OTR Exam Excellence: Master NBCOT 4
with Confidence.
Which option would NOT be considered a clinical indication for an OTR® to conduct a
comprehensive functional capacity evaluation (FCE)?
A. To identify work restrictions
B. To confirm, rule out, or discover diagnosis
C. To screen after a job offer
D. To determine a level of motivation to return to work -
\*D: Referral for FCE is not used to determine the worker's motivation to return to a
preinjury job
A, B, & C: These responses are all clinical indications for completion of an FCE.
An OTR® is performing wheelchair training with a client with T1 spinal cord injury (SCI).
What is the BEST method to instruct the client in pressure relief techniques?
A. Perform weight shift by pushing up on arm rests with upper extremities.
B. Perform weight shift by leaning toward the feet
C. Perform weight shift by enlisting aide or caregiver assistance.
D. Perform weight shift by grabbing a door handle and standing. -
\*A: Clients with T1 SCI should be able to shift weight and relieve pressure
independently and when needed.
B: This technique may cause shearing and may increase fall risk.
C: Although this technique may work, it should not be necessary for a client with T1
SCI, and it does not promote independence.
D: Grabbing a door handle may be unsafe and increase the risk of fall.
A client with multiple sclerosis (MS) presents with balance deficits and impaired lower-
body ADL resulting from increased spasticity in the bilateral lower extremities. The
OTR® wants to promote safety during bathing tasks, particularly the parts of the task
that require standing. What might the OTR® FIRST suggest?
A. That the client maintain at least 90° of hip flexion on a shower chair
B. That the client use a long-handled bath sponge to reach the lower legs and feet
C. That the caregiver be instructed in stretches to the lower extremities
D. That the client place one foot at a time on a small stool while washing -
\*A: A addresses both the balance deficits and the spasticity that interfere with lower-
body ADLs. By sitting down to wash, the client reduces the risk of falls, and flexed hips
may lessen spasticity in the lower extremities.
B: Using a long-handled bath sponge is a compensatory strategy that does not help
decrease the pain and discomfort associated with spasticity.
C: Stretching helps decrease spasticity, but this option also reduces independence.
D: This option is an environmental modification that may promote hip flexion but does
not address the balance impairments and may further compromise the client's balance.
,During the initial evaluation for a client with Parkinson's disease, the OTR® asks the
client to "pretend you are brushing your teeth," that is, show the movement of brushing
teeth without using the supplies needed for brushing teeth. The client is unable to
initiate movement of the dominant arm toward the mouth to demonstrate oral hygiene.
Which step should the OTR take NEXT in the evaluation of this client?
A. Try a wrist weight to stabilize the arm during teeth brushing
B. Ask whether the caregiver can provide arm support to bring the hand to the mouth
C. Observe as the client brushes teeth with toothbrush and toothpaste at the bathroom
sink
D. Provide a mobile arm support to compensate for arm movement when brushing teeth
-
\*C: 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.
A: 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.
A 4-year-old child with autism always flushes the toilet before using it and leaves the
toilet unflushed after using it. What should the OTR® do to ensure correct toileting
habits?
A. Give a reward every time the child flushes the toilet after using it
B. Suggest a sensor-activated toilet to ensure it is flushed after each use
C. Use a visual schedule depicting the correct flow of actions during toileting
D. Facilitate memory by prompting the child to flush the toilet after each use -
\*C: A visual schedule tends to work better than auditory and operant conditioning for
children with autism when teaching them the correct steps in using the toilet.
A, B, D: Giving a reward, using a sensor-activated toilet, or prompting the child to flush
the toilet are behavioral and environmental modifications that do not necessarily ensure
transfer of learning in other contexts.
A student in the third grade with a learning disability has attended school-based
occupational therapy for several years to improve visual-perceptual skills for completing
curriculum-based school work. The latest update report to the parents indicates the
student is not making progress toward the stated Individualized Education Program
(IEP) goals. This report is similar to the previous two reports. What action should the
OTR® take NEXT to address the lack of progress?
A. Continue occupational therapy intervention knowing that developmental progress due
to maturity is still possible.
B. Discuss alternative classroom modifications and adaptations with the student's
teacher.
, C. Request the special education team schedule an interim meeting to modify the
student's IEP.
D. Send a letter to the student's parents informing them that occupational therapy is no
longer beneficial to their child. -
\*B: The student's response to occupational therapy intervention and teacher data is
important in implementing an effective intervention plan. The intervention plan appears
to need modification on the basis of the student's response.
A: The practitioner must continuously gather data to inform the intervention decisions on
the basis of student response and teacher data. Continuing occupational therapy
intervention without any modification at this point would indicate that the practitioner is
not attending to this information.
C: The intervention plan is modified before changing the goals in the IEP because the
goals may not be the problem; rather, the practitioner may not have implemented the
right intervention yet or the student's status has changed and requires modification of
the intervention.
D: Discontinuing occupational therapy services is not the appropriate response without
gathering more information. The practitioner must collect necessary systematic data to
inform intervention decisions and support the best outcomes for the student.
An OTR® working in an acute care hospital has completed the initial self-care
evaluation with a patient who has had a recent TBI and is functioning at Level VI
(Confused-Appropriate) on the Rancho Los Amigos scale. During grooming and
hygiene tasks the patient is able to stand at the sink with stand-by assistance, is easily
distracted and consistently requires verbal and tactile prompts. The OTR® observed
that the patient put toothpaste on a washcloth when preparing to brush teeth and
attempted to brush hair with a toothbrush. Additionally, the OTR® noted that the patient
has minimal spontaneous functional movement of the left upper extremity and uses
synergistic movements when asked to grasp and hold objects. Which neurobehavioral
deficit is the patient exhibiting during grooming tasks?
A. Constructional disorder
B. Ideational apraxia
C. Stereopsis
D. Visual agnosia -
\*B: Ideational apraxia involves a patient using an object improperly or using the wrong
tool with the action that is required, such as putting toothpaste on the washcloth or
brushing the hair with a toothbrush.
A: Constructional disorder occurs when a patient has a deficit in organizing and
assembling parts into a whole.
C: Stereopsis occurs when a patient is unable to perceive depth in relation to self or
other objects.
D: Visual agnosia occurs when a patient cannot verbally identify objects from visual
input.
An OTR® receives a referral to complete a functional capacity evaluation (FCE) on a
client who is employed full time as a machinist in the tool-and-die trade. The client
completed a course of outpatient therapy after a wrist fracture to the dominant hand.
with Confidence.
Which option would NOT be considered a clinical indication for an OTR® to conduct a
comprehensive functional capacity evaluation (FCE)?
A. To identify work restrictions
B. To confirm, rule out, or discover diagnosis
C. To screen after a job offer
D. To determine a level of motivation to return to work -
\*D: Referral for FCE is not used to determine the worker's motivation to return to a
preinjury job
A, B, & C: These responses are all clinical indications for completion of an FCE.
An OTR® is performing wheelchair training with a client with T1 spinal cord injury (SCI).
What is the BEST method to instruct the client in pressure relief techniques?
A. Perform weight shift by pushing up on arm rests with upper extremities.
B. Perform weight shift by leaning toward the feet
C. Perform weight shift by enlisting aide or caregiver assistance.
D. Perform weight shift by grabbing a door handle and standing. -
\*A: Clients with T1 SCI should be able to shift weight and relieve pressure
independently and when needed.
B: This technique may cause shearing and may increase fall risk.
C: Although this technique may work, it should not be necessary for a client with T1
SCI, and it does not promote independence.
D: Grabbing a door handle may be unsafe and increase the risk of fall.
A client with multiple sclerosis (MS) presents with balance deficits and impaired lower-
body ADL resulting from increased spasticity in the bilateral lower extremities. The
OTR® wants to promote safety during bathing tasks, particularly the parts of the task
that require standing. What might the OTR® FIRST suggest?
A. That the client maintain at least 90° of hip flexion on a shower chair
B. That the client use a long-handled bath sponge to reach the lower legs and feet
C. That the caregiver be instructed in stretches to the lower extremities
D. That the client place one foot at a time on a small stool while washing -
\*A: A addresses both the balance deficits and the spasticity that interfere with lower-
body ADLs. By sitting down to wash, the client reduces the risk of falls, and flexed hips
may lessen spasticity in the lower extremities.
B: Using a long-handled bath sponge is a compensatory strategy that does not help
decrease the pain and discomfort associated with spasticity.
C: Stretching helps decrease spasticity, but this option also reduces independence.
D: This option is an environmental modification that may promote hip flexion but does
not address the balance impairments and may further compromise the client's balance.
,During the initial evaluation for a client with Parkinson's disease, the OTR® asks the
client to "pretend you are brushing your teeth," that is, show the movement of brushing
teeth without using the supplies needed for brushing teeth. The client is unable to
initiate movement of the dominant arm toward the mouth to demonstrate oral hygiene.
Which step should the OTR take NEXT in the evaluation of this client?
A. Try a wrist weight to stabilize the arm during teeth brushing
B. Ask whether the caregiver can provide arm support to bring the hand to the mouth
C. Observe as the client brushes teeth with toothbrush and toothpaste at the bathroom
sink
D. Provide a mobile arm support to compensate for arm movement when brushing teeth
-
\*C: 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.
A: 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.
A 4-year-old child with autism always flushes the toilet before using it and leaves the
toilet unflushed after using it. What should the OTR® do to ensure correct toileting
habits?
A. Give a reward every time the child flushes the toilet after using it
B. Suggest a sensor-activated toilet to ensure it is flushed after each use
C. Use a visual schedule depicting the correct flow of actions during toileting
D. Facilitate memory by prompting the child to flush the toilet after each use -
\*C: A visual schedule tends to work better than auditory and operant conditioning for
children with autism when teaching them the correct steps in using the toilet.
A, B, D: Giving a reward, using a sensor-activated toilet, or prompting the child to flush
the toilet are behavioral and environmental modifications that do not necessarily ensure
transfer of learning in other contexts.
A student in the third grade with a learning disability has attended school-based
occupational therapy for several years to improve visual-perceptual skills for completing
curriculum-based school work. The latest update report to the parents indicates the
student is not making progress toward the stated Individualized Education Program
(IEP) goals. This report is similar to the previous two reports. What action should the
OTR® take NEXT to address the lack of progress?
A. Continue occupational therapy intervention knowing that developmental progress due
to maturity is still possible.
B. Discuss alternative classroom modifications and adaptations with the student's
teacher.
, C. Request the special education team schedule an interim meeting to modify the
student's IEP.
D. Send a letter to the student's parents informing them that occupational therapy is no
longer beneficial to their child. -
\*B: The student's response to occupational therapy intervention and teacher data is
important in implementing an effective intervention plan. The intervention plan appears
to need modification on the basis of the student's response.
A: The practitioner must continuously gather data to inform the intervention decisions on
the basis of student response and teacher data. Continuing occupational therapy
intervention without any modification at this point would indicate that the practitioner is
not attending to this information.
C: The intervention plan is modified before changing the goals in the IEP because the
goals may not be the problem; rather, the practitioner may not have implemented the
right intervention yet or the student's status has changed and requires modification of
the intervention.
D: Discontinuing occupational therapy services is not the appropriate response without
gathering more information. The practitioner must collect necessary systematic data to
inform intervention decisions and support the best outcomes for the student.
An OTR® working in an acute care hospital has completed the initial self-care
evaluation with a patient who has had a recent TBI and is functioning at Level VI
(Confused-Appropriate) on the Rancho Los Amigos scale. During grooming and
hygiene tasks the patient is able to stand at the sink with stand-by assistance, is easily
distracted and consistently requires verbal and tactile prompts. The OTR® observed
that the patient put toothpaste on a washcloth when preparing to brush teeth and
attempted to brush hair with a toothbrush. Additionally, the OTR® noted that the patient
has minimal spontaneous functional movement of the left upper extremity and uses
synergistic movements when asked to grasp and hold objects. Which neurobehavioral
deficit is the patient exhibiting during grooming tasks?
A. Constructional disorder
B. Ideational apraxia
C. Stereopsis
D. Visual agnosia -
\*B: Ideational apraxia involves a patient using an object improperly or using the wrong
tool with the action that is required, such as putting toothpaste on the washcloth or
brushing the hair with a toothbrush.
A: Constructional disorder occurs when a patient has a deficit in organizing and
assembling parts into a whole.
C: Stereopsis occurs when a patient is unable to perceive depth in relation to self or
other objects.
D: Visual agnosia occurs when a patient cannot verbally identify objects from visual
input.
An OTR® receives a referral to complete a functional capacity evaluation (FCE) on a
client who is employed full time as a machinist in the tool-and-die trade. The client
completed a course of outpatient therapy after a wrist fracture to the dominant hand.
