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Master the NBCOT: Comprehensive 6-
option Multiple Choice Practice.
A COTA® is working with a client diagnosed with age-related macular degeneration. Which intervention strategies should the COTA use to improve the client's independence in meal preparation? Select the 3 BEST choices. Teach the client to use different tactile indicators on a few key microwave buttons Teach the client to use the central vision to see the microwave buttons Instruct the client to use small-print timers and recipe books Instruct the client to lower the general and task lighting in the kitchen and near the microwave Teach the client to use a dark cutting board to slice an egg and a white cutting board to chop broccoli Instruct the client to reduce clutter in the kitchen - \The correct answers are A, E, and F. A: Tactile indicators on key microwave buttons help the client supplement remaining vision with tactile sensation. E, F: Increasing contrast promotes the visibility of items in the kitchen. Reducing clutter makes items easier to locate and reduces visual distractions. B: Age-related macular degeneration results in the loss of central vision. Teaching this client to use peripheral vision would be more beneficial. C: Using smaller print would make the meal preparation activities more difficult. Using large-print timers and recipe books would help improve the client's performance. D: Reducing the lighting would hinder the client's ability to view the microwave controls. Increased lighting is more appropriate. A COTA® is considering how to prevent skin breakdown in a client with an incomplete spinal cord injury. Which methods are appropriate for preventing pressure sores? Select the 3 BEST choices. Teaching the client to inspect the skin on a daily basis Relieving and eliminating all pressure points Regularly turning or moving the body to different positions Removing after-market cushioning from the wheelchair Applying moist heating pads to areas of discomfort Encouraging the client to remain still in bed - \The correct answers are A, B, and C.
A: The client must learn to perform self-inspections regularly to be increase awareness of desensitized areas and decrease the risk of skin breakdown. B: Pressure points, or areas where bony prominences press against skin, must be relieved or eliminated. C: Turning on a regular basis may increase the blood flow to areas that may be at risk, such as where bony prominences press against skin. D: Removing wheelchair cushioning can result in further skin breakdown. E: Moisture and heat should be avoided in sensitive areas. F: Lying still in bed increases risk of skin breakdown. A COTA® is working with the caregiver of a client with dementia who is experiencing caregiver stress. What recommendations are appropriate for the COTA to make? Select the 3 BEST choices. Recommend that the caregiver inquire about medication to reduce the caregiver's stress Recommend that the caregiver inquire about additional sleep medication for the client Recommend that the caregiver contact a local adult day care to inquire about its services Recommend that the caregiver find a teenager in the neighborhood who can watch the client Recommend that the caregiver consider journaling to encourage emotional expression Recommend that the caregiver join a support group with others having similar experiences - \The correct answers are C, E, and F. C: COTAs have a responsibility to provide caregivers with information related to local resources to reduce caregiver burden. E: Appropriate intervention includes education on strategies for successful coping. F: Caregiver training and education include resources for community support. A, B: Recommending medication for the caregiver or adjusting a medication dosage for a client is not within the occupational therapy scope of practice. D: A teenager would not be an appropriate choice as a sitter for a client with dementia. The teenager would be a unfamiliar person and would lack formal training on how to manage the client appropriately.
B: A clean, dry tile floor produces no greater risk than other surfaces. C: New or moved furniture can be a factor related to falls, but familiar furniture is not considered a risk factor. D: Vestibular dysfunction is an intrinsic factor, not an environmental factor, related to falls in the elderly. A COTA® is working with a 5-year-old with autism spectrum disorder (ASD) on developing a toileting routine. Which intervention strategies are appropriate? Select the 3 BEST choices. Using a picture checklist that depicts the routine Teaching energy conservation techniques to incorporate into the routine Showing a video that demonstrates the toileting routine Encouraging the child to invite a peer to model the routine Incorporating adaptive equipment or orthotics into the routine Modeling the routine with a toy doll - \The correct answers are A, C, and F. Visual supports, such as picture checklists, videos, and models, have been found to be effective intervention strategies for children with ASD. B: Children with ASD do not typically experience complications such as fatigue or shortness of breath that would suggest the need for energy conservation techniques. D: Although it may be appropriate for a child with ASD to watch a peer model other routines, watching a child model this routine would compromise his or her privacy. E: Children with ASD, unless they have a comorbid condition, do not usually need adaptive equipment or orthotics to complete toileting. A client with rheumatoid arthritis in the dominant hand complains of pain while stirring food on the stove. The COTA® uses fading techniques to instruct the client on how to resume cooking with less pain. Which approaches to this activity use fading? Select the 3 BEST choices. Advise the client to use the nondominant hand in all activities that aggravate the arthritis Outline the steps of the task that cause pain and problem solve solutions with the client Instruct the client in joint protection techniques, and provide opportunities to practice giving fewer cues as the client becomes more proficient with techniques Adapt the activity with lightweight built-up handles to decrease grasp strength requirements Modify the number of cues over time
Instruct the client in energy conservation techniques, such as reducing the food preparation done at one time. Provide opportunities to practice giving fewer cues as the client - \The correct answers are C, E, and F. C, E, F: Fading approaches to treatment involve reducing or eliminating support as a client's skills improve or develop. The COTA begins by providing education on joint protection (e.g., stirring with the forearm in a neutral position and without the thumb pinching) and energy conservation (e.g., purchasing precut vegetables) and then reduces the number of cues as the client performs the tasks repeatedly. A: Advising the client to use the nondominant hand changes the physical demands but may compromise coordination and safety. B: Outlining the steps of the task to problem solve solutions uses a coaching approach. D: Adapting the handles uses an activity modification approach. A COTA® is working with a client who uses a wheelchair because of a progressive condition. Which adaptations might the COTA suggest to improve client mobility within the home? Select the 3 BEST choices. Add extra height to the wheelchair cushion to allow for easy access to countertops Remove strips along doorjambs to allow greater pass through for the wheelchair Use a front-loading washer and dryer with a table nearby for folding laundry Remove carpeting and throw rugs so the wheelchair will be easier to navigate Use a long-handled reacher and dressing aid to dress more independently Install offset hinges to doorways to provide wider access from room to room - \The correct answers are B, D, and F. Removing strips along door jambs, removing carpeting and throw rugs, and installing offset hinges to doorways specifically promote wheelchair mobility within the home. A: Adding extra height to the wheelchair cushion would improve access for meal preparation and cleanup but would not address mobility. C: A front-loading washer and dryer and a table for folding laundry would improve home management activities but would not address mobility. E: A long-handled reacher and dressing aid would improve dressing activities but would not address mobility. A child in elementary school has difficulty attending to homework tasks because of symptoms associated with attention deficit hyperactivity disorder. The parents want recommendations for improving their child's on-task behavior. Which recommendations
B: Modification of the community mobility context to match a client's abilities, such as the use of adaptive equipment to assist transfers into and out of vehicles whether a driver or passenger, is within the scope of a generalist occupational therapy practitioner. C: Making transportation resources or information available to clients is pertinent to every practice setting and does not require specialized training or certification. E: COTAs without specialty credentials in driver rehabilitation refer clients to certified driving rehabilitation specialists as appropriate. A: Conducting on-road driving evaluations requires specialized training. D: Direct assistance to transportation users is not within the scope of practice of many practice settings. F: Providing rides to and from therapy sessions is not acceptable within most practice settings. A young adult client with complete C5-C6 quadriplegia from a spinal cord injury is being discharged from inpatient rehabilitation to the family home in a rural area. Which community mobility interventions would be relevant to this client? Select the 3 BEST choices. Teaching the client to drive an automobile using hand controls Educating the client on use of the wheelchair to access a subway system Providing training for the family and client on how to safely transfer and secure the client and wheelchair in the family vehicle Working collaboratively with the client to read and understand a bus schedule Educating the client and family in alternative resources such as paratransit and supplemental transit options that serve their area Providing resources for driver rehabilitation services, including vehicle adaptations and adaptive driver assessments - \The correct answers are C, E, and F. C: AOTA's (2016) statement Driving and Community Mobility states that occupational therapy's role in addressing community mobility includes addressing passenger safety such as securing passengers and wheelchairs. E: Education regarding available public and supplemental transport services is within scope of occupational therapy practice. F: Referral to a driver rehabilitation specialist is appropriate to address the future community mobility needs and considerations of the client and family. A: Behind-the-wheel driver training requires referral to a certified driving rehabilitation specialist and is not within the scope of practice of the COTA.
B, D: An occupational profile should include consideration of community mobility relevant to the client and the client's context. Because the client lives in a rural area, education on use of bus and subway systems is not appropriate to the client's context. A COTA® working in an outpatient psychiatric setting has been meeting monthly with a closed-membership group of people with depression to promote socialization. Up to this point, the group has been functioning as a parallel group, but the participants are ready to progress to the next level, a cooperative group. Which activities would be appropriate to facilitate this transition? Select the 3 BEST choices. Organize making a quilted wall hanging for the reception area to which each participant contributes a square Design a music playlist for the next group meeting that includes the music interests expressed by each group member Have participants plant seeds in ceramic pots that they decorate themselves Distribute journals in which participants write their own poetry collection Have participants plan a dinner to which each participant contributes a dish Appoint a leader to organize a sale of baked goods that the parti - \The correct answers are A, B, and E. A, B, E: The group can progress from a parallel to a cooperative group by taking an already mastered skill, such as making a quilt square, selecting favorite music, or cooking a dish, and adding the component of coordination and cooperation. To make quilted wall hanging, design a playlist, or plan a dinner, participants still work on their own, but they need to interact with one another to complete the activity using each participant's contribution. C: Decorating one's own pot and planting seeds in it are parallel group activities. D: Writing poetry in a journal instead of as a group is a parallel activity that would fail to advance the participants' social skills. F: Going from parallel group activities to planning and organizing a bake sale is a huge leap, not a logical next step. A COTA® is working on laundry tasks with a client with hemiplegia. Folding the laundry proves too difficult because of the weaker extremity, and the client becomes increasingly frustrated. Which intervention strategies can the COTA use to modify the activity? Select the 3 BEST choices. Partially fold a piece of laundry and then allow the client to finish folding the item Stop the task and move on to the next planned activity Instruct the client to sort the laundry using both hands together Engage in appropriate therapeutic use of self to address the client's frustration Require that the client fold half the number of items originally planned
C: Rolling chairs in the kitchen are not likely to be a concern because they are easily moved out of the client's way. The client's visual acuity is 20/200 in both eyes. The vision cannot be corrected using medical or surgical interventions or with the use of eyeglasses. How would the client's vision be described? Select the 3 BEST choices. Presbyopia Some useable vision Normal vision Legal blindness Profound low vision Low vision - \The correct answers are B, D, and F. B, D, F: Acuity of 20/200 qualifies this client as legally blind, with some useable vision; however, the vision loss is significant enough that it affects occupational performance. Vision that cannot be corrected by medical or surgical intervention or with the use of eyeglasses is a defining feature of low vision. A: Presbyopia is a normal age-related change that results in difficulty focusing on objects at a near distance. Bifocals or reading glasses are often prescribed for presbyopia. C: Normal vision is defined as 20/12 to 20/25 visual acuity. The visual acuity of 20/ is outside the normal range. E: Profound low vision is defined as 20/500 to 20/1000 visual acuity. A COTA® is working with a client with a peripheral nerve injury affecting sensation in the hand. The client is a chef and is eager to return to work but has diminished protective sensation. What recommendations fit this client's intervention plan? Select the 3 BEST choices. Cook foods without visually observing the hand to improve efficiency Use equipment with soft, textured grips to maximize gross grasp and in-hand manipulation during kitchen tasks Protect the affected hand from exposure to sharp items Avoid using sharp tools to prevent injury to the affected hand Use built-up handles to distribute gripping pressure Protect the affected hand from exposure to cold and heat sources - \The correct answers are C, E, and F. C: The client may be educated about specialized steel mesh gloves that can be worn to protect the insensate hand during cutting tasks.
E: Enlarged handles would more evenly distribute grip forces for better control of kitchen tools during use and reduce the likelihood of blisters. F: Client education for diminished protective sensation includes information about avoiding extreme temperatures and testing temperature with the affected hand. A: Cooking without visual compensation to monitor the sensory-impaired hand can result in cuts and burns. B: Use of equipment with soft, textured grips can prevent further nerve compression, but this recommendation does not address protecting the affected hand secondary to sensory loss. D: The client is a chef and therefore unable to avoid exposure to knives. A COTA® is treating a client who sustained second- and third-degree burns on the dorsal forearm and hand. Which intervention techniques would be appropriate for this client? Select the 3 BEST choices. Volar resting hand splint Volar intrinsic plus splint PROM of hand into a fist, then extension of all finger joints PROM of hand with each joint isolated For positioning in supine, hand above elbow and elbow above heart For positioning in supine, hand level with elbow and elbow level with heart - \The correct answers are B, D, and E. B: Burns to the dorsum of the hand require the metacarpophalangeal joints to be splinted in 70°-90° of flexion to prevent clawing of the fingers and shortening of the tendons and ligaments. This type of splint is also referred to as an antideformity, safe position, or intrinsic plus splint. D: With burns on the dorsal surface of the hand, the extensor tendons are at risk for rupture. The hand needs to receive PROM with each joint ranged individually to prevent extensor tendon rupture. E: The hand is positioned above the elbow and the elbow is positioned above the heart to decrease edema when the client is supine. A: A resting hand splint provides support or immobilization but does not elongate the collateral ligaments of the fingers and can result in the fingers clawing after dorsal burns. C: When ranging the dorsally burned hand as a unit, extensor tendons are at risk of rupture.
Complete multiple transfers in the client's hospital room throughout the day - \The correct answers are A, B, and E. A: The "goal, plan, do, check" approach is a cognitive strategy from the CO-OP (Cognitive Orientation to daily Occupational Performance) program that can be used to promote ability to complete tasks such as transfers. B: Generalization involves the ability to use skills and complete tasks in different contexts. Transfers should be practiced in varied contexts to help generalize performance to the home environment. E: Use of memory strategies is one means to train the client to use existing cognitive skills to complete transfers. C: Visual feedback may promote improvement in sitting balance during toileting, but these skills may not carry over to transfers. D: Bridging may be necessary to increase strength for transfers but will not build skills in transfers, which need to be practiced in context. F: Completing transfers in the same context does not support varied practice and will not lead to skill generalization. A COTA® is working with a client who has an L2 spinal cord injury. What clinical signs relative to the injury level is the COTA likely to find 1-2 months postinjury? Select the 3 BEST choices. Lower-extremity muscles are spastic. Muscles are spastic relative to the level of injury. Sympathetic functions are hypoactive. Muscles are flaccid throughout innervation. Senses are elevated throughout the body. Sacral segments are spastic below the level of injury. - \The correct answers are A, B, and F. A, B, F: Muscles below the level of injury generally develop spasticity because the monosynaptic reflex arc is intact but separated from higher inhibitory influences. C: Sympathetic functions below the level of injury are hyperactive. D: Although muscles may initially be flaccid for a short period of spinal shock, spasticity regularly develops below the injury. E: Sensory loss below the level of injury is common. Whether the injury is complete or incomplete determines the degree to which sensory impairment or absence occurs.
A client with breast cancer had surgery including removal of the lymph nodes of the dominant upper extremity. The client was referred to outpatient occupational therapy for ROM, lymphedema management, and education to prevent infection and further lymphedema. Which educational and adjunctive intervention strategies are indicated for the affected upper extremity before the client engages in purposeful and occupational activities? Select the 3 BEST choices. Gradient compression garments Transcutaneous electrical nerve stimulation Resistive shoulder exercises Manual decongestive therapy Referral for antibiotics for cellulitis Education to avoid bug bites and burns to the affected extremity - \The correct answers are A, D, and F. A: Gradient compression garments such as stockings and sleeves may be useful in providing limb support, which promotes edema reduction. D: Manual decongestive therapy targets the pathways of the lymph and promotes edema reduction. F: Education in skin and wound precautions can prevent further infection and lymphedema. B: Use of modalities may exacerbate edema conditions and are generally contraindicated in clients with cancer. C: Resistive shoulder exercises may increase arm edema. Gentle AROM of the upper extremity is preferred. E: Antibiotic management is outside the occupational therapy scope of practice. A client with osteoarthritis is independent with ADLs using compensatory strategies. The client wants to participate in a fitness program at a community wellness center. Which activities would be beneficial to recommend for this client? Select the 3 BEST choices. Progressive resistive weight activity Low-resistance circuit program Step aerobics and stretching class Water aerobics exercise group Stationary bike use Isometric exercises in a small group - \The correct answers are D, E, and F. D: Water-based exercises allow for low-impact ROM.
B: Changing a patient's diet is outside the scope of occupational therapy practice. C: Dysphagia can occur at any stage of the disease progression. When dysphagia is suspected, the COTA must proceed with caution related to eating until qualified professionals can evaluate the patient. F: 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. However, the dysphagia is a more pressing issue at this time as it has considerable safety concerns. A COTA® is working on feeding with a child who presents with limited neck extension during cup drinking. What feeding equipment would be appropriate to introduce to this client? Select the 3 BEST choices. Drinking cup with handles Spouted sippy cup Nose cutout cup Cup with a straw Dysphagia cup Juice box - \The correct answers are C, D, and F. C: A nose cutout cup is made of flexible plastic, and a portion of the cup is cut out so the client's nose fits inside the cup rather than bumps into the outside of it. This type of cup is appropriate for a client with limited neck extension because it does not require tipping the head back to take a drink. D: The client could draw liquid up through a straw, which would reduce the need to tip the head back. F: A juice box has a straw allowing the client to draw liquid in without tipping the head back. The COTA could also squeeze the juice box as needed to facilitate drawing up the liquid. A: A drinking cup with handles helps a client grasp the cup but does not address limited neck extension. B: A spouted sippy cup is appropriate to help a client pace the flow of liquid but does not address limited neck extension. E: A dysphagia cup is appropriate to help a client who needs to use a chin tuck to facilitate swallowing; it is not appropriate to promote neck extension. A COTA® is working with a child with visual figure ground difficulties. Which interventions are appropriate? Select the 3 BEST choices.
Giving directional cues Teaching a visual search strategy Using a color-coding system Providing a checklist Locating a specific toy in a toy box Identifying a shirt sleeve on a solid colored shirt - \The correct answers are B, E, and F. B, E, F: Figure ground perception is the ability to distinguish the foreground from the background. Teaching a visual search strategy is appropriate for clients with visual figure ground difficulties. Practicing the ability to separate essential information from distracting information, as in the case of a toy in a toy box and a sleeve on a shirt, help train this skill. A: 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 but will not help a client with visual figure ground difficulties. D: Providing a checklist is appropriate for clients who have difficulty following directions or sequencing tasks but will not help a client with visual figure ground difficulties. A client with autism spectrum disorder (ASD) is interested in learning how to use the bus and subway. What symptoms of this diagnosis may result in challenges when using public transportation? Select the 3 BEST choices. Motor impairments may make it difficult to board and exit public transportation. Impaired executive functioning may result in misjudging when to get on or off a bus. Sensory-perceptual processing may result in being overwhelmed when attempting to process the sights, movement, sounds, and smells related to public transportation use. Emotional dysregulation may make it difficult for a person to respond successfully in unexpected situations such as a no-show, late ride, or detour in route. Money management skills are needed for handling money and paying fares. Deficits in social interactions may make it difficult to use public transportation. - \The correct answers are B, C, and D. B: Executive function deficits are a common symptom of ASD and may result in impaired judgment. C: The sensory environment encountered when using public transportation is variable and difficult to control, resulting in a potentially uncomfortable level of anticipation and sensory input for a client with ASD.
A COTA® is providing occupational therapy services to a client in acute care diagnosed with a pulmonary embolism. What possible causes of a pulmonary embolism might this client be experiencing? Select the 3 BEST choices. Pulmonary hypertension Deep vein thrombosis Pulmonary edema Heart failure Lung cancer Obesity - \The correct answers are B, D, and F. B: 90% of pulmonary embolisms are caused by a deep vein thrombosis in a lower extremity. D, F: Heart failure and obesity are risk factors for pulmonary embolism. A, C, D: Clients with pulmonary hypertension, pulmonary edema, and lung cancer are not at high risk for a pulmonary embolism. A client with dementia was provided with an ultra lightweight wheelchair. The client has stood up impulsively and fallen several times. What components would the OTR®- COTA® team consider to improve the client's safety while using the wheelchair? Select the 3 BEST choices. Anti-tippers Flip-up footrests Reclined seat Inclined seat Push handles Axle placement - \The correct answers are A, D, and F. A: Anti-tippers prevent the client from tipping backward in the chair and falling. D: The inclined seat hinders the client from impulsively falling out of the chair. Wheel lock extenders would be recommended because the tilt of the seat will make it difficult for the client to access the wheel locks. F: Moving the client's center of gravity behind the axle and tilting the inclined seat posteriorly can prevent the client from impulsively getting up. B, C, E: Flip-up footrests, reclined seat, and push handles will have no impact on the client's safety while using the wheelchair because they do not prevent the client from getting out of the chair.
A COTA® is working with a client who is unable to drive. The COTA is educating the client on the benefits of a fixed transit system in comparison with a paratransit system. What are advantages of a fixed transit system? Select the 3 BEST choices. Fixed transit is more economical than paratransit. Fixed transit offers more autonomy than paratransit. Fixed transit offers more flexibility than paratransit. Fixed transit rides may be customized for the rider's disability. Fixed transit offers door-to-door service. Fixed transit requires less cognitive training than paratransit. - \The correct answers are A, B, and C. A: Fixed transit systems cost less than paratransit systems because they use general, publicly scheduled routes rather than providing individualized service. B, C: The rider may choose from a variety of times and routes to get to the destination rather than a time designated by the paratransit driver. D: Paratransit eligibility is based on disability; therefore, specific accommodations may be made for the rider. E: Paratransit offers door-to-door or curb-to-curb service. F: Paratransit requires less cognitive ability than fixed transit because the driver may provide assistance. The rider does not need to manage routes, money, or route transfers. A COTA® is facilitating a task-oriented group with five group members and observes that the group is in the storming phase of group development. Which characteristics are typical of the storming phase of group development? Select the 3 BEST choices. The group is now running smoothly and handles problems efficiently after two participants worked out their differences early on. The group is meeting for the first time, and participants are asking the group leader for help because they do not understand the task at hand. A participant who has recently joined the group disagrees with everything another participant says, and a third participant questions whether accomplishing the task is even possible. The group leader is exhausted by all the questions about the details of the finished product. No one seems to want to work together, and the participants seem to expect the leader to solve this problem. Two group members di - \The correct answers are C, E, and F.
