NBCOT Exam questions (185 question review) UPDATED ACTUAL
Questions and CORRECT Answers
Question: The client lives in a long-term care facility and uses a wheelchair to get to the dining room. The
client propels the chair using only the feet. **When a client propels a wheelchair using only the feet,
footrests are removed because they are in the way.** The COTA®has removed the client's wheelchair
footrests. Which reason BEST explains why the CO- TA® removed the footrests from the wheelchair? A,
D
Correct Answer: Even if staff push the client or the client propels the chair using only the hands, the client
would still need to have the feet on the footrests so that the legs do not dangle. B: A drop seat could be used
if the client's legs are short to make sure the feet are supported on the footrests and do not dangle.
Question: A COTA® is working with an infant who is recovering from a brachial plexus injury. What type
of sling should the COTA® fabricate? A sling that fits proximally around the humerus A sling that fits
proximally around the humerus will prevent the child from sustaining further injury to the brachial plexus
during ADLs. **B, C, D
Correct Answer: A sling that was fit proximally around the radius, ulna, or clavicle would not be effective
in preventing the child from sustaining further injury to the brachial plexus.**
Question: Which client factor is likely affected in a client in the hospital-based setting with Guillain-Barré
syndrome? Sensation Because of the painful sensations that are intially reported with Guillain-Barré
syndrome, the client's tolerance for tactile input and current sensory abilities will likely influence
interventions with the client. **B, C, D
Correct Answer: Cognition, vision, and hearing are not affected by Guillain-Barré syndrome.**
Question: The initial evaluation documentation for a client with Parkinson's disease indicates that the OTR
asked the client to "pretend you are brushing your teeth," Observe as the client brushes teeth with
toothbrush and toothpaste at the bathroom sink The client may not have understood the verbal instructions,
and performing the task in the actual context may allow for more accurate demonstration of the client's
abilities. that is, show the movement of brushing teeth without using the supplies needed for brushing teeth.
The client was unable to initiate movement of the dominant arm toward the mouth to demonstrate oral
hygiene. Which step should the CO- TA® take NEXT in the evaluation of this client? **A
Correct Answer: If the client is unable to initiate movement of the dominant arm during simulated teeth
brushing, it is unlikely that adding weight would facilitate movement. B: Suggesting the assistance of a
caregiver for brushing teeth may entail a greater level of assistance than the client actually requires. The
client should be provided opportunity to complete ADLs at the highest level of independence desired. D:
Clients with Parkinson's disease may have difficulty initiating or limitations in movement because of
rigidity. Use of a mobile arm support would not be appropriate without further evaluation of the client's
needs.**
Question: A COTA® in home health care is treating a client who has Stage III Alzheimer's disease. The
client lives with an adult daughter. The daughter reports that the client likes to wander around the house and
has fallen twice in the middle of the night. The house is a single-level home with both front and back
entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no
steps at the front entrance. The client's daughter is determined to have the client remain at home with her as
long as possible. To prevent the client from getting out A bed alarm system A bed alarm system will alert
the daughter when the client is attempting to leave the bed and is more suitable for use when the daughter is
,not able to stay in the same room as the client for surveillance. **A
Correct Answer: Neither a nightlight nor a full bedrail will alert the daughter if the client is getting out of
bed. Full bedrails may in fact pose a further danger to the client if the client attempts to climb over the
bedrails to get out of bed. C: A video room monitor will require the daughter to stay awake and look at the
monitor regularly.** of bed unnoticed at night, what would be an appropriate recommendation?
Question: A COTA® wants to develop a group activity for clients with personality disorder in an inpatient
psychiatric facility. The group has Allen Cognitive Level (ACL) scores ranging from 5.0 to 5.4. What
activity would be MOST appropriate to use with these clients in the initial stages of the group?
Role-playing social interactions People with personality disorders and people with an ACL in the low 5s
have difficulty with social interactions because they are egocentric. Role playing social interactions would
be best option when initiating a group with these clients. Improving social interaction will form the basis for
the rest of the interventions appropriate for this group. **A
Correct Answer: Volunteer activities would be more appropriate for clients at ACL 5.6 and above. The
tasks involved would be too complex for lower levels. B: Long-term budgeting and house maintenance
would be more appropriate for clients at ACL 5.6 and above. The tasks involved would be too complex for
lower levels. C: Vocational retraining and job seeking would be appropriate for clients at ACL 5.2 and
above, but job seeking would be more appropriate for clients at ACL 5.4 and above, and levels for
vocational training could vary. Clients at ACLs from 5.2 to 5.4 would need more repetition in training to
solve problems and create solutions so that they would not have to problem-solve independently.**
Question: A COTA® is using groups in a residential rehabilitation facility for people with substance abuse.
The COTA has identified a group of clients who have difficulty with as- Behavioral The behavioral frame
of reference uses repetition to shape a client's behaviors in a safe environment in order to reduce negative
thoughts and emotions associated with the stressful event. In this example, the COTA wants the clients to
practice assertiveness in their interactions so that they can feel prepared and confident sertiveness during
encounters with significant others. The COTA decides to use role playing with the group members to help
them improve their response in such events. What frame of reference does this intervention choice suggest?
in future interactions outside the therapy setting. **A
Correct Answer: A psychodynamic frame of reference is mostly discussion based and individualized. B: A
sensorimotor frame of reference uses sensory experiences to assist in regulation of responses. D: A
developmental frame of reference examines the client's age and expectations of the environment and uses
activities that facilitate successful completion in this context.**
Question: A child with Down syndrome has a goal of learning to don socks independently. Which
adaptation would be MOST appropriate to facilitate this task? Loops sewn in socks Loops sewn in socks
would be appropriate for a child with Down syndrome to compensate for decreased fine motor skills. **A
Correct Answer: Socks that go over the calf are more difficult to don than ankle socks and socks that
approach the calf. B: Smaller socks are contraindicated for clients who have difficulty donning socks. C: A
sock aide or donner is recommended for clients who have difficulty with bending.**
Question: On an inpatient rehabilitation unit, the COTA® observes a newly evalu- Clear the unswallowed
food from the patient's mouth and then notify the nurse supervisor and the OTR®. ated patient with
Parkinson's disease eating breakfast seated in a bedside chair. The COTA observes a fork on the floor and
milk spilled on the patient's gown and tray. The patient begins coughing, spitting up pieces of pancake, and
then says hello with unswallowed food in the mouth. What should the COTA do FIRST with this patient? B
is the most important immediate action, because the food in the mouth could cause a choking episode. A
speech therapist may be needed to evaluate for dysphagia and advise on appropriate diet changes or
, recommend further testing such as a video swallow. It is appropriate to discuss with the client whether the
client wants increased independence with feeding using adaptive techniques or equipment, and providing
education on the role of occupational therapy with feeding would help initiate this part of the intervention
planning process. **A
Correct Answer: Adaptive feeding equipment is an important consideration for developing an intervention
plan for occupational therapy, but the apparent dysphagia is more urgent and requires immediate attention
from the proper team members. C: Addressing proximal stability by enhancing positioning with the bedside
chair to the table and tray may help reduce tremors and improve distal stability to manipulate the utensils,
but again the dysphagia is a more pressing issue at this time. D: Changing a patient's diet is outside the
scope of occupational therapy practice.**
Question: A COTA® is positioning a child with quadriplegic cerebral palsy in a wheelchair. Which device
would MOST increase neck stability? Molded head rest Some children with quadriplegic cerebral palsy
have poor head control. A molded head rest helps promote neck stability and improve head control. **A
Correct Answer: A lap belt will increase safety and keep the child's hips in position. B: An abduction
wedge will separate the child's legs to help maintain a wide base of support. D: Lateral supports will prevent
the child from laterally flexing at the trunk.**
Question: Which intervention is most appropriate for a child with visual figure ground difficulties?
Teaching a visual search strategy Figure ground perception is the ability to distinguish the foreground from
the background. A visual search strategy is appropriate for clients with visual figure ground difficulties.
**A
Correct Answer: Giving directional cues may not help the client distinguish the foreground from the
background. C: Using a color-coding system is appropriate for clients who have difficulty with visual
organization. D: Providing a checklist is appropriate for clients who have difficulty with following
directions or sequencing tasks.**
Question: A client with multiple sclerosis (MS) experiences ataxic movements when performing fine
motor self-care tasks. During treatment addressing oral hygiene, what should the COTA® FIRST do?
Position the client's trunk and upper extremities to provide proximal support. Proximal support of the trunk,
shoulder, and elbow may help increase distal control of the hands and fingers. This client may be positioned
to lean against a table and prop the elbows on it, which may provide enough support to allow for improved
control of the hands while performing oral hygiene. **A, B
Correct Answer: Adaptive equipment and splinting may be effective but are more involved interventions
that may be trialed if positioning is not sufficient. D: Massaging trigger points may help reduce pain
associated with MS but is unlikely to affect ataxic symptoms or tremors.**
Question: A COTA® and client with multiple sclerosis Aquatic therapy to reduce the effects of weakness
while promoting gentle exercise (MS) collaborate to select client-centered interventions; the client
expresses interest in developing an exercise program but states that weakness and fatigue are barriers.
Occupational therapy goals include having the client learn an exercise program. What intervention should
the COTA® FIRST recommend? The buoyancy of water helps reduce the effects of weakness. Aquatic
exercise programs for clients with MS should be in room-temperature or cooler waters because of heat
sensitivity. **A
Correct Answer: A home exercise program may be intimidating to someone new to exercise, although it is
important to educate people with MS in how to monitor their fatigue and prevent overexertion. B, D:
Strengthening would likely not be a first approach to introducing an exercise program. Evidence shows that
Questions and CORRECT Answers
Question: The client lives in a long-term care facility and uses a wheelchair to get to the dining room. The
client propels the chair using only the feet. **When a client propels a wheelchair using only the feet,
footrests are removed because they are in the way.** The COTA®has removed the client's wheelchair
footrests. Which reason BEST explains why the CO- TA® removed the footrests from the wheelchair? A,
D
Correct Answer: Even if staff push the client or the client propels the chair using only the hands, the client
would still need to have the feet on the footrests so that the legs do not dangle. B: A drop seat could be used
if the client's legs are short to make sure the feet are supported on the footrests and do not dangle.
Question: A COTA® is working with an infant who is recovering from a brachial plexus injury. What type
of sling should the COTA® fabricate? A sling that fits proximally around the humerus A sling that fits
proximally around the humerus will prevent the child from sustaining further injury to the brachial plexus
during ADLs. **B, C, D
Correct Answer: A sling that was fit proximally around the radius, ulna, or clavicle would not be effective
in preventing the child from sustaining further injury to the brachial plexus.**
Question: Which client factor is likely affected in a client in the hospital-based setting with Guillain-Barré
syndrome? Sensation Because of the painful sensations that are intially reported with Guillain-Barré
syndrome, the client's tolerance for tactile input and current sensory abilities will likely influence
interventions with the client. **B, C, D
Correct Answer: Cognition, vision, and hearing are not affected by Guillain-Barré syndrome.**
Question: The initial evaluation documentation for a client with Parkinson's disease indicates that the OTR
asked the client to "pretend you are brushing your teeth," Observe as the client brushes teeth with
toothbrush and toothpaste at the bathroom sink The client may not have understood the verbal instructions,
and performing the task in the actual context may allow for more accurate demonstration of the client's
abilities. that is, show the movement of brushing teeth without using the supplies needed for brushing teeth.
The client was unable to initiate movement of the dominant arm toward the mouth to demonstrate oral
hygiene. Which step should the CO- TA® take NEXT in the evaluation of this client? **A
Correct Answer: If the client is unable to initiate movement of the dominant arm during simulated teeth
brushing, it is unlikely that adding weight would facilitate movement. B: Suggesting the assistance of a
caregiver for brushing teeth may entail a greater level of assistance than the client actually requires. The
client should be provided opportunity to complete ADLs at the highest level of independence desired. D:
Clients with Parkinson's disease may have difficulty initiating or limitations in movement because of
rigidity. Use of a mobile arm support would not be appropriate without further evaluation of the client's
needs.**
Question: A COTA® in home health care is treating a client who has Stage III Alzheimer's disease. The
client lives with an adult daughter. The daughter reports that the client likes to wander around the house and
has fallen twice in the middle of the night. The house is a single-level home with both front and back
entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no
steps at the front entrance. The client's daughter is determined to have the client remain at home with her as
long as possible. To prevent the client from getting out A bed alarm system A bed alarm system will alert
the daughter when the client is attempting to leave the bed and is more suitable for use when the daughter is
,not able to stay in the same room as the client for surveillance. **A
Correct Answer: Neither a nightlight nor a full bedrail will alert the daughter if the client is getting out of
bed. Full bedrails may in fact pose a further danger to the client if the client attempts to climb over the
bedrails to get out of bed. C: A video room monitor will require the daughter to stay awake and look at the
monitor regularly.** of bed unnoticed at night, what would be an appropriate recommendation?
Question: A COTA® wants to develop a group activity for clients with personality disorder in an inpatient
psychiatric facility. The group has Allen Cognitive Level (ACL) scores ranging from 5.0 to 5.4. What
activity would be MOST appropriate to use with these clients in the initial stages of the group?
Role-playing social interactions People with personality disorders and people with an ACL in the low 5s
have difficulty with social interactions because they are egocentric. Role playing social interactions would
be best option when initiating a group with these clients. Improving social interaction will form the basis for
the rest of the interventions appropriate for this group. **A
Correct Answer: Volunteer activities would be more appropriate for clients at ACL 5.6 and above. The
tasks involved would be too complex for lower levels. B: Long-term budgeting and house maintenance
would be more appropriate for clients at ACL 5.6 and above. The tasks involved would be too complex for
lower levels. C: Vocational retraining and job seeking would be appropriate for clients at ACL 5.2 and
above, but job seeking would be more appropriate for clients at ACL 5.4 and above, and levels for
vocational training could vary. Clients at ACLs from 5.2 to 5.4 would need more repetition in training to
solve problems and create solutions so that they would not have to problem-solve independently.**
Question: A COTA® is using groups in a residential rehabilitation facility for people with substance abuse.
The COTA has identified a group of clients who have difficulty with as- Behavioral The behavioral frame
of reference uses repetition to shape a client's behaviors in a safe environment in order to reduce negative
thoughts and emotions associated with the stressful event. In this example, the COTA wants the clients to
practice assertiveness in their interactions so that they can feel prepared and confident sertiveness during
encounters with significant others. The COTA decides to use role playing with the group members to help
them improve their response in such events. What frame of reference does this intervention choice suggest?
in future interactions outside the therapy setting. **A
Correct Answer: A psychodynamic frame of reference is mostly discussion based and individualized. B: A
sensorimotor frame of reference uses sensory experiences to assist in regulation of responses. D: A
developmental frame of reference examines the client's age and expectations of the environment and uses
activities that facilitate successful completion in this context.**
Question: A child with Down syndrome has a goal of learning to don socks independently. Which
adaptation would be MOST appropriate to facilitate this task? Loops sewn in socks Loops sewn in socks
would be appropriate for a child with Down syndrome to compensate for decreased fine motor skills. **A
Correct Answer: Socks that go over the calf are more difficult to don than ankle socks and socks that
approach the calf. B: Smaller socks are contraindicated for clients who have difficulty donning socks. C: A
sock aide or donner is recommended for clients who have difficulty with bending.**
Question: On an inpatient rehabilitation unit, the COTA® observes a newly evalu- Clear the unswallowed
food from the patient's mouth and then notify the nurse supervisor and the OTR®. ated patient with
Parkinson's disease eating breakfast seated in a bedside chair. The COTA observes a fork on the floor and
milk spilled on the patient's gown and tray. The patient begins coughing, spitting up pieces of pancake, and
then says hello with unswallowed food in the mouth. What should the COTA do FIRST with this patient? B
is the most important immediate action, because the food in the mouth could cause a choking episode. A
speech therapist may be needed to evaluate for dysphagia and advise on appropriate diet changes or
, recommend further testing such as a video swallow. It is appropriate to discuss with the client whether the
client wants increased independence with feeding using adaptive techniques or equipment, and providing
education on the role of occupational therapy with feeding would help initiate this part of the intervention
planning process. **A
Correct Answer: Adaptive feeding equipment is an important consideration for developing an intervention
plan for occupational therapy, but the apparent dysphagia is more urgent and requires immediate attention
from the proper team members. C: Addressing proximal stability by enhancing positioning with the bedside
chair to the table and tray may help reduce tremors and improve distal stability to manipulate the utensils,
but again the dysphagia is a more pressing issue at this time. D: Changing a patient's diet is outside the
scope of occupational therapy practice.**
Question: A COTA® is positioning a child with quadriplegic cerebral palsy in a wheelchair. Which device
would MOST increase neck stability? Molded head rest Some children with quadriplegic cerebral palsy
have poor head control. A molded head rest helps promote neck stability and improve head control. **A
Correct Answer: A lap belt will increase safety and keep the child's hips in position. B: An abduction
wedge will separate the child's legs to help maintain a wide base of support. D: Lateral supports will prevent
the child from laterally flexing at the trunk.**
Question: Which intervention is most appropriate for a child with visual figure ground difficulties?
Teaching a visual search strategy Figure ground perception is the ability to distinguish the foreground from
the background. A visual search strategy is appropriate for clients with visual figure ground difficulties.
**A
Correct Answer: Giving directional cues may not help the client distinguish the foreground from the
background. C: Using a color-coding system is appropriate for clients who have difficulty with visual
organization. D: Providing a checklist is appropriate for clients who have difficulty with following
directions or sequencing tasks.**
Question: A client with multiple sclerosis (MS) experiences ataxic movements when performing fine
motor self-care tasks. During treatment addressing oral hygiene, what should the COTA® FIRST do?
Position the client's trunk and upper extremities to provide proximal support. Proximal support of the trunk,
shoulder, and elbow may help increase distal control of the hands and fingers. This client may be positioned
to lean against a table and prop the elbows on it, which may provide enough support to allow for improved
control of the hands while performing oral hygiene. **A, B
Correct Answer: Adaptive equipment and splinting may be effective but are more involved interventions
that may be trialed if positioning is not sufficient. D: Massaging trigger points may help reduce pain
associated with MS but is unlikely to affect ataxic symptoms or tremors.**
Question: A COTA® and client with multiple sclerosis Aquatic therapy to reduce the effects of weakness
while promoting gentle exercise (MS) collaborate to select client-centered interventions; the client
expresses interest in developing an exercise program but states that weakness and fatigue are barriers.
Occupational therapy goals include having the client learn an exercise program. What intervention should
the COTA® FIRST recommend? The buoyancy of water helps reduce the effects of weakness. Aquatic
exercise programs for clients with MS should be in room-temperature or cooler waters because of heat
sensitivity. **A
Correct Answer: A home exercise program may be intimidating to someone new to exercise, although it is
important to educate people with MS in how to monitor their fatigue and prevent overexertion. B, D:
Strengthening would likely not be a first approach to introducing an exercise program. Evidence shows that
