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Wheelchair NBCOT® Exam Questions

Stephanie Shane OT/L

Pass the NBCOT®

  1. The topic of the February 7, 2013, newsletter MLN Matters, published by the Medicare Learning Network under the Centers for Medicare and Medicaid Services, was changes in the criteria for mobility assistive equipment and MRADLs, which OT’s working with positioning, seating, and wheelchairs need to know for reimbursement. What does the Medicare acronym MRADLs stand for?

A.

Movement-related ADLs

B.

Motion-related ADLs

C.

Motor-related ADLs

D.

Mobility-related ADLs

The right answer is D

The Medicare beneficiary must have significant limitations in one or more MRADLs that prevent task accomplishment, increase risk during task accomplishment, or prevent task accomplishment in a reasonable amount of time to qualify for coverage of mobility assistive equipment.

  1. An OT is performing a physical examination as part of a positioning and seating assessment. For which trio of conditions would the OT apply manual pressure to the pelvis to determine whether a deformity is flexible or inflexible?

A.

Scoliosis, lordosis, sarcoidosis

B.

Lordosis, exocytosis, windswept deformity

C.

Kurtosis, kyphosis, lordosis

D.

Scoliosis, windswept deformity, kyphosis

The right answer is D

With scoliosis, the pelvis rotates anteriorly; with windswept deformity, the pelvis rotates laterally; and with kyphosis, the pelvis rotates posteriorly.

  1. Seating biomechanics take into account the client’s stability, postural support, and mobility needs. When determining seating requirements, what would the OT FIRST assess?

A.

Head and neck

B.

Upper extremities

C.

Trunk

D.

Pelvis

The right answer is D

The pelvis and lower extremities need to be stabilized first for overall postural support, followed by the trunk, and then the head, neck, and upper extremities can be addressed for both stability and mobility needs.

  1. A client sustained a C4 spinal cord injury in a car accident, and the OT is recommending a power wheelchair with a sip-and-puff controller. Which of the following options would be best for providing pressure relief to the buttocks by changing orientation in space but not body position?

A.

Tilt in space

B.

Recline

C.

Elevating leg rests

D.

Pelvic bar

The right answer is A

A tilt-in-space feature rotates the seat around a fixed axis, does not change the client’s position, and provides pressure relief for the buttocks.

  1. An OT is measuring a client for a new wheelchair. The client’s hip width is 18 inches. The client does not use any lateral trunk supports but lives in a cold climate and frequently wears bulky clothing. What seat width should the OT recommend?

A.

16 inches

B.

18 inches

C.

20 inches

D.

22 inches.

The right answer is C

A clearance of 1–2 inches bilaterally between the hips and the side of the wheelchair is recommended. Two inches will more easily accommodate bulky clothing.

  1. A frail older adult client who uses an ultra lightweight manual wheelchair with a foam cushion comes to the clinic complaining of low back pain. The client’s caregiver indicates that the skin on the client’s coccyx is very pink, and there is concern about skin breakdown. The OT observes that the client’s seated position is stable without supports, the client’s upper extremities rest on the armrests without the shoulders hiking, the feet rest on the foot plates bilaterally, and the hips are at a 45° angle, which keeps the knees higher than waist level. The client indicates that this sitting posture is usual and is maintained most of the day. What intervention would the OT try INITIALLY to relieve the client’s pain and protect the skin?

A.

Add an adjustable-tension back support so that the client can lean back further

B.

Lower the footrests so that the thighs are level with the seat of the chair and the feet rest flat on the footrests

C.

Replace the client’s foam cushion with a gel cushion

D.

Analyze how pressure is distributed on the pelvis using pressure mapping

The right answer is B

The client’s footrests are too high, resulting in increased pressure at the ischial tuberosities and the coccyx. When the hip joint is maintained in flexion, the pelvis is prone to tilt posteriorly, increasing pressure in the lumbar region. Lowering the footrests distributes pressure more evenly over the thighs.

  1. When considering a wheeled mobility device with a client, the OT proposes a scooter. Which of the following client characteristics was the primary reason for proposing a scooter versus a manual wheelchair?

A.

The client is unable to safely ambulate in the home.

B.

The client’s home can easily accommodate a wheeled mobility device for moving from room to room in the home.

C.

The client claims he will consistently use any wheeled mobility device he is prescribed.

D.

The client is able to walk around his home, but cannot walk any distance in the community.

The right answer is D

Because the client is able to walk around his home he does not qualify for a manual wheelchair.

  1. An OT is performing a physical examination to determine the client’s seating and positioning needs before ordering a new wheelchair. What rule of thumb would the OT use for the client’s ability to sit upright?

A.

Minimal hip flexion of 90°

B.

Minimal hip flexion of 80°

C.

Minimal hip flexion of 70°

D.

Minimal hip flexion of 60°

The right answer is A

The ability to achieve 90° of hip flexion is necessary for postural stability when sitting upright without support.

  1. The client lives in a long-term care facility and uses a wheelchair to get to the dining room. The OT has removed the client’s wheelchair footrests. Which reason BEST explains why the OT removed the footrests from the wheelchair?

A.

Staff push the client, and the footrests get in the way.

B.

The client’s legs are short, so the client does not need the footrests.

C.

The client propels the chair using only the feet.

D.

The client propels the chair using only the hands.

The right answer is C

When a client propels a wheelchair using only the feet, footrests are removed because they are in the way.

  1. A client is a hands-dependent sitter. What goals would the OT have for such clients when providing a positioning and seating system?

A.

Support the upper extremity and hands for activities

B.

Support the pelvis and trunk to free the hands for activities

C.

Provide armrests to support the arms and hands for activities

D.

Provide a lapboard to support the client and free the hands for activities

The right answer is B

Hands-dependent sitters require the use of one or both hands to maintain an upright seated position. Positioning must begin with the pelvis and trunk; if they are supported, the client will not need to use the hands to sit upright.

  1. A client was provided with an ultra lightweight wheelchair. Because the client is at risk for falls, the drop seat was tilted posteriorly to help prevent the client from getting out of the chair; also, because of the client’s short stature, the axle was moved forward to make it easier for the client to propel the chair. What two accessories would the OT recommend to improve the client’s safety while using the wheelchair?

A.

Solid rubber casters, antitippers

B.

Antitippers, brake lever extenders

C.

Brake lever extenders, flip-up footrests

D.

Flip-up footrests, antitippers

The right answer is B

Because the client’s center of gravity is now behind the axle and the drop seat is tilted posteriorly, the client is more vulnerable to tipping backward in the chair; thus, the OT would recommend antitippers. The OT would recommend brake lever extenders because the tilt of the drop seat and the client’s short stature will make it difficult for the client to access the brake levers.

  1. A client’s family purchased an ultra lightweight wheelchair (K0005) for the client. It has the correct seat height, seat width, and seat depth, but the client has difficulty propelling it. The OT asks the client to demonstrate moving the chair forward. What two potential problems would the OT FIRST focus on?

A.

Location of the axle in relation to the client’s center of gravity, seat-back height

B.

Height of seat back, position of leg rests

C.

Position of leg rests, location of axle in relation to the client’s center of gravity

D.

Distance of axle from the floor; location of the axle in relation to the client’s center of gravity

The right answer is A

If the axle is behind the client’s center of gravity, the client may not be able to grasp enough of the pushrim during propulsion, making movement less efficient; if the seat back is too high, it can prevent the shoulder extension necessary to contact the pushrim.

  1. Although fitted with an ultra lightweight wheelchair (K0005), a client with bilateral above-the-knee amputations is prone to losing sitting balance and falling forward when propelling the chair. The position of the axle is in front of the pelvis. The OT needs to find a balance between stability and the effectiveness of arm propulsion. Because the chair is a K0005, which solution will the OT MOST likely suggest?

A.

Move the axle forward so that the client’s center of gravity is behind the axle

B.

Move the axle back so the client’s center of gravity is over the axle and add antitippers

C.

Exchange the client’s pushrims for ones that have knobs for easier pushing

D.

Make no changes to the axle but add antitippers to prevent falls

The right answer is B

By moving the axle backward, compromised stability will be offset by the antitippers, but movement efficiency will be increased during propulsion and the client’s center of gravity will no longer be at the front of the wheelchair, thus reducing the risk of falling forward.

  1. A client has been referred to the occupational therapy clinic to be assessed for a new wheelchair and positioning support system. Currently, the client has a standard wheelchair with a custom-contoured cushion shaped to support a spinal deformity associated with scoliosis. The OT considers several options with the client but again recommends a custom-contoured cushion? What is the most important reason for making this recommendation?

A.

The cushion requires little maintenance.

B.

The cushion does not change shape.

C.

The cushion can be molded to fit the client and support him in a stable position.

D.

The cushion is made of lightweight materials

The right answer is C

Custom-contoured cushions are molded to fit a specific client and support the client and any deformities in a stable position.

  1. A client is being evaluated for a new wheelchair cushion because a Stage I pressure ulcer developed on the skin over the right ischial tuberosity. The OT is using pressure mapping to determine which cushion best redistributes pressure for the client and determines that one type of cushion best redistributes the pressure. However, the client refuses it because it feels unstable. Which cushion type would MOST likely elicit this response?

A.

Foam

B.

Foam molded

C.

Hybrid foam and gel

D.

Air filled

The right answer is D

Clients often report they feel unstable sitting on an air-filled cushion because the air in the cushion shifts with the client’s movements.

  1. A client is being evaluated for a standard wheelchair (K0001), but after the intake interview, the OT is concerned that Medicare will not reimburse the cost of the wheelchair. Which of the client’s statements could make him ineligible?

A.

“I’m unable to ambulate safely with a cane or walker.”

B.

“We don’t have enough room to move the wheelchair between rooms in our home.”

C.

“I’m unable to push myself up a ramp in a wheelchair.”

D.

I’m unable to remove the armrest to transfer.”

The right answer is B

This criterion is one of the minimal criteria to be met for Medicare reimbursement for a mobility device.

  1. A client has lost considerable weight since his admission to a long-term care facility, and his family is concerned because he constantly complains about how sore he gets from sitting in his wheelchair now that he is “nothing but bones.” Why would the OT recommend a wheelchair cushion for this client?

A.

It will provide a cushioned surface on which to sit.

B.

It will raise the seat height for better mobility.

C.

It will redistribute pressure on his sitting surface.

D.

It will prop up the client so he is sitting upright.

The right answer is C

The purpose of a wheelchair cushion is to redistribute pressure on the sitting surface away from the ischial tuberosities and the coccyx.

  1. A client who uses an ultra lightweight wheelchair asks whether the chair can accommodate a wraparound lapboard. The OT is not familiar with this type of lapboard. Who on the rehabilitation team would be the BEST person for the OT to consult to obtain this information?

A.

Another OT

B.

A physical therapist

C.

A rehabilitation engineer

D.

A medical equipment supplier

The right answer is D

The medical equipment supplier would be the person most familiar with the range of rehabilitation products and their features.

  1. An adolescent client who has muscular dystrophy uses a manual wheelchair that has a backrest cushion and a gel seat insert. The client reports a recent onset of shoulder pain while propelling the wheelchair over a carpeted surface. The OT observes that the wheelchair has a backrest cushion that positions the client’s pelvis beyond the rear wheel axle. Which wheelchair modification should the OT recommend to reduce the client’s shoulder pain?

A.

Remove the backrest cushion.

B.

Change to an air-filled seat cushion.

C.

Raise the seat height.

D.

Adjust the axle plate.

  • The right answer is A

Removing the backrest cushion will position the client’s pelvis directly over the rear wheel axle, which will make propulsion easier.

  1. When measuring a client for a wheelchair, what are the four basic measurements the OT MUST take?

A.

Seat width, seat depth, seat height, seat-back height

B.

Seat width, seat depth, seat height, footrest length

C.

Seat width, seat depth, seat-back height, footrest length

D.

Seat width, seat depth, footrest length, seat-to-back angle

The right answer is A

These measurements must be provided when ordering a wheelchair. Other measurements are helpful for comfort (e.g., armrest height).

  1. An OT and a Level II Fieldwork student at a long-term care facility observe a new resident moving his wheelchair forward by gripping the front of the pushrim and giving it multiple tiny pushes. The OT asks the student, “Why do you think he is pushing his wheelchair that way?” The student observes a bit longer and responds:

A.

The seat back is too low.

B.

The wheelchair is too wide.

C.

The seat back is too high.

D.

The armrests are too low.

The right answer is C

When the seat back height is above the lower angle of the scapula, it can prevent adequate shoulder extension, which is necessary for contacting the pushrim.

  1. A client is being discharged home after spending 2 weeks in rehab after a stroke. She has arrived for transfer safety training. For a wheelchair-to-bed standing pivot transfer, which of the following steps would be FIRST in the sequence of the transfer?

A.

Positioning the chair at a 45° angle to the bed

B.

Telling the client to scoot forward in the wheelchair.

C.

Swinging the footrests out of the way

D.

Setting the brakes on the wheelchair

The right answer is A

For the client’s safety, the wheelchair needs to be positioned with the least amount of space for him to travel.

  1. The topic of the February 7, 2013, newsletter MLN Matters, published by the Medicare Learning Network under the Centers for Medicare and Medicaid Services, was related to changes in the criteria for mobility assistive equipment and mobility-related ADLs (MRADLs), which OT’s working with positioning, seating, and wheelchairs need to know for reimbursement. Which of the following is NOT an MRADL specifically cited by Medicare?

A.

Feeding

B.

Cooking

C.

Bathing

D.

Grooming

The right answer is B

Cooking is not specifically cited by Medicare; Medicare regulations state that beneficiaries must have significant limitations in tasks such as “toileting, feeding, dressing, grooming, or bathing.”

  1. A client presents at the occupational therapy clinic with a windswept deformity and needs to be assessed for a new wheelchair and a positioning device. In the documentation required for Medicare, the OT uses the term “windswept deformity” and also describes the impairment in body structure as follows:

A.

Pelvis rotates posteriorly, increasing trunk flexion

B.

Pelvis rotates anteriorly, increasing curvature of the lumbar spine

C.

One side of the pelvis is lower than the other

D.

Pelvis rotated to one side, resulting in the spine, trunk, and thighs moving to the opposite side

Incorrect. You answered A.

The thighs moving to the opposite side of the rotated pelvis is a classic sign of windswept deformity.

  1. A client has been referred to occupational therapy for a wheeled mobility assessment. The client has a standard wheelchair (K0001), which he can propel, but wants the OT to recommend a power wheelchair so that he can visit around the neighborhood with greater ease. His wife states that she is able to push him in the neighborhood if he needs help, but he tells the OT that he needs to get out of the house ALONE. Why is the client ineligible for a Certificate of Medical Necessary for a power wheelchair?

A.

He is able to propel a standard wheelchair.

B.

He prefers, but does not need, a power wheelchair.

C.

He does not want caregiver assistance, even though it is available.

D.

He wants a power wheelchair to visit in the neighborhood.

The right answer is A

  1. One of several criteria for prescription of a power wheelchair is that the client is not capable of self-propelling a manual wheelchair.

A client is being considered for a power wheelchair, because her functional status has deteriorated and she is unable to move around her home. She currently has a wheelchair that her family purchased for her at a drug store. According to the Healthcare Common Procedure Coding System (HCPCS) for durable medical equipment, including wheelchairs and their accessories her current standard wheelchair would have which HCPCS code?

A.

K0005

B.

K0001

C.

K0002

D.

K0007

The right answer is B

K0001 is the code for a standard chair, which is the most basic, least adjustable wheelchair and meets the minimal standard for Medicare.

  1. A client is being discharged from a rehab facility. During the discharge interview, the OT asks questions such as, “Who is available to assist the client in each physical context the client needs to be in?” “When are they available?” “Who will check the Roho cushion and reinflate it as needed?” “Who will clean the cushion cover?” Under which assessment category do these questions fall?

A.

Physical context

B.

Social context

C.

Physical skills context

D.

Equipment context

The right answer is B

The social context includes people who support and assist the client in multiple environments.

  1. Upon evaluation a client for a wheelchair, the OT determines that a standard narrow adult chair would be suitable for the individual. The dimensions of the chair will be:
  2. 18 wide x 18 deep x 20 high
  3. 16 wide x 16 deep x 18.5 high
  4. 14 wide x 16 deep x 18.5 high.
  5. 16 wide x 16 deep x 20 high
  6. An OT conducts a home evaluation for an indiv with a complete T10 SCI. The only entrance to the home has 5 steps, a total of 35 inches in height. The OT recommends that the family have a ramp construct that is
  7. a. 35 feet long
  8. 17.5 feet long
  9. 70.5 feet long
  10. . 48 feet long

-one foot of ramp length for each inch of rise.

  1. an ot provides consultation services to members of a town chamber of commerce who have expressed interest in improving their business accessibility. The minimum door width that the ot recommends as being acceptable and not requiring modification is
  2. 32 inches
  3. 28 inches
  4. 30 inches
  5. 34 inches

-measurements less than 32 inches must be modified.

  1. an individual is being evaluated for a wheelchair to use for functional mobility. She expresses concern that she will not be able to continue her volunteer work at her local church. The church’s doorways are 31 inches wide, and the client knows, from remodeling her home, that 32 inches is the minimum width recommended for wheelchair access. The most appropriate recommendation for the therapist to make is to:
  2. have the church widen its doorways to comply with ada requirements (religious organizations are exempt from ada requirements)
  3. order a wheelchair with wrap around armrests (reduce width by 1 inch)
  4. order a customized narrow adult wheelchair (too expensive)
  5. have the client explore alternative volunteer activities in accessible locations.
  6. a religious congregation obtained private funding to build a ramp so that members with disabilities can attend services. The entrance to the congregation building has 6 steps with a rise of 8 inches each. The most appropriate recommendation for the ot consultant to make is to for construction of a ramp that is:
  7. 48 feet long
  8. 48 feet long with a 4 x4 landing at the ramp’s mid point (1 foot of ramp for every foot of rise 6 steps with a rise of 8 inches is 48 inches. )
  9. 60 feet long
  10. 60 feet long with a 4×4 landing at the ramps mid point.

 

  1. a college is converting a historical building into wheelchair accessible dormitory space. To allow for a 360 degree turning radius, the ot recommends that the space between the student’s desk and bed be a minimum of
  2. 4×4 (too small)
  3. 5×5
  4. 6×6

d 8 x8

 

  1. an ot measures a person for a wheelchair. The widest point across the person’s hips and thighs is 16 inches and the greatest length from the persons posterior portion of his buttocks to the popliteal fossa is 18 inches. The ot recommends a wc seat with the dimensions of:
  2. 18 wide by 20 deep
  3. 18 inches wide by 16 inches deep (two inches are added to the widest point across hips and thighs. For depth, 2 inches are subtracted from the posterior portion of buttocks to the popliteal fossa to prevent rubbing. )
  4. 18 wide by 18 deep
  5. 16 inches wide by 18 inches deep.

 

  1. an ot also advises the direct care staff on proper positioning of the patient’s right arm while the patient is seated in a wc. What is the most appropriate position for the ot to recommend for placement of the patients right arm?
  2. rest the arm in an inclined, padded arm trough attached to the right wc armrest throughout the day (avoid shoulder traction and weight on the shoulder)
  3. rest the arm on the wc lapboard throughout the day
  4. cross the patient’s arms across the chest and have the patient cradle the affected extremity with the unaffected extremity (contraindicated can result in shoulder traction).
  5. wear a shoulder sling 24 hours a day to avoid weight on the shoulder (contraindicated and only for a short time).

 

  1. an ot provides caregiver training to the spouse of an indv. With cerebellar cortical degeneration. The focus of the session is on community mobility using a wheelchair. The individual is dependent upon his spouses assistance for mobility. The ot advises the spouse that when descending a steep grade the best method is to:
  2. a. go down backwards with all wc wheels maintaining contact with ground surface (enables the spouse to use her body weight to slow the chair’s momentum.
  3. tilt the wc backwards to its gravitational balance point and then go down forward.
  4. tilt the wc backwards to its gravitational balance point and then go down backwards.
  5. push forward as on flat surfaces but lean body back for extra lag.

 

An OT is completing a wheelchair assessment for an adult client who has progressive cerebellar degeneration and requires the use of a power wheelchair for mobility. What type of control switch would be MOST BENEFICIAL for enabling this client to independently operate the wheelchair?

A.

Sip and puff

B.

Joystick

C.

Chin-activated toggle

D.

Proximity-sensing microswitch

Correct! You answered A.

The right answer is A

Cerebellar degeneration results in loss of balance and coordination. A sip-and-puff control switch would allow control of the power wheelchair without the client needing to use coordination.

  1. a student with charcot-marie tooth disease participates in a re-evaluation session. He reports that he has difficulty keeping his feet on the wc footrests. The most appropriate recommendation for the ot to make is
  2. an exercise routine to strengthen lower extremities
  3. ankle straps on foot rests. (ankle straps prevent slipping off footrests)
  4. heel loops on the foot rests
  5. elevating foot rests.

charcot-marie tooth a neuropathic muscular atrophy characterized by progressive weakness of the distal muscle of the arms and feet.

  1. an ot is conducting a home eval for an sci patient. Upon arriving at the house, it is observed that the only entrance has 5 steps, each with a 7 inch rise. A ramp to allow accessibility is recommended to the family. The ramp length according to standards is
  2. 72
  3. 48
  4. 35 (1 foot of ramp for every rise)
  5. 60
  6. A local pharmacy hires an ot to consult on a redesign of the pharmacy’s customer service area. The ot recommends that the pharmacy counter be no higher than:
  7. 29 inches
  8. 33 inches
  9. c. 31 inches
  10. 35 inches.
  11. a school age child with duchennes muscular dystrophy . although he is able to use a manual chair for distances between classes, he is tired on arrival. What would be the best recommendation the ot could make for the wc use at school.
  12. retain the manual chair to build up strength
  13. change to an ultralight sports model because it requires less strength

change to a power wc to reduce effort. (progressive disease)

  1. encourage walking with a walker to alternate mobility methods.

 

  1. in order for an indv sitting in a wc to achieve maximal postural positioning, the ot should position the indv pelvis in a
  2. moderate posterior tilt
  3. neutral position
  4. slight anterior tilt.
  5. slight posterior tilt.

 

  1. When ordering a wc for an indv who has medicare part b, the ot must be sure the wc.
  2. will increase functional indep
  3. is medically necessary
  4. will maintain patient function
  5. will reduce deformity

 

  1. an ot completes a home assessment has recommended a hospital bed, lightweight wc, bedside commode, reachers, long-handed sponge, shower chair, and hand held shower. The family states they can only afford the items that can be billed as DME. The ot should
  2. explain to the family that hey will need to pay for all the items
  3. order only the reachers and long handed sponge.
  4. order on the shower chair and hand held shower
  5. order on the light weight wc and hospital bed.
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