, and color. A major component of pre-writing skills are the pre-writing shapes. These are the pencil strokes that most letters, numbers and early drawings are comprised of and are typically mastered in a sequential order. Pre-writing skills are essential for the child to be able to develop the ability to hold and move a pencil fluently and effectively to produce legible writing. An adaptation is a change in the structure, function, or form of the activity. Adaptations may involve changing the tool or the technique used to complete a task. It is important to note that, although adapting an activity may involve making changes to the activity it does not change the outcome of the activity. The manner of how the activity is accomplished, is purposefully altered to make it achievable for the patient. Adaptations may require: • Restructuring of the physical environment • Changing the technique used to perform an activity • Modifying or substituting objects used in performing an • Using adaptive equipment

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Scenario Set 3
Opening Scene
Jose is a 27-year-old chef who sustained a deep partial-thickness burn to the volar surface of his right dominant hand when he lifted a heated frying pan from the stove. Jose has been admitted to the burn unit of his local hospital for inpatient treatment. He is married and his partner who works at the same restaurant has been by his side since the accident offering him emotional support. Jose is alert and eager to make a full recovery so that he can return to his job as soon as possible.

Scenario item 1 of 4

On the day of Jose's admission, the OTRⓇ receives a referral to evaluate and treat him. What goals would the OTRⓇ most likely establish during the acute care phase of Jose’s recovery?


Your Response
Yes    No		 Answer Key Action
No 1.
Yes 2.
No 3.
No 4.
Yes 5.
Yes 6.

Rationale

The term deep partial-thickness burn describes damage to the epidermis and upper two thirds of the dermis. During the acute care phase, medical management is of utmost importance for the survival of the patient, and the goal of OT is primarily preventive. Rehabilitation management of burn survivors can be divided into three overlapping phases to aid in categorizing and determining effective intervention goals. These phases of recovery are the acute care phase, the surgical and postoperative phase, and the inpatient and outpatient rehabilitation phase. As the patient recovers and wound closure progresses, the nature of OT also changes, with treatment directed at restoring function. The acute care phase is usually the first 72 hours after a major burn injury. Initially, when the wounds are deep partial or full thickness, the acute care rehabilitation goals are as follows: •Provide cognitive reorientation and psychologic support. •Reduce edema. •Prevent loss of joint and skin mobility. •Prevent loss of strength and activity tolerance. •Promote occupational performance, such as independence in self-care skills. •Provide patient and caregiver education.

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Scenario Set 3
Opening Scene
Jose is a 27-year-old chef who sustained a deep partial-thickness burn to the volar surface of his right dominant hand when he lifted a heated frying pan from the stove. Jose has been admitted to the burn unit of his local hospital for inpatient treatment. He is married and his partner who works at the same restaurant has been by his side since the accident offering him emotional support. Jose is alert and eager to make a full recovery so that he can return to his job as soon as possible.

Scenario item 2 of 4

While educating Jose and his partner on the extent of his burn injury and the treatment and rehabilitation which will be necessary for him to regain function of his hand, they ask the OTRⓇ what complications Jose can expect from a deep partial-thickness burn to his hand. What is the MOST accurate information the OTRⓇ should provide Jose and his partner?


Your Response
Yes    No		 Answer Key Action
No 1.
No 2.
No 3.
Yes 4.
Yes 5.
Yes 6.

Rationale

1.
2.
3.
4.
5.
6.

Scenario Set 3
Opening Scene
Jose is a 27-year-old chef who sustained a deep partial-thickness burn to the volar surface of his right dominant hand when he lifted a heated frying pan from the stove. Jose has been admitted to the burn unit of his local hospital for inpatient treatment. He is married and his partner who works at the same restaurant has been by his side since the accident offering him emotional support. Jose is alert and eager to make a full recovery so that he can return to his job as soon as possible.

Scenario Set 3 of 4

As the OTR® will be working with Jose on a regular basis they need to be able to help him manage his pain. How can the OTR® contribute to Jose's pain management?


Your Response
Yes    No		 Answer Key Action
Yes 1.
Yes 2.
No 3.
No 4.
No 5.
Yes 6.

Rationale

1.
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5.
6.

Scenario Set 3
Opening Scene
Jose is a 27-year-old chef who sustained a deep partial-thickness burn to the volar surface of his right dominant hand when he lifted a heated frying pan from the stove. Jose has been admitted to the burn unit of his local hospital for inpatient treatment. He is married and his partner who works at the same restaurant has been by his side since the accident offering him emotional support. Jose is alert and eager to make a full recovery so that he can return to his job as soon as possible.

Scenario item 4 of 4

One of the main goals of OT intervention is to prevent Jose from developing a hand deformity. To achieve this goal, preventive positioning is required by using an orthotic to maintain the affected hand in an antideformity position. What principles should the OTRⓇ follow when fabricating a splint for Jose's right upper limb?


Your Response
Yes    No		 Answer Key Action
Yes 1.
No 2.
No 3.
Yes 4.
Yes 5.
No 6.

Rationale

1.
2.
3.
4.
5.
6.

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