NBCOT Exam Prep: 185 High-Yield
Practice Questions
A COTA® is reviewing the medical chart of a client who has Parkinson's disease. The
neurologist has indicated that the client has a festinating gait. What does the client's gait
look like? -
\The client's steps are small and rapid.
**Festinating gait is marked by small, rapid steps resulting from a forward-tilted posture
of the head and trunk.**
An OTR® has completed an initial evaluation with a client who has relapsing and
remitting multiple sclerosis. Sensorimotor skills assessment indicates that the client's
daily activities are limited by low endurance and decreased upper-extremity
coordination. In addition, the client has been unable to remain in a job as a clerical
worker. What additional information, that the COTA® can gather, is MOST important
before developing an intervention plan? -
\Contextual and environmental factors that support the client's ability to adapt
**Contextual and environmental factors provide information about a client's available
support systems, which can influence his or her ability to adapt to the diagnosis.**
The client lives in a long-term care facility and uses a wheelchair to get to the dining
room. The COTA®has removed the client's wheelchair footrests. Which reason BEST
explains why the COTA® removed the footrests from the wheelchair? -
\The client propels the chair using only the feet.
**When a client propels a wheelchair using only the feet, footrests are removed
because they are in the way.**
A, D: Even if staff push the client or the client propels the chair using only the hands, the
client would still need to have the feet on the footrests so that the legs do not dangle.
B: A drop seat could be used if the client's legs are short to make sure the feet are
supported on the footrests and do not dangle.
A COTA® is working with an infant who is recovering from a brachial plexus injury.
What type of sling should the COTA® fabricate? -
\A sling that fits proximally around the humerus
A sling that fits proximally around the humerus will prevent the child from sustaining
further injury to the brachial plexus during ADLs.
,**B, C, D: A sling that was fit proximally around the radius, ulna, or clavicle would not be
effective in preventing the child from sustaining further injury to the brachial plexus.**
Which client factor is likely affected in a client in the hospital-based setting with Guillain-
Barré syndrome? -
\Sensation
Because of the painful sensations that are intially reported with Guillain-Barré
syndrome, the client's tolerance for tactile input and current sensory abilities will likely
influence interventions with the client.
**B, C, D: Cognition, vision, and hearing are not affected by Guillain-Barré syndrome.**
The initial evaluation documentation for a client with Parkinson's disease indicates that
the OTR asked 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 was unable to initiate movement of the dominant arm toward the mouth to
demonstrate oral hygiene. Which step should the COTA® take NEXT in the evaluation
of this client? -
\Observe as the client brushes teeth with toothbrush and toothpaste at the bathroom
sink
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 COTA® in home health care is treating a client who has Stage III Alzheimer's
disease. The client lives with an adult daughter. The daughter reports that the client
wanders around the house and has fallen twice in the middle of the night. The house is
a single-level home with both front and back entrances. It has five steps at the back
door leading to the garage, with railings on both sides, and has no steps at the front
entrance. The client's daughter is determined to have the client remain at home with her
as long as possible. The daughter has expressed fear that the client might fall down the
stairs at the back door while wandering. To prevent the client from using the back door,
what would be the MOST likely recommendation? -
\Using a poster to camouflage the back door and the door knob
,Evidence has shown that camouflaging a door and its doorknob can decrease way-
finding behavior when a client with Alzheimer's disease wanders.
A COTA® in home health care is treating a client who has Stage III Alzheimer's
disease. The client lives with an adult daughter. The daughter reports that the client
likes to wander around the house and has fallen twice in the middle of the night. The
house is a single-level home with both front and back entrances. It has five steps at the
back door leading to the garage, with railings on both sides, and has no steps at the
front entrance. The client's daughter is determined to have the client remain at home
with her as long as possible. To prevent the client from getting out of bed unnoticed at
night, what would be an appropriate recommendation? -
\A bed alarm system
A bed alarm system will alert the daughter when the client is attempting to leave the bed
and is more suitable for use when the daughter is not able to stay in the same room as
the client for surveillance.
**A: Neither a nightlight nor a full bedrail will alert the daughter if the client is getting out
of bed. Full bedrails may in fact pose a further danger to the client if the client attempts
to climb over the bedrails to get out of bed.
C: A video room monitor will require the daughter to stay awake and look at the monitor
regularly.**
A COTA® wants to develop a group activity for clients with personality disorder in an
inpatient psychiatric facility. The group has Allen Cognitive Level (ACL) scores ranging
from 5.0 to 5.4. What activity would be MOST appropriate to use with these clients in
the initial stages of the group? -
\Role-playing social interactions
People with personality disorders and people with an ACL in the low 5s have difficulty
with social interactions because they are egocentric. Role playing social interactions
would be best option when initiating a group with these clients. Improving social
interaction will form the basis for the rest of the interventions appropriate for this group.
**A: Volunteer activities would be more appropriate for clients at ACL 5.6 and above.
The tasks involved would be too complex for lower levels.
B: Long-term budgeting and house maintenance would be more appropriate for clients
at ACL 5.6 and above. The tasks involved would be too complex for lower levels.
C: Vocational retraining and job seeking would be appropriate for clients at ACL 5.2 and
above, but job seeking would be more appropriate for clients at ACL 5.4 and above, and
levels for vocational training could vary. Clients at ACLs from 5.2 to 5.4 would need
more repetition in training to solve problems and create solutions so that they would not
have to problem-solve independently.**
A COTA® is using groups in a residential rehabilitation facility for people with substance
abuse. The COTA has identified a group of clients who have difficulty with
, assertiveness during encounters with significant others. The COTA decides to use role
playing with the group members to help them improve their response in such events.
What frame of reference does this intervention choice suggest? -
\Behavioral
The behavioral frame of reference uses repetition to shape a client's behaviors in a safe
environment in order to reduce negative thoughts and emotions associated with the
stressful event. In this example, the COTA wants the clients to practice assertiveness in
their interactions so that they can feel prepared and confident in future interactions
outside the therapy setting.
**A: A psychodynamic frame of reference is mostly discussion based and individualized.
B: A sensorimotor frame of reference uses sensory experiences to assist in regulation
of responses.
D: A developmental frame of reference examines the client's age and expectations of
the environment and uses activities that facilitate successful completion in this
context.**
A child with scoliosis is wearing a spinal orthosis and has a goal of donning a shirt
independently. Which adaptation would be MOST appropriate to aid in this task? -
\Front-opening garment
A front-opening garment will facilitate the most independence in getting dressed.
A child with Down syndrome has a goal of learning to don socks independently. Which
adaptation would be MOST appropriate to facilitate this task? -
\Loops sewn in socks
Loops sewn in socks would be appropriate for a child with Down syndrome to
compensate for decreased fine motor skills.
**A: Socks that go over the calf are more difficult to don than ankle socks and socks that
approach the calf.
B: Smaller socks are contraindicated for clients who have difficulty donning socks.
C: A sock aide or donner is recommended for clients who have difficulty with bending.**
On an inpatient rehabilitation unit, the COTA® observes a newly evaluated patient with
Parkinson's disease eating breakfast seated in a bedside chair. The COTA observes a
fork on the floor and milk spilled on the patient's gown and tray. The patient begins
coughing, spitting up pieces of pancake, and then says hello with unswallowed food in
the mouth. What should the COTA do FIRST with this patient? -
\Clear the unswallowed food from the patient's mouth and then notify the nurse
supervisor and the OTR®.
B is the most important immediate action, because the food in the mouth could cause a
choking episode. A speech therapist may be needed to evaluate for dysphagia and
Practice Questions
A COTA® is reviewing the medical chart of a client who has Parkinson's disease. The
neurologist has indicated that the client has a festinating gait. What does the client's gait
look like? -
\The client's steps are small and rapid.
**Festinating gait is marked by small, rapid steps resulting from a forward-tilted posture
of the head and trunk.**
An OTR® has completed an initial evaluation with a client who has relapsing and
remitting multiple sclerosis. Sensorimotor skills assessment indicates that the client's
daily activities are limited by low endurance and decreased upper-extremity
coordination. In addition, the client has been unable to remain in a job as a clerical
worker. What additional information, that the COTA® can gather, is MOST important
before developing an intervention plan? -
\Contextual and environmental factors that support the client's ability to adapt
**Contextual and environmental factors provide information about a client's available
support systems, which can influence his or her ability to adapt to the diagnosis.**
The client lives in a long-term care facility and uses a wheelchair to get to the dining
room. The COTA®has removed the client's wheelchair footrests. Which reason BEST
explains why the COTA® removed the footrests from the wheelchair? -
\The client propels the chair using only the feet.
**When a client propels a wheelchair using only the feet, footrests are removed
because they are in the way.**
A, D: Even if staff push the client or the client propels the chair using only the hands, the
client would still need to have the feet on the footrests so that the legs do not dangle.
B: A drop seat could be used if the client's legs are short to make sure the feet are
supported on the footrests and do not dangle.
A COTA® is working with an infant who is recovering from a brachial plexus injury.
What type of sling should the COTA® fabricate? -
\A sling that fits proximally around the humerus
A sling that fits proximally around the humerus will prevent the child from sustaining
further injury to the brachial plexus during ADLs.
,**B, C, D: A sling that was fit proximally around the radius, ulna, or clavicle would not be
effective in preventing the child from sustaining further injury to the brachial plexus.**
Which client factor is likely affected in a client in the hospital-based setting with Guillain-
Barré syndrome? -
\Sensation
Because of the painful sensations that are intially reported with Guillain-Barré
syndrome, the client's tolerance for tactile input and current sensory abilities will likely
influence interventions with the client.
**B, C, D: Cognition, vision, and hearing are not affected by Guillain-Barré syndrome.**
The initial evaluation documentation for a client with Parkinson's disease indicates that
the OTR asked 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 was unable to initiate movement of the dominant arm toward the mouth to
demonstrate oral hygiene. Which step should the COTA® take NEXT in the evaluation
of this client? -
\Observe as the client brushes teeth with toothbrush and toothpaste at the bathroom
sink
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 COTA® in home health care is treating a client who has Stage III Alzheimer's
disease. The client lives with an adult daughter. The daughter reports that the client
wanders around the house and has fallen twice in the middle of the night. The house is
a single-level home with both front and back entrances. It has five steps at the back
door leading to the garage, with railings on both sides, and has no steps at the front
entrance. The client's daughter is determined to have the client remain at home with her
as long as possible. The daughter has expressed fear that the client might fall down the
stairs at the back door while wandering. To prevent the client from using the back door,
what would be the MOST likely recommendation? -
\Using a poster to camouflage the back door and the door knob
,Evidence has shown that camouflaging a door and its doorknob can decrease way-
finding behavior when a client with Alzheimer's disease wanders.
A COTA® in home health care is treating a client who has Stage III Alzheimer's
disease. The client lives with an adult daughter. The daughter reports that the client
likes to wander around the house and has fallen twice in the middle of the night. The
house is a single-level home with both front and back entrances. It has five steps at the
back door leading to the garage, with railings on both sides, and has no steps at the
front entrance. The client's daughter is determined to have the client remain at home
with her as long as possible. To prevent the client from getting out of bed unnoticed at
night, what would be an appropriate recommendation? -
\A bed alarm system
A bed alarm system will alert the daughter when the client is attempting to leave the bed
and is more suitable for use when the daughter is not able to stay in the same room as
the client for surveillance.
**A: Neither a nightlight nor a full bedrail will alert the daughter if the client is getting out
of bed. Full bedrails may in fact pose a further danger to the client if the client attempts
to climb over the bedrails to get out of bed.
C: A video room monitor will require the daughter to stay awake and look at the monitor
regularly.**
A COTA® wants to develop a group activity for clients with personality disorder in an
inpatient psychiatric facility. The group has Allen Cognitive Level (ACL) scores ranging
from 5.0 to 5.4. What activity would be MOST appropriate to use with these clients in
the initial stages of the group? -
\Role-playing social interactions
People with personality disorders and people with an ACL in the low 5s have difficulty
with social interactions because they are egocentric. Role playing social interactions
would be best option when initiating a group with these clients. Improving social
interaction will form the basis for the rest of the interventions appropriate for this group.
**A: Volunteer activities would be more appropriate for clients at ACL 5.6 and above.
The tasks involved would be too complex for lower levels.
B: Long-term budgeting and house maintenance would be more appropriate for clients
at ACL 5.6 and above. The tasks involved would be too complex for lower levels.
C: Vocational retraining and job seeking would be appropriate for clients at ACL 5.2 and
above, but job seeking would be more appropriate for clients at ACL 5.4 and above, and
levels for vocational training could vary. Clients at ACLs from 5.2 to 5.4 would need
more repetition in training to solve problems and create solutions so that they would not
have to problem-solve independently.**
A COTA® is using groups in a residential rehabilitation facility for people with substance
abuse. The COTA has identified a group of clients who have difficulty with
, assertiveness during encounters with significant others. The COTA decides to use role
playing with the group members to help them improve their response in such events.
What frame of reference does this intervention choice suggest? -
\Behavioral
The behavioral frame of reference uses repetition to shape a client's behaviors in a safe
environment in order to reduce negative thoughts and emotions associated with the
stressful event. In this example, the COTA wants the clients to practice assertiveness in
their interactions so that they can feel prepared and confident in future interactions
outside the therapy setting.
**A: A psychodynamic frame of reference is mostly discussion based and individualized.
B: A sensorimotor frame of reference uses sensory experiences to assist in regulation
of responses.
D: A developmental frame of reference examines the client's age and expectations of
the environment and uses activities that facilitate successful completion in this
context.**
A child with scoliosis is wearing a spinal orthosis and has a goal of donning a shirt
independently. Which adaptation would be MOST appropriate to aid in this task? -
\Front-opening garment
A front-opening garment will facilitate the most independence in getting dressed.
A child with Down syndrome has a goal of learning to don socks independently. Which
adaptation would be MOST appropriate to facilitate this task? -
\Loops sewn in socks
Loops sewn in socks would be appropriate for a child with Down syndrome to
compensate for decreased fine motor skills.
**A: Socks that go over the calf are more difficult to don than ankle socks and socks that
approach the calf.
B: Smaller socks are contraindicated for clients who have difficulty donning socks.
C: A sock aide or donner is recommended for clients who have difficulty with bending.**
On an inpatient rehabilitation unit, the COTA® observes a newly evaluated patient with
Parkinson's disease eating breakfast seated in a bedside chair. The COTA observes a
fork on the floor and milk spilled on the patient's gown and tray. The patient begins
coughing, spitting up pieces of pancake, and then says hello with unswallowed food in
the mouth. What should the COTA do FIRST with this patient? -
\Clear the unswallowed food from the patient's mouth and then notify the nurse
supervisor and the OTR®.
B is the most important immediate action, because the food in the mouth could cause a
choking episode. A speech therapist may be needed to evaluate for dysphagia and
