Ace NBCOT Exam: Neurologic
Impairments Prep.
An OTR® has received evaluation orders for a client who recently experienced
traumatic brain injury. The COTA® will be treating the client after the evaluation is
completed. The client displays severe memory impairment and can only respond to
simple commands without being distracted. What Rancho Los Amigos level BEST
corresponds with the client's behavior?
A. VII
B. III
C. V
D. II -
\C. V
Orthostatic hypotension is a common complication of spinal cord injury (SCI). What
should the COTA®do for the client when it occurs?
A. Sit the client up.
B. Lean the client back.
C. Call the nurse.
D. Nothing; the client is not at risk -
\B. Lean the client back.
A client with T1 spinal cord injury exhibits headache, sweating, congestion,
hypertension, and bradycardia. What is the client MOST likely experiencing?
A. Spasticity
B. Autonomic dysreflexia
C. Orthostatic hypotension
D. Hypertonia -
\B. Autonomic dysreflexia
A COTA® is treating a client who has had a CVA. During the session, the COTA®
notices the client is having trouble communicating through speech. Which of the
following disorders BEST describes what the COTA® is observing?
A. Apraxia
B. Aphasia
C. Paresis
D. Hemiplegia -
\B. Aphasia
An inpatient who has hemiplegia and unilateral neglect is progressing toward
documented ADL goals but continues to have poor balance and requires verbal cuing
during self-care. The case manager informs the COTA® that the insurance company
has not authorized continued therapy and the patient will be discharged in 2 days to live
,at home with family. In addition to informing the OTR® about the patient's discharge,
which task should the COTA® complete NEXT?
A. Determine family and caregiver training needs
B. Provide the patient with a written home program
C. Modify the patient goals to reflect the discharge date
D. Schedule the patient for outpatient occupational therapy services -
\A. Determine family and caregiver training needs
For a client with an L2 spinal cord injury, which statement BEST describes the muscle
segments below the injury level 1 to 2 months postinjury?
A. Senses are elevated.
B. Muscles are spastic.
C. Sympathetic functions are hypoactive.
D. Muscles are flaccid. -
\B. Muscles are spastic.
A COTA® is working with a client in the active phase of C8 spinal cord injury. What is
the BEST method of preventing heterotopic ossification in the client?
A. Low-load prolonged stretch
B. Maintenance of joint ROM
C. High-low limited stretch
D. Application of leg wraps -
\B. Maintenance of joint ROM
An inpatient is functioning at Level IV (confused-agitated) on the Rancho Los Amigos
scale after sustaining a TBI 2 weeks ago. What method should be used to get the
patient's attention at the start of a session at bedside?
A. Pass a strong-smelling substance back and forth under the patient's nose
B. Firmly rub along the patient's sternum until the patient responds
C. State the patient's name in a calm voice and establish direct eye contact
D. Hold the patient by the chin so the patient cannot look away -
\C. State the patient's name in a calm voice and establish direct eye contact
A COTA® is preparing to discharge a client with a complete L2 spinal cord injury who is
planning to go home. Which IADLs would the client likely need assistance with?
A. Financial management
B. Meal preparation
C. Use of technology
D. Home maintenance -
\D. Home maintenance
A COTA® is educating a client with C7 spinal cord injury to use tenodesis grasp.
What is an appropriate explanation to the client of how tenodesis works?
A. To hold on to an item, bring the wrist back, which opens the fingers.
B. Drop the wrist down to activate the grasp and hold on to an item.
C. Press one hand against the other to flex the fingers.
, D. Bring the wrist back, and the fingers will grasp to hold on to an item. -
\D. Bring the wrist back, and the fingers will grasp to hold on to an item.
A client who has a T2 spinal cord injury is learning to independently transfer to a variety
of surfaces. Which type of transfer is BEST for this client to use when transferring from
a wheelchair to a car?
A. Sliding board
B. Stand-step
C. Stand-pivot
D. Bent-pivot -
\A. Sliding board
A client with traumatic brain injury is at Rancho Level IV (i.e., confusion with agitation).
The client is demonstrating the ability to use mental repetition with cues from the
COTA® during basic self-care routines. The COTA wants the client to be less
reliant on the verbal cues and able to self-monitor performance during the tasks. What
strategy is appropriate for the COTA to use?
A. Have the client estimate and report the difficulty of a task before completing it
B. Provide the client with a verbal description of the client's task performance
C. Organize increasingly complex self-care routines by providing highly structured
practice
D. Give consistent, reliable tactile cues throughout self-care completion -
\A. Have the client estimate and report the difficulty of a task before completing it
A client with T5 spinal cord injury is having difficulty with lateral trunk flexion, which is
limiting independent transfers. The client is returning to work as a banker and will be
spending 4 to 6 hours continuously in a wheelchair. Which activity intervention should
the COTA® consider FIRST?
A. Have the client move in diagonal patterns of movement over a therapy ball
B. Provide verbal cues for the client to realign the trunk during tasks
C. Place objects on the floor that the client has to reach for
D. Have the client practice weight shifting in the wheelchair for pressure relief -
\D. Have the client practice weight shifting in the wheelchair for pressure relief
The upper-extremity movements of a client with traumatic brain injury (TBI) are
exaggerated, and the client consistently overreaches or underreaches for an item, such
as during a feeding activity. How can the COTA address the impact of this condition?
Select the 3 BEST choices.
A. Allow the ataxic limb to move freely
B. Provide a weighted-vest for mealtime
C. Grasping a solid surface for stability
D. Provide wrist weights for stabilization
E. Apply resistance to reduce exaggerated movements
F. Weight utensils to reduce the effects of movements -
\C. Grasping a solid surface for stability
E. Apply resistance to reduce exaggerated movements
Impairments Prep.
An OTR® has received evaluation orders for a client who recently experienced
traumatic brain injury. The COTA® will be treating the client after the evaluation is
completed. The client displays severe memory impairment and can only respond to
simple commands without being distracted. What Rancho Los Amigos level BEST
corresponds with the client's behavior?
A. VII
B. III
C. V
D. II -
\C. V
Orthostatic hypotension is a common complication of spinal cord injury (SCI). What
should the COTA®do for the client when it occurs?
A. Sit the client up.
B. Lean the client back.
C. Call the nurse.
D. Nothing; the client is not at risk -
\B. Lean the client back.
A client with T1 spinal cord injury exhibits headache, sweating, congestion,
hypertension, and bradycardia. What is the client MOST likely experiencing?
A. Spasticity
B. Autonomic dysreflexia
C. Orthostatic hypotension
D. Hypertonia -
\B. Autonomic dysreflexia
A COTA® is treating a client who has had a CVA. During the session, the COTA®
notices the client is having trouble communicating through speech. Which of the
following disorders BEST describes what the COTA® is observing?
A. Apraxia
B. Aphasia
C. Paresis
D. Hemiplegia -
\B. Aphasia
An inpatient who has hemiplegia and unilateral neglect is progressing toward
documented ADL goals but continues to have poor balance and requires verbal cuing
during self-care. The case manager informs the COTA® that the insurance company
has not authorized continued therapy and the patient will be discharged in 2 days to live
,at home with family. In addition to informing the OTR® about the patient's discharge,
which task should the COTA® complete NEXT?
A. Determine family and caregiver training needs
B. Provide the patient with a written home program
C. Modify the patient goals to reflect the discharge date
D. Schedule the patient for outpatient occupational therapy services -
\A. Determine family and caregiver training needs
For a client with an L2 spinal cord injury, which statement BEST describes the muscle
segments below the injury level 1 to 2 months postinjury?
A. Senses are elevated.
B. Muscles are spastic.
C. Sympathetic functions are hypoactive.
D. Muscles are flaccid. -
\B. Muscles are spastic.
A COTA® is working with a client in the active phase of C8 spinal cord injury. What is
the BEST method of preventing heterotopic ossification in the client?
A. Low-load prolonged stretch
B. Maintenance of joint ROM
C. High-low limited stretch
D. Application of leg wraps -
\B. Maintenance of joint ROM
An inpatient is functioning at Level IV (confused-agitated) on the Rancho Los Amigos
scale after sustaining a TBI 2 weeks ago. What method should be used to get the
patient's attention at the start of a session at bedside?
A. Pass a strong-smelling substance back and forth under the patient's nose
B. Firmly rub along the patient's sternum until the patient responds
C. State the patient's name in a calm voice and establish direct eye contact
D. Hold the patient by the chin so the patient cannot look away -
\C. State the patient's name in a calm voice and establish direct eye contact
A COTA® is preparing to discharge a client with a complete L2 spinal cord injury who is
planning to go home. Which IADLs would the client likely need assistance with?
A. Financial management
B. Meal preparation
C. Use of technology
D. Home maintenance -
\D. Home maintenance
A COTA® is educating a client with C7 spinal cord injury to use tenodesis grasp.
What is an appropriate explanation to the client of how tenodesis works?
A. To hold on to an item, bring the wrist back, which opens the fingers.
B. Drop the wrist down to activate the grasp and hold on to an item.
C. Press one hand against the other to flex the fingers.
, D. Bring the wrist back, and the fingers will grasp to hold on to an item. -
\D. Bring the wrist back, and the fingers will grasp to hold on to an item.
A client who has a T2 spinal cord injury is learning to independently transfer to a variety
of surfaces. Which type of transfer is BEST for this client to use when transferring from
a wheelchair to a car?
A. Sliding board
B. Stand-step
C. Stand-pivot
D. Bent-pivot -
\A. Sliding board
A client with traumatic brain injury is at Rancho Level IV (i.e., confusion with agitation).
The client is demonstrating the ability to use mental repetition with cues from the
COTA® during basic self-care routines. The COTA wants the client to be less
reliant on the verbal cues and able to self-monitor performance during the tasks. What
strategy is appropriate for the COTA to use?
A. Have the client estimate and report the difficulty of a task before completing it
B. Provide the client with a verbal description of the client's task performance
C. Organize increasingly complex self-care routines by providing highly structured
practice
D. Give consistent, reliable tactile cues throughout self-care completion -
\A. Have the client estimate and report the difficulty of a task before completing it
A client with T5 spinal cord injury is having difficulty with lateral trunk flexion, which is
limiting independent transfers. The client is returning to work as a banker and will be
spending 4 to 6 hours continuously in a wheelchair. Which activity intervention should
the COTA® consider FIRST?
A. Have the client move in diagonal patterns of movement over a therapy ball
B. Provide verbal cues for the client to realign the trunk during tasks
C. Place objects on the floor that the client has to reach for
D. Have the client practice weight shifting in the wheelchair for pressure relief -
\D. Have the client practice weight shifting in the wheelchair for pressure relief
The upper-extremity movements of a client with traumatic brain injury (TBI) are
exaggerated, and the client consistently overreaches or underreaches for an item, such
as during a feeding activity. How can the COTA address the impact of this condition?
Select the 3 BEST choices.
A. Allow the ataxic limb to move freely
B. Provide a weighted-vest for mealtime
C. Grasping a solid surface for stability
D. Provide wrist weights for stabilization
E. Apply resistance to reduce exaggerated movements
F. Weight utensils to reduce the effects of movements -
\C. Grasping a solid surface for stability
E. Apply resistance to reduce exaggerated movements
