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NBCOT PRACTICE 2026 PRACTICE QUESTION
SET TWO
◉ In the assessment phase of early intervention, an OT assesses the daily living skills of an infant. In the context of early intervention, the areas that are being assessed are: A. Feeding and sleeping patterns B. Play and leisure patterns C. Motor development patterns D. Sensory development patterns. Answer: A. Daily living skills in infants refer to self-sustaining skills, such as feeding and sleeping. Sleep patterns can be evaluated from the parent's description of a typical day. Daily living skills also refer to bathing and dressing, but this is as it involves the parents. (Pediatric Occupational Therapy and Early Intervention by Case-Smith) ◉ An assessment team in early intervention has completed an evaluation of a toddler. In compiling the Individualized Family Service Plan, the goals should be determined by the: A. Service coordinator for the case B. Therapists from each discipline C. Reimbursing agency D. Parents. Answer: D. Although therapists suggest goals based on the evaluation process, ultimately a child's parents decide which
goals will be included and which goals are a priority. Goals that relate specifically to the family's concerns about the care of their child are included in the plan. If therapists have other goals, these can be added with parental consent. (Pediatric Occupational Therapy and Early Intervention by Case-Smith) ◉ In early intervention there are different types of risk factors. A child with Down syndrome is an example of: A. Biological risk B. Environmental risk C. Established risk D. Recurring risk. Answer: C. Children with known chromosomal, structural, or metabolic defects are classified as having established risk. (Pediatric Occupational Therapy and Early Intervention by Case-Smith) ◉ The parent of a child that is being treated in therapy describes how the child covers their ears when riding in the car with the windows down. The parent does not understand why the child persists in this behavior. The OT explains that this behavior could be the result of: A. Sensory defensiveness B. Gravitational insecurity C. Underresponsiveness
such as peripheral neuropathies. Therefore, a sensory evaluation is necessary to determine if sensation is diminished. A person with diminished sensation secondary to peripheral neuropathy may not be able to perceive or gauge pressure when wearing a splint. This can lead to skin breakdown. (Introduction to Splinting: A Clinical Reasoning & Problem Solving Process by Coppard and Lohman) ◉ An OT is asked to administer a test to a child and compare the assessment results or scores to the sample population of children that have similar characteristics as this child. The BEST type of evaluation to administer would be: A. Criterion-referenced test B. Norm-referenced test C. Skilled observation D. Checklist. Answer: B. A norm-referenced test is developed by giving the test in question to a large number of children, usually several hundred or more. This group is the more normative group and norms or averages are derived from this sample. When a norm- referenced test is administered, the performance of the child being tested is compared to the normative sample. (Occupational Therapy for Children by Case-Smith) ◉ During an evaluation, the OT must determine a child's exact chronological age. The child was born on March 6, 2003 and the testing date is July 12, 2006. The child's chronological age is: A. 4 years, 6 months, 5 days
B. 3 years, 2 months, 6 days C. 4 years, 5 months, 6 days D. 3 years, 4 months, 6 days. Answer: D. The day, month, and year of the child's birth date is subtracted from the date of testing. (Occupational Therapy for Children by Case-Smith) ◉ An OT has to calculate the corrected age for a child that was born prematurely. The child had a due date of September 20, 2005 and their birth date was June 12, 2005. The child was born 3 months, 8 days premature and is currently 1 year, 1 month, 25 days old. The therapist determines the corrected age is: A. 10 months, 17 days B. 12 months, 2 days C. 9 months, 8 days D. 7 months, 10 days. Answer: A. Corrected age is used for children who were born prematurely to "correct" for the number of weeks they were born before the due date. Generally the age is corrected until the child turns 2 years old. Many practitioners consider 36 to 37 weeks and above to be full-term gestation. Children with a gestation period of 36 weeks and above do not receive a corrected age. Subtract the birth date from the due date to yield the exact measurement of prematurity, and to calculate the corrected age, subtract the amount of prematurity from the chronological age. (Occupational Therapy for Children by Case-Smith)
C. Self-identity versus role diffusion stage D. Security versus instability. Answer: B. This stage is characterized by holding on and letting go and is exemplified by the crisis that occurs through the toilet-training process. This stage brings independent movement away from the parents, enabling the child to explore the environment. Parents must provide opportunities for the child to make choices and develop a sense of self-controlled will. (Occupational Therapy for Children by Case-Smith) ◉ Which one of the four components of the adaptation process pertains to reception of sensory stimuli from internal and external environments? A. Assimilation B. Accommodation C. Association D. Differentiation. Answer: A. Assimilation is the reception of sensory stimuli from internal and external environments. Accommodation is the motor response to these stimuli. Association is the organized process of relating current sensory information with the current motor response and then relating this relationship to past responses. Differentiation is the process of identifying the specific elements in a situation that are useful and relevant to another situation to refine the responsive pattern. (Occupational Therapy for Children by Case-Smith)
◉ A 4-year-old has been diagnosed with mental retardation. A characteristic that is likely to occur with impaired intellectual ability is: A. Acceptable social skills B. Impairment of occupational performance areas C. Development of bizarre attachment to unusual objects D. Poor eye contact. Answer: B. A child diagnosed with mental retardation will show significantly impaired intellectual ability, behavioral deficits, and impairmnet of the skills required for independence in occupational performance areas (i.e., age- appropriate play, dressing, and communication). (Occupational Therapy for Children by Case-Smith) ◉ A 3-year-old has accidentally ingested lead while playing near ceramic tiles that the family bought to renovate their house. A system that an OT working in pediatric acute care would note to be affected by lead poisoning would be: A. Vocal B. Circulatory C. Digestive D. Cardiac. Answer: B. In lead poisoning, lead affects the circulatory system by severely limiting the body's ability to synthesize heme, leading to the accumulation of alternate metabolites in the body and, ultimately, anemia. The most significant and irreversible damage occurs in the nervous system. Fluid builds up in the brain, and intracranial pressure can reach life-threatening levels. Cortical
D. Neurochemical imbalances. Answer: D. Although researchers are still struggling to find conclusive evidence for the etiology of ADHD, studies have demonstrated that ADHD runs in families and three genes have been found to be related to ADHD implicating genetic factors. Imaging in individuals with ADHD has shown decreased activity in the frontal parietal lobes, which inhibit impulsiveness, pointing to neurologic factors. Medications that influence neurotransmitter function are effective in treatment of ADHD, indicating neurochemical imbalances. (Occupational Therapy for Children by Case-Smith) ◉ A 5-year-old child has been diagnosed with a pervasive disorder that affects both the neurologic and motor behavioral functions. The diagnosis that MOST closely relates to the child's condition is: A. Respiratory distress syndrome B. Tourette's syndrome C. Asperger's syndrome D. Learning disabilities. Answer: B. Tourette's syndrome is a pervasive disorder that affects neurologic and motor behavioral function, especially motor tics and vocalizations. Therefore, it is likely that the child has Tourette's syndrome. (Occupational Therapy for Children by Case-Smith) ◉ A 5-year-old child with Down syndrome shows significant loss of weight, high fever, and paleness, and is diagnosed with acute lymphoid leukemia. In which of the following phases of leukemia
will he be administered chemotherapy to treat small deposits of cells that remain after remission? A. Phase I - Induction therapy B. Phase II - Central nervous system prophylaxis C. Phase III - Intensification and consolidation D. Phase IV - Maintenance or continuation therapy. Answer: C. Chemotherapy is administered in Phase III - the intensification and consolidation phase- to remove small deposits of cells that remain after remission. (Occupational Therapy for Children by Case-Smith) ◉ A 5-year-old child presents with difficulty climbing stairs, rising from a sitting or lying position, and demonstrates progressive fatigue caused by muscle weakness. The OT might suspect a problem with: A. Duchenne's muscular dystrophy B. Limb-girdle muscular dystrophy C. Facioscapulohumeral muscular dystrophy D. A congenital muscular dystrophy. Answer: A. Duchenne's muscular dystrophy is an X-linked recessive disorder caused by the deficiency in the production of dystrophin. Dystrophin is a component of the plasma membrane of the muscle fibers, the deficiency of which causes the muscle to degenerate and malfunction. The calf muscles are enlarged because of fibrosis and proliferation of the adipose tissue, which causes muscle weakness. Therefore, the child's condition could be diagnosed as Duchenne's
qualified to address deficits related to swallowing or dysphagia, chewing, and drooling. (Occupational Therapy for Children by Case- Smith) ◉ A kindergarten teacher observed that a 5-year-old child does not participate in play with other children and avoids movement activities on the playground. A screening test you would recommend for this child to determine if there is a need for a more comprehensive examination is: A. Ages & Stages Questionnaires B. The First STEP C. Short Sensory Profile D. Denver Developmental Screening Test-II (Denver-II). Answer: C. The teacher has already identified the child as being at risk for developmental or functional deficits. Therefore, it is appropriate to use a type II assessment, which is the Short Sensory Profile. This caregiver questionnaire measures the frequency of behaviors related to sensory processing, modulation, and emotional responsivity to sensory input in children 3 to 12 years of age. The Ages & Stages Questionnaires, First STEP, and the Denver-II pertain to the early screening to identify children at risk for disabilities. (Occupational Therapy for Children by Case-Smith) ◉ A scenario in which an OT would use the School Function Assessment examination is:
A. To measure the student's schoolwork task performance in the classroom and provide information for effective programs and consultation in the school setting B. To assess what the child "did do" and what the child "could do" to help determine the effect of the child's physical disability on engagement in everyday occupations C. For screening children to determine whether they warrant further, more comprehensive evaluation D. To measure children's ability to participate in the academic and social aspects of the school environment. Answer: D. The School Function Assessment is a judgment-based questionnaire designed to measure a student's performance of functional tasks that support his or her participation in the academic and social aspects of an elementary school program (kindergarten through grade 6). Three scales evaluate the student's level of participation, the type and amount of task supports needed, and his or her activity performance on specific school tasks. (Occupational Therapy for Children by Case- Smith) ◉ An occupational therapy assistant (OTA) works with an OT in an early intervention program at a local school. The portion of the evaluation that the OT can assign the OTA to perform is: A. Selecting evaluation methods and measures B. Interpreting and analyzing assessment data C. Administering some of the assessments
◉ Neck righting (NOB). Answer: infant in supine and turn head to one side, infant log rolls entire body integration:5 years ◉ body on body righting (BOB). Answer: infant in supine flex on hip and knee toward chest ,infant segmentally rolls upper trunk to maintain alignment integration:5 years ◉ primitive squeeze grasp. Answer: 4 mos ◉ palmar grasp. Answer: 5 mos ◉ radial palmar grasp. Answer: 6 mos ◉ radial digital grasp. Answer: 8 mos ◉ palmar supinate grasp. Answer: 1-1/2 years writing tool held with fisted hand, wrist flexed and supinated ◉ digital pronate grasp. Answer: 2-3 years, tool held with fingers, wrist in neutral with slight ulnar deviation and forearm pronated
◉ static tripod. Answer: 31/2-4 years. tool held with crude approximation of the thumb, index and middle fingers, ring and little finger slightly flexed, grasped proximally ◉ dynamic tripod. Answer: 4.5 - 6 year olds: Tool held with precise opposition of distal phalanges of thumb index and middle fingers, ring and little finger flexed to form a stable arch, wrist slightly extended ◉ glaucoma. Answer: loss of peripheral vision ◉ macular degeneration. Answer: loss of central vision ◉ Kleinert protocol. Answer: passive flexion/active extension dorsal block splint 0-4 weeks continue splint adjust wrist to neutral tendon gliding light occupation based activities d/c splint 6- 8 weeks strength and work/leisure 8-12 weeks ◉ Duran protocol. Answer: passive flexion and extension ◉ Glascow coma scale. Answer: Severe < Moderate 9- 12
◉ feeding 9 mos. Answer: lateral tongue movements make mastication effective. drink from cup but jaw not firm ◉ feeding 9 mos. Answer: finger feeds self meals ◉ feeding 12 mos. Answer: dips spoon in twists spoon on way to mouth ◉ feeding 12 mos. Answer: jaw firm, rotary chewing ◉ feeding 15 mos. Answer: scoops food with spoon and brings to mouth ◉ feeding 24 mos. Answer: able to chew most meats and raw vegetables ◉ Rancho level I. Answer: no response, total assistance ◉ rancho level II. Answer: generalized response, total assist responds to painful, repeated auditory, external stimuli. response inconsistent
◉ rancho level III. Answer: localized response, total assist withdraw from painful, turns for auditory, blinks w strong light. inconsistent response to simple verbal commands. response related to stimulus. ◉ rancho level IV. Answer: confused agitated, max assist alert, heightened activity. mood swings, incoherent verbalizations, aggressive behavior, absent short term memory ◉ rancho level V. Answer: confused, inappropriate non agitated, max assist not oriented to person place or time, non-purposeful sustained attn, unable to learn new info, may be able to perform learned tasks ◉ rancho level VI. Answer: confused, appropriate mod assist inconsistently oriented x3, attend to highly familiar tasks up to 30 min w mod A, assistive memory aide, emerging awareness of appropriate response, unaware of impairments ◉ rancho level VII. Answer: automatic, appropriate min assist for ADLs consistently oriented p, p, mod A for time, attend to highly familiar task w min A for 30 min, min sup for new learning w carryover, initiates ADLs can monitor accuracy, overestimates abilities, oppositional/uncooperative
