# Situation: The adult medical-surgical ward of a 150-bed provincial hospital has 28 clients on the day shift. The charge nurse works with three staff nurses and two nursing attendants. The nursing attendants are unlicensed workers trained through a health care services program and the hospital's orientation. A 74-year-old woman is on day 6 after an ischemic stroke with right-sided weakness. At the team conference, the nurse reviews her problems and the current plan: - Unsteady gait, walks with a quad cane: physical therapy daily - Pauses to find words: speech-language pathology 3 times a week - Cannot fasten buttons or grip a toothbrush with the right hand: nursing staff help her dress - Eats 90% of a regular diet, weight stable since admission: no referral Which team member is BEST suited to address the problem that her current plan does not cover?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630354  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: The adult medical-surgical ward of a 150-bed provincial hospital has 28 clients on the day shift. The charge nurse works with three staff nurses and two nursing attendants. The nursing attendants are unlicensed workers trained through a health care services program and the hospital's orientation.

A 74-year-old woman is on day 6 after an ischemic stroke with right-sided weakness. At the team conference, the nurse reviews her problems and the current plan:
- Unsteady gait, walks with a quad cane: physical therapy daily
- Pauses to find words: speech-language pathology 3 times a week
- Cannot fasten buttons or grip a toothbrush with the right hand: nursing staff help her dress
- Eats 90% of a regular diet, weight stable since admission: no referral
Which team member is BEST suited to address the problem that her current plan does not cover?

## 보기

1. Physical therapist
2. Nutritionist-dietitian
3. Medical social worker
4. Occupational therapist **✔ 정답**

**정답: 4**

## 해설

The only problem without the right discipline is the loss of fine hand function for dressing and grooming; activities of daily living and adaptive devices are the work of the occupational therapist. The gait and word-finding problems are already covered, and her intake and weight give no reason for a nutrition referral.

## 심화 해설

Team conference gap analysis

The client has four documented problems. Three already have a clearly matched discipline: unsteady gait is managed by physical therapy, word-finding pauses are managed by speech-language pathology, and stable intake with 90% meal consumption and unchanged weight means no nutrition referral is indicated. The remaining problem is the loss of fine hand function—specifically the inability to fasten buttons or grip a toothbrush with the right hand—which directly impairs dressing and grooming.

Fine motor control for dressing, grooming, and use of adaptive devices falls within the scope of occupational therapy, not physical therapy. Physical therapy addresses gross mobility such as transfers and gait, while occupational therapy targets the task-level skills needed for activities of daily living (ADL). The current plan lists “nursing staff help her dress” as the intervention, but that is compensatory assistance rather than restorative rehabilitation of hand function. A referral to an occupational therapist would add the missing discipline that can retrain fine motor performance and introduce adaptive equipment such as button hooks or built-up toothbrush handles.

Watch out! Do not confuse the role of the physical therapist with that of the occupational therapist. Both are rehabilitation professionals, but physical therapy focuses on mobility and gross motor function, whereas occupational therapy focuses on the fine motor and cognitive-perceptual skills required for self-care tasks.

Evidence supports the value of occupational therapy specifically for ADL recovery after stroke. A Cochrane review concluded that occupational therapy for adults with stroke aims to improve independence in ADLs including dressing, grooming, and personal hygiene, and that these are the very activities impaired by stroke-related functional limitations [1]. A systematic scoping review of hospital-based interventions similarly identified occupational therapists as the key providers of early, activity-based retraining of basic ADLs after stroke [2].

For the upper extremity component, activity-based task-oriented training—an approach used within occupational therapy—has been examined for its effect on upper limb recovery. A systematic review found that activity-based task-oriented training is a priority intervention for improving upper extremity function because upper limb disability undermines the capacity to perform daily activities . A randomized controlled trial further demonstrated that 8 weeks of task-oriented ADL training improved upper limb function, daily activities, and quality of life in chronic stroke patients when compared with conventional occupational therapy . These findings reinforce that the fine hand deficits described in this client—buttoning and gripping a toothbrush—are precisely the type of upper extremity ADL limitations that occupational therapy is designed to address.

Key point! In a team conference question, identify the problem that lacks a matched discipline. Here, gait and word-finding are already covered, nutrition is not indicated, and fine hand function for ADLs is the uncovered problem—making the occupational therapist the best-suited team member.
References (research sources)

- [1]Occupational therapy for adults with problems in activities of daily living after stroke.Research articleLegg LA, Lewis SR, Schofield-Robinson OJ, Drummond A, Langhorne P (2017) · DOI: 10.1002/14651858.CD003585.pub3

- [2]Systematic review of hospital-based interventions to improve post-stroke independence in activities of daily living.Meta-analysis/systematic reviewGrant T, Wales K, Jolliffe L, Schneider EJ, Glascott J, Sansonetti D, Drummond AE, Lannin NA. (2026) · DOI: 10.1111/1440-1630.70119

## 임상 시나리오

Stroke Rehab Team Gap AnalysisMatching the Missing Discipline to Unmet ADL Needs
After a stroke, review each problem against the assigned discipline. Gait instability belongs to physical therapy, word-finding pauses belong to speech-language pathology, and stable intake with 90% meal consumption requires no nutrition referral.

The uncovered gap is fine motor loss—inability to fasten buttons or grip a toothbrush—which directly impairs dressing and grooming. This is the scope of occupational therapy, not physical therapy. OT provides task-level retraining and adaptive devices such as button hooks or built-up toothbrush handles.

CautionNursing assistance with dressing is compensatory, not restorative. Do not confuse PT and OT: PT targets gross mobility and transfers, while OT targets fine motor and cognitive-perceptual skills for ADLs.

## 핵심 개념

- **Occupational therapy** — Rehabilitation discipline focused on fine motor skills, cognitive-perceptual function, and task-level training for activities of daily living, including adaptive device use.
- **Activities of daily living (ADL)** — Self-care tasks such as dressing, grooming, feeding, and toileting that are targeted by occupational therapy interventions.
- **Fine motor function** — Coordinated small muscle movements of the hands and fingers required for tasks like buttoning, writing, or gripping utensils.
- **Physical therapy** — Rehabilitation discipline that addresses gross motor function, mobility, transfers, balance, and gait training.
- **Adaptive devices** — Equipment such as button hooks or built-up handles that compensate for impaired hand function during ADLs.

## 같은 주제 문제

- [Situation: The adult medical-surgical ward of a 150-bed provincial hospital has 28 clients…](https://mymerci.kr/pages/nclex_q.php?qn_id=630351)
- [Situation: The adult medical-surgical ward of a 150-bed provincial hospital has 28 clients…](https://mymerci.kr/pages/nclex_q.php?qn_id=630352)
- [Situation: The adult medical-surgical ward of a 150-bed provincial hospital has 28 clients…](https://mymerci.kr/pages/nclex_q.php?qn_id=630353)
- [Situation: The adult medical-surgical ward of a 150-bed provincial hospital has 28 clients…](https://mymerci.kr/pages/nclex_q.php?qn_id=630355)
- [Situation: A 30-bed adult medical ward admits many clients with diabetes, liver disease, a…](https://mymerci.kr/pages/nclex_q.php?qn_id=630451)
- [Situation: A 30-bed adult medical ward admits many clients with diabetes, liver disease, a…](https://mymerci.kr/pages/nclex_q.php?qn_id=630452)
- [Situation: A 30-bed adult medical ward admits many clients with diabetes, liver disease, a…](https://mymerci.kr/pages/nclex_q.php?qn_id=630453)
- [Situation: A 30-bed adult medical ward admits many clients with diabetes, liver disease, a…](https://mymerci.kr/pages/nclex_q.php?qn_id=630454)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._