Conquer the NBCOT: Key Practice
Questions and Answers.
An OTR is working with a 4-year-old child with developmental delays. The goal of
occupational therapy for this child is to promote hand function, allowing the child to hold
a crayon more efficiently. Which activity is MOST EFFECTIVE in developing this hand
skill? -
\Correct Answer D: Eye dropper painting is an activity which effectively promotes a
precision grasp. With this activity, the child squeezes the eye dropper using the first two
digits and thumb, forming the tripod grasp needed to efficiently hold a crayon or writing
tool. The other activities promote gross hand strengthening and do not fully address
grasp required to hold a crayon more efficiently.
Answer A: Rolling clay into a ball is an activity that works on the regulation of pressure
through the hand instead of grasp development.
Answer B: Finger painting is an activity which involves the development of tactile
awareness and finger isolation.
Answer C: Crumpling paper is an activity that is best suited to develop the in-hand
manipulation skill of translation (finger to palm).
A client diagnosed with depression and anorexia nervosa attends an evening support
group for 90 minutes each week. The client reports limited occupational engagement.
The OTR collaborates with the client to develop a plan to increase involvement in
avocational activities. The client expresses interest in exercise and volunteerism. In high
school, the client was captain of the swim team, played tennis, and worked in an after-
school program for young children. Which is the MOST APPROPRIATE activity for the
client to explore? -
\Answer: A Exploring a local elementary school for volunteer opportunities best meets
the most beneficial criteria. It addresses the client's interest in volunteerism and
experience with after-school programs for young children. Providing the client a familiar
context and familiar occupations in which to engage encourages participation and is
likely to combat some of the depression symptoms of isolation and withdrawal.
Answer B: A soup kitchen is not an appropriate context for volunteering for a client with
anorexia. Clients with anorexia often do not want to be around food so this context
might not lead to increased engagement.
Answer C: Swimming lessons only addresses the exercise aspect of the client's interest.
Clients with anorexia also tend to obsess about exercise so this choice might promote
that tendency.
A 10-year-old child with cerebral palsy is working in the classroom on signing work. The
OTR has been facilitating written name production during direct intervention times;
however, the task is tedious and frustrating to the child. The OTR has consulted with the
,teacher and decided to incorporate some adaptive equipment to provide positive
feedback to the child as well as identify the child's work. Which is the MOST appropriate
adaptive equipment to use with this child? -
\Correct Answer: D A name stamp can be used to allow the child to independently sign
and identify work without the tedious task of writing the name. Name stamps are
commonly used with children with significant motor impairment or delays to increase
independence in this school-based task. Name stamps can be adjusted yearly to reflect
progressive changes in developmental handwriting, sizing, and style to better customize
the experience.
Answer A: A pencil grip may facilitate a more functional grasping pattern, but does not
increase the child's ability to write the name independently given the information
provided.
Answer B:A raised notebook is used to facilitate an upright pattern when completing
written work. This is not the best response to allow the child to immediately begin to
identify personal work in the classroom.
Answer C:A weighted pencil is often used with children who present with tremors or
shaky hands. In this case, the prompt does not provide any information regarding this
symptom.
An OTR is discussing home modifications to allow a 35-year-old client to return home
after sustaining a C8 spinal cord injury. The client lives at home with two children,
spouse, and elderly mother-in-law. Which of the following home modifications reflect the
principles of universal design? -
\Correct Answer: C Installing a toilet seat with a switch to adjust it to a comfortable
height will not only benefit the client, but it can also benefit others in the house. The seat
can be lowered to the height that is safe for the children, or raised to the height for the
spouse, elderly mother-in-law, or client to use. The principles of universal design aim to
provide products and environments that work well for almost everyone, whether the
person has a disability or not. The home modifications should not disrupt the lives of the
other people living in the home. The modifications should make the home convenient,
safe, and accessible to everyone.
Answer A: Rearrange the living room takes away living space from the rest of the family.
The presence of hospital equipment was found to make the home a "landscape of care"
instead of a "family landscape."
Answer B:The shower chair may not be used by other members of the family and needs
to be removed before they can use the shower or tub. This does not promote universal
design as the shower chair is not designed with the needs of people with a wide range
of abilities.
Answer D: Removing the bathroom door may allow the client to use the wheelchair to
get in the bathroom, however, it disrupts the person's privacy and the usability of the
bathroom by the rest of the family.
Bottom Line: The principles of universal design aim to provide products and
environments that work well for almost everyone, whether the person has a disability or
, not. The home modifications should not disrupt the lives of the other people living in the
home. The modifications should make the home convenient, safe, and accessible to
everyone.
A client exhibits visual deficits following a cerebrovascular accident. Which of the
following are MOST IMPORTANT for the OTR to include in the initial occupational
therapy evaluation? -
\Correct Answer: D Many changes occur in visual perception following a
cerebrovascular accident (CVA) due to alteration of lower level visual functions
including visual acuity, visual field loss, and oculomotor control. These foundational
skills must be addressed first. Visual field loss and oculomotor control are foundational
in the visual perceptual hierarchy. Deficits in these functions prevent the central nervous
system from accurately carrying out the higher level visual functions.
Answer A:Using the visual perceptual hierarchy, visual memory is a higher level visual
function. The foundational visual skills, including visual field loss, must be assessed
first.
Answers B & C:Using the visual perceptual hierarchy, visuocognition is a higher level
visual function. The foundational skills, including visual field loss and oculomotor
control, must be assessed first.
An OTR is working with a 12-year-old child diagnosed with emotional disturbance. The
child has a history of being off task, poor social skills, and becoming overly upset about
things when something does not go as anticipated. The child attends middle school and
the teacher reports that the child has difficulty following directions, completing
schoolwork, and has frequent outbursts resulting in visits to the principal's office. What
intervention or strategy is MOST EFFECTIVE for improving school behavior and
performance? -
\Correct Answer: A - A token economy or contingency method is most effective to help
this child participate in nonpreferred activities such as schoolwork, transitions, and
social situations. Token economies are based on the principle of allowing access to a
desired event or item contingent on performance or compliance with a directive,
instruction, or rule. Tokens are earned through performance of tasks, engagement in
prescribed activities, or demonstration of appropriate behavior. Once a specific amount
of tokens are earned the child can earn the opportunity to engage with a preferred
activity as a reward.
Answer B:A therapy ball to sit on in the classroom may be an effective strategy for self-
regulation and may help the child attend in class; however, this strategy does not
effectively address school behavior and performance.
Answer C:Movement breaks throughout the school day are best used to support a
child's self-regulation instead of actual school behavior and performance.
Answer D:Referral to social work or school counselor for further intervention may occur
after all other strategies are exhausted or already be a service on this child's education
plan based on the severity of needs.
Questions and Answers.
An OTR is working with a 4-year-old child with developmental delays. The goal of
occupational therapy for this child is to promote hand function, allowing the child to hold
a crayon more efficiently. Which activity is MOST EFFECTIVE in developing this hand
skill? -
\Correct Answer D: Eye dropper painting is an activity which effectively promotes a
precision grasp. With this activity, the child squeezes the eye dropper using the first two
digits and thumb, forming the tripod grasp needed to efficiently hold a crayon or writing
tool. The other activities promote gross hand strengthening and do not fully address
grasp required to hold a crayon more efficiently.
Answer A: Rolling clay into a ball is an activity that works on the regulation of pressure
through the hand instead of grasp development.
Answer B: Finger painting is an activity which involves the development of tactile
awareness and finger isolation.
Answer C: Crumpling paper is an activity that is best suited to develop the in-hand
manipulation skill of translation (finger to palm).
A client diagnosed with depression and anorexia nervosa attends an evening support
group for 90 minutes each week. The client reports limited occupational engagement.
The OTR collaborates with the client to develop a plan to increase involvement in
avocational activities. The client expresses interest in exercise and volunteerism. In high
school, the client was captain of the swim team, played tennis, and worked in an after-
school program for young children. Which is the MOST APPROPRIATE activity for the
client to explore? -
\Answer: A Exploring a local elementary school for volunteer opportunities best meets
the most beneficial criteria. It addresses the client's interest in volunteerism and
experience with after-school programs for young children. Providing the client a familiar
context and familiar occupations in which to engage encourages participation and is
likely to combat some of the depression symptoms of isolation and withdrawal.
Answer B: A soup kitchen is not an appropriate context for volunteering for a client with
anorexia. Clients with anorexia often do not want to be around food so this context
might not lead to increased engagement.
Answer C: Swimming lessons only addresses the exercise aspect of the client's interest.
Clients with anorexia also tend to obsess about exercise so this choice might promote
that tendency.
A 10-year-old child with cerebral palsy is working in the classroom on signing work. The
OTR has been facilitating written name production during direct intervention times;
however, the task is tedious and frustrating to the child. The OTR has consulted with the
,teacher and decided to incorporate some adaptive equipment to provide positive
feedback to the child as well as identify the child's work. Which is the MOST appropriate
adaptive equipment to use with this child? -
\Correct Answer: D A name stamp can be used to allow the child to independently sign
and identify work without the tedious task of writing the name. Name stamps are
commonly used with children with significant motor impairment or delays to increase
independence in this school-based task. Name stamps can be adjusted yearly to reflect
progressive changes in developmental handwriting, sizing, and style to better customize
the experience.
Answer A: A pencil grip may facilitate a more functional grasping pattern, but does not
increase the child's ability to write the name independently given the information
provided.
Answer B:A raised notebook is used to facilitate an upright pattern when completing
written work. This is not the best response to allow the child to immediately begin to
identify personal work in the classroom.
Answer C:A weighted pencil is often used with children who present with tremors or
shaky hands. In this case, the prompt does not provide any information regarding this
symptom.
An OTR is discussing home modifications to allow a 35-year-old client to return home
after sustaining a C8 spinal cord injury. The client lives at home with two children,
spouse, and elderly mother-in-law. Which of the following home modifications reflect the
principles of universal design? -
\Correct Answer: C Installing a toilet seat with a switch to adjust it to a comfortable
height will not only benefit the client, but it can also benefit others in the house. The seat
can be lowered to the height that is safe for the children, or raised to the height for the
spouse, elderly mother-in-law, or client to use. The principles of universal design aim to
provide products and environments that work well for almost everyone, whether the
person has a disability or not. The home modifications should not disrupt the lives of the
other people living in the home. The modifications should make the home convenient,
safe, and accessible to everyone.
Answer A: Rearrange the living room takes away living space from the rest of the family.
The presence of hospital equipment was found to make the home a "landscape of care"
instead of a "family landscape."
Answer B:The shower chair may not be used by other members of the family and needs
to be removed before they can use the shower or tub. This does not promote universal
design as the shower chair is not designed with the needs of people with a wide range
of abilities.
Answer D: Removing the bathroom door may allow the client to use the wheelchair to
get in the bathroom, however, it disrupts the person's privacy and the usability of the
bathroom by the rest of the family.
Bottom Line: The principles of universal design aim to provide products and
environments that work well for almost everyone, whether the person has a disability or
, not. The home modifications should not disrupt the lives of the other people living in the
home. The modifications should make the home convenient, safe, and accessible to
everyone.
A client exhibits visual deficits following a cerebrovascular accident. Which of the
following are MOST IMPORTANT for the OTR to include in the initial occupational
therapy evaluation? -
\Correct Answer: D Many changes occur in visual perception following a
cerebrovascular accident (CVA) due to alteration of lower level visual functions
including visual acuity, visual field loss, and oculomotor control. These foundational
skills must be addressed first. Visual field loss and oculomotor control are foundational
in the visual perceptual hierarchy. Deficits in these functions prevent the central nervous
system from accurately carrying out the higher level visual functions.
Answer A:Using the visual perceptual hierarchy, visual memory is a higher level visual
function. The foundational visual skills, including visual field loss, must be assessed
first.
Answers B & C:Using the visual perceptual hierarchy, visuocognition is a higher level
visual function. The foundational skills, including visual field loss and oculomotor
control, must be assessed first.
An OTR is working with a 12-year-old child diagnosed with emotional disturbance. The
child has a history of being off task, poor social skills, and becoming overly upset about
things when something does not go as anticipated. The child attends middle school and
the teacher reports that the child has difficulty following directions, completing
schoolwork, and has frequent outbursts resulting in visits to the principal's office. What
intervention or strategy is MOST EFFECTIVE for improving school behavior and
performance? -
\Correct Answer: A - A token economy or contingency method is most effective to help
this child participate in nonpreferred activities such as schoolwork, transitions, and
social situations. Token economies are based on the principle of allowing access to a
desired event or item contingent on performance or compliance with a directive,
instruction, or rule. Tokens are earned through performance of tasks, engagement in
prescribed activities, or demonstration of appropriate behavior. Once a specific amount
of tokens are earned the child can earn the opportunity to engage with a preferred
activity as a reward.
Answer B:A therapy ball to sit on in the classroom may be an effective strategy for self-
regulation and may help the child attend in class; however, this strategy does not
effectively address school behavior and performance.
Answer C:Movement breaks throughout the school day are best used to support a
child's self-regulation instead of actual school behavior and performance.
Answer D:Referral to social work or school counselor for further intervention may occur
after all other strategies are exhausted or already be a service on this child's education
plan based on the severity of needs.
