AOTA practice test for NBCOT. SLCHC class of 17

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 The client is already receiving external feedback from the COTA and needs to create internalized feedback mechanisms to decrease reliance on cueing. Self-estimation of task difficulty is one method to generate internal feedback.

A COTA® is working with a client with traumatic brain injury to promote orientation to place and time. The client is at Rancho Level IV (i.e., with confusion and agitation). What intervention is appropriate to improve the client's orientation to place and time? A. Have the client use a logbook that provides a calendar with the current therapy session schedule B. Engage the client in a daily self-care routine of showering, dressing, and grooming C. Allow the client to guide intervention sessions by providing minimal structure to the sessions D. Organize an orientation group in which the client can share perceptions of orientation

A. Have the client use a logbook that provides a calendar with the current therapy session schedule A logbook allows a client to have passive orientation provided by family or staff. Providing the current therapy schedule in the logbook may increase the client's awareness of timing.

A COTA® is preparing a client with T1 spinal cord injury for discharge to home alone. What is the BEST recommendation for required home assistance? A. Homemaking assistance for a few hours a daily B. Attendant care 24 hours a day C. Attendant care 12 hours a day D. Homemaking assistance for several hours daily

A. Homemaking assistance for a few hours a daily A client with low-level (T1) SCI should be independent in personal care and only require a few hours of homemaking assistance each day upon discharge.

A student in the second grade has mild cerebral palsy. During a session, the student tells the COTA® about wanting to play computer games, "like other kids." After consulting with the OTR® about this, what action should the COTA® take NEXT to determine if this is an appropriate activity to include as part of the student's school-based occupational therapy intervention? (retired NBCOT question) A. Identify the impact of computer use on curriculum-based activities B. Have the student practice on different computer operating systems C. Complete an analysis of the activity components D. Assess the student's fine and gross motor development

A. Identify the impact of computer use on curriculum-based activities Services provided in a school setting need to be educationally based activities that facilitate the child's ability to learn. The use of the computer in this situation must relate to a curriculum activity that meets the child's educational outcomes. If other students are playing computer games in the classroom to meet educational needs, then this would be an appropriate activity.

Which accommodation under the Americans With Disabilities Act (ADA) would be MOST likely to foster a successful transition to work at a fast-paced office for a high school student with Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome)? A. Install space enclosures or cubicle walls B. Widen doorways throughout the office C. Enlarge signs and elevator controls D. Prohibit other workers from speaking loudly

A. Install space enclosures or cubicle walls *RATIOANLE: Simple alterations to the physical space such as installing cubicle walls are considered reasonable accommodation under ADA and would allow a person who is easily distracted to concentrate on work more successfully by screening out extraneous stimuli from the environment.

Which occupational therapy intervention strategy is MOST appropriate for use with an older adult with low vision? A. Instruct the client to reduce clutter and improve organization of the home and work environments. B. Instruct the client in the use of bold, colored patterns on tablecloths. C. Teach the client to use a medication chart printed in typical-size print (12-point Times Roman). D. Teach the client how to use the sense of smell to compensate for vision loss.

A. Instruct the client to reduce clutter and improve organization of the home and work environments. *RATIONALE: Reducing visual and physical clutter makes it easier for the client with low vision to find objects and reduces fall risk.

A child with arthrogryposis needs to use utensils that are angled to be able to put food into the mouth. Which characteristic of clients with this condition necessitates use of these adapted utensils? A. Joint contractures in the arms and hands B. Spasticity in the arms and hands C. Hypotonia in the arms and hands D. Decreased sensation in the arms and hands

A. Joint contractures in the arms and hands Arthrogryposis is characterized by joint contractures. Angled utensils promote independence with feeding by allowing a client with contractures in the arms and hands to put food into the mouth.

A COTA® is engaged in a casual discussion with a colleague about a client. The COTA conveys that the client is rude and obnoxious but deserves to be treated equally. What is the ethical basis for the COTA's concern? A. Justice B. Fidelity C. Nonmaleficence D. Veracity

A. Justice *RATIONALE: In the Occupational Therapy Code of Ethics (2015), Principle 4, Justice, states, "Occupational therapy personnel shall promote fairness and objectivity in the provision of occupational therapy services."

A COTA® is planning an occupational therapy intervention focused on leisure exploration for a client with oppositional defiant disorder who likes graffiti, body piercings, and tattoos. Which activity would be MOST appropriate? A. Making posters with colored markers on poster paper B. Leather tooling a wallet with premade designs C. Knitting a blanket following an assigned pattern D. Freestyle painting a design on the wall in a public area

A. Making posters with colored markers on poster paper *RATIONALE: People with oppositional defiant disorder respond best to moderate, but not too much, structure. The choice of activities should be client centered and should capture the interests of the individual. Making posters allows the client to capture the style of art found in graffiti and tattoos while providing clear boundaries in the form of the poster paper and safe tools.

A COTA® working with an adult client with major depression in an inpatient setting intervenes with the client to reduce the impact of occupational and environmental demands on performance of daily occupations. What is most likely to be the COTA®'s PRIMARY theoretical approach to designing an intervention? A. Modifying the environment or the occupation to reduce demands, address personal goals, and use developed skills B. Facilitating age-appropriate occupation through motivation and habit formation C. Exposing underlying conflicts from early childhood relationships that impede current engagement in occupations D. Challenging ineffective adaptive responses and focusing on enhanced occupational adaptation

A. Modifying the environment or the occupation to reduce demands, address personal goals, and use developed skills The COTA®'s primary theoretical approach is the Person-Environment-Occupation-Performance model.

For which condition is a custom wheelchair seating system MOST appropriate? A. Multiple sclerosis (MS) B. Recent total hip replacement C. Guillain-Barré syndrome D. Acute traumatic brain injury (TBI)

A. Multiple sclerosis (MS) *RATIONALE: A custom seating system is indicated for a client who will likely be a long-time wheelchair user (e.g., a person with MS) to prevent deformity and skin breakdown.

A 4-year-old child with right hemiparesis has a goal to pick up and hold toys with the right hand. What type of orthosis would be MOST appropriate to help increase functional use of the hand? A. Neoprene thumb loop splint B. Resting pan splint C. Wrist cock-up splint D. Ulnar deviation splint

A. Neoprene thumb loop splint *RATIONALE: A neoprene thumb loop splint helps reduce spasticity and enables an optimal position to pick up and hold toys.

The caregiver of a client with Alzheimer's disease questions the home health COTA® about a recent increase in the client's dosage of donepezil (Aricept) prescribed by the physician. The caregiver is particularly concerned about potential consequences of the increased dosage. What is the COTA®'s most appropriate suggestion for the caregiver? A. Observe the client for signs of dizziness, which increases potential for falls. B. Because the medication can cause photosensitivity, keep the client out of direct sunlight. C. Have the physician monitor the client closely for potential drug toxicity. D. Monitor the client's hydration carefully because the drug can cause dry mouth and constipation.

A. Observe the client for signs of dizziness, which increases potential for falls. Donepezil is a cholinergic-modulating drug that may improve memory and cognition and reduce negative mood, anxiety, and hallucinations; however, dizziness is a side effect.

Which statement BEST describes the role of occupational therapy in an early intervention program under the Individuals With Disabilities Education Act Part C? A. Occupational therapy is one of 16 primary services provided for children in need of early intervention services. B. Occupational therapy is a related service provided only as a support to special education services. C. Occupational therapy is provided as a fee-for-service intervention for children in need of early intervention services. D. Occupational therapy is primarily a school-based service provided for children in need of early intervention.

A. Occupational therapy is one of 16 primary services provided for children in need of early intervention services. *RATIONALE: As part of IDEA Part C, occupational therapy is listed as a primary service, as are speech and physical therapy and special instruction.

A COTA® is facilitating an activity for a group that includes an adolescent with major depression. Partway into the session, the adolescent complains of an inability to concentrate on the activity because the bright lights in the room have caused sore eyes. How should the COTA® respond? A. Offer the client a choice to discontinue the session and ask the nurse about medication effects. B. Immediately report the situation to the nurse and ask the client to rest for the day. C. Ignore the client's response because it might be an effort to avoid work. D. Speak to the client privately and inquire whether the client is telling the truth.

A. Offer the client a choice to discontinue the session and ask the nurse about medication effects. COTA®s should be cognizant of the possible functional performance effects of medication. Offering a choice is an effective way of handling an adolescent.

A COTA® assigned to the stroke unit of an acute care hospital is implementing treatment for a patient with a hemiplegic hand. Based on the expected pattern of progression in the acute phase after a stroke, which areas of focus should be considered at this stage to enable the patient to overcome barriers to ADL performance? A. Passive range of motion and positioning of the affected upper extremity, bed mobility B. Visual and cognition issues, upper-extremity orthotic needs C. Transfers, therapeutic exercise for upper-extremity strengthening D. Community mobility, fine motor coordination

A. Passive range of motion and positioning of the affected upper extremity, bed mobility *RATIONALE: In the acute stage of recovery, passive range of motion, positioning of the affected extremity, and bed mobility are critical components in restoring function for ADL performance.

A COTA® 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 armrests 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. Perform weight shift by pushing up on armrests with upper extremities. Clients with T1 SCI should be able to shift weight and relieve pressure independently and when needed. This pressure is relieved best by lifting the lower extremities from the surface by pushing up on the armrests.

A client is being discharged home after spending 2 weeks in rehab after a stroke. The client's last session is addressing transfer safety training. For a wheelchair-to-bed standing pivot transfer, which of the following steps would be FIRST in the sequence of the transfer? A. Positioning the chair at a 45° angle to the bed B. Telling the client to scoot forward in the wheelchair. C. Swinging the footrests out of the way D. Setting the brakes on the wheelchair

A. Positioning the chair at a 45° angle to the bed *RATIONALE: For the client's safety, the wheelchair needs to be positioned with the least amount of space for him to travel.

A COTA® is working with a client in the active phase of C6 spinal cord injury. What piece of durable medical equipment would be BEST suited for assisting in the client's community mobility? A. Power recliner with standard arm drive B. Lightweight folding wheelchair C. Power recliner with head control D. Manual rigid wheelchair

A. Power recliner with standard arm drive At C6, wrist extension is still preserved at some functional level, allowing for the control of a power recliner with standard arm drive.

A client with traumatic brain injury is able to live in a supportive home environment and complete light housekeeping and laundry. What area is most appropriate for the COTA® to address next with the client? A. Practice shopping skills B. Establish a self-care routine C. Reestablish skills for washing a car D. Provide a noise-free environment

A. Practice shopping skills Providing community reentry skills training is appropriate once a client has demonstrated the ability to perform ADLs and basic homemaking tasks.

A client with traumatic brain injury is able to live in a supportive home environment and complete light housekeeping and laundry. What area is most appropriate for the COTA® to address next with the client? A. Practice shopping skills B. Establish a self-care routine C. Reestablish skills for washing a car D. Provide a noise-free environment

A. Practice shopping skills *RATIONALE: Providing community reentry skills training is appropriate once a client has demonstrated the ability to perform ADLs and basic homemaking tasks.

A statement in the Occupational Therapy Code of Ethics (2015) reads, "Occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services." Which principle is this statement part of? A. Principle 1, Beneficence B. Principle 5, Veracity C. Principle 4, Justice D. Principle 3, Autonomy

A. Principle 1, Beneficence *RATIONALE: Principle 1, Beneficence, involves the commitment to benefit others and to be concerned with the well-being and safety of service recipients.

For a client with C5 spinal cord injury (SCI) in the acute phase of rehabilitation, what is the BEST position to place the client's forearms in? A. Pronation B. Supination C. Flexion D. Extension

A. Pronation The forearm should be pronated because clients with C5 SCI are prone to contractures in their supinators because of their inability to pronate actively.

A client diagnosed with dissociative personality disorder is admitted to an inpatient psychiatric hospital as a result of suicidal behavior and impulses, severe anxiety, and periods of violence brought on by the emergence of new personalities. How is the COTA® in this milieu therapy setting likely to intervene? A. Provide a safe, nonthreatening, success-oriented environment to increase the client's sense of control. B. Offer group therapy opportunities for verbalizing experiences and describing other personalities. C. Offer group training in development of coping skills. D. Offer participation in psychodrama groups to encourage catharsis.

A. Provide a safe, nonthreatening, success-oriented environment to increase the client's sense of control. *RATIONALE: Clients in the acute phases of multiple personality disorder require opportunities for safe and supportive exploration of new personalities.

A COTA® is working with a kindergarten student who has form constancy issues and needs assistance locating the correct space for writing the student's name on a worksheet. Which intervention would support this student's ability to successfully locate where to write his or her name on a worksheet? A. Provide materials for the student to develop a collage with the word "name" printed in different fonts B. Encourage the student to construct the letters in "name" on a pegboard or a light box toy C. Allow the student to spell the word "name" out loud before moving to the worksheet D. Eliminate unnecessary information and decorations from the worksheet

A. Provide materials for the student to develop a collage with the word "name" printed in different fonts Form constancy involves the recognition of forms regardless of the size, shape, or position; developing a collage with the word "name" printed in different fonts would help the student locate the correct space.

A COTA® is working on a task-oriented gardening activity with a small group of adolescents in an inpatient mental health setting. One of the participants becomes self-absorbed and distractible and has bursts of energy that are affecting the other members of the group. What is the COTA®'s MOST appropriate response? A. "How are we doing with our planting? We need to get this done today." B. "I want speak to you privately about your behavior during the group work today." C. "You are distracting the other members of the group from getting their work done." D. "Please stop this behavior. It is distracting. Perhaps you want to do something else?"

A. "How are we doing with our planting? We need to get this done today." *RATIOANLE: When a client starts shows symptoms of a manic episode, particularly emotional and cognitive symptoms, it is best to help the client engage in goal-directed action.

A COTA® is working with an infant who is recovering from a brachial plexus injury. What type of sling should the COTA® fabricate? A. A sling that fits proximally around the humerus B. A sling that fits proximally around the radius C. A sling that fits proximally around the ulna D. A sling that fits proximally around the clavicle

A. 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.

An 18-year-old client is admitted to an inpatient psychiatric hospital. The psychiatrist describes an uninterrupted 18-month period of illness that includes visual and auditory hallucinations. What type of issues would the COTA® expect to see when the client attempts to do a task? A. Aggressive outbursts of behaviors when frustrated with a project B. Overassertive, controlling behaviors during group activities IncorrectC. Difficulty engaging in problem solving D. Panic over task choices

A. Aggressive outbursts of behaviors when frustrated with a project *RATIONALE: During task performance, clients with symptoms of schizophrenia can show elevated levels of frustration and aggression during challenging tasks.

Which occupational therapy assessment tool for motor and sensory function would BEST be used with the population with spinal cord injury in determining baseline performance? A. American Spinal Injury Association (ASIA) Scale B. Canadian Occupational Performance Measure (COPM) C. Modified Ashworth Scale (MAS) D. Manual muscle testing

A. American Spinal Injury Association (ASIA) Scale *RATIONALE: The ASIA Scale is used to determine baseline sensory and motor control performance for clients with spinal cord injury.

A COTA® is using Fidler's task-oriented group as a context for treatment to help participants explore healthy ways to deal with conflict. Which of the following activities would be BEST for this group? A. An activity that is challenging and likely to cause tension among members B. An activity that is highly structured so participants know exactly what is expected of them C. A parallel group activity that enables participants to work alongside one another D. An activity that facilitates participants' success and thus improves their self-esteem

A. An activity that is challenging and likely to cause tension among members A task-oriented group presents opportunities for participants to practice situations they may encounter in daily life. A group environment in which conflicts are likely to occur can help participants practice resolving conflict in appropriate ways.

A COTA® is scheduled to lead a discussion group for clients attending an outpatient psychiatric facility. What planning should the COTA® do in advance of the discussion to MOST EFFECTIVELY promote interaction within the group? (retired NBCOT question) A. Arrange the chairs so the group and leader sit in a circle B. Place the chairs in rows with the least talkative participants in front C. Sit next to the participants who tend to be most quiet D. Have the most talkative participants directly across from the COTA®

A. Arrange the chairs so the group and leader sit in a circle Group discussions should facilitate interaction among group members and the group leader, and arranging the chairs in a circle encourages interaction.

A COTA® is working with a 3-year-old child with autism and oral defensiveness to improve feeding skills. Which activity is BEST to begin desensitization of this child's oral defensiveness? A. Ask the child to hold a vibrating toy and put it close to the face. B. Provide deep pressure on distal parts of the upper extremities and provide slow linear rocking. C. Ask the child to touch the lips with a piece of cracker, providing positive reinforcement. D. Provide only preferred foods and allow the child to select the food during feeding sessions.

A. Ask the child to hold a vibrating toy and put it close to the face. Tools can be used to provide oral stimulation to desensitize oral hypersensitivity.

A COTA® is preparing to perform bedside ADLs with a client with spinal cord injury. As the COTA® assists the client into a sitting position, the client reports dizziness and nausea. What action is the MOST APPROPRIATE for the COTA® to take? A. Assist the client in returning to a reclining position and elevate the client's feet. The COTA® should alert the client's nurse, physician, and supervising OTR® as soon as possible. B. Place the client upright, remove restrictive devices, and check the client's catheter. The COTA® should alert the client's nurse, physician, supervising OTR® as soon as possible. C. Ensure the client is seated and quickly leave to alert the nurse or physician. D. Encourage the client to remain seated, with assistance, and wait for symptoms to pass. The COTA® should alert the client's nurse, physician, and supervising OTR® as soon as possible.

A. Assist the client in returning to a reclining position and elevate the client's feet. The COTA® should alert the client's nurse, physician, and supervising OTR® as soon as possible. The client is experiencing orthostatic hypotension and should be returned to a supine position, with feet elevated over the heart. The COTA® should alert the client's nurse, physician, and supervising OTR® as soon as possible.

Performing a functional transfer with a client with CVA, the COTA® blocks the client's affected knee and instructs the client to reach for the desired surface and move toward the stronger side. What transfer technique does this BEST describe? A. Assisted stand pivot B. Bent pivot transfer C. Maximum assist transfer D. Dependent lift transfer

A. Assisted stand pivot An assisted stand pivot is used to move a client from one surface to another.

An OTR® and COTA® team who work with adult clients with mental illness attend an introductory workshop on guided imagery. The OTR® and COTA® want to begin applying the skills obtained from the workshop with clients. With which of the following clients would it be MOST appropriate for the OTR® and COTA® to use guided imagery? A. Clients with generalized stress disorder B. Clients with chronic schizophrenia C. Clients with chronic bipolar disorder with psychotic episodes D. Clients with schizoaffective disorder

A. Clients with generalized stress disorder Many people respond well to relaxation with guided imagery, but guided imagery alone is contraindicated for people with hallucination potential, such as in schizophrenia, bipolar disorder with psychosis, or schizoaffective disorder.

Which example is an indirect intervention that an OTR®; can provide to support a child with mental and behavioral challenges? A. Coaching a caregiver on how to monitor the child's arousal levels at home and in the community B. Providing special instructions and working with the COTA® to provide the most effective sensory processing activities for the child C. Discreetly observing the child for any signs of problems in adapting in the classroom environment D. Working with the classroom teacher during recess to create activities that support good social interactions

A. Coaching a caregiver on how to monitor the child's arousal levels at home and in the community *RATIONALE: An indirect occupational therapy intervention is defined as working with and through one or more members of the team surrounding the child. During indirect intervention, the OTR does not directly work with the child to remediate difficulties. This option is a form of indirect intervention because it is geared toward caregiver education rather than direct client intervention.

Which example is an indirect intervention that an OTR®; can provide to support a child with mental and behavioral challenges? A. Coaching a caregiver on how to monitor the child's arousal levels at home and in the community B. Providing special instructions and working with the COTA® to provide the most effective sensory processing activities for the child C. Discreetly observing the child for any signs of problems in adapting in the classroom environment D. Working with the classroom teacher during recess to create activities that support good social interactions

A. Coaching a caregiver on how to monitor the child's arousal levels at home and in the community *RATIONALE: An indirect occupational therapy intervention is defined as working with and through one or more members of the team surrounding the child. During indirect intervention, the OTR does not directly work with the child to remediate difficulties. This option is a form of indirect intervention because it is geared toward caregiver education rather than direct client intervention.

Which example is an indirect intervention that a COTA® can provide to support a child with mental and behavioral challenges? A. Coaching a caregiver on how to monitor the child's arousal levels at home and in the community B. Providing special instructions and supporting the OTR®; in providing most effective sensory processing activities for the child C. Discreetly observing the child for any signs of problems in adapting in the classroom environment D. Working with the classroom teacher during recess to create activities that support good social interactions

A. Coaching a caregiver on how to monitor the child's arousal levels at home and in the community An indirect occupational therapy intervention is defined as working with and through one or more members of the team surrounding the child. During indirect intervention, the COTA does not directly work with the child to remediate difficulties. This option is a form of indirect intervention because it is geared toward caregiver education rather than direct client intervention.

A COTA® is providing intervention to a client with an anxiety disorder who hyperventilates when faced with difficult work tasks. The COTA begins to work with the client on physiological responses and the thought processes leading up to the panic attacks and suggests that the client begin journaling. What frame of reference does this intervention suggest? A. Cognitive-behavioral B. Psychodynamic C. Cognitive disability D. Behavioral

A. Cognitive-behavioral A: The cognitive-behavioral frame of reference works on the thoughts and reactions related to environmental triggers. Through journaling and reflection, the client can identify triggers that cause the anxiety to escalate.

What is the BEST compensatory strategy a COTA® can apply to address the on-road performance of a client with visual field deficits? A. Compensate with extra head turns and frequent eye movements. B. Use prescription lenses. C. Impose speed-limit or night-driving restrictions. D. Train the client in the use of alternative transportation and start the driving retirement process.

A. Compensate with extra head turns and frequent eye movements. *RATIONALE: All the choices are compensatory strategies, but the best answer to this question is A, which encompasses the most comprehensive approach.

A COTA® is running a group with clients with schizophrenia in an inpatient psychiatric facility. The group members have low cognitive ability, minimal insight into the condition, and low motivation, and they do not know each other very well. What leadership style would be BEST for the COTA to use? A. Directive B. Facilitative C. Cooperative D. Advisory

A. Directive A directive leadership style is most appropriate for these group members because the group leader will assume responsibility for the group in all aspects: activity choice, social participation, rule setting, and so forth. The directive approach is best with clients who have low cognitive ability and low motivation.

A COTA® is leading a group for clients who have depression and are unable to initiate tasks or make choices about what to do. Which leadership style would be MOST effective with this group? A. Directive B. Facilitative C. Advisory D. Co-leadership

A. Directive For participants who are unable to make choices or direct their behavior, the group leader must structure the group to limit the number of choices. A directive leadership style best ensures participants' success in engaging in the group activities.

A COTA® is using suspended equipment in working with a child who has vestibular issues. The COTA® is worried that the child might be receiving too much input. What physical indicator suggests that the child might be receiving too much vestibular input? A. Dizziness B. A flushed face C. An expression of hunger D. Efficient motor coordination

A. Dizziness When providing vestibular input, the therapist looks for warning signs that too much input is being provided. Warning signs include the child's report of nausea or dizziness, blanching, hyperactivity, and lethargy.

A COTA® is teaching a client with stroke compensatory strategies to don a pullover shirt. The client has hemiparesis that limits upper-extremity movement in the affected side. What is the FIRST step the client should be taught? A. Dress the affected arm by placing the sleeve over the affected arm B. Put the head through the neck opening by bending the neck forward C. Place the unaffected arm into the sleeve by placing the sleeve over the unaffected arm D. Rub the affected arm on the leg to straighten the sleeve

A. Dress the affected arm by placing the sleeve over the affected arm Dressing the weaker side should be the first step in upper-body dressing.

A COTA® is performing upper-extremity activities with a client experiencing left hemiparesis. The COTA® notes a decrease in ROM in the left upper extremity. What factors BEST describe this decrease in ROM? A. Edema, joint contracture, and weakness B. Edema, muscle tone, and sensation C. Sensation, muscle tone, and proprioception D. Sensation, ataxia, and proprioception

A. Edema, joint contracture, and weakness The client is most likely experiencing weakness, edema, and contracture of the left upper extremity as a result of the left hemiparesis.

A COTA® is working with a young adult experiencing acute lower back pain. What is the FIRST action the COTA® should take? A. Educate the client in basic body mechanics. B. Provide long-duration, low-intensity back exercises. C. Recommend short-duration, high-intensity back exercises. D. Refer the client for vocational counseling and planning.

A. Educate the client in basic body mechanics. Management of clients with lower back pain should initially include education in body mechanics and application to engaging in occupations to prevent further injury.

A COTA® and OTR® are discussing wheelchair options with a client with incomplete T3 spinal cord injury. The client asks whether the purchase of an electric wheelchair should be considered. How would the OTR® and COTA® BEST respond? A. Electric wheelchairs are useful for long distances, although a manual wheelchair can promote improved function. B. Electric wheelchairs are very expensive and may not be covered by primary payer sources. C. Electric wheelchairs are large and bulky and will prevent accessibility in the home and community. D. Electric wheelchairs may stunt future progress in rehab.

A. Electric wheelchairs are useful for long distances, although a manual wheelchair can promote improved function. Clients with T3 spinal cord injury are generally independent in their wheelchair mobility; recommendations include a rigid or folding lightweight wheelchair.

A 7-year-old child presents with amelia and uses a myoelectric hand. Which terminal device is the client MOST likely to wear? A. Externally powered prosthesis B. Body-powered prosthesis C. Passive prosthesis D. Hook prosthesis

A. Externally powered prosthesis A myoelectric hand is paired with an externally powered prosthesis, which involves the placement of an electrode to pick up electromyographic signals to move the electric hand.

A COTA® is assisting an OTR®; in running psychoeducational group sessions for an after-school program for children with behavioral and sensory processing challenges. Which example is an ESSENTIAL characteristic of psychoeducational programming for this group? A. Facilitating parents and children to learn sensory modulation techniques and strategies for identifying challenging behaviors B. Planning activities and games that will allow participants opportunities to regulate arousal levels C. Allowing reflection time after group games so that children can discuss behaviors displayed during activities D. Ensuring that group dynamic principles are applied during task performance in sessions

A. Facilitating parents and children to learn sensory modulation techniques and strategies for identifying challenging behaviors In psychoeducational groups, the leader is tasked with teaching members and families new skills or strategies for managing specific life and developmental challenges.

A COTA® is helping a 3-year-old child with autism develop functional play skills. Which play activity is BEST for achieving this goal? A. Feeding and dressing dolls B. Stacking various colored rings C. Locating items buried in a rice table D. Pretending to be an imaginary character.

A. Feeding and dressing dolls Functional play uses real objects to re-create real-life situations.

A COTA® is working with a child on tooth brushing. The COTA® lets the child brush the teeth for a minute. The child fails to brush the majority of the teeth. Next, the COTA® uses the toothbrush to brush all of the child's teeth. What strategy is the COTA® using with this child? A. Forward chaining B. Modifying C. Grading D. Backward chaining

A. Forward chaining Forward chaining involves the therapist encouraging the child to complete the first step of the task, and then the therapist completes the rest of the task.

An OTR® is evaluating a child with scoliosis for dressing ability. The child is wearing a spinal orthosis and requires adaptations to perform the task successfully. Which adaptation might the OTR recommend to help this client don a shirt independently? A. Front-opening garment B. Pullover garment C. Back-opening garment D. Garment with a zipper in the back

A. Front-opening garment *RATIONALE: A front-opening garment facilitates the most independence in getting dressed.

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? A. Front-opening garment B. Pullover garment C. Back-opening garment D. Garment with a zipper in the back

A. Front-opening garment A front-opening garment will facilitate the most independence in getting dressed.

A client with stroke is taught to dress the weaker side first when donning a button-down shirt. The client then initiates putting the weaker lower extremity into the pant leg. What learning has occurred for the client? A. Generalization B. Transfer C. Automaticity D. Acquisition

A. Generalization The client demonstrates generalization, which is the ability to take a strategy used with one task and apply that strategy to a new task.

A COTA® who works with adult clients with mental illness attends an introductory workshop on guided imagery. The COTA wants to begin applying the skills obtained from the workshop with clients. For which type of disorder is guided imagery an appropriate intervention technique? A. Generalized stress disorder B. Chronic schizophrenia C. Bipolar disorder with psychosis D. Schizoaffective disorder

A. Generalized stress disorder Guided imagery is a type of mindfulness technique that encourages relaxation. It is an evidence-based strategy that has been found to be effective with people with stress-related disorders. The technique allows clients to practice skills in a situation with less pressure than might be encountered in a real situation, which gives them the ability to approach the real-life situation with less anticipatory stress and strategies to cope with stress as it arises.

A client who has had a stroke presents with homonymous hemianopia. What area of the client's vision has been lost? A. Half of the visual field in both eyes B. The eye most affected by the stroke C. Macula or central vision only D. Vision on the same side as the lesion

A. Half of the visual field in both eyes *RATIONALE: Hemi means "half" and anopia means "blindness," so hemianopia means vision loss in half of the visual field. Homonymous means that the deficit is the same in both eyes.

An OTR®; is working with a child who has autism. The teachers and parents complain that each time the child uses the bathroom, the child will be in the bathroom for at least 10 minutes. The child becomes fixated and needs to flush the toilet five times or the child gets very upset. The OTR decides to create a social story to help the child understand the implications of such behavior. Which example of a social story sentence goal is MOST appropriate for this goal? A. "I will not flush the toilet more than 1 time each time I use it." B. "I will only flush the toilet one time when I go to the bathroom in the school or in a public place." C. "It may bother other people when a child uses the bathroom for a long time and flushes the toilet 5 times." D. "I will not spend a long time in the bathroom so others can use it too."

B. "I will only flush the toilet one time when I go to the bathroom in the school or in a public place." *RATIONALE: This response is an example of a control or affirmative social story sentence in which a child is asked to write his or her own sentence to help the child recall necessary information or expectations.

A COTA® is working with a child who has autism. The teachers and parents complain that each time the child uses the bathroom, the child will be in the bathroom for at least 10 minutes. The child becomes fixated and needs to flush the toilet 5 times, or the child becomes upset. After discussing the situation with the OTR®;, the COTA decides to create a social story to help the child understand the implications of such behavior. Which example of a social story sentence is MOST appropriate for this goal? A. "I will not flush the toilet more than 1 time each time I use it." B. "I will only flush the toilet one time when I go to the bathroom in the school or in a public place." C. "It may bother other people when a child uses the bathroom for a long time and flushes the toilet 5 times." D. "I will not spend a long time in the bathroom so others can use it too."

B. "I will only flush the toilet one time when I go to the bathroom in the school or in a public place." This response is an example of a control or affirmative social story sentence in which a child is asked to write his or her own sentence to help the child recall necessary information or expectations.

In which of the following groups is group process the MOST important? A. An open-membership group for people with stroke that meets weekly, in which the COTA® demonstrates self-ROM and then participants range their own extremities to demonstrate that they understand the correct procedures B. A closed-membership group for war veterans that meets daily to facilitate coping with the impact of posttraumatic stress disorder by engaging in expressive media, discussion, and reflection C. A diagnosis-specific group for patients with arthritis that meets weekly to measure ROM, monitor pain control, and discuss energy conservation techniques D. A group for adolescent students in an after-school program who are receiving tutoring in math, reading, and fine motor skills

B. A closed-membership group for war veterans that meets daily to facilitate coping with the impact of posttraumatic stress disorder by engaging in expressive media, discussion, and reflection Because discussion among peers is a principal component of this group, group process is essential to the effectiveness of this intervention. People with posttraumatic stress disorder often find it helpful to share their experiences with others who have had similar experiences, and the group process is often effective in this context.

A COTA® is working with a child with dysgraphia on schoolwork. Which intervention strategy might the COTA® provide? A. A magazine that is of high interest and at the child's reading level B. A copy of partially completed notes so that he only has to fill in key words C. A lab partner during science experiments D. A calculator to complete math tasks

B. A copy of partially completed notes so that he only has to fill in key words Dysgraphia is a learning disability associated with difficulty producing written language. This option is correct because it requires that the child focus on writing less during instruction.

Which occupational therapy group would benefit MOST from a highly directive and authoritative leadership style? A. A group of preschool children exploring sensory experiences to develop age-appropriate prehension and grasp skills B. A group of adolescents diagnosed with oppositional defiant disorder attending a gang prevention group in an alternative education setting C. A group of middle-aged clients in an outpatient day treatment setting who are learning to manage their depression D. A group of healthy older adults in an apartment complex exploring ways to stay fit and healthy

B. A group of adolescents diagnosed with oppositional defiant disorder attending a gang prevention group in an alternative education setting Adolescents, particularly those diagnosed with oppositional defiant disorder, need boundaries, and an authoritative leadership style is critical to successfully managing this group.

What piece of adaptive equipment is MOST useful for a client with an incomplete T2 spinal cord injury? A. A weighted spoon B. A long-handled sponge C. A plate protector D. A button hook

B. A long-handled sponge Clients with a T2 spinal cord injury will need assistance reaching and washing immobile lower extremities.

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 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 provide a defined, safe environment for the client to wander in the house, what would be the MOST likely recommendation? A. A deadbolt above the front doorknob B. A side bolt placed high on the front door C. A gated living room, using child safety gates D. A walk with the client several times a day

B. A side bolt placed high on the front door *RATIONALE: A side bolt that is not within reach of the client is one strategy to prevent the client from opening the front door and wandering away from the house without the daughter's awareness.

A COTA® has been working on increasing the attention span of an 8-year-old child with autism who is distractible during handwriting activities in the classroom. Using a sensory integration approach, which environment is the BEST to address concentration and attention skills? A. An isolated room free from any kind of distraction B. A small classroom with two other children doing handwriting and soft background music C. A small corner of a sensory gym where two other children are swinging D. A quiet corner in the child's classroom separated from the rest of the room by a chalkboard divider

B. A small classroom with two other children doing handwriting and soft background music Sensory integration techniques emphasize the use of naturalistic environments for intervention. Using a small classroom where two other children are doing handwriting tasks is the most naturalistic environment similar to an actual classroom without unnecessary sensory stimulation.

A client has C6 complete tetraplegia. Which hand functions can this client be expected to demonstrate? A. Limited grasp to pick up an item between the proximal and distal interphalanges B. Ability to pick up an object by stabilizing it between the palms of both hands C. Inability to use the hands for any functional tasks or object manipulation D. Ability to manipulate the power control of a wheelchair using the tips of the fingers

B. Ability to pick up an object by stabilizing it between the palms of both hands Radial wrist extension allows the client with C6 tetraplegia to stabilize the hands for compensatory grasp activities such as picking up a bottle or sliding an object to the edge of the table.

A COTA® is working with a client who has cognitive deficits after a stroke. The OTR®; wants the client to be able to complete transfers when the client discharges to home. What strategy should the COTA use to enhance the client's ability to transfer at home? A. Complete multiple transfers in the client's hospital room throughout the day B. Address transfers in the client's hospital room, the clinic treatment area, and the hospital recreation room C. Provide the client with visual feedback on trunk posture by having the client sit in front of a mirror during toileting D. Practice bridging in the client's hospital room bed to increase trunk extension

B. Address transfers in the client's hospital room, the clinic treatment area, and the hospital recreation room Generalization involves the ability to use skills and complete tasks in different contexts. Tasks should be practiced in varied contexts.

A COTA® is working with a client with polyarticular juvenile rheumatoid arthritis (JRA). Which biomechanical technique would be appropriate to include in the client's intervention plan during an exacerbation? A. A resistive exercise program B. An AROM program C. A taping program D. A pacing program

B. An AROM program AROM exercises, along with splinting, monitoring joint function, preventing deformation, teaching energy conservation techniques, and instruction in the use of adaptive equipment, are all recommended intervention for a child with JRA.

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 Aphasia is defined as having difficulty with communication.

A 4-year-old child with attention deficit hyperactivity disorder is using a tire swing for vestibular input to feel more organized. After a few minutes, the child appears to have some autonomic reactions to the fast swinging. Which course of action for the COTA® is BEST? A. Immediately ask the child to stop and sit in a corner to relax with a blanket. B. Ask the child to slow down the swinging by pulling a trapeze bar for proprioceptive input. C. Ask the child to slow down while doing slow, deep breathing exercises. D. Let the child continue because the vestibular stimulation ceases with autonomic activation.

B. Ask the child to slow down the swinging by pulling a trapeze bar for proprioceptive input. Research indicates that proprioceptive input inhibits vestibular stimulation.

A COTA® is working with a child with Down syndrome and has been told not to allow the child to do a somersault (forward roll) because of congenital joint instability and risk of spinal cord injury. Which joint is the target of this precaution? A. Glenohumeral joint B. Atlantoaxial joint C. Patellofemoral joint D. Subtalar joint

B. Atlantoaxial joint The atlantoaxial joint is located at the first and second cervical vertebrae; instability at this joint could result in spinal cord damage if proper precautions are not taken. Many children with Down syndrome are at risk for instability at this joint.

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 This combination of symptoms describes autonomic dysreflexia. The symptoms would prompt an COTA® to sit the client upright and remove any noxious stimulus.

In reading a client's medical chart, the COTA® notes that the client has a history of postprandial orthostatic hypotension. What activity precautions should the COTA give the client? A. Limit standing to 30 minutes while completing an occupation such as cooking. B. Avoid a positional change from lying down to standing within 30 minutes of eating a meal. C. Take several minutes to move from lying down to sitting and then to standing after being in bed all night. D. Avoid leaning the head too far forward, for example, bending over to tie shoes while sitting.

B. Avoid a positional change from lying down to standing within 30 minutes of eating a meal. Postprandial orthostatic hypotension occurs when a person goes from supine to standing shortly after eating a meal. It generally affects older adults, people with hypertension, and people with Parkinson's disease.

A COTA® is working with a client in the active phase of a T2 spinal cord injury. The client reports a terrible headache and is sweating profusely. What is the BEST method to address the client's symptoms? A. Check blood pressure and alert nurse. B. Bring upright and remove restrictive clothing. C. Recline quickly and elevate legs. D. Bring upright and apply abdominal binder.

B. Bring upright and remove restrictive clothing. The client is likely experiencing autonomic dysreflexia, a serious and life-threatening condition. The client should be placed upright, restrictive clothing should be removed, and the bladder should be voided (or catheter tubing checked for obstruction).

A COTA® is working on postoperative discharge plan for a school-age child with neurofibromatosis. The COTA® recommends that the parents move the child's clothes from the top drawer so that the child can access them independently. Why might the COTA® make this recommendation? A. Children with neurofibromatosis have weakened shoulder girdles and reduced upper-extremity strength. B. Children with neurofibromatosis are of short stature and have skeletal anomalies. C. Children with neurofibromatosis have decreased sensation and often drop things. D. Children with neurofibromatosis have difficulty initiating routines.

B. Children with neurofibromatosis are of short stature and have skeletal anomalies. *RATIONALE: Children with neurofibromatosis are of short stature and have skeletal anomalies. Because of their reduced height, they may benefit from environmental modifications that allow them to reach objects independently.

Which activity is an important part of the process of deciding whether a professional dilemma might in fact involve a violation of the Occupational Therapy Code of Ethics (2015)? A. Taking quick action to reduce the potential for the dilemma to become greater B. Clearly stating the dilemma in a way that focuses on the most important issue to be resolved C. Seeking justification for the actions of those involved D. Determining the best way to protect one's self-interest

B. Clearly stating the dilemma in a way that focuses on the most important issue to be resolved Not all professional dilemmas involve a violation of the Code of Ethics. Before taking action, reflecting on one's own beliefs and values and examining the facts are important. Being able to articulate what the dilemma is usually leads to a better determination of whether a violation is involved. Once the dilemma is clearly framed, it is important to look carefully at the language in the Code to see if it addresses the situation.

A COTA® and an OTR® working in a community hospital were asked to serve on a team assessing the livability of surrounding communities. Which definition BEST describes the concept of livability? A. Provision of sidewalks, crossing signals, and curb cuts to ensure that all citizens of the community can move around the community without an automobile B. Community design that promotes maximum participation of all citizens, regardless of age or ability C. Mix of housing that allows families with and without children and people of all ages and incomes to live in inclusive neighborhoods D. Design of the physical aspects of a community to allow equal access to goods and services for wheelchair users

B. Community design that promotes maximum participation of all citizens, regardless of age or ability *RATIONAE: Livability is a concept that extends beyond specific types of physical access or design to encompass all aspects of community life that may invite participation by all community dwellers, regardless of age or ability.

Which group activity would be the MOST appropriate to engage clients in an expressive activity using the psychodynamic approach? A. Baking chocolate chip cookies B. Constructing a magazine collage C. Hiking in the woods D. Attending a dance performance

B. Constructing a magazine collage The psychodynamic approach makes use of projective media such as clay, magazine collages, painting, and poetry.

A COTA® at a private outpatient clinic is working with a child with a severe anxiety disorder. The COTA decides to use an alter approach to intervention following the Ecology of Human Performance (EHP) Model. Which approach BEST exemplifies the alter intervention strategy? A. Teaching the child strategies to monitor arousal and anxiety levels in different situations B. Corresponding with the school personnel to discuss ways to support the child at school C. Discussing advantages and disadvantages of home schooling with the child's parents D. Developing an educational training program for parents to inform them about children's anxieties

B. Corresponding with the school personnel to discuss ways to support the child at school *RATIOANLE: According to the EHP Model, the alter intervention approach focuses on the client's context. Interventions are geared toward providing appropriate contexts to support the client's needs.

An extremely agitated adult is admitted to an inpatient psychiatric hospital late on a Friday afternoon. Because nursing is short staffed, the nurse on the unit requests that the patient attend an occupational therapy group being led by a COTA® that evening. The COTA® calls the OTR®, who is working at a location far from the unit, for guidance. The OTR® is unable to return to the unit in time to evaluate the client before the session. What is the BEST course of action the OTR® would direct the COTA® to take? A. Allow the patient to attend the group B. Do not allow the patient to attend the group C. Cancel the group and evaluate the client D. Permit the patient to attend the group because the OTR® will complete the evaluation upon returning to the unit.

B. Do not allow the patient to attend the group IncorrectC. Cancel the group and evaluate the client The COTA®is not permitted to initiate treatment of a client; the OTR® must do the initial assessment of the client. Allowing the patient to attend a group session would be an ethics violation and liability risk.

A COTA® is working in an outpatient clinic with a child with ADHD. The client reports having difficulty keeping the bedroom neat and tidy without the mother's assistance. On the basis of this condition, which activity demand related to cleaning one's room would be problematic for the client? A. The mother's expectation that food not be eaten in bedrooms B. Drawers that are not designated for specific types of clothing C. A small wastepaper basket D. Lack of space under the client's bed

B. Drawers that are not designated for specific types of clothing According to AOTA (2008, pp. 634), "Activity demands include the specific objects and their properties used in the activity, the physical space requirements of the activity, the social demands, sequence and timing, the required actions or skills needed to perform the activity, and the required body functions and structures used during the performance of the activity." The lack of designated drawers for different types of clothing may prevent the client from keeping the room neat and tidy.

A COTA®, in conjunction with an OTR®, is working at an after-school program connected to a women's homeless shelter. The mother of a 10-year-old boy tells the COTA® that the child has recently loss quite a bit of weight and is excessively thirsty. To which specialist should the child be referred? A. Pediatrician B. Endocrinologist C. Neurologist D. Psychiatrist

B. Endocrinologist These factors, along with polyuria and dehydration, are common signs of Type 1 diabetes. Onset is usually around age 10. The appropriate referral would be to an endocrinologist.

A client with multiple sclerosis indicates in the occupational profile that cleaning the home is an important IADL. The client has good balance and fair plus (3+/5) upper-extremity strength, is independent with self-care using adaptive equipment, and needs stand-by assistance for showering due to lack of endurance. The client easily becomes fatigued when cleaning. Which intervention is MOST important to include in the intervention plan? A. Upper-extremity strengthening program B. Energy conservation strategies C. Cognitive rehabilitation techniques D. Ergonomic workstation modifications

B. Energy conservation strategies *RATIONALE: Instruction in energy management strategies and activity techniques is used to address fatigue in clients with multiple sclerosis.

A COTA® in an adult day treatment program decides to use a group intervention with clients with schizophrenia who live in a supported living environment with 24-hour supervision. The COTA believes that a sensorimotor approach would help the clients reach their goal to increase independence in overall function and goal-directed activity in the home context. What would be an appropriate group activity that uses the sensorimotor approach? A. Discussing task performance B. Exercising to music C. Using a sensory room D. Baking cookies

B. Exercising to music Exercising to music is used in sensorimotor approaches to enhance motor learning and sensory functioning. It can be used by the COTA to improve skills for daily living and has been recommended as an evidence-based approach for people with schizophrenia.

Which type of splint should be used with a client who has a recent diagnosis of carpal tunnel syndrome? A. Restriction splint B. Immobilization splint C. Mobilization splint D. Ulnar gutter splint

B. Immobilization splint The purpose of splinting for carpal tunnel syndrome is to rest and reduce inflammation. An immobilization splint is most appropriate for this purpose.

A COTA® is working with a 10-year-old girl with Rett's syndrome. What can the COTA® expect by the time the girl reaches late childhood? A. Ability to cook a simple meal B. Inability to walk or speak C. Inability to express discomfort D. Independence with putting earrings on

B. Inability to walk or speak Girls with Rett's syndrome experience a decline in functional skills. Commonly, by the time a girl with Rett's syndrome reaches late childhood, she would no longer be able to walk or talk.

A COTA® wants to teach a home exercise strengthening program to a child with a mild intellectual disability. How should the COTA® modify the home exercise program so that the client can follow it independently? A. Reduce the number of exercises from 20 to 15 to encourage independence. B. Incorporate simplified vocabulary and pictures to encourage independence. C. Model the home exercise program and allow the child to follow along to encourage independence. D. Pair the child with a peer who has a similar home exercise program to encourage independence.

B. Incorporate simplified vocabulary and pictures to encourage independence. A child with a mild intellectual disability might be able to read between the second-grade and seventh-grade levels. Simplified words and pictures may allow the child to follow the home exercise program with greater independence.

A patient who has a complete C7 spinal cord injury is learning adaptive dressing techniques. What dressing goals should the patient be expected to achieve? A. Independence with upper and lower body dressing with contact guard assistance B. Independence with upper body dressing and minimal assistance with lower body dressing C. Minimal assistance with upper and lower body dressing using assistive devices D. Standby assistance for lower body dressing with adaptive equipment

B. Independence with upper body dressing and minimal assistance with lower body dressing A patient with a complete C7 spinal cord injury would be able to dress the upper body independently and the lower extremities with some assist, using assistive devices as needed.

A COTA® is working with a high school student with juvenile rheumatoid arthritis (JRA). The COTA® suggests that the student stop using the arms and hands to carry heavy textbooks to class and instead use a backpack. What type of strategy did the COTA® recommend? A. Energy conservation B. Joint protection C. Work simplification D. Pacing

B. Joint protection Using a backpack instead of arms and hands to carry heavy books will put less stress on the student's hand joints and is in line with a joint protection strategy.

A student in the second grade has sensory modulation disorder. When handwriting in class the student consistently places excessive force on the pencil, causing the pencil point to break. Which activity would provide the child with proprioceptive input for regulating the amount of pressure applied to the pencil during handwriting? (retired NBCOT question) A. Tracing the letters of the alphabet with fingertips B. Kneading modeling clay with both hands on a desktop C. Cutting firm resistance therapy putty with scissors D. Drawing shapes and letters on a chalk board with jumbo chalk

B. Kneading modeling clay with both hands on a desktop Proprioceptive input is provided through firm pressure to skin or joints, which the student would receive from kneading modeling clay.

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. Orthostatic hypotension occurs when the person's blood pressure drops on assuming an upright posture. Leaning the client back or helping the client lie down will help restore the blood pressure back to normal.

A client is evaluated by an OTR® to determine ability to return to work as a dry cleaner assistant after a total hip replacement 4 months ago. The client reports having to carry loads of laundry weighing as much as 10 lbs. one-third to two-thirds of the day. Per the Dictionary of Occupational Titles (DOT), at what strength demand should the COTA® design work simulation tasks? A. Sedentary CorrectB. Light C. Heavy D. Very heavy

B. Light *RATIONALE: A light strength demand is defined by DOT as requiring a force exertion or weight carried of 20 lb occasionally as much as one-third of the day, 10 lb frequently one-third to two-thirds of the day, and negligible weight constantly over two-thirds of the day.

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 Heterotopic ossification refers to the growth of bone in abnormal anatomic locations and is best prevented with joint ROM and medication routine.

A COTA® is working with a child with autism spectrum disorder who has a hard time engaging in positive social behaviors in the cafeteria. Which intervention strategy would be most appropriate to help the child learn how to behave in the cafeteria? A. Using proximity control B. Modeling the desired behavior C. Giving the child a break D. Giving the child a time out

B. Modeling the desired behavior Modeling the desired behavior and reminding the child of the behavioral expectations are two examples of gentle corrections that could be made in this situation.

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. Muscles below the level of injury generally develop spasticity because the monosynaptic reflex arc is intact but separated from higher inhibitory influences.

A COTA® is conducting a woodworking group in the psychiatric unit of a federal correctional facility. Which statement best reflects the policies and procedures related to this group that involves the safety and welfare of all inmates at this facility? A. All participants must put away tools and clean up all work areas B. No participant may return to the housing units until all tools have been counted. C. Participants are allowed to have coffee and a snack only at the conclusion of the group session. D. The OTR® may not allow a COTA® to run groups in federal corrections facilities.

B. No participant may return to the housing units until all tools have been counted. *RATIONALE: Because tools may be used to escape or as weapons, any occupational therapy group that uses tools must follow the facility's policy on counting tools.

How would a COTA® use coaching to help improve social skills for a client with Asperger syndrome? A. Role-play a scenario in which friends are deciding how to spend the evening. B. Outline what will be expected of the client in a job interview. C. Provide practice opportunities on how to ask someone on a date. D. Accompany the client to a store and help the client return a sweatshirt.

B. Outline what will be expected of the client in a job interview. *RATIOANLE: This approach delivers clear expectations that will help the client perform well on the job interview. Providing support by outlining expectations will help the client improve social skills in this professional setting.

A client with a C6 spinal cord injury (SCI) is performing a dressing task. Which type of equipment would the COTA® most likely give the client to assist with buttoning a shirt? A. No adaptive equipment would be needed B. Palmar-cuff buttonhook C. Extended buttonhook D. Standard buttonhook

B. Palmar-cuff buttonhook A client with a C6 SCI may not be able to grasp a buttonhook with the fingers, so a palmar cuff would provide the needed grasp.

A COTA® is assisting an OTR®; with developing social skills group programming for elementary-aged children with autism spectrum disorder. Which statement reflects the application of the essential elements of social skills group programming? A. Session formats should regularly be changed to improve participants' adaptive skills. B. Parents need to receive intensive training and home programming as part of the intervention. C. The COTA determines rules for behavior for the group at the beginning of each session on the basis of the assessments done. D. Parents and children are primary participants in goal setting to improve social skills.

B. Parents need to receive intensive training and home programming as part of the intervention. Parent involvement is critical to the success of social skills programming.

Which characteristic of a general education classroom would promote access to the general education curriculum of a student diagnosed with Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome)? A. Large classroom size B. Predictable transitions C. Teacher's gender D. Low level of structure

B. Predictable transitions Preparing students with autism spectrum disorder for transitions (e.g., from math activities to reading activities) is a fundamental strategy in managing the classroom environment to facilitate their engagement. Because all students benefit, preparation for transitions is considered best practice in an inclusive classroom setting.

A 16-year-old client with attention deficit hyperactivity disorder is learning how to set a table for a job at a banquet facility. The client has trouble remembering proper utensil placement and requires increased time to complete the task. Which intervention strategy would help the client place the utensils in the correct order? A. Construct single-step cards with pictures of single utensils and corresponding steps to follow when setting the table B. Provide a visual cue card that has a picture of a completed place setting to follow when setting the table C. Develop a visual reinforcement chart and put a star or check mark on it for every table successfully set D. Set a visual timer to a specified amount of time and require the client to complete the task in that time

B. Provide a visual cue card that has a picture of a completed place setting to follow when setting the table A visual cue card with a picture of a completed place setting provides a reminder to help the client properly place each utensil.

Which example offers the BEST way to incorporate community mobility exposure into psychosocial rehabilitation? A. Refer the client to a certified driver rehabilitation specialist. B. Provide opportunities for practice and role play before the client uses a mode of transportation. C. Provide the client with information on personal safety during travel. D. Educate the client on the availability of city or county pedestrian walkways or bike paths.

B. Provide opportunities for practice and role play before the client uses a mode of transportation. *RATIONALE: This choice allows for skill training in choosing a mode of transportation.

A client with stroke demonstrates deficits in visual-perceptual skills. One of the client's goals is to be more independent with dressing. What activity would be appropriate for the intervention session? A. Drawing a clock diagram on paper B. Putting on a button-front shirt C. Copying a pegboard design from a pattern D. Completing a bed-to-chair transfer

B. Putting on a button-front shirt The client can remediate visual-perceptual skills through task-specific practice in choosing a shirt from the closet, identifying the top and bottom of the shirt, and locating the sleeve.

A COTA® asks a client with impaired balance to dust and polish a bookshelf in standing position without upper-extremity support. The COTA® notes no loss of balance during reaching and bending tasks. How would the COTA® appropriately grade the activity to provide the just-right challenge? A. Add weights to the client's wrists. B. Reduce the client's base of support. C. Have the client stand on a stool. D. Provide a walker during cleaning activities.

B. Reduce the client's base of support. *RATIONALE: A therapeutic activity in which the COTA® is addressing balance in someone with deficits would likely begin with the client in a wide base of support, or with the feet hip- to shoulder-width apart. If the client can successfully participate in this IADL task with a wide base of support, the COTA® may upgrade the task and have the client move the feet closer together, narrowing the base of support and increasing the challenge.

A child with a sensory processing disorder and Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome) is attending a regular classroom. Which reasonable accommodation would be BEST for this child under the Individuals With Disabilities Education Act? A. Place the student's desk at the back of the classroom to address sensory needs. B. Reduce the number of math problems to one per page. C. Increase opportunities for supported spontaneous activities. D. Vary the number of other students at the student's lunch table for socialization.

B. Reduce the number of math problems to one per page. Presenting math problems one to a page reduces sensory overload by removing clutter on the page, allowing the student to attend to one math problem at a time and supporting the student in an inclusive setting by altering the task.

A COTA® is conducting a cooking activity in an outpatient occupational therapy group in a community mental health setting. One of the group members is an adult with obsessive-compulsive disorder (OCD). During meal preparation, the client washes hands repetitively and excessively each time the client touches a food item, which delays the group's progress in the activity. What should the therapist do to help the client more efficiently perform the task? A. Assign the client to a role that does not involve touching food. B. Remind the client of triggers for compulsive behavior and recommend use of latex gloves for the activity. C. Encourage the client to use utensils to avoid touching the food. D. Assign the client the role of teaching and managing hygienic cooking behaviors.

B. Remind the client of triggers for compulsive behavior and recommend use of latex gloves for the activity. Cognitive-behavioral therapy approaches to OCD include helping the client overcome the tendency toward compulsive behavior by identifying the triggers to a compulsive episode, planning a strategy for overriding the compulsion, and continuing to do the activity or task.

Which treatment activity would support a pediatric client's ability to increase visual attention to complete homework tasks? A. Providing directional cues paired with verbal cues B. Reorganizing a worksheet so that the answer spaces are clearly defined C. Using raised-line paper to complete assignments D. Color-coding folders and notebooks for different subjects

B. Reorganizing a worksheet so that the answer spaces are clearly defined Reorganizing a worksheet with clearly defined answer spaces would help the child attend to relevant information on the worksheet.

A 9-year-old client with juvenile rheumatoid arthritis has a goal to decrease stiffness and promote joint alignment. What orthosis would be MOST appropriate to help this client? A. Neoprene thumb loop splint B. Resting pan splint C. Wrist cock-up splint D. Ulnar deviation splint

B. Resting pan splint A resting pan splint promotes joint alignment and reduces stiffness.

A 9-year-old child with spina bifida has a goal of learning skills to promote independent health maintenance. Which task should the COTA® address FIRST to promote independent health maintenance? A. Medication management B. Self-catheterization C. Prevention of further health care problems D. Navigation of the insurance system

B. Self-catheterization Children with spina bifida generally become independent in self-catheterization at home and at school between age 5 and 9 years.

An allegation of ethical misconduct is submitted against an occupational therapy practitioner. The AOTA Ethics Commission determines that the alleged behavior may not be a true breach of the Occupational Therapy Code of Ethics (2015) warranting sanctions, but the behavior is not in keeping with appropriate standards of practice. What action is the Ethics Commission MOST likely to take? A. Issue a reprimand to the Complainant for submitting a false ethics claim B. Send a letter to educate the Respondent, the Complainant, or both about standards of practice and professional behavior C. Temporarily suspend AOTA membership of the Complainant D. Report conclusions and sanctions applied to both the Complainant and the Respondent in official AOTA publications

B. Send a letter to educate the Respondent, the Complainant, or both about standards of practice and professional behavior *RATIONALE: is part of the role and responsibilities of the AOTA Ethics Commission to educate the membership on issues related to the Code of Ethics. Educative letters can be issued as a final action to Complainants, Respondents, or both to clarify the issues involved in an ethics complaint.

A COTA® is conducting the first session of an occupational therapy group for adolescents with oppositional defiant disorder in an inpatient behavioral treatment center. Which activity is a priority? A. Assess individual members' likes and dislikes B. Set ground rules with clear expectations C. Do an ice breaker using a large parachute D. Identify the time-out chair for participants who misbehave

B. Set ground rules with clear expectations Clients with oppositional defiant disorder need clear rules about what behaviors are acceptable and not acceptable. Expectations for participation in the group need to be made explicit.

A COTA® is positioning in bed a client who has weakness on one side of the body resulting from a traumatic brain injury. Which position is most appropriate for the client? A. Supine with head supported on a pillow B. Side lying with affected extremity on top placed on a pillow C. Supine without a pillow to support head D. Side lying with affected extremity on top resting on abdomen

B. Side lying with affected extremity on top placed on a pillow Side lying allows for normal postural positioning to minimize the effects of muscle tone. The use of a pillow under the top upper extremity allows the shoulder to be positioned in neutral.

A COTA® is establishing an occupational therapy group in a state correctional facility for clients with schizophrenia who are the parents of small children. What area of focus would be MOST important for a group in this setting? A. Psychoanalytic intervention B. Skills in performing ADLs and IADLs C. Strength and endurance training D. Indoor sports activities

B. Skills in performing ADLs and IADLs Occupational therapy in the criminal justice system focuses primarily on community reentry. Skills in ADLs and IADLs, including child care, are essential to community reentry. For these clients, assessing parenting skills would be a focus of the occupational therapy evaluation process.

While reviewing the chart of a client with spinal cord injury, the COTA® notices that the client has experienced past episodes of autonomic dysreflexia in the hospital. What is the BEST recommendation the COTA® can make to the client concerning dysreflexia? A. Suggest that the OTR® treat the client because the COTA® is unfamiliar with the condition. B. Suggest the client carry an emergency card describing the condition for medical personnel and others. C. Suggest the client wear elastic stockings and abdominal binders to increase blood pressure. D. Suggest the client leave sessions early if experiencing symptoms.

B. Suggest the client carry an emergency card describing the condition for medical personnel and others. Clients susceptible to autonomic dysreflexia are encouraged to carry an emergency card describing the condition and treatment.

A client is a hands-dependent sitter. What goals would the OTR®-COTA® team have for such clients when providing a positioning and seating system? A. Support the upper extremity and hands for activities B. Support the pelvis and trunk to free the hands for activities C. Provide armrests to support the arms and hands for activities D. Provide a lapboard to support the client and free the hands for activities

B. Support the pelvis and trunk to free the hands for activities *RATIONALE: Hands-dependent sitters require the use of one or both hands to maintain an upright seated position. Positioning must begin with the pelvis and trunk; if they are supported, the client will not need to use the hands to sit upright.

A COTA® wants to use an intervention activity that will provide a child with proprioceptive input. Which intervention activity would provide this type of input? A. Looking for toys hidden in a bin of dried rice or beans B. Swinging on a platform swing while "climbing" a rope with the hands C. Finger painting at an easel D. Walking on a balance beam

B. Swinging on a platform swing while "climbing" a rope with the hands Proprioceptive input is gained through the child's muscles and joints. "Climbing" a rope would provide this type of input.

A COTA® is working with a child who dislikes having hair washed, playing in sand, and shaking hands. What type of sensory dysfunction might this child have? A. Somatodyspraxis B. Tactile defensiveness C. Gravitational insecurity D. Hyporesponsivity

B. Tactile defensiveness Tactile defensiveness is characterized by difficulty making sense of or interpreting tactile input. The child in this scenario might feel that the tactile input outlined in this option is noxious.

An OTR®; is working in a school system with a client who has chronic behavioral challenges that include heightened anxiety, aggression during stressful situations, and sudden bouts of anger. The OTR decides to use affective education as a primary intervention strategy for this client. Which approach BEST reflects affective education training? A. Gradually introducing stressful or feared events with role-playing before the actual event B. Teaching and identifying somatic clues related to uncomfortable and aggressive emotions C. Generating and writing down coping strategies and training in articulating these strategies during stressful events D. Educating the family and child about the behavioral disorder, course of treatment, and major intervention strategies

B. Teaching and identifying somatic clues related to uncomfortable and aggressive emotions *RATIOANLE: Affective education includes helping children recognize their own feelings to help them respond appropriately to stressors.

A COTA® is working in a school system with a child who has chronic behavioral challenges that include heightened anxiety, aggression during stressful situations, and sudden bouts of anger. The school encourages the use of affective education as a primary intervention strategy for children with behavioral challenges. Which approach BEST reflects affective education training? A. Gradually introducing stressful or feared events with role-playing before the actual event B. Teaching and identifying somatic clues related to uncomfortable and aggressive emotions C. Generating and writing down coping strategies and training in articulating these strategies during stressful events D. Educating the family and child about the behavioral disorder, course of treatment, and major intervention strategies

B. Teaching and identifying somatic clues related to uncomfortable and aggressive emotions Affective education includes helping children recognize their own feelings to help them respond appropriately to stressors.

Which intervention strategy would be MOST appropriate for a child with thoracic kyphosis? A. Teaching the child to don pants with a reacher B. Teaching the child how to perform toilet hygiene while wearing a back brace C. Teaching the child how to self-feed while using a plate guard D. Teaching the child to bathe while using a tub chair

B. Teaching the child how to perform toilet hygiene while wearing a back brace A scoliosis back brace is recommended for children with thoracic kyphosis.

A client with traumatic brain injury is demonstrating agitation. What strategy would minimize the client's frustration and confusion? A. Provide tactile stimulation by tapping the client's upper extremity B. Tell the client orientation information about his or her location and what will occur in session C. Ask the client to state why he or she is in the hospital D. Have the client complete a fine motor task as a distraction

B. Tell the client orientation information about his or her location and what will occur in session Providing passive orientation and preparing the client for what to expect in the session provides a sense of familiarity, decreasing confusion and agitation.

A COTA® is treating an adolescent client with major depression for the first time since the OTR® completed the initial evaluation. The client has been withdrawn and has stayed in bed except for meals. The COTA® is selecting an activity to use in the first treatment session with this client. What is the MOST important consideration in choosing an activity for the first individual treatment session with this client? A. The activity should involve some degree of challenge. B. The activity should be completed easily. C. The activity should require multiple sessions to finish. D. The activity should require primarily observational learning.

B. The activity should be completed easily. Activities for clients with major depression should be able to be completed easily to provide a sense of success and competence.

During passive range of motion (PROM) exercises for a client with stroke, the client's shoulder is resistant to flexion beyond 90°, although the client reports being pain free. What does this finding suggest to the COTA®? A. Shoulder subluxation is inhibiting movement. B. The scapula is not gliding to produce full flexion. C. The humerus is locked in against the acromion. D. Spasticity is preventing the shoulder from reaching full range.

B. The scapula is not gliding to produce full flexion. The muscles supporting the scapula have likely shortened from disuse and are limiting the full range of shoulder motion. Both the humerus and the scapula must move to support full shoulder motion.

A 75-year-old client presents to a COTA® after a distal radius fracture 2 weeks earlier. The client's goals, as reported by the OTR®, are to increase range of motion (ROM) and return to the client's favorite activity of gardening. Because the surgeon used a primary healing technique, what must therapy focus on FIRST? A. Therapy must focus on edema reduction, because the client is still in a cast. B. Therapy can begin with passive and active range of motion (PROM and AROM), because the client's bone is fixed with a plate. C. Therapy should not begin for another 2 weeks because the client is elderly and the client's bones are probably brittle. D. Therapy can be aggressive and include strengthening from the first day of therapy.

B. Therapy can begin with passive and active range of motion (PROM and AROM), because the client's bone is fixed with a plate. *RATIONALE: Primary healing is when a surgeon can secure bone fragments using a plate, screws, or both. When bone is secured in this way, healing is more stable at an earlier stage. This stability allows the COTA or OTR to guide the client through AROM and PROM as soon as therapy is indicated.

What would be considered the first line of treatment in the acute setting for the medical management of a cardiovascular accident (CVA)? A. Anticoagulants B. Thrombolytic agents C. Antiplatelet treatments D. Nonsteroidal anti-inflammatory drugs

B. Thrombolytic agents Thrombolytic agents are the first line of treatment in the acute management of CVA to dissolve the clot that is blocking the flow of blood through its vessel.

A COTA® is providing intervention to a 4-year-old with developmental delays and is working on sorting. What outcome would be the result of a goal for this child if the intervention focused on sorting eating utensils according to type and size? A. To be able to note key features or attributes and relate them to what is already kept in one's memory B. To be able to categorize objects by similarities and to note differences C. To be able to note the similarities among objects D. To be able to determine the spatial relationship between objects

B. To be able to categorize objects by similarities and to note differences *RATIONALE: Being able to sort by type and size would support the child's ability to categorize objects on the basis of similarities and to note differences among objects. This skill is an important precursor to successful participation in ADLs and educational occupations.

A COTA® is providing intervention to a 4-year-old with developmental delays and is working on sorting. What outcome would be the result of a goal for this child if the intervention focused on sorting eating utensils according to type and size? A. To be able to note key features or attributes and relate them to what is already kept in one's memory B. To be able to categorize objects by similarities and to note differences C. To be able to note the similarities among objects D. To be able to determine the spatial relationship between objects

B. To be able to categorize objects by similarities and to note differences Being able to sort by type and size would support the child's ability to categorize objects on the basis of similarities and to note differences among objects. This skill is an important precursor to successful participation in ADLs and educational occupations.

An OTR® and COTA® are attending an individualized education program (IEP) team planning for a 10-year-old child with autism. Which principle BEST contributes to an effective IEP? A. Set academic, functional, and measurable goals achievable within a 6-month time frame. B. To the maximum extent possible, the student must be educated with nondisabled peers. C. Transition planning must begin with an emphasis on future vocational goals and independent life skills. D. To be succinct, the IEP must report only the needs and challenges of the student.

B. To the maximum extent possible, the student must be educated with nondisabled peers. A general education environment is considered first because the IEP process includes placement in the least restrictive environment possible.

A COTA® is treating a 4-year-old child with autism, addressing feeding skills. A main concern for the parents is their inability to eat at a restaurant because the child can only tolerate food served at home. They also would like the child to tolerate sitting at a restaurant for at least 10 minutes to eat. Which treatment goal should the COTA® prioritize? A. Tolerate holding a novel finger food for 5 minutes while seated at a restaurant. B. Tolerate sitting at a restaurant for 5 minutes while eating preferred home food. C. Tolerate sitting at a restaurant for 1 minute while eating a novel snack. D. Tolerate putting a novel finger food near mouth while seated at a restaurant.

B. Tolerate sitting at a restaurant for 5 minutes while eating preferred home food. Increasing food intake is difficult if the child is unable to tolerate sitting for a long time. Increasing the amount of time seated at a restaurant with preferred food must be the priority.

An 8-year-old child with juvenile rheumatoid arthritis requires a splint to prevent drifting of the metacarpophalangeal joints toward the small finger. Which splint would be the MOST appropriate for this client? A. Cock-up splint B. Ulnar deviation splint C. Dynamic splint D. Resting pan splint

B. Ulnar deviation splint An ulnar deviation splint provides improved stability and alignment of the metacarpophalangeal joints and reduces ulnar drift, or drifting of the metacarpophalangeal joints toward the small finger.

According to the Model of Human Occupation (MOHO), occupational therapy intervention will best benefit adult clients with mental illness through which of the following approaches? A. Understanding the interaction between the client's perceived level of task mastery and the demands of the environment B. Understanding the client's dimensions of occupational participation and performance C. Understanding how the environment can be adapted, modified, and restored to enable effective performance D. Understanding how the client uses sensory information in the environment

B. Understanding the client's dimensions of occupational participation and performance *RATIONALE: The "dimensions of doing" is part of MOHO.

A COTA® is working with a client with C5 spinal cord injury. What is the BEST splinting strategy to use to encourage sensory feedback? A. Use of padded splints B. Use of dorsal splints C. Use of hand-based splints D. Use of dynamic splints

B. Use of dorsal splints *RATIONALE: A dorsally based splint will allow for maximal sensory feedback while worn

A client's wrist and thumb joints are limited in range of motion, and the client complains of some mild discomfort that affects the client's caregiving duties at home. The OTR® wants to facilitate movement, increase circulation, and decrease pain. What would be the MOST appropriate use of thermal modalities? A. Use deep heat while stretching the client's stiff joints. B. Use superficial heat before or during a passive stretch. C. Use superficial heat or deep heat without stretching the client's stiff joints. D. Use a different modality for this problem.

B. Use superficial heat before or during a passive stretch. *RATIONALE: Mild heat before or during a passive stretch will give the best results and increase range of motion and circulation, because the heat will have a soothing effect and decrease discomfort.

A COTA® is working with a 6-year-old child with attention deficit hyperactivity disorder on self-monitoring energy and arousal levels inside the classroom. Which intervention is BEST to use for this goal? A. Instruct the parents to use a sensory diet to reinforce learning. B. Use the ALERT Program to train the child to self-regulate. C. Train the child to use breathing and relaxation techniques. D. Provide a therapy ball for seating in the classroom.

B. Use the ALERT Program to train the child to self-regulate. The ALERT Program teaches children self-regulation skills to self-monitor their arousal and energy levels.

A COTA® is worried that occupational therapy services will not be approved by a third-party payer for a particular client. Given previous experiences with the third-party payer and knowledge of what services the payer typically allows, the COTA omits some information when contributing to the documentation so that the client's services appear more reimbursable. What ethical principle has the COTA violated by adjusting the documentation in this way? A. Beneficence B. Veracity C. Justice D. Nonmaleficence

B. Veracity The principle of veracity requires that the COTA provide accurate and objective information in representing the work of the profession. Veracity requires timely, accurate documentation of services provided. Any deviation is both unethical and illegal. The COTA's license may also be in jeopardy.

A client in the burn unit sustained deep partial-thickness burns to the bilateral dorsal hands 1 week ago. What is the BEST position for splinting to prevent deformity? A. Volar hand splint with wrist in neutral, metacarpals (MPs) in slight hyperextension, and interphalangeals (IPs) in full extension B. Volar hand splint with wrist in 30° extension, MPs in 70° flexion, and IPs in full extension C. Dorsal hand splint with wrist in neutral, MPs in 90° flexion, and IPs in 50°-70° flexion D. Dorsal hand splint with wrist in 30° flexion and MPs and IPs in full extension

B. Volar hand splint with wrist in 30° extension, MPs in 70° flexion, and IPs in full extension *RATIONALE: When a burn occurs on the dorsal surface of the hand, it has potential to form a claw-hand deformity. The intrinsic-plus position is the best splinting position to prevent contracture.

The COTA® is treating a client who presents with hemiplegia from a cardiovascular accident. The client's hand is flaccid. To fabricate a custom resting hand orthosis, in what position should the COTA® place the wrist and metacarpophalangeals (MCPs)? A. Wrist at 10° flexion and MCPs at 0° flexion B. Wrist at 25° extension and MCPs at 55° flexion C. Wrist at 45° flexion and MCPs at 10° flexion D. Wrist at 60° flexion and MCPs at 0° flexion

B. Wrist at 25° extension and MCPs at 55° flexion A resting hand orthosis keeps soft tissue positioned in optimal mobility with flexion of the MCPs at 45° to 60°; 55° would accomplish this, and 25° of slight extension would maintain the wrist in a position that would not compromise the median nerve.

A COTA® is asked by the COTA's manager to educate two people with Parkinson's Disease (PD) about the use of adaptive equipment as part of the organization's mission to serve the health of indigent community members. The manager asks the COTA not to bill for the services and to offer them pro bono. Is this practice ethically sound? A. No; the practice is supported by the ethical principle of justice, but it violates reimbursement laws. B. Yes; the practice is supported by the ethical principle of justice and does not violate organizational policies. C. Yes; the needs of people with PD outweigh the risk of not providing education. D. No; occupational therapy is provided in a market-based system, so a monetary transaction must take place.

B. Yes; the practice is supported by the ethical principle of justice and does not violate organizational policies. *RATIONALE: This practice is supported by the principle of Justice. Offering pro bono services in this situation upholds a society in which everyone has an equitable opportunity to achieve occupational engagement, and it addresses barriers to accessing occupational therapy services within the parameters of organizational policies.

A COTA® working in an psychiatric inpatient setting is assigned to work individually with an adolescent with major depression. The adolescent has refused to participate for 3 days, claiming not to feel well. How should the COTA® BEST respond? A. "I think that participating in occupational therapy will make you feel a lot better. Let's talk about what you like to do at home." B. "I noticed you've been feeling like this for 3 days straight now, and it might be really helpful for you to participate in occupational therapy." C. "I can see that you aren't feeling well. Let's try doing something you like that will not take too long and see what happens." D. "I can see that you aren't feeling well. I'll stop by again tomorrow and see if you are up to going to occupational therapy."

C. "I can see that you aren't feeling well. Let's try doing something you like that will not take too long and see what happens." When working with a client who is depressed, it is essential to relate with understanding and empathy. Encouraging participation in any way can be helpful.

A COTA® is approached by a client with Alzheimer's dementia who asks, "Do I finish high school next year, or am I already finished? I don't want to go back." What is the BEST response for the COTA® to make? A. "Try to remember that you completed high school 60 years ago. Would you like to see your graduation picture?" B. "I'll have to find out if you finished high school. Could you ask me again at a later time?" C. "It sounds like you're a little worried about that. You're already finished with high school. You don't have to go back." D. "Didn't you go to college?"

C. "It sounds like you're a little worried about that. You're already finished with high school. You don't have to go back." *RATIONALE: The recommended method of communicating with a client with Alzheimer's is to provide as brief and accurate a response as possible without overchallenging the client. Addressing the emotional rather than the factual components of the request, when appropriate, is also recommended.

A COTA® in an acute care setting is working on a dressing program with a client with spinal cord injury. What statement by the COTA is appropriate to facilitate positive coping for the client? A. "I have selected these clothes for you today." B. "Would you like to wear the blue or the red shirt?" C. "What clothes do you want to wear today?" D. "You should wear these clothes today."

C. "What clothes do you want to wear today?" To promote positive psychosocial adaptation, clients with spinal cord injury should be allowed opportunities to participate in decision making and to guide care tasks that require assistance.

A COTA® is working on exploring the home environment with an infant in early intervention. The child is approximately 3 months behind in gross motor skills. At what age would the COTA® expect the child to crawl, given the delay? A. <6 months B. 9 months C. 12 months D. 15 months

C. 12 months Infants typically begin to crawl by age 9 months. Given this child's delay, crawling may emerge around 12 months.

An OTR® and COTA® are measuring a client for a new wheelchair. The client's hip width is 18 inches. The client does not use any lateral trunk supports but lives in a cold climate and frequently wears bulky clothing. What seat width should the OTR®-COTA® team recommend? A. 16 inches B. 18 inches C. 20 inches D. 22 inches

C. 20 inches *RATIONALE: A clearance of 1 to 2 inches bilaterally between the hips and the side of the wheelchair is recommended. Two inches will more easily accommodate bulky clothing.

A COTA® is working with a child on shoe tying. At around what age can the COTA® expect a typically developing child to master this skill? A. 4 years old B. 5 years old C. 6 years old D. 7 years old

C. 6 years old A typically developing child can master shoe tying at age 6.

Using the Allen Cognitive Level Screen-5 for screening, followed by use of the Allen Diagnostic Module and the Routine Task Inventory for confirmation of screening results, the supervising OTR® identifies Level 4 as the current level of functioning of a client in an adult day treatment center. What is the MOST appropriate scenario for activity completion for this client? A. The task includes mostly familiar steps but also one step requiring new learning. B. The project and tasks involved are relatively unstructured. The client is given opportunities to find and revise errors. C. A model of the completed project is provided for the client to imitate. Simple instructions are provided. D. The project is designed to encourage relatively independent planning and organizing to complete tasks.

C. A model of the completed project is provided for the client to imitate. Simple instructions are provided. Level 4 activities typically require a model as a guide to task completion, simple directions, and unshared tools. Unstructured tasks, problem solving, planning, and even independent completion of unfamiliar steps without guidance are likely too challenging for a person at Level 4.

Which statement BEST describes a task-oriented group in the "storming" phase of group development? A. The group is now running smoothly and handles problems efficiently because two participants were able to work out their differences early on B. The group is meeting for the first time, and participants are asking the group leader for help because they do not understand the task at hand. C. A participant who has recently joined the group sets up a roadblock to everything another participant says, and a third participant questions whether accomplishing the task is even possible. D. The group leader is exhausted by all the questions about the details of the finished product. No one seems to want to work together, and the participants seem to expect the leader to solve this problem.

C. A participant who has recently joined the group sets up a roadblock to everything another participant says, and a third participant questions whether accomplishing the task is even possible. It is common for disagreements to occur during the storming phase. Setting up roadblocks and questioning the task at hand are normal during this stage.

A COTA® is discussing with a set of parents different types of technology to improve the handwriting skills of their 8-year-old child with autism. Which approach is the BEST example of a basic technology that can improve handwriting skills? A. An iPad tracing application for correct letter formation. B. Computer software that prompts the child to copy sentences. C. A pencil grip to facilitate pencil grasp during writing. D. Dot-to-dot tracing of correct letter formation.

C. A pencil grip to facilitate pencil grasp during writing. Of the options, only a pencil grip is considered a basic technology.

A client scores an Allen Cognitive Level (ACL) of 4.0 with the Allen Cognitive Disability Framework. A COTA® is working with the client in an adult day treatment center. A. Any project with mostly familiar steps; no more than two steps of the task should require new learning. B. A project that is unstructured; the client should be given opportunities to find and revise errors. C. A project that is set up with a model final product; simple instructions should be provided, along with supervision. D. A project that encourages relatively independent planning and organizing to complete; none of the steps should require new learning.

C. A project that is set up with a model final product; simple instructions should be provided, along with supervision. A person with an ACL of 4.0 can perform only simple tasks and will have difficulty with problem solving. A model with clear instructions should be provided along with supervision for cues and guidance when needed.

A client with Down syndrome recently began working at a small pizza restaurant. The job duties include keeping the tables clean and restocking each table with condiments and napkins. The employer reports that the client is disorganized in completing tasks. In addition, when the client becomes frustrated, the client's behavior offends the other workers. Which intervention provided by the COTA® would be the MOST practical with this client? A. Implement a monthly consultation meeting for all workers at the restaurant to discuss their concerns with employee performance. B. Prevent work injuries for the client by enrolling the client in an ergonomic training program with the other workers. C. Adapt the job duties by providing the client with a checklist of duties and having the client mark off tasks as they are completed. D. Provide cognitive retraining to teach the client strategies for sequencing job duties for improved organization.

C. Adapt the job duties by providing the client with a checklist of duties and having the client mark off tasks as they are completed. *RATIONALE: A task adaptation (i.e., checklist) provides the least restrictive support to enable this client to remain in this job.

A COTA® is assisting a client with an incomplete T2 spinal cord injury (SCI). The client is anxious and concerned about being able to live independently. Which response is the MOST accurate for the COTA® to give the client, based on the COTA®'s knowledge of the typical recovery pattern of a client with a T2 SCI? A. Suggest the client make arrangements for a long-term residential facility with support. B. Advise the client not to be concerned with the future and to concentrate on rehabilitation. C. Advise the client that recovery from SCI is often unpredictable, and people with SCI can live fulfilling, active lives. D. Suggest the client move to a supportive apartment when available to increase independence.

C. Advise the client that recovery from SCI is often unpredictable, and people with SCI can live fulfilling, active lives. *RATIONALE: The COTA® can provide information regarding traditional prognosis and facilitate optimal independence and functioning.

Which statement BEST describes settings for intervention under IDEA Part C in early intervention services? A. All interventions must be provided in the school context. B. All interventions must be provided in the home context. C. All interventions must be provided in all natural contexts of performance. D. All interventions must be provided in the preschool context.

C. All interventions must be provided in all natural contexts of performance. *RATIOANLE: As part of IDEA Part C, all interventions must be provided in all of the client's natural environments.

Which compensatory approach can the COTA® BEST use to optimize driving comfort for a client with a small body size? A. Devices to assist with transfers B. Automatic transmission, power brakes, and cruise control C. An adjustable seat, seat belt, and other controls. D. Adaptation of the parking brake

C. An adjustable seat, seat belt, and other controls. These adaptations will help compensate for the effects of having a small body size and increase the client's driving comfort.

A COTA® is working with a 7th grader diagnosed with oppositional defiant disorder. Which condition that often occurs concurrently with oppositional defiant disorder should the COTA® look for? A. Depression B. Conduct disorder C. Attention deficit hyperactivity disorder D. Schizophrenia

C. Attention deficit hyperactivity disorder Attention deficit hyperactivity disorder (ADHD) often occurs with oppositional defiant disorder (ODD), so practitioners conducting an assessment with a client with ODD should always look for signs of ADHD.

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? A. Psychodynamic B. Sensorimotor C. Behavioral D. Developmental

C. Behavioral *RATIOANLE: 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.

With which situation would a child with autism spectrum disorder (ASD) likely have difficulty? A. Remembering a parent's work telephone number B. Copying homework assignments into a daily planner C. Being able to interpret nonverbal cues while socializing D. Giving a speech on preferred topic

C. Being able to interpret nonverbal cues while socializing Children with ASD may appear to go off topic or speak tangentially and often have difficulty picking up on their communication partner's nonverbal cues.

With which situation would a child with autism spectrum disorder (ASD) likely have difficulty? A. Remembering a parent's work telephone number B. Copying homework assignments into a daily planner C. Being able to pick up on a peer's nonverbal cues during a conversation D. Giving a speech on preferred topic

C. Being able to pick up on a peer's nonverbal cues during a conversation Children with ASD may appear to go off topic or speak tangentially and often have difficulty picking up on their communication partner's nonverbal cues.

A COTA®'s guiding framework about improving the lives of clients with mental illness is that changing clients' negative beliefs about experiences and situations ultimately reduces negative emotional states and behaviors. What is the COTA®'s main theoretical perspective? A. Psychoanalytic B. Developmental C. Cognitive-behavioral D. Occupational

C. Cognitive-behavioral Cognitive-behavioral therapy focuses on changing how one thinks about behavior to change the behavior itself.

A COTA® is intervening with a client who is in an active state of mania. The client has difficulty concentrating on the assessment procedure and displays disruptive behavior, saying the COTA is "stupid" and "asking dumb questions." The COTA tells the client, "I would like to help you, but I will not tolerate this behavior. You are not being nice to me right now, and I deserve to be treated better than this." Which interpersonal strategy does the COTA's statement exemplify? A. Validation B. Limit setting C. Confrontation D. Reframing

C. Confrontation *RATIOANLE: Confrontation, in which the practitioner identifies the client's behavior in an effort to help the client self-manage his or her behavior, is an appropriate interpersonal strategy when dealing with clients with mental illness. Confrontation may include limit setting.

A COTA® is intervening with a client who is in an active state of mania. The client has difficulty concentrating on the assessment procedure and displays disruptive behavior, saying the COTA is "stupid" and "asking dumb questions." The COTA tells the client, "I would like to help you, but I will not tolerate this behavior. You are not being nice to me right now, and I deserve to be treated better than this." Which interpersonal strategy does the COTA's statement exemplify? A. Validation B. Limit setting C. Confrontation D. Reframing

C. Confrontation Confrontation, in which the practitioner identifies the client's behavior in an effort to help the client self-manage his or her behavior, is an appropriate interpersonal strategy when dealing with clients with mental illness. Confrontation may include limit setting.

A COTA® is working with an 8-year-old client in the classroom. The COTA® notices that the child's eyes are not in alignment when copying from far point to near point. What type of school-related tasks might the child experience as a result of eye misalignment? A. Manipulating a pencil from writing point to eraser B. Answering a question posed by the teacher C. Copying assignments from the chalkboard into an assignment notebook D. Organizing papers into a folder

C. Copying assignments from the chalkboard into an assignment notebook Misalignment of the eyes, along with shaking eyes, excessively large or small pupils, and pupils that are not black but appear to have an opaque film over them are all red flags related to visual problems. Misalignment of the eyes may complicate the child's ability to copy assignments from the chalkboard into an assignment notebook.

A COTA® is working with an adolescent with traumatic brain injury on cooking skills. While completing an activity analysis of making simple meals on the stovetop, the COTA® notes that the client must be able to judge the relative distance between self and the stove to safely complete a cooking task. Which visual-perceptual skill does the client need to be able to judge this distance? A. Visual closure B. Position in space C. Depth perception D. Visual memory

C. Depth perception Depth perception is a person's ability to judge the relative distance between self and another object in space.

A COTA® is working with a client in the active phase of C6 spinal cord injury. What is the MOST IMPORTANT treatment activity to consider? A. Providing accessibility recommendations B. Educating on preventative health measures C. Developing pressure relief methods D. Recommending durable medical equipment

C. Developing pressure relief methods *RATIONALE: A high priority for the active phase of rehabilitation is determining a method to prevent decubitus ulcers

A COTA&#174; is assigned to a district that emphasizes schoolwide mental health promotion and problem prevention using a Response to Intervention Model. Which intervention approach is an example of Tier 1 of this model? A. Running group programs to facilitate social inclusion for students who struggle with maintaining peer relationships B. Holding meetings and conversations with schoolteachers to discuss the role of occupational therapy in mental health promotion C. Discussing with classroom teachers strategies to help children who are at high risk of being bullied D. Collaborating with mental health practitioners to provide the most appropriate care for students requiring intervention

C. Discussing with classroom teachers strategies to help children who are at high risk of being bullied *RATIOANLE: This option is an example of Tier 1 programming. Tier 1 programs are indicated for the general school population.

A COTA® is preparing a forearm splint for a client with a high complete spinal cord injury. What surface of the client's forearm should the base of the splint rest upon? A. Ulnar B. Medial C. Dorsal D. Volar

C. Dorsal The splint should be dorsal, rather than volar to ensure maximal sensory feedback while the forearm is resting on a surface.

During a commode-to-bed transfer, the client begins to slip from the COTA®'s grasp. What action is best for the COTA® to take? A. Continue with the transfer, and try to get the client to the bed as quickly as possible. B. Have the client return to the commode. C. Ease the client to the floor, then get assistance. D. Call for help, and get the attention of the client's nurse.

C. Ease the client to the floor, then get assistance. Easing the client to the floor protects both the client and the therapist from injury.

A kindergarten teacher has a student with a significant visual impairment. The teacher has questions for the COTA® about the best way to teach the student the location of materials in the classroom so that the child can access them independently. Which strategy would be appropriate for the COTA®, in conjunction with the OTR®, to suggest? A. Encourage the child to use depth perception and spatial awareness skills to understand where he or she is in relation to the materials. B. Encourage the child to use social skills and ask peers to retrieve materials for him. C. Encourage the child to use tactile and proprioceptive senses to understand where he or she is in relation to the materials. D. Encourage the child to use imitation skills and to follow peers to understand where he or she is in relation to the materials.

C. Encourage the child to use tactile and proprioceptive senses to understand where he or she is in relation to the materials. Using these senses will help the child to establish a mental map of the classroom.

A COTA® works with elderly clients with low vision. A client with macular degeneration is referred after substantial symptom progression and loss of vision. The client's spouse states that for the past 3 months, the client has uncharacteristically refused to participate in social activities, is frequently irritable and uncommunicative, and is unwilling to perform personal care or routine tasks. What should the COTA® advise the spouse to do? A. Consider exploring assisted living alternatives. B. Insist that the client resume accompanying the spouse to bridge club and prepare a snack to share with the club. C. Encourage the client to consult a mental health provider. D. Advise the client and spouse to seek professional counseling to adjust to the inevitable changes in the marriage.

C. Encourage the client to consult a mental health provider. People with low vision are at high risk for mood disorders and depression.

A COTA® is working with a client in the active phase of C5 spinal cord injury. The client voices concern about increased discomfort from sitting in his/her chair. What is the BEST recommendation regarding frequency of pressure relief technique? A. Three times B. Every hour C. Every 30 minutes D. Every 3 hours

C. Every 30 minutes Pressure relief should be performed every 30 minutes to prevent skin breakdown.

Which statement BEST describes an important consideration for COTA®s working with clients with dementia and their caregivers? A. Providing a variety of new occupations creates a sense of well-being for the caregiver and care recipient. B. A brief respite from caregiving benefits the caregiver but is detrimental to the care recipient. C. Everyday occupation is central to a caregiver's sense of well-being. D. Psychologically resisting the inevitability of chronic illness improves satisfaction with caregiving.

C. Everyday occupation is central to a caregiver's sense of well-being. Embracing everyday occupation has been shown to improve a sense of well-being in the caregiver and offers a suitable context for caregiving.

A COTA is treating a client who had a split-thickness skin graft 2 days ago on the left posterior axillary area. What postoperative occupational therapy intervention would be the BEST choice? A. Perform gentle passive left shoulder ROM to pain tolerance twice daily B. Perform active left shoulder ROM as tolerated, incorporated into daily activities. C. Fabricate an axilla splint with left shoulder in 120° abduction and slight external rotation D. Use a continuous passive motion machine to 120° shoulder abduction

C. Fabricate an axilla splint with left shoulder in 120° abduction and slight external rotation The postoperative phase of care is 5-10 days post-skin graft operation. During this phase, it is important not to disturb the grafted area so that graft adherence will occur. However, to prevent deformity from scar tightness and shrinkage, it is important to position the arm in antideformity position—that is, 120° abduction and slight external rotation.

An adult client is receiving home health occupational therapy services from a COTA®. At the initial intervention session, an adult child of the client informs the COTA® that the client's spouse passed away 2 months ago. The adult child states that the client has never been so down, that the client has to be encouraged to go to restaurants or movies, and that the client often cries. How should the COTA® respond? A. Tell the client's adult child that the client is experiencing depression and the COTA® will discuss with the OTR® the need for the client to seek psychiatric care. B. Describe the difference between grief and depression to the client's adult child. C. Further explore with the client's adult child the extent of the client's sadness and negative moods before discussing the situation with the supervising OTR®. D. Ask the client's adult child about any potential physical or psychological abuse the client may have experienced in his or her lifetime.

C. Further explore with the client's adult child the extent of the client's sadness and negative moods before discussing the situation with the supervising OTR®. Clinical reasoning dictates the need for further information in this scenario. It is unlikely that the COTA® can make an informed decision and plan a course of action until he or she knows the degree to which the client's behaviors constitute a change from typical behavior. This situation should also be discussed with the supervising OTR®.

A COTA® is working with a 3-year-old with a developmental delay in preschool. The child is having a tantrum because it is time to stop playing and go to circle time. Which strategy might have prevented a tantrum? A. Praising the child when the child is engaging in positive behaviors and making good choices B. Teaching the child how to self-calm C. Giving a warning before the preferred activity came to a close D. Telling the child the rules and expectations and following them

C. Giving a warning before the preferred activity came to a close Giving the child a warning when a preferred activity is coming to a close will help the child transition to the next activity and may reduce the likelihood of a tantrum.

A COTA® is working with a child who is overresponsive to vestibular input, extremely scared of movement, and fearful of jumping. What type of sensory dysfunction might this child have? A. Somatodyspraxia B. Tactile defensiveness C. Gravitational insecurity D. Hyporesponsivity

C. Gravitational insecurity *RATIONALE: Gravitational insecurity is characterized by hypersensitivity to vestibular input. Children with this type of sensory integrative dysfunction are often extremely fearful of movement and having their feet off of the ground.

A COTA® is treating a 4-year-old child with autism. At the gym, the child appeared very guarded with movement and does not want to climb the stairs, try the swing, or use the mini seesaw. When the COTA® encourages the child to jump on the trampoline, the child runs to the mother and cries. What is the MOST likely reason for these behaviors? A. Tactile defensiveness B. Vestibular bilateral integration problems C. Gravitational insecurity D. Visuoconstructional dyspraxia

C. Gravitational insecurity Overresponsiveness to vestibular sensations and avoidance of movements that require changes in position are typical indicators of gravitational insecurity.

A COTA&#174; is providing dressing skills training for a client with traumatic brain injury (TBI). The client has a sequencing deficit. What strategy is appropriate for the COTA to use with this client? A. Use picture cards of dressing and have the client put the steps of dressing in order B. Have the client write out the steps in dressing using paper and pencil C. Hand the client each item of clothing and provide assistance in donning the item D. Ask the client which clothing item should be selected next

C. Hand the client each item of clothing and provide assistance in donning the item Minimizing environmental distractions and decreasing the complexity of the task allows the client with TBI to experience success with completion of one step of the task at a time.

An OTR® and COTA® are working with a client 8 weeks after a unilateral traumatic transtibial amputation. The client's residual limb is well healed, and the team has identified prosthetic fitting and training as the next step. The client wants to use a prosthesis but indicates that the residual limb is not healed enough and is fearful about wearing it. The client's mother currently performs all limb care, including washing, dressing, and wrapping. What is the BEST strategy to progress the client to prosthetic training? A. Have the prosthetist make the client a prosthesis and implement a wearing schedule. B. Recommend that the client wait another month and then return for prosthetic fitting and training. C. Have the client talk with other clients who have similar amputations. D. Refer the client for psychiatric evaluation and treatment.

C. Have the client talk with other clients who have similar amputations. *RATIONALE: Encouraging the client to talk with others who have experienced similar amputations can help facilitate acceptance.

A COTA® is working with a child diagnosed with oppositional defiant disorder in a public middle school. The child has been breaking rules in the physical education class by not wearing sneakers in the gym, chewing gum during class, and repeatedly forgetting to bring a swimsuit for the swimming class. Which solution would be BEST for this student? A. Referral to an alternative school located nearby B. Assignment of in-school suspension during gym class C. Implementation of a behavioral plan D. Replacement of gym class with another class

C. Implementation of a behavioral plan A behavioral plan would provide the student with expectations and explicit consequences and would provide educational personnel and the family with consistent strategies to effectively manage the student's difficult behaviors. In addition, a behavioral plan would allow the student to stay in the least restrictive environment, consistent with the Education for All Handicapped Children Act of 1975 (Pub. L. 94-142).

A client who sustained a traumatic brain injury is asked to perform a bedside dressing ADL. The client's clothes are laid out on the bed, but the client requires prompting to begin the activity. Which performance component may explain the client's behavior? A. Memory B. Attention C. Initiation D. Impulsivity

C. Initiation Initiation can be described as the ability to perform a specific task without prompts. This ability is part of the client's executive function.

Which intervention strategy would be appropriate when teaching a compensatory approach for the production of written language to a child who has a diagnosis of developmental coordination disorder? A. Provide the child with a pencil grip. B. Encourage the teacher to provide a copy of his or her notes. C. Instruct the child in keyboarding. D. Allow the child to use print instead of cursive writing.

C. Instruct the child in keyboarding. Instructing the child in keyboarding would provide the child with a compensatory way to produce written language instead of handwriting.

A client with rheumatoid arthritis in the dominant hand complains of pain while stirring food on the stove. The COTA® uses fading techniques to instruct the client on how to resume cooking with less pain. Which approach BEST describes fading? A. Advise the client to use the nondominant hand in all activities that aggravate the arthritis. B. Outline the steps of the task that cause pain and problem solve solutions with the client. C. Instruct the client in joint protection techniques and reduce the number of cues over time. D. Adapt the activity with lightweight built-up handles to decrease grasp.

C. Instruct the client in joint protection techniques and reduce the number of cues over time. *RATIONALE: This approach begins by providing meaningful education on joint protection—such as stirring with the forearm in a neutral position and without the thumb pinching—and then reduces the number of cues as the client performs the tasks repeatedly. Fading approaches to treatment involve reducing or eliminating support as a client's skills improve or develop. The result is improved independence and decreased pain in the activity, in this case cooking.

A COTA® is working with a child who was recently identified as having vestibular issues. The COTA® would like to use suspended equipment in the session. What type of vestibular input should the therapist first introduce? A. Rotational movement B. Vertical movement C. Linear movement D. Continuous movement

C. Linear movement Suspended equipment provides the opportunity for children to gain vestibular input. Linear movement is usually tolerated the best and is introduced first.

A COTA® is working with a child with ADHD who is transitioning from elementary school to middle school and discussing the child's concerns with the educational team. Given the child's condition, with which occupation might the child need support? A. Meeting a new friend B. Initiating a routine C. Listening to instructions or conversations D. Forming a bond with more than one teacher

C. Listening to instructions or conversations Children with ADHD typically have difficulty paying attention to details and may miss important information that is conveyed verbally, such as with instructions or conversations.

To ensure appropriate and professional management of ethical complaints, what does the AOTA Ethics Commission strive to do? A. Complete an investigation within 15 days of notifying the Respondent that it is being conducted B. Disclose all details of complaints to AOTA members C. Maintain strict rules of confidentiality in every aspect of the Ethics Commission's investigational work D. Follow legal proceedings of the state in which the complaint was filed

C. Maintain strict rules of confidentiality in every aspect of the Ethics Commission's investigational work IncorrectD. Follow legal proceedings of the state in which the complaint was filed *RATONALE: Confidentiality guidelines are set and strictly enforced by the Ethics Commission and are applied to all parties involved in the complaint.

A COTA® in an outpatient psychosocial program sets goals with a client to improve motivation for completing basic ADLs every day, resume daily community activity, and medication management of sertraline (Zoloft). The therapist is MOST likely working with a client with what diagnosis? A. Obsessive-compulsive personality disorder (OCD) B. Schizophrenia C. Major depression D. Substance abuse disorder

C. Major depression Major depression is characterized by loss of interest in self-care and socialization. Sertraline is a typical pharmacological treatment for depression.

A client with Alzheimer's disease (AD) perseverates on having to pick up children from daycare. At which stage of the disease process is this client likely at? A. End B. Early C. Middle D. Late

C. Middle *RATIONALE: The middle stage of AD is characterized by clients' thinking that they are back in an earlier stage of life.

A COTA® is planning a feeding session with a client with a C5 spinal cord injury (SCI). Which feeding utensil or adaptive equipment would be MOST APPROPRIATE to introduce during the session? A. An electric self-feeder B. Utensils with built-up grips C. Mobile arm support D. Tenodesis orthosis

C. Mobile arm support A mobile arm support is best for a client with a C5 injury because the client would most likely show shoulder muscle activity along with biceps and upper trapezius.

A COTA® is positioning a child with quadriplegic cerebral palsy in a wheelchair. Which device would MOST increase neck stability? A. Lap belt B. Abduction wedge C. Molded head rest D. Lateral supports

C. Molded head rest Some children with quadriplegic cerebral palsy have poor head control. A molded head rest helps promote neck stability and improve head control.

A child with limited neck extension is working on drinking out of a cup. What type of feeding equipment would be MOST appropriate to introduce to this client? A. Drinking cup with handles B. Spouted sippy cup C. Nose cutout cup D. Dysphagia cup

C. Nose cutout cup A nose cutout cup is made of flexible plastic, and a portion of the cup is cut out so the client's nose is able to fit inside the glass rather than bump into the outside of it. This type of cup is appropriate for a client with limited neck extension because it does not require tipping the head back to take a drink.

The mother of a 7-year-old boy with autism asks the COTA® to teach her child to urinate in the toilet bowl. Which method is BEST to teach this skill? A. Use a water gun to squirt water inside the toilet bowl to teach the concept of toileting. B. Ask the child to sit, keep deflecting the urine stream inside the bowl, and then slowly stand. C. Place a piece of cereal inside the bowl to serve as a target during the treatment session. D. Use a piece of cardboard to elevate the rim of the bowl for a visual cue.

C. Place a piece of cereal inside the bowl to serve as a target during the treatment session. *RATIOANLE: a target such as a piece of cereal can help increase a child's attention to accuracy when learning to urinate while standing.

A COTA® is working with a client with a T2 spinal cord injury. While performing ADLs, the client reports a pounding headache and is sweating profusely. What action is MOST APPROPRIATE for the COTA® to take to help the client? A. Ensure the client is seated and quickly leave to alert the nurse or physician and the OTR®. B. Recline the client and elevate the legs until the symptoms diminish, alerting the client's nurse, physician, and supervising OTR® as soon as possible. C. Place the client upright, remove restrictive devices, and check the client's catheter, alerting the client's nurse, physician, and the supervising OTR® as soon as possible. D. End the session early to allow the client some rest, and alert nursing staff.

C. Place the client upright, remove restrictive devices, and check the client's catheter, alerting the client's nurse, physician, and the supervising OTR® as soon as possible. The client is experiencing autonomic dysreflexia, a medical emergency. The COTA® should place the client in an upright position, remove anything restrictive, and check the client's catheter for an obstruction. The COTA® should alert the client's nurse, physician, and the supervising OTR® as soon as possible.

Which game is MOST difficult for a 7-year-old child with autism? A. Following simple designs using interlocking blocks B. Completing puzzles while on a swing C. Playing Simon Says with a peer D. Making a sandwich using play dough

C. Playing Simon Says with a peer *RATIONALE: Playing Simon Says requires social skills, auditory processing, and praxis skills, which are typical areas of challenge for children with autism.

A client with stroke is receiving occupational therapy services to increase independence with feeding, grooming, hygiene, and toileting. What area of function is likely to MOST influence the client's performance in these ADLs? A. Decreased upper-extremity range of motion (ROM) B. Limitation in swallowing ability C. Postural instability for sitting and standing D. Deficits in visual-perceptual skills

C. Postural instability for sitting and standing *RATIONALE: Clients with stroke often experience postural imbalance and difficulty making postural adjustments during activities. The client's base of support is the first consideration in improving the sitting and standing ability required to complete ADLs.

What should a COTA&#174; do for the affected upper extremity when positioning a client with hemiparesis in side lying on the affected side? A. Place in adduction B. Place on the humeral head C. Protract forward D. Support in internal rotation

C. Protract forward The affected upper extremity should be placed in protraction to allow optimal soft-tissue lengthening.

A COTA® is working with a client with bulimia. The client has become preoccupied with hiding purging behaviors from friends and family. While developing an occupational profile with the client, the COTA notices that as the client's bulimia has evolved, the client has replaced many valued activities with the bulimia. The client has severe occupational imbalance, with no participation in anything but binging and purging behaviors. Which strategy would be MOST successful with this client? A. Teach the client relaxation strategies to provide relief from the stress caused by the bulimia. B. Recommend social activities to encourage the client to interact with friends and family in a more positive way. C. Provide the client with leisure activities that will create more balance and offer the client more control over the client's life. D. Assign the client small-group activities with other clients to provide the client with information about the health impact of bulimia.

C. Provide the client with leisure activities that will create more balance and offer the client more control over the client's life. *RATIOANLE: The client is demonstrating occupational imbalance, so exploring new leisure activities would be important to help the client create a more balanced life. Learning a new skill would also allow the client to feel more control over his or her life.

A COTA® is working with a second-grade student on handwriting. The student is unable to make firm strokes on the paper when writing, which makes the writing difficult to read. Which intervention would be appropriate to increase this student's legibility? A. Position the student's paper on a vertical surface B. Provide the student with markers that have built-up shafts C. Provide the student with a mechanical pencil D. Allow the student to dictate answers

C. Provide the student with a mechanical pencil A mechanical pencil will help the student make a firmer mark on the paper without exerting more pressure.

An OTR® is evaluating a second-grade student's handwriting abilities. The OTR observes that the student is unable to make firm strokes on the paper when writing, which makes the writing difficult to read. Which intervention would be appropriate to increase this student's legibility? A. Position the student's paper on a vertical surface B. Provide the student with markers that have built-up shafts C. Provide the student with a mechanical pencil D. Allow the student to dictate answers

C. Provide the student with a mechanical pencil RATIONALE: A mechanical pencil will help the student make a mark on the paper without exerting more pressure.

A school-age child is learning to dress independently. The COTA® plans to use backward chaining methods to teach the child to zip and unzip a front-opening jacket. Which step of the task should the child complete FIRST when using this technique? (retired NBCOT question) A. Pull the fastened zipper tab from the bottom of the jacket upward B. Hook both sides of the zipper together at the bottom of the jacket C. Pull the fastened zipper tab from the top of the jacket downward D. Hold the bottom edge of the fabric and zipper tightly while the COTA® pulls the zipper closed

C. Pull the fastened zipper tab from the top of the jacket downward During backward chaining, the COTA® assists with the majority of the task completion (zipping the jacket) and allows the child to complete the last step of the process (e.g., unzipping the jacket) independently.

A COTA® is working with an 18-month-old child with bilateral transverse upper-arm deficiency who was recently fitted with myoelectric prosthetics. Which self-care tasks would be appropriate to work on in therapy? A. Donning and doffing prosthetics independently B. Using ties or hook-and-loop fastener to fasten shoes bimanually C. Raising upper extremities to assist with upper-body dressing D. Indicating to a caregiver when more juice is desired

C. Raising upper extremities to assist with upper-body dressing On the basis of the child's condition and age, raising the upper extremities to assist with upper-body dressing is appropriate.

A COTA® is working with a client who has visual processing speed and divided attention deficits. In identifying the client's fitness to drive skills, what task is likely to be MOST DIFFICULT for the client? A. Identifying a gray vehicle on a rainy day B. Accurately reading traffic signs or identifying colors on a traffic light C. Reacting quickly when a car pulls out in front of the driver's vehicle D. Accurately judging the space when pulling into a parking space

C. Reacting quickly when a car pulls out in front of the driver's vehicle *RATIONALE: Visual processing speed and divided attention are the critical client factors necessary for dividing attention between multiple stimuli on the road and reacting quickly to prevent a potential adverse event.

A COTA® is working with an adult client with sensory processing difficulties who finds it uncomfortable to commute to a job via train because of the noise of the train and of other passengers talking. Which environmental modification would allow the client to continue to commute and maintain employment? A. Encourage the client to obtain a driver's license and avoid train travel B. Petition the train system to allow the client to occupy a compartment alone and ask others to sit elsewhere C. Recommend the use of noise-cancelling headphones with a device that plays music or books the client enjoys D. Assist the client in seeking employment closer to home to avoid train travel

C. Recommend the use of noise-cancelling headphones with a device that plays music or books the client enjoys *RATIONALE: Environmental modification in the form of assistive technology would allow the client to continue to commute and maintain employment. Benson (2009) specifically suggested the use of headphones to manage noisy environments for people who have sensory processing impairments.

A COTA® is working with a child who has scoliosis with a curve of 70°. The child would like to engage in sports activities. On the basis of this medical condition, which factor would most likely limit the child's ability to participate in sports? A. The need to wear a therapeutic brace B. Weak abdominal muscles C. Reduced cardiopulmonary function D. Ability to manage pain

C. Reduced cardiopulmonary function Children with a scoliosis curve between 65° and 80° may have reduced cardiopulmonary function.

While a COTA® is working with a client on vocational training in a community-based setting, the client becomes frustrated with a computer task and states, "I am too slow at the computer; I can't do this." The COTA responds, "I notice that you take your time to be very careful not to make mistakes while you are working. I am sure that employers would think that is a positive quality in a job candidate." Which interpersonal strategy does the COTA's statement exemplify? A. Interpretation B. Metaphor C. Reframing D. Encouragement

C. Reframing *RATIONALE: In this example, the COTA turns a quality that the client perceives as negative (typing slowly) into a positive quality (being careful not to make mistakes). By reframing this quality, the COTA aims to change the client's thinking about a quality that the client possesses.

An adult with posttraumatic stress disorder (PTSD) is admitted to an inpatient psychiatric unit after a suicide attempt. What would be the BEST initial intervention for a COTA® to attempt with this client? A. Individualized assertiveness training B. Reality-orientation group C. Relaxation-focused group D. Daily routine group

C. Relaxation-focused group Brown and Stoffel (2011) list relaxation as one of the primary interventions for people with PTSD.

A COTA® is working on dressing in early intervention with a 2-year-old who has a developmental delay. The child is able to take off socks and put legs through pant holes when pants are held up. What is the next area of dressing the COTA® should address? A. Lace shoes. B. Put on mittens. C. Remove coat. D. Put on socks.

C. Remove coat. At age 2, a child should be able to doff a coat after fasteners have been unfastened; the child should also be able to remove shoes if not tied; begin to help with pulling down pants; and locate armholes in shirt.

A COTA® chooses to incorporate the use of a variety of experiences, different media, and novel instructional materials during a handwriting intervention session. Which model of practice is guiding the COTA®'s intervention? A. Neurodevelopmental B. Acquisitional C. Sensorimotor D. Biomechanical

C. Sensorimotor A sensorimotor approach to handwriting would include the incorporation of a variety of sensory experiences, different media, and novel instructional materials during a handwriting intervention session. It would also include offering the child multiple different writing tools, writing surfaces, and positions for writing.

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 D. Hold the patient by the chin so the patient cannot look away Correct! You answered C. The right answer is C Providing a calm environment and gaining the patient's attention through eye contact are effective strategies for a patient at Level IV, who has confusion, agitation, and a short attention span.

On the way to treat a student in the lunchroom, a COTA® working under a fee-for-service contract observes another client with Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome) reacting negatively to a student who accidently brushed against the client in line. Which response would be BEST? A. Do nothing, because the COTA® is on the way to a session with another student B. Deliver negative consequences to the client for misbehaving C. Suggest that the client move to the end of the line to avoid being crowded D. Suggest that the client eat alone in a room to avoid being crowded

C. Suggest that the client move to the end of the line to avoid being crowded Being the last person in line will create the space the client needs to successfully wait in line for lunch. Additionally, the client will feel safer knowing that no unwanted sensory stimulation can come from behind.

An OTR® who supervised an occupational therapy assistant student in the student's final Level II fieldwork in an acute psychiatric hospital hires the student for a COTA® position. The student plans to sit for the NBCOT® exam in 2 weeks. How should the OTR® supervise this new employee? A. Supervise the new employee as a COTA® because the employee has completed all courses and fieldwork B. Always provide direct, face-to-face supervision for the new employeeC. Supervise the employee consistent with national and state guidelines on uncertified employees D. Ask the new employee to initiate an occupational therapy evaluation

C. Supervise the employee consistent with national and state guidelines on uncertified employees Only after passing the NBCOT® examination can an occupational therapy assistant use the COTA® designation.

A COTA® is working with a 14-year-old with Down syndrome on doing laundry. The COTA plans to use a backward chaining strategy. Which intervention would be MOST appropriate? A. The COTA premeasures the detergent. The client then pours the detergent into the washing machine. B. The COTA places a clothing item in the client's hand. Then, the COTA guides the client's hand into the opening of the washing machine. C. The COTA demonstrates the steps of setting the cycle on the washing machine dial, adding the detergent, loading the clothes, and shutting the lid. The client then presses the start button of the washing machine. D. The COTA instructs the client to take a single clothing item out of the basket and put it into the washing machine. When the client is successful, the COTA encourages the client to pick up two or more items and put them into the washing machine.

C. The COTA demonstrates the steps of setting the cycle on the washing machine dial, adding the detergent, loading the clothes, and shutting the lid. The client then presses the start button of the washing machine. Backward chaining is a process in which the COTA supports the client in completing the last step of a task sequence. As the client improves, the COTA encourages the client to complete each preceding step in reverse order until the client is able to complete the entire task sequence independently.

A COTA&#174; is working with a child diagnosed with anxiety disorder. The child exhibits an increased sense of fear and anxiety during novel situations that significantly impedes participation in many school activities. The COTA decides to use a cognitive reframing approach to intervention. Which intervention applies the cognitive reframing approach? A. The COTA uses an engine metaphor and asks the child to identify whether his or her arousal level is high, medium, or low. B. The COTA uses stories with sentences to help the child be aware of his or her environment and context. C. The COTA facilitates the child to talk about and rate his or her fears. D. The COTA provides a set of movement-based activities to allow the child to regulate his or her arousal level.

C. The COTA facilitates the child to talk about and rate his or her fears. Cognitive reframing is a cognitive-behavioral therapy that uses positive self-talk to remove self-defeating and negative thoughts.

An OTR®; works in an early intervention facility that uses the Family Systems Model of care for its clients who have mental health concerns. In which example is the Family Systems Model of care applied? A. The OTR focuses on the specific needs of the child needing early intervention programming. B. The OTR evaluates the child and interviews each family member separately to identify their concerns. C. The OTR gains an understanding of various multiple factors that may have an impact on family functions. D. The OTR uses child-centered and child-focused clinical reasoning to guide assessment and treatment.

C. The OTR gains an understanding of various multiple factors that may have an impact on family functions. Internal (family dynamics, values, beliefs) and external (insurance, employment, access to health care) factors influence family functions and need to be addressed in a Family Systems Model of care.

A COTA® is working with a client who has major depression and works for a service-based business that opens at 9:00 a.m. and closes at 5:00 p.m. The client finds work meaningful but is unable to keep up with a full-time schedule because of the depression. The COTA would like to advocate for workplace accommodations. According to the Americans With Disabilities Act of 1990 (ADA), what is a reasonable accommodation for this client? A. The client should be allowed to work 3 hours per day. B. The client should be given a flexible start time. C. The client could job share with a coworker. D. The client can break for 3 hours in the middle of the day.

C. The client could job share with a coworker. To satisfy the client's needs while respecting the business's normal operations, this option is best for the client, according to ADA guidelines. The ADA suggests that the employer should not have to provide accommodations that would disrupt the flow of normal operations.

A COTA® is working with a child who is recovering from a motor vehicle accident. During the session, the child seems to lose awareness and stops working on a puzzle for as long as 30 seconds at a time. On the basis of this information, what should the COTA® be concerned about? A. The client is having tonic-clonic seizures. B. The client is having myoclonic seizures. C. The client is having absence seizures. D. The client is having akinetic seizures.

C. The client is having absence seizures. People having absence seizures look like they are "zoning out" or daydreaming; these seizures are characterized by a brief lapse or loss of awareness. In addition, clients who experience absence seizures will suspend all motor activity (even eye blinking) during a seizure. These seizures usually last less than 30 seconds.

A client with early-stage Huntington's disease is displaying excessive voluntary movements. The client prefers to bathe in the shower. What recommendation would be appropriate to improve the client's ability to bathe as independently as possible? A. The client should sponge bathe. B. The client should receive an assist from the home health aide. C. The client should use safety bars and a tub bench. D. The client should use soap on a rope.

C. The client should use safety bars and a tub bench. *RATIONALE: Safety bars and a tub bench will allow increased safety and independence in the shower.

A COTA® is working with a child on shoe tying. The COTA® is using backward chaining. Which statement describes this technique? A. The therapist downgrades the activity so that the child is able to complete the task with fewer activity demands. B. The therapist models the task for the child and encourages the child to imitate what he or she observes. C. The therapist performs the first several steps of the task and allows the child to complete the last step of the task. D. The therapist encourages the child to complete the first step of the task, and the therapist then completes the rest of the task.

C. The therapist performs the first several steps of the task and allows the child to complete the last step of the task. This option accurately describes backward chaining.

A COTA® reviews recommended guidelines on the use of weighted vests to help provide sustained touch pressure and promote organization in a child with autism. Which statement describes a correct use of a weighted vest? A. The child must be between 4 and 7 years old. B. The vest is worn for 45 minutes to 1 hour at a time daily. C. The vest's weight should be no more than 10% of the child's body weight. D. Weight should be distributed over the trunk and upper extremities.

C. The vest's weight should be no more than 10% of the child's body weight. *RATIOANLE: The evidence-based recommendation is that the vest weigh no more than 10% of the child's body weight.

A client with spinal cord injury has been on bedrest for several days. The COTA&#174; is preparing to begin mobility activities with the client. What device is best to use for mobilizing the client? A. Stander or standing table B. Standard wheelchair C. Tilt-in-space wheelchair D. Mat table for sitting

C. Tilt-in-space wheelchair Orthostatic hypotension often occurs with deconditioning from bed rest, and a tilt-in-space wheelchair allows the client to be reclined quickly if the client's blood pressure drops too low in sitting.

A client with stroke is demonstrating a 1-finger-width separation of the acromion and the head of the humerus. In the intervention session, what should be the FIRST step of the COTA&#174;? A. Fit the upper extremity with a sling B. Recommend that the client not use the upper extremity C. Train the client and caregiver in safe handling of the upper extremity during transfers D. Provide PROM to minimize contractures of the upper extremity

C. Train the client and caregiver in safe handling of the upper extremity during transfers Providing training in safe handling techniques to properly position and move the affected upper extremity is the most important approach to addressing shoulder subluxation.

Parents of children with disabilities often report socioeconomic as well as personal challenges to involving their children in community-based physical activity programs. Which example represents a socioeconomic issue that needs to be considered when planning a community-based physical activity program? A. Some children have disabilities that don't allow them to be physically active. B. Parents of children with disabilities may prefer home-based activities to protect their children from harm. C. Transportation costs or availability can prevent access to community-based programs. D. Some facilities that sponsor physical activity programs may not be accessible to children with disabilities.

C. Transportation costs or availability can prevent access to community-based programs. *RATIOANLE: Transportation costs, whether related to operating an automobile or using public transportation, can be a barrier to access for families with children with disabilities.

A COTA® is working with a client with amyotrophic lateral sclerosis to address interosseous muscle wasting and atrophy in the dominant hand and to promote self-feeding. Which compensatory strategy would be MOST beneficial? A. Weighted utensils B. Built-up foam grip C. Universal cuff with a D-ring D. Hands-free options

C. Universal cuff with a D-ring *RATIONALE: A universal cuff compensates for loss of finger extension and facilitates grip to allow the client to hold utensils.

During a journal reading activity led by the COTA®, a client becomes very emotional when disclosing sensitive personal feelings on how the client's family perceives the client's admission to the mental health facility. Several other clients recognize that they share the same feelings and perceptions, which makes the client feel better. According to Yalom's therapeutic factors in groups, what curative factor is this? A. Altruism B. Catharsis C. Universality D. Cohesion

C. Universality Universality is the curative factor gained from other members' sharing of similar feelings, thoughts, and problems.

A COTA® will begin teaching dressing skills to a 4-year-old child with autism. To ensure success during the first attempt, which activity should the COTA® choose? A. Use a shirt with large buttons for easy manipulation of donning and doffing. B. Use the child's favorite shirt that fits really well to practice dressing skills. C. Use an over-the-head shirt that is slightly large for the child. D. Use a cotton shirt that does not have an itchy hem and collar.

C. Use an over-the-head shirt that is slightly large for the child. When beginning to teach dressing skills, the COTA® begins with basic, simple articles of clothing, such as loose-fitting pants and over-the-head, slightly large shirts, to allow for success.

A client with depression enjoyed exercising in the past because it helped the client experience more positive feelings. The client now has difficulty finding the motivation to participate in exercise. Which strategy would be BEST for the COTA® to use to encourage this client to resume exercise? A. Use motivational interviewing to encourage exploration of desirable leisure activities. B. Provide opportunities for the client to explore new leisure pursuits. C. Use the remotivation approach to determine the appropriate motivational stage for intervention related to exercise. D. Provide the client with useful feedback about performance in occupational therapy interventions related to exercise and why the client should resume it.

C. Use the remotivation approach to determine the appropriate motivational stage for intervention related to exercise. *RATIONALE: Remotivation is an evidence-based intervention for motivation that helps clients reengage in desired positive behaviors. Because the client has already self-identified exercise, remotivation will help the COTA assist the client in a specific motivation strategy to resume exercise.

A COTA® is working with a 4-year-old child who has gravitational insecurity and a hypersensitive vestibular system. Which activity would be MOST EFFECTIVE to use initially for modulating this sensory integrative dysfunction? (retired NBCOT question) A. Swinging in a rotational pattern while lying prone in a net swing B. Jumping up and down on a trampoline while holding onto the side rails C. Using both feet to slowly push back and forth while prone on a platform swing D. Riding down a 45° incline ramp while lying prone on a scooter board

C. Using both feet to slowly push back and forth while prone on a platform swing Pushing back and forth while prone in a swing places the child in a secure position while receiving proprioceptive input from pushing. The linear swing pattern provides a low level of vestibular input.

A COTA® is working on functional mobility with an infant in early child intervention. The infant is able to stand while holding onto a surface or piece of furniture. What is the next "just-right" developmental challenge? A. Transitioning from sitting to kneeling B. Bearing weight through both lower extremities C. Walking with hand-held assistance D. Standing on one foot

C. Walking with hand-held assistance Infants are typically able to take steps with hand-held assistance around age 10 months, after they are able to stand up while holding on to a surface or a piece of furniture.

A client has two children, a 3½-year-old and a 2-year-old. Because of postpartum depression, she has been unable to return to work since the birth of the younger child. What home- and community-based occupational therapy services would BEST help the client improve her worker role? A. Job simulation and work retraining in the home B. Facilitation of employer-client meetings to negotiate bringing the children to work C. Weekly goal setting, time management activities, and use of a positive-events diary to build self-confidence D. Facilitation of employer-client meetings to negotiate work- at-home options

C. Weekly goal setting, time management activities, and use of a positive-events diary to build self-confidence *RATIONALE: Nonpharmacological approaches to treating depression, including postpartum depression, focus on assistance with gradual lifestyle reexamination and positive support to build self-confidence, assist with task demands through time management, and problem solving.

A COTA® is providing services for a client who is being referred for a particular emerging technology intervention that has little evidence to support its effectiveness. With consideration for the ethical principle of Veracity, what is the best way for the COTA to address the needs of the client? A. Suggest that the client not pursue this intervention and consider other options. B. Suggest that the client look up the technology online. C. Give the client a brochure provided by the manufacturer of the technology. D. Educate the client about the risks and benefits of the new technology with consideration of the limited research.

CorrectD. Educate the client about the risks and benefits of the new technology with consideration of the limited research. *RATIONALE: The principle of Veracity encompasses addressing new treatment possibilities, including new technologies. Veracity further addresses comprehensive and accurate conveyance of information. Education ahead of evidence is acceptable.

A COTA® in an inpatient facility is conducting a cooking activity to teach effective coping skills to a small group of adolescents. A group member becomes frustrated with a teammate and is verbally threatening. What is the BEST response for the COTA® to say in this situation? A. "I see that you're upset by your teammate. Let's calm down and take a deep breath." B. "You seem upset by your teammate. Verbally threatening is not a good behavior to show others." C. "I need you to calm down and reflect for a while. We can discuss this later." D. "Do you want to take a minute to calm down, or go back to your room?"

D. "Do you want to take a minute to calm down, or go back to your room?" *RATIONALE: When a potentially dangerous situation commences, such as a threat of assault, the COTA® should offer the adolescent choices for effective coping strategies to deal with emotional outbursts.

A client arrives at the occupational therapy clinic 10 minutes late for a session crying uncontrollably. When the COTA® attempts to engage the client in conversation, the client responds, "I don't want to talk about it. Is that so bad?" Which response would be MOST effective? A. "Let's have our session later, after you've stopped crying." B. "You are upset. How can I help you?" C. "Come on, now; that's enough of that." D. "It must be very difficult."

D. "It must be very difficult." "It must be very difficult" acknowledges the client's feelings without being judgmental and lets the client know that the COTA® sees that client is upset.

A COTA® working in an outpatient mental health setting meets with a client with depression 3 weeks after the client's discharge from the hospital. The client expresses concern about phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI) the client has been prescribed, saying that the drug's negative side effects deplete the client's ability to function. The client plans to stop taking the medication. What is the COTA®'s MOST appropriate response? A. "Discontinue use of the medication until you see your doctor." B. "Remember the dietary restrictions related to MAOIs." C. "Side effects are present in all medications. You just have to get used to them." D. "Let's get your psychiatrist or a nurse on the phone now so you can discuss your concerns."

D. "Let's get your psychiatrist or a nurse on the phone now so you can discuss your concerns." Psychiatrists are responsible for medication management for clients with mental illness. Therefore, providing the client the opportunity to inquire about the medication directly would be the most appropriate recommendation. If contacting the psychiatrist right at the moment is impossible, leaving a message with contact information for the client would be the next best alternative.

An OTR® supervises a COTA® who works with a group of adults who are continuing their recovery from alcohol and drug addiction by living in a halfway house. The OTR® suggests that the COTA® become familiar with a particular group intervention in working with these clients. What type of intervention would the OTR® MOST likely suggest? A. An occupational deprivation group B. Project MAINSTREAM C. A heavy work activity group D. A 12-step self-help group

D. A 12-step self-help group Most substance abuse programs include one or more self-help groups that use a classic 12-step process. Most substance abusers seek help through self-help groups. Occupational therapy practitioners working with this population are likely to become involved in facilitating or supporting these groups.

Principle 2, Nonmaleficence, of the Occupational Therapy Code of Ethics (2015) imparts an obligation to do no harm to others. Which of the following ethical violations is MOST likely a violation of the principle of Nonmaleficence? A. The director of an occupational therapy program receives a gift from a vendor in appreciation for the purchase of several items for the program. Because the gift is worth less than $75, the director decides not to report it to the employer. B. A clinical supervisor offers a reduced fee for hand management services to a physician who regularly refers clients to the occupational therapy program. C. To convince a research participant to continue in a low-risk study, an occupational therapy researcher offers an additional $50 incentive to the participant. D. A COTA&#174; meets the sibling of a service recipient and has an intimate relationship with the sibling while continuing to provide occupational therapy for the family member.

D. A COTA&#174; meets the sibling of a service recipient and has an intimate relationship with the sibling while continuing to provide occupational therapy for the family member. *RATIONALE: The principle of Nonmaleficence, specifically Subprinciples 2C, 2F, and 2G, are violated when occupational therapy practitioners engage in personal relationships with service recipients and their family members.

A COTA® is working in an inpatient psychiatric setting where the average length of stay is 5 days. Which group activity would be MOST appropriate for patients with depression? A. A parallel group in which participants work on a free-form clay project of their choice B. A cooperative group in which participants plant a garden C. A project group in which participants paint a watercolor on a blank canvas D. A parallel group in which each participant completes his or her own solid-color ceramic tile trivet

D. A parallel group in which each participant completes his or her own solid-color ceramic tile trivet Simple and concrete activities are most appropriate for clients hospitalized with depression. For the trivet activity, the solid color removes the need to make decisions about color and pattern, the trivet provides clear physical boundaries, and gluing the tile onto the backing is simple and concrete. Participation in a parallel group minimizes the need for social interaction but allows physical proximity to others.

An OTR® and COTA® are working with a client with a unilateral transradial amputation. The client is switching to a salesperson position from a computer operator position. The client does not wear a prosthesis and is independent in all one-handed skills. The client is concerned that the appearance of a residual limb may put the client at a disadvantage during sales calls and would like to obtain a prosthesis. What is the BEST prosthesis for the client? A. An active realistic myoelectric prosthesis B. An active realistic prosthesis C. A passive hook prosthesis D. A passive realistic cosmetic prosthesis

D. A passive realistic cosmetic prosthesis *RATIONALE: The client's goal for the prosthesis is cosmetic. The client is a high-functioning one-handed person and does not require an active prosthesis. The additional time and expense needed to develop prosthetic skills is not warranted given the client's current level of functioning.

A COTA&#174; in a private clinic is discussing with other practitioners potential peers who can be paired or grouped with a 3-year-old client. The client has autism, and the goals include improving play and social skills. Which potential peer has appropriate characteristics to consider when choosing peers to partner with this client? A. A child of the other gender, to promote gender diversity and exposure to children of that gender B. A child with the same diagnosis who has not been paired with another child during therapy sessions C. A child with the same diagnosis and developmental level as the client D. A slightly older child with a slightly higher developmental level than the client

D. A slightly older child with a slightly higher developmental level than the client *RATIOANLE: Peers of different ages and different developmental statuses can promote different types of play and leisure behaviors and can advocate a multitude of play skills.

A client with chronic inactive rheumatoid arthritis (RA) has been referred for occupational therapy. All the joints in the client's wrists and hands are affected by the RA, but the only visible sign is the beginning of ulnar drift. What type of splint is BEST to prescribe for this client with the goal of reducing pain at night? A. A rigid, prefabricated metacarpophalangeal (MCP) joint ulnar deviation splint B. A prefabricated thermoplastic resting hand splint C. A custom-fabricated wrist cock-up splint D. A soft, prefabricated wrist, thumb, and MCP joint support

D. A soft, prefabricated wrist, thumb, and MCP joint support Splinting all the joints of the hand reduces the chances of increased stress on unsupported joints. Studies have suggested that compliance increases with soft splints Because the client does not have significant deformities, a prefabricated splint should fit.

An OTR® is completing a motor evaluation with an 8-year-old child with spina bifida resulting in a lesion at L5. What type of motor functions can the child be expected to demonstrate? A. Full use of the upper extremities but poor or absent trunk control; use of assistive technology for mobility B. Ability to activate the long muscles of the back during functional movement; ambulation for short distances with hip, knee, and ankle orthoses C. Good trunk control and ability to flex the hips and abduct and extend the knees; ambulation with knee, ankle, and foot orthoses; use of a wheelchair for energy conservation likely D. Ability to flex the hips and extend the knees; ambulation with ankle and foot orthoses; use of a wheelchair unlikely

D. Ability to flex the hips and extend the knees; ambulation with ankle and foot orthoses; use of a wheelchair unlikely A child with spina bifida and an L5 lesion can be expected to flex the hips, extend the knees, and ambulate with ankle and foot orthoses.

A COTA® in an inpatient facility is working with an adolescent with major depression who repeatedly expresses feelings of worthlessness and poor self-concept. What therapeutic activities will BEST address this client's self-concept issues? A. Activities that establish normal daily routines B. Activities that engage the client socially C. Activities that do not require too many choices D. Activities that allow for self-expression

D. Activities that allow for self-expression *RATIOANLE: For clients who have self-concept symptoms, activities that allow for self-expression and self-exploration, such as a collage, help combat feelings of worthlessness and guilt.

A COTA® is working in a clubhouse with a group of clients who have mental health issues. Which leadership style would be MOST effective for the COTA® to use? A. Director B. Authority figure C. Facilitator D. Advisor

D. Advisor The clubhouse model puts the locus of control on the members. When designing groups, the members formulate the goals, and the COTA®, in collaboration with the OTR®, acts as an advisor.

A COTA® is working with a 2-year-old child in early intervention and suspects that the child may have an underlying hearing impairment. The COTA® reports this information to the OTR®. To whom should the COTA®, in conjunction with the OTR®, refer the client? A. The nurse assigned to the case B. The primary care physician C. A speech-language pathologist D. An audiologist

D. An audiologist An audiologist is the appropriate team member to assess a child's hearing.

A COTA® is using the Ayres Sensory Integration Intervention following a sensory integration frame of reference intervention plan for a 6-year-old child with attention deficit hyperactivity disorder and sensory-seeking behaviors. When selecting activities for this intervention program, what principle should the COTA® keep in mind? A. The sensory environment is completely structured to allow for optimum integration of sensory information. B. Sensory experiences are limited to one sensory factor at a time to ensure mastery. C. Passive participation on the part of the child is always encouraged. D. Appropriate activities are done individually and not in a small group.

D. Appropriate activities are done individually and not in a small group. The Ayres Sensory Integration Intervention program is applied individually rather than in groups.

A COTA&#174; is conducting a treatment session with a child who has low frustration tolerance for highly structured activities. During a writing activity, the child gets very frustrated. Following the Occupational Adaptation (OA) model, which approach should the COTA take to reduce the child's frustration with the main task? A. Teach the use of a coping strategy to help the child get less upset with the challenging task. B. Ask the child to put down the pencil, take a 30-second break, and then go back to writing. C. Ask the child to do two more sentences and then choose a reward activity of choice. D. Ask the child to do a treasure hunt game instead and incorporate a writing task into the game.

D. Ask the child to do a treasure hunt game instead and incorporate a writing task into the game. *RATIOANLE: When using the OA approach, the COTA diverts the client's primary energy used in a frustrating and challenging task. To tap into the secondary adaptive energy, the COTA engages the client in an activity that is meaningful and enjoyable and slowly incorporates small chunks of the challenging task into it.

A client recovering from substance abuse disorder is referred for occupational therapy services. What intervention is the COTA® MOST likely to provide? A. Group psychotherapy B. Medication management C. Assistance with locating a new apartment D. Assistance with finding meaningful ways to spend free time

D. Assistance with finding meaningful ways to spend free time Substance abuse becomes the primary activity of people with this disorder. Education about and experimentation with alternative uses of time should be a primary focus of intervention.

A COTA&#174; is completing an intervention to address a client's decreased postural stability when performing tasks in standing. The client has hemiparesis after a stroke. The COTA wants to elicit a postural response at the trunk when completing an intervention activity. Where should the COTA place task objects FIRST to elicit a trunk response? A. Above the client's head B. Within arm's reach C. On a moveable surface D. Beyond arm's reach

D. Beyond arm's reach Tasks that are beyond arm's reach will facilitate a weight shift and challenge the client's postural abilities.

A COTA&#174; 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. Wrist extension elicits finger grasp, which is the proper method to explain the use of tenodesis.

A COTA® is working with a child with bradydactyly. Which occupation might the child have difficulty with? A. Eating a sandwich. B. Talking with a friend on the phone. C. Ordering at a restaurant. D. Buttoning shirt buttons

D. Buttoning shirt buttons A child with bradydactyly has overly large digits and may have difficulty with ADLs that require fine motor manipulation.

A COTA® work in an interdisciplinary adult day program for clients with chronic mental illness. Other professionals working in the program include a recreational specialist, an art therapist, and a social worker. For what area is the COTA® MOST likely to assume leadership? A. Creative expression B. Crisis management C. Sports activities D. Community integration

D. Community integration Each of the four choices would include opportunities for the COTA® to provide service. However, COTA®s focus more directly on activities needed for participation in the community.

A COTA® working in a neurology unit was referred a client with low back pain. During the interview, the client confides that stressful life events have recently been prominent in the client's life. The client added that the low back pain started after the stressful life events. Malingering and fear of illness do not seem to be a part of this scenario. What is the client's likely diagnosis? A. Low back pain B. Factitious disorder C. Histrionic personality disorder D. Conversion disorder

D. Conversion disorder All symptoms point to conversion disorder.

A client sustained partial-thickness and deep-thickness burns over a total body surface area of 60%, including the bilateral arms and legs. In the acute phase postburn, on which factor should the COTA® focus through intervention? A. Fluid retention B. Scar management C. Sensory reeducation D. Deformity prevention

D. Deformity prevention *RATIONALE: During the acute phase of the burn, it is important to position the client to prevent the development of deformity and contracture.

A child with attention deficit hyperactivity disorder (ADHD) is working on developing on-task behaviors in the classroom. Which intervention strategy would be appropriate to support the child in developing on-task behaviors? A. Modifying the classroom environment so that the child is not sitting near close friends and will have a tendency to talk less to the surrounding students. B. Introducing the child to other students with ADHD so that they can discuss what it feels like to have this condition. C. Requesting that the teacher not penalize the student for off-task behavior until the student's medication has been adjusted. D. Developing a behavior modification program in which the child is rewarded for being on task at different intervals throughout the day.

D. Developing a behavior modification program in which the child is rewarded for being on task at different intervals throughout the day. *RATIONALE: Developing a behavior modification program in which the child is rewarded for being on task at different intervals throughout the day would be an appropriate occupational therapy intervention to support the child in developing consistently on-task behaviors.

A child with attention deficit hyperactivity disorder (ADHD) is working on developing on-task behaviors in the classroom. Which intervention strategy would be appropriate to support the child in developing on-task behaviors? A. Modifying the classroom environment so that the child is not sitting near close friends and will have a tendency to talk less to the surrounding students. B. Introducing the child to other students with ADHD so that they can discuss what it feels like to have this condition. C. Requesting that the teacher not penalize the student for off-task behavior until the student's medication has been adjusted. D. Developing a behavior modification program in which the child is rewarded for being on task at different intervals throughout the day

D. Developing a behavior modification program in which the child is rewarded for being on task at different intervals throughout the day. Developing a behavior modification program in which the child is rewarded for being on task at different intervals throughout the day would be an appropriate occupational therapy intervention to support the child in developing consistently on-task behaviors.

According to Allen's Cognitive Disabilities Model, to what type of group will clients with active acute symptoms of schizophrenia respond best? A. Free-choice task and activities group B. Assertiveness training group C. Psychoeducational group D. Directive task and activities group

D. Directive task and activities group The presence of active acute symptoms indicates limited cognitive processing. Organized task activities with brief, specific directions are likely to render the greatest success.

A COTA® has recommended that a student with a learning disability use an assignment notebook to write down homework assignments for each class. Which factor related to learning disabilities does this compensatory strategy address? A. Disorders of sequencing and adapting prioritization and problem solving B. Disorders of social skills and concentration C. Disorders of sensory integration and perception D. Disorders of thinking and memory

D. Disorders of thinking and memory People with learning disabilities often have difficulty with short- and long-term memory. Using an assignment notebook would mean that the student would not have to recall the assignments after leaving the class.

With which occupation might a child with arthrogryposis multiplex congenital likely have difficulties? A. Being fed. B. Socializing with friends C. Listening to a teacher's instructions. D. Donning a shirt.

D. Donning a shirt. Children with arthrogryposis multiplex congenital have incomplete contractures or fibrous ankylosis of all or many of their joints, which would make donning a shirt, the only occupation that involves the use of the extremities, difficult without adaptive equipment or modified techniques.

A COTA® working with older adults facing driving cessation is concerned about ensuring their continued community mobility for psychosocial as well as functional reasons. What evidence does the literature provide that supports a psychosocial focus with this population? A. Older adults have been found to be more content once they no longer face the pressure to drive. B. Driving cessation has been linked to episodes of psychosis. C. Research indicates that families of older adults are relieved when older adults can no longer drive. D. Driving cessation has been linked to social isolation, depression, and early nursing home admission.

D. Driving cessation has been linked to social isolation, depression, and early nursing home admission. *RATIONALE: Several studies have indicated a link between driving cessation and social isolation, depression, and early nursing home admission (Classen, 2010).

A patient who has a moderate hemiparesis is participating in homemaking activities. Which activity would MOST EFFECTIVELY incorporate graded weight bearing through the involved upper extremity? (Retired NBCOT question). A. Vacuuming floors B. Washing dishes C. Folding towels D. Dusting a table

D. Dusting a table Dusting a table allows the patient to bear weight through the involved upper extremity while the uninvolved upper extremity wipes the table.

A COTA&#174; is concerned with preventing shoulder pain in a client with hemiparesis in the acute stages of stroke recovery. Which intervention is appropriate to prevent shoulder pain in this client? A. Allow the client to dangle the hemiplegic upper extremity alongside the chair B. Position the client in side lying on the hemiplegic side with internal rotation and scapular retraction C. Use overhead pulleys with prolonged stretch at end range D. Emphasize activities that allow external rotation, shoulder flexion within 90°, and scapular protraction

D. Emphasize activities that allow external rotation, shoulder flexion within 90°, and scapular protraction Clients with hemiparesis should be encouraged to move the upper extremity with external rotation, shoulder flexion within 90°, and scapular protraction to allow for optimal motor recovery by promoting soft tissue elongation.

A client who has undergone electroconvulsive therapy (ECT) in the early morning arrives for an evening occupational therapy task group in an inpatient psychiatric unit. What is the COTA®'s BEST choice for working with the client at this time? A. Contact the nursing staff to escort the client back to the client's room. B. Remind the client of the need for 24 hours of bed rest after ECT. C. Invite the client to participate in a different group that focuses on reminiscence. D. Encourage the client to choose one of the available tasks to work on during the group.

D. Encourage the client to choose one of the available tasks to work on during the group. ECT is immediately followed by a short, required bed rest, especially if residual symptoms include headache, nausea, and dizziness; regular activities can then be resumed.

A COTA® is working with a teenager with autism on eating in the cafeteria using good table manners. Which strategy would be appropriate to meet this outcome? A. Partially feeding the teenager and using a backward chaining technique B. Requesting that the teenager take a time out or break to work on self-calming strategies C. Delaying gratification by postponing lunch until the teenager can demonstrate good table manners D. Encouraging the teenager to model the behavior of a peer who is eating with good table manners

D. Encouraging the teenager to model the behavior of a peer who is eating with good table manners A modeling strategy, which would consist of having a peer complete the task and then having the child copy the peer, is the most appropriate option.

A COTA® is working with a high school student with a history of traumatic brain injury on taking the bus to the library independently. The student has trouble remembering the directions to the library. Which intervention strategy is BEST to help the student follow the directions to the library and take the appropriate bus? A. Provide the student with a handheld listening device B. Shadow the student to ensure that the student is independent C. Provide the student with a bus route map and highlight the appropriate bus route D. Fabricate pocket-sized cue cards with pictures of landmarks and key information for the student to follow

D. Fabricate pocket-sized cue cards with pictures of landmarks and key information for the student to follow Pocket-sized cue cards are an appropriate intervention strategy for a high school student with a history of traumatic brain injury who has trouble remembering directions.

A COTA&#174; has recently had a conflict with a physical therapist who works at the same treatment facility. During a team meeting that includes the client, the COTA says that the physical therapist is using outdated approaches that are ineffective. One of the other team members feels that the COTA has violated an ethical principle and wants to discuss the matter with the COTA after the meeting concludes. Which principle will the team member discuss with the COTA in relation to the COTA's comment? A. Beneficence B. Autonomy C. Justice D. Fidelity

D. Fidelity The principle of fidelity requires that a COTA treat other professionals with respect, discretion, and integrity. By allowing the interpersonal conflict to affect comments during a team meeting, the COTA has not been respectful of the physical therapist's practice choices and has not used appropriate conflict resolution strategies. Principle 6I of the Occupational Therapy Code of Ethics (2015) states that occupational therapy practitioners "shall respect the practices, competencies, roles, and responsibilities of their own and other professions to promote a collaborative environment reflective of interprofessional teams."

An OTR® asks the COTA® to have the client's caregiver complete a proxy assessment of the client's driving skills. What assessment would be BEST for the caregiver to complete? A. AARP Driver Safety Course B. Driving Habits Questionnaire C. SAFER Driving: The Enhanced Driving Decisions Workbook D. Fitness-to-Drive Screening Measure (previously known as the Safe Driving Behavior Measure)

D. Fitness-to-Drive Screening Measure (previously known as the Safe Driving Behavior Measure) *RATIONALE: The Fitness-to-Drive Screening Measure was developed for caregivers to rate the driving ability of the person for whom they care.

A COTA® is treating a client who is functioning at Level 1 of autism spectrum disorder without intellectual impairment (Asperger syndrome). What factor would be MOST likely to limit the client's occupational performance? A. Memory limitations B. Poor speech intelligibility C. Low intellectual ability D. Habitual behaviors

D. Habitual behaviors Autism spectrum disorder is characterized primarily by social interaction problems and habitual behaviors.

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&#174; 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 Weight shifting for pressure relief is an essential skill to enable clients with spinal cord injury to minimize the risk of skin breakdown while completing tasks during the workday.

Which occupation-based intervention activity is MOST appropriate to develop the bilateral hand skills of a 3-year-old child with autism? A. Holding a cup while pouring water from a large pitcher B. Donning a dress and buttoning the five 2-inch buttons on the dress C. Writing the child's own name while stabilizing the paper D. Holding the handle of a small bucket while filling it with water from a faucet

D. Holding the handle of a small bucket while filling it with water from a faucet Of the options, holding the handle of a small bucket while filling it with water from a faucet is the most appropriate play-based activity for the child's age.

What is the FIRST step in the process of designing a group protocol for clients with mental illness? A. Find appropriate dates and times for conducting the group. B. Identify the appropriate outcomes of the group and methods for tracking and recording them. C. Develop group goals and determine the size of the group. D. Identify a problem and the factors that will motivate the people in the group to change.

D. Identify a problem and the factors that will motivate the people in the group to change. Motivation to change is regarded as an initial step in developing a group protocol. It requires identification of a problem and interaction with potential group members to determine what will promote change.

A softball player sustained a deep partial-thickness burn to the anterior aspect of the right arm from the wrist, proximal to the ulnar styloid process, to the mid-upper arm. A split-thickness skin graft from thigh to mid-forearm was performed 3 days postinjury. To minimize the risk of graft rejection in the initial phase (7 days postinjury), what strategy should the client be instructed to perform? A. Daily active pronation and supination exercises at least 5 times per day B. Desensitization using ice to gently rub the burned areas from distal to proximal C. Retrograde massage followed by elastic bandage wrapping from distal to proximal D. Immobilization using the elbow extension splint and avoiding forearm movement

D. Immobilization using the elbow extension splint and avoiding forearm movement *RATIONALE: During the initial phase post-skin graft operation, it is important to maintain immobilization for 2-7 days or per the physician's specific instruction.

A child with Down syndrome has a goal of learning to don socks independently. Which adaptation would be MOST appropriate to facilitate this task? A. Long socks over the calf B. Smaller socks C. Sock aide or donner D. Loops sewn in socks

D. 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 client with middle-stage Parkinson's disease demonstrates tremor and rigidity bilaterally in upper extremities, mild difficulties with executive functioning, and increased fatigue during ADL and IADL performance. Which is the BEST occupational therapy intervention for a client in the middle stages of Parkinson's disease? A. Splinting to minimize tremor and to provide wrist and finger stability during fine motor coordination tasks B. Progressive resistive exercises to improve fine motor control function and to reduce the intensity of tremors C. Adapting the home with environmental control units to address fatigue and fine motor skills D. Modification of clothing with minimal fasteners or hook-and-loop closures to reduce fine motor demands

D. Modification of clothing with minimal fasteners or hook-and-loop closures to reduce fine motor demands *RATIONALE: Modifying or eliminating clothing fasteners decreases the demand on fine motor coordination for a client experiencing tremors.

According to the Occupational Therapy Practice Framework: Domain and Process, using a dark cutting board to cut up a hard-boiled egg and a white cutting board to chop broccoli would be an example of what type of intervention strategy? A. Restore (remediate) B. Establish C. Create, promote (health promotion) D. Modify

D. Modify *RATIONALE: Modify is an intervention approach in which the practitioner finds ways to revise a current context to support performance. Using contrast to enhance visibility in the kitchen is a modification.

A COTA® at a private outpatient clinic is working with a 10-year-old client with attention deficit hyperactivity disorder and depression. At the start of the session, the child shows signs of being depressed and reports feelings of worthlessness because of academic difficulties. The client refuses to participate in the planned handwriting activity for the day. What is the MOST appropriate course of action for the COTA®? A. Ask the child to cheer up because many activities have been planned for the day. B. Ask whether the child wants to discontinue the session and reschedule for a later time. C. Discontinue the session and report the signs of depression to the parent. D. Offer the child a change in activities from planned handwriting to artwork.

D. Offer the child a change in activities from planned handwriting to artwork. *RATIOANLE: When a client is depressed and shows signs of self-concept issues, engaging in occupations that involve self-expression can help the client deal with his or her emotions.

A COTA® is working with a child with sickle cell anemia. Which intervention strategy would be appropriate when working with this child? A. Joint protection B. PROM C. Pursed-lip breathing D. Pain management

D. Pain management Children with sickle cell anemia may experience pain and may need support to manage their pain.

A COTA® has been leading a developmental group that is in charge of planning a staff party at an inpatient facility. After a few sessions, the COTA® observes that the group has now bonded with one another and appears united and emotionally supportive of one another. According to Tuckman's theory of group development, at what stage is this group? A. Forming B. Storming C. Norming D. Performing

D. Performing In group dynamics, the performing stage is characterized by group productivity derived from a sense of trust, unity, and supportiveness.

A COTA® is working with an infant on learning how to transition from sitting to kneeling. Which activity would be the most appropriate to achieve this outcome? A. Place a toy on the kitchen table. B. Place a toy on the caregiver's lap. C. Place a toy on a low coffee table on the other side of the room from the child. D. Place a toy on a surface that cannot be reached in sitting.

D. Place a toy on a surface that cannot be reached in sitting. Placing the toy on a surface that can only be reached in kneeling or standing (not sitting) would create the next "just-right" challenge.

A COTA® is working on cooking skills with a client with a severe intellectual disability. Which activity would the client likely be able to complete with supervision? A. Making a frozen pizza in the oven. B. Preparing a cold salad. C. Heating up a microwave meal. D. Pouring juice from a pitcher to a cup.

D. Pouring juice from a pitcher to a cup. *RATIONALE: Clients with a severe intellectual disability have an IQ between 25 and 40 and are able to perform some basic ADLs, but they often need supervision or caregiver assistance for basic tasks.

A COTA® is working on life skills training with a client who has Prader-Willi syndrome. Given the nature of Prader-Willi syndrome, which life skills may present more of a problem? A. Buying a greeting card for a friend and remembering who the intended recipient is. B. Vacuuming the floor and needing to move light objects to vacuum under them. C. Going to a movie and sitting through the previews. D. Preparing a meal and waiting to serve it until lunchtime.

D. Preparing a meal and waiting to serve it until lunchtime. Individuals with Prader-Willi syndrome often present with food-seeking behaviors, which might make waiting to eat until lunchtime difficult.

A client with age-related macular degeneration reports difficulty completing meal preparation activities. Which intervention would be MOST appropriate for this client? A. Reduce room and task lighting in the kitchen area B. Remove window coverings in the kitchen area C. Use items with busy patterns in the kitchen area D. Provide background contrast in the kitchen area

D. Provide background contrast in the kitchen area *RATIONALE: Changing the background to increase contrast in the kitchen allows items to be seen and identified easier. For example, using a dark cutting board to chop an onion promotes the visibility of the onion.

A 3-year-old child with autism is receiving community-based occupational therapy. One of the child's goals is to increase independence in dressing. Which task should the COTA® address FIRST? A. Tying and untying knots B. Buttoning a series of buttons C. Buckling shoes or belt D. Putting on a pullover shirt

D. Putting on a pullover shirt Putting on a pullover shirt is recommended as an intervention activity for a 3-year-old child with autism. The other skills are more advanced and are generally achieved by typically developing children after age 3.5 years.

A client has bipolar disorder. Under supervision of an OTR®, a COTA® focuses, with the client's permission, on the client's work environment because the employer appears to be resistant to providing accommodations and the intervention plan includes goals for work. Consequently, the COTA provides educational information to the client's boss about bipolar disorder. What approach does this intervention strategy take? A. Delay deterioration in performance skills B. Maintain performance of component skills C. Prevent secondary disability and anticipatory action D. Reduce behaviors and environmental barriers

D. Reduce behaviors and environmental barriers By educating the employer about the work environment, the therapist can reduce environmental barriers at work by explaining bipolar disorder, answering questions about the condition, and providing education about accommodations, thus facilitating the employer's ability to provide necessary accommodations for this client.

When the AOTA Ethics Commission determines that unethical conduct has occurred, it typically issues a disciplinary action. Which disciplinary action does NOT require public report of conclusions and sanctions? A. Suspension of AOTA membership B. Censure C. Revocation of AOTA membership D. Reprimand

D. Reprimand Reprimand is a formal expression of disapproval of conduct communicated privately by letter from the AOTA Ethics Commission.

A COTA® is working on bed mobility with a client in the active phase of C8 spinal cord injury. The client becomes dizzy and nauseous when brought to the sitting position. What is the BEST action for the COTA® to take? A. Apply antiembolism stockings and continue activity. B. Return to the lying position and loosen clothing. C. Transfer to wheelchair and elevate legs. D. Return to the lying position and elevate legs.

D. Return to the lying position and elevate legs. The client appears to be experiencing symptoms of orthostatic hypotension and should be reclined with legs elevated until symptoms subside

An OTR® and COTA® team want to develop interventions for homeless adults with mental illness to improve independent living skills. Which of the following roles is MOST appropriate for the team? A. Employment retraining B. Job searching C. Housing procurement D. Room and self-care management

D. Room and self-care management Evidence has indicated that basic life skills training in areas such as room and self-care management, food and nutrition management, money management, and safe community participation leads to increased skill and knowledge in managing these areas.

Many issues arise when a client has difficulty with functional ambulation caused by abnormal gait. What should be the FIRST priority for the COTA® when addressing the issue of functional ambulation? A. Gait pattern during ambulation B. Independence with mobility C. Appropriate ambulation aid D. Safety throughout ambulation

D. Safety throughout ambulation *RATIONALE: Client safety and prevention of injury should always be the first priorities during any activity, including functional ambulation. With regard to functional ambulation, safety can mean reviewing the client's medical record for current status and precautions, considering the client's physical abilities, and being aware of the external environment.

A 6-year-old child with autism is trying to kick a ball through a goal 10 feet away. The child has made six attempts already. Although the child is able to kick the ball with correct movements, the child does not seem to be able to calibrate the amount of motor input to approximate the goal. When the child kicks the ball, it always lands beyond the goal. What skill seems to be impaired for this child? A. Visual dyspraxia B. Ideational dyspraxia C. Verbal dyspraxia D. Somatosensory dyspraxia

D. Somatosensory dyspraxia Somatosensory dyspraxia occurs when a person is unable to process tactile-kinesthetic or proprioceptive input to complete a motor plan. This child is able to coordinate the movements for kicking the ball but is unable to adequately calibrate the force with which to kick the ball and send it into the goal.

A COTA® is working with a child who has sensory integrative dysfunction related to motor planning. According to Ayres Sensory Integration, what type of sensory input would be most supportive in developing this child's motor planning skills? A. Proprioceptive, visual, and auditory B. Vestibular, tactile, and olfactory C. Visual, auditory, and olfactory D. Tactile, vestibular, and proprioceptive

D. Tactile, vestibular, and proprioceptive Children with motor planning problems benefit from vestibular and proprioceptive input. They might also have difficulties with tactile perception.

To prevent skin breakdown in a client with an incomplete spinal cord injury, which method is BEST for preventing pressure sores? A. Removing after-market cushioning from wheelchair B. Applying moist heating pads to areas of discomfort C. Encouraging the client to remain still in bed D. Teaching the client to inspect the skin on a daily basis

D. Teaching the client to inspect the skin on a daily basis The client must learn to perform self-inspections regularly.

A COTA® is working in a preschool with a child who has a developmental delay in toileting. The child is beginning to show interest in toileting and can stay dry for more than 2 hours at a time. What is the next "just-right" challenge for this child? A. Moving the bowels regularly B. Wiping independently after having a bowel movement C. Managing clothing during toileting D. Telling someone when he or she has to go to the bathroom

D. Telling someone when he or she has to go to the bathroom *RATIONALE: At age 2, children typically begin to show interest in toileting, can stay dry for 2 or more hours, and can flush the toilet independently and urinate regularly. The next developmental challenges include telling someone that they have to use the bathroom, waking up dry after sleeping, wiping self after urinating, and washing hands independently.

A COTA&#174; is assisting an OTR®; who uses the Cognitive Orientation to daily Occupational Performance (CO-OP) approach to encourage use of effective and appropriate social behaviors for a 9-year-old with attention deficit hyperactivity disorder. Which example illustrates an application of the CO-OP approach? A. The COTA, with some input from the child, establishes goals for the child regarding essential skills that the COTA thinks need to be developed. B. The COTA directly teaches important strategies to help the child remember how to respond in stressful social situations. C. The COTA targets multiple skills in social situations to optimize the learning environment. D. The COTA asks questions to allow the child to process what behaviors were appropriate and inappropriate in a situation.

D. The COTA asks questions to allow the child to process what behaviors were appropriate and inappropriate in a situation. This approach is an example of the "ask, don't tell" principle of guided discovery using the CO-OP. The COTA asks rather than tells the child the sources of breakdown during performance of occupations.

A COTA® is working with a second grader with autism who is fully included in a general education classroom. The teacher has indicated that the child is "on yellow." On the basis of this information, what sort of support should the COTA® provide the child in terms of behavior? A. The child may benefit from physical restraint. B. The child may benefit from a time out. C. The child may benefit from being removed from the classroom on a regular basis. D. The child may benefit from environmental adjustments, cues, or facilitation.

D. The child may benefit from environmental adjustments, cues, or facilitation. Yellow-zone behavior is usually considered mildly problematic and does not pose a safety risk to the child or other people. This type of behavior can usually be addressed by making environmental adjustments or providing cues or facilitation

A client scores a Allen Cognitive Level (ACL) of 4.0 with the Allen Cognitive Disability Framework. Given this score, what discharge arrangement would the COTA®, in consultation with the OTR®, likely recommend for this client? A. This client could be discharged home alone with weekly checks for novel safety issues and health maintenance needs and reminders. B. This client could be discharged home with family for support in all areas of IADLs and personal care, including bathing, dressing, and hygiene. C. This client should remain in the psychiatric facility under close 24-hour supervision for safety and personal care needs. D. This client could be discharged to a supported living arrangement with the expectation that the client can independently complete the morning self-care routine.

D. This client could be discharged to a supported living arrangement with the expectation that the client can independently complete the morning self-care routine. *RATIONALE: A client with an ACL of 4.0 should be in a supported living arrangement but would be expected to complete habitual routines independently (e.g., morning self-care).

A physician has referred a client to an outpatient setting for an occupational therapy evaluation and intervention. The client has late effects from a stroke that occurred approximately 10 years ago. The OTR® is performing a screening before initiating the evaluation. Which is the MOST likely reason for completing the screening? A. To complete the occupational profile and become acquainted with the client B. To meet the client and conduct a standardized interview before the evaluation C. To complete the assessments to save time during the evaluation process D. To identify whether the client may benefit from occupational therapy services

D. To identify whether the client may benefit from occupational therapy services *RATIONALE: The purpose of a screening is to determine whether a client would benefit from an occupational therapy evaluation or services.

A COTA® is fabricating a splint for a patient who had a recent palmar contracture release. What is the PRIMARY purpose of the splint? A. To protect the surgical site B. To block MCP joint extension C. To increase MCP joint flexion D. To maximize finger extension

D. To maximize finger extension *RATIONALE: Palmar contracture release is to bring the fingers out of flexion and into extension; splinting postsurgically allows the fingers to rest in extension.

A COTA® is working with a child who has a diagnosis of myelomeningocele spina bifida. Which ADLs might be difficult for a child with this condition? A. Grooming at the sink B. Feeding oneself lunch C. Upper-body bathing D. Toileting at school

D. Toileting at school Children with myclomeningocele spina bifida have sensorimotor problems at or below the level of their lesion. Lower-extremity paralysis and loss of sensation is common. Bowel and bladder programs may need to be implemented to help children with toileting across environments.

A client is 2 days poststroke in acute care with right hemiparesis and requires moderate to total assistance for basic ADLs. The client's FIM™ scores on admission to occupational therapy are 2 for dressing, 1 for bathing, and 3 for feeding. Which intervention is MOST appropriate to provide first? A. Refer the client for a driving evaluation in preparation for community reentry B. Educate the client and caregiver about a home program addressing right-side awareness C. Supervise the client in completing hygiene tasks standing at the sink while emphasizing use of the right arm D. Train the client in postural activity at the edge of the bed to increase supported sitting

D. Train the client in postural activity at the edge of the bed to increase supported sitting Postural stability is essential to performing many ADLs, and hemiparesis influences the client's ability to maintain postural stability at the edge of the bed.

A COTA® is working with an adolescent client with juvenile rheumatoid arthritis on joint protection techniques. Which recommendation is aligned with joint protection principles? A. Carry as many laundry baskets as possible when putting away laundry to reduce the number of trips required B. Engage in high-weight, high-resistance activities with frequent repetitions to maintain strength C. Use a medicine bag-style satchel to carry books and other materials in the hand rather than on the shoulder D. Use a backpack to carry books and other materials on the back by placing the straps at both shoulders

D. Use a backpack to carry books and other materials on the back by placing the straps at both shoulders Carrying items in a backpack on the back with the straps at both shoulders is an example of a joint protection technique; the client uses the largest joints possible to complete the task.

A school-based COTA&#174; is working with a child who has severe emotional disturbance. The child frequently responds "No" to provoke a strong response from others, is extremely disorganized when provided a series of instructions, and has sudden emotional outbursts when frustrated with challenging tasks. Which strategy to enhance the client's behavioral performance in school will be MOST effective? A. Ask the child whether he or she wants to do a particular activity during therapy B. Plan activities that have a difficulty level that is no more than one or two levels higher than the child's ability C. Avoid the use of written rules because they will only provoke strong emotional reactions from the child D. Use a small, enclosed room to help contain behavioral expression during sudden outbursts

D. Use a small, enclosed room to help contain behavioral expression during sudden outbursts *RATIONALE: During emotional outbursts, a small and enclosed room can help contain behavioral expressions and reduce attention seeking.

Which clinical situation would be LEAST amenable to positioning and splinting solutions for decreasing soft-tissue contracture to improve functional use for occupational performance? A. Use of a volar antispasticity hand splint while weight bearing to decrease flexor tone in the wrist and fingers B. Use of a C-bar splint to stretch the first web space of the hand secondary to a medial nerve injury C. Use of a knee extension splint for a client with a below-the-knee amputation while sitting in a wheelchair D. Use of an elbow extension splint post fracture to release a boney block

D. Use of an elbow extension splint post fracture to release a boney block *RATIONALE: A boney block can only be removed surgically.

A client's family asks the COTA® to withhold information regarding the client's lack of progress in occupational therapy, in consultation with the OTR®, and without information to support limitation of information exchange, the COTA decides to accurately discuss progress and related concerns with the client. Which ethical principle underlies the COTA's justification for disclosure? A. Autonomy B. Justice IncorrectC. Nonmaleficence D. Veracity

D. Veracity *RATIONALE: In the Occupational Therapy Code of Ethics (2015), Principle 5, Veracity, states, "Occupational therapy personnel shall provide comprehensive, accurate, and objective information when representing the profession." Veracity refers to comprehensive, accurate, and objective transmission of information, including documentation of clinical status.

174; A client with a nondisplaced shaft fracture of the right fifth metacarpal has a physician's order for full-time splinting. Which orthosis would the COTA® be MOST likely to fabricate? A. Dorsal hood splint with the wrist in approximately 20° flexion, all metacarpophalangeal (MCP) joints of the affected hand in 70°-90° flexion, and interphalangeal (IP) joints of the affected hand in 0° extension B. Volar-based ulnar gutter with MCP and IP joints of the ring and fifth fingers in 0° extension and the wrist in neutral C. Dorsal-based wrist cockup splint with MCP and IP joints free and the wrist in approximately 20° extension D. Volar-based ulnar gutter with MCP joints of the ring and fifth fingers in 70°-90° flexion, fourth and fifth IP joints in 0° extension, and the wrist in approximately 20° extension

D. Volar-based ulnar gutter with MCP joints of the ring and fifth fingers in 70°-90° flexion, fourth and fifth IP joints in 0° extension, and the wrist in approximately 20° extension *RATIONALE: the MCP joints in flexion helps prevent contracture of the collateral ligaments.

Which of the following is an open-ended question that can be used when interviewing a client who has a substance-related disorder? A. What type of work do you do? B. How many times per week do you go out with friends? C. Do you have any hobbies or leisure skills? D. What do you do during a typical 24-hour day?

D. What do you do during a typical 24-hour day? *RATIONALE: Open-ended questions require respondents to reply with more than one-word answers, providing the practitioner with more information about the client's experience.

Which of the following is an open-ended question that can be used when interviewing a client who has a substance-related disorder? (retired NBCOT question) A. What type of work do you do? B. How many times per week do you go out with friends? C. Do you have any hobbies or leisure skills? D. What do you do during a typical 24-hour day?

D. What do you do during a typical 24-hour day? *RATIONALE: Open-ended questions require respondents to reply with more than one-word answers, providing the practitioner with more information about the client's experience.

A client with bipolar disorder in an outpatient setting is having difficulty following a medication routine. The client does not understand the physician's orders for the medication and prefers to take medication with some alcohol because it "helps take the edge off." What approach would be appropriate for the COTA® to take on this visit? A. Provide the client with information about the prescribed medication, dosage and timing, precautions, and side effects. B. Develop a treatment plan that includes activities to enhance occupational balance and leisure. C. Instruct the client in breathing and relaxation activities to decrease the feeling of being on edge. D. Suggest that the client participate in a group facilitated by the COTA titled "Get Your Life Back—NOW!"

A. Provide the client with information about the prescribed medication, dosage and timing, precautions, and side effects. The COTA should support the physician's treatment plan and assist the client with medication adherence. If the client is adequately medicated and stable, occupational therapy will be more productive. In addition, medication management could be considered a safety issue. If the client is not able to complete medication management, the client's health and mental health are at risk for decline.

A COTA® is working on sequencing a bedtime routine with a child with autism. Which activities would be supportive of this outcome? A. Providing the child with pictures of the different tasks involved in the routine so that the child may perform them in order. B. Encouraging the child to complete the last task in a series of tasks so that the child is more inclined to want to complete the routine. C. Allowing the child to select which activities to eliminate from the routine. D. Introducing the child to adaptive equipment (e.g., an electric toothbrush) so that the routine takes less time.

A. Providing the child with pictures of the different tasks involved in the routine so that the child may perform them in order. Clients with autism benefit from the use of visual supports, such as pictures. Using pictures may help this child recall steps so that the child can perform them in the correct order.

A COTA® uses cognitive-behavioral interventions in psychosocial practice with clients with stress and anxiety disorders. What intervention is the COTA® MOST likely to use? A. Psychoeducation that provides resources and information about the client's illness and ways to cope with it B. Creative expression using art to free underlying emotions and conflicts C. Psychotherapy that builds trust in the client-therapist relationship and brings unconscious conflicts to a conscious level D. Reminiscence to increase awareness of remote memories and thereby improve the ability to recall and recognize

A. Psychoeducation that provides resources and information about the client's illness and ways to cope with it A hallmark of cognitive-behavioral therapy is use of psychoeducation. Evidence supports the benefits of this approach.

A COTA® is working in early intervention with a toddler with developmental delays. The child is just beginning to actively cooperate during dressing. What is the next "just-right" challenge for this child? A. Pulling off shoes and socks B. Locating the armholes of a shirt C. Pulling down pants with an elastic waistband D. Dressing with minimal assistance

A. Pulling off shoes and socks Around age 1, children begin cooperating during dressing. The next developmental challenge would be to encourage the child to remove shoes and socks.

A COTA® is working on life skills with a teenager who has achondroplasia, or dwarfism. Which of the following tasks might pose a challenge for the client? A. Reaching an upper cupboard to obtain a box of cereal B. Transporting silverware from the dishwasher to the silverware drawer C. Sweeping the kitchen floor after a meal D. Making toast using a toaster

A. Reaching an upper cupboard to obtain a box of cereal People with achondroplasia (often referred to as dwarfism) usually grow be to 4 feet tall or less in height. Their limbs have typical width but are usually shorter in length. A client with this condition might have difficulty reaching an upper cupboard to obtain an item.

Which activity would a client with age-related macular degeneration likely have difficulty performing? A. Reading printed material B. Engaging in functional mobility C. Seeing well at nighttime D. Tolerating glare from lights

A. Reading printed material *RATIONALE: Difficulty reading printed material is a characteristic feature of age-related macular degeneration because of the gradual loss of ability to see clearly and development of a dark or empty area in the center of the vision.

A COTA&#174; is approaching a client with stroke to begin an intervention session in inpatient rehabilitation. The client is sitting at the dining table in a wheelchair with hips extended and is leaning on the unaffected left upper extremity. What should the COTA's FIRST approach be? A. Reposition the client in the wheelchair with hips flexed at 90° and the upper extremity resting in the lap B. Transfer the client to another wheelchair that provides a lap tray for upper-extremity support C. Transfer the client to a standard chair with arms for positioning in posterior pelvic tilt D. Recommend further assessment by the OTR®; to determine the client's postural needs

A. Reposition the client in the wheelchair with hips flexed at 90° and the upper extremity resting in the lap Ideal seated posture for a client with hemiparesis is hips flexed at 90° with shoulders over hips and arms relaxed in lap; the upper extremities should not be used to provide support in sitting.

A school-based COTA® is working with a 6-year-old student on learning how to tie shoes so the student can be more independent in getting ready for physical education (PE) class. The COTA plans to use the strategy of teaching the skill in context. Which intervention would be MOST appropriate? A. Review the steps of shoe tying with the student right before getting ready for PE class, then have the student tie the shoes before lining up to go to PE class B. Provide the student with pictures depicting the steps in shoe tying, then ask the student to put the pictures in order C. Place elastic laces in the student's shoes and tie them, then encourage the student to put the shoes on without untying or retying the shoes D. Encourage the student to complete the first two steps of tying shoes (i.e., pulling the laces tight and crossing them), then complete the rest of task for the client

A. Review the steps of shoe tying with the student right before getting ready for PE class, then have the student tie the shoes before lining up to go to PE class Consistently having the student practice shoe tying at the time that the student actually needs to tie the shoes is an example of teaching the skill in context.

Which is an element of social skills training used by COTA®s? A. Role playing B. Psychoeducation C. Rote training D. Authoritative guidance

A. Role playing Role playing allows a client to practice social skills in a structured and safe environment, enhancing the possibility that the skills will carry over to real-world situations.

A child with a developmental disability and poor postural control is working on toileting in the bathroom. Which equipment is recommended to support the child's postural control while sitting on the toilet? A. Safety rails B. Toileting schedule C. Floor-based toilet paper holder D. Handheld urinal

A. Safety rails Safety rails, or grab bars, would support this client's postural control while toileting and promote use of the hands to maintain balance.

A client with traumatic brain injury has a field loss resulting in decreased scanning ability. The client has a goal to improve environmental scanning for tasks such as locating foods in the refrigerator and finding items in the grocery store. What intervention activity would be MOST appropriate for the client? A. Scan the kitchen cupboards for meal preparation items B. Cross out horizontal lines on a piece of paper C. Read a paragraph of standard-size newsprint D. Use the Dynavision scan board in the clinic

A. Scan the kitchen cupboards for meal preparation items *RATIONALE: Completing tasks that closely relate to the goal tasks and practicing them in similar environments allows for greater task generalization.

A student in preschool has hypotonia with poor trunk control and good head control. The student wants to join peers when sitting on the floor during story time. Which position is BEST for supporting the student when participating in this classroom activity? (retired NBCOT question) A. Seated in a floor sitter that has a corner-shaped backrest and pelvic straps B. Semireclined in a bean bag chair placed on the floor against a wall C. Straddled over a bolster on the floor with the hips at 90° D. Lying prone on a 45° incline wedge placed on the floor

A. Seated in a floor sitter that has a corner-shaped backrest and pelvic straps Corner chairs position the child in an upright seated position by providing trunk support, and the seated position facilitates placement of the upper extremities in a position for function.

A COTA® is working with a 5-year-old child with autism to develop in-hand manipulation skills. Which activity is BEST to help this child develop shifting? A. Separating playing cards while holding them in one hand. B. Crumpling various sizes of paper in a supinated hand. C. Taking two or more coins from a change purse. D. Moving a penny from the palm to the fingers.

A. Separating playing cards while holding them in one hand. When separating playing cards, a child uses the tripod grasp to practice shifting skills.

A client diagnosed with glaucoma was referred for occupational therapy to promote functional mobility. During the evaluation, the OTR® determines that the client's family would benefit from caregiver training. What type of caregiver training would be MOST appropriate? A. Sighted-guide training B. Guide dog training C. White cane training D. Travel aid training

A. Sighted-guide training *RATIONALE: Sighted-guide training teaches caregivers a technique for guiding a client safely through environments and is within the occupational therapy scope of practice.

An inpatient is functioning at Level V (confused, inappropriate) on the Rancho Los Amigos Scale after having a TBI 3 weeks ago. What should be the focus of intervention during this phase of rehabilitation? A. Simple, familiar activities B. Multisensory stimulation C. Compensatory strategies for self-care D. Dressing using assistive devices

A. Simple, familiar activities A patient at Level V would be more successful completing familiar, previously learned tasks because of the patient's limited attention span, impaired memory, and lack of initiation.

A COTA® is planning a group activity for children who are 3 years old and have Down syndrome. One of the group goals is to improve bilateral upper-extremity gross motor coordination. Which activity would be MOST BENEFICIAL to include as part of the intervention for promoting progress toward this goal? (retired NBCOT question) A. Singing songs that incorporate arm and hand movements B. Drawing on a chalk board with large pieces of colored chalk C. Playing interactive child-led movement games D. Taking turns jumping rope to music

A. Singing songs that incorporate arm and hand movements Upper-extremity motor control is facilitated through repetitive and alternating movements through the upper extremity. The use of songs with arm and hand movements allows for bilateral and repetitive motor actions and is playful and fun for the child.

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 a T2 spinal cord injury is able to complete independent transfers that may require the use of a sliding board.

A COTA® is shifting roles within a skilled nursing facility to become the manager of the therapeutic recreation department. In which way does supervision from the OTR® change? A. Supervision is no longer needed. B. Supervision continues as previously scheduled. C. The OTR® and COTA® meet monthly to discuss clients. D. The OTR® and COTA® meet quarterly to discuss clients.

A. Supervision is no longer needed. *RATIONALE: Because of their training and education, COTAs are often well equipped to handle other careers, such as managing a therapeutic recreation department. Because this position does not entail providing occupational therapy services, supervision from an OTR® is not needed.

Regarding mental health services, of what is the place-and-train approach an example? A. Supported employment B. Transitional employment C. Job matching D. The clubhouse model

A. Supported employment The place-and-train approach first places the client in a supported employment situation and then trains the client to do the job.

A preschool-age child who has autism and a sensory modulation disorder is working to improve independence with self-care. During dressing sessions, the child typically refuses clothing made of certain fabrics, pulls away from touch, and becomes extremely irritated when dressing in long-sleeved shirts and long pants. Which of the following deficits is typically associated with these behaviors? (Retired AOTA question ) A. Tactile defensiveness B. Motor dyspraxia C. Postural insecurity D. Proprioceptive dysfunction

A. Tactile defensiveness *RATIONALE: Children with tactile sensitivity or defensiveness dislike touch, including the texture of certain fabrics.

A patient has an anxiety disorder and has been undergoing treatment in a psychiatric facility. During an occupational therapy session, the COTA® observes the patient's anxiety increasing and level of concentration has diminished compared to the behaviors observed in previous sessions. What INITIAL action should the COTA® take based on these observations? (retired NBCOT question) A. Talk with the patient about the changes in function B. Divert the patient's attention away from the anxious feelings C. Redirect the patient's attention to positive thoughts D. Inform the nursing staff about the behavioral changes

A. Talk with the patient about the changes in function Clients who begin demonstrating increased anxiety should be encouraged to express their feelings.

A COTA&#174; is assisting an OTR®; who uses the Cognitive Orientation to daily Occupational Performance (CO-OP) approach to help a group of children with high-functioning autism develop effective problem-solving skills. Which example is the BEST application of the CO-OP during the goal-setting phase of the first group activity? A. The COTA allows the group to set its own goals and facilitates ways to redirect the goals as needed. B. The COTA performs dynamic performance analysis to identify the strengths and weaknesses of the group. C. The COTA directly informs the group whether the set activity goal is too easy or too difficult. D. The COTA facilitates strategies to help the group set its goals appropriately.

A. The COTA allows the group to set its own goals and facilitates ways to redirect the goals as needed. During the first goal-setting phase, the COTA allows clients to develop meaningful goals for themselves.

A COTA&#174; is working with a child with autism who gets easily frustrated with challenging tasks. The child's current goal is to learn how to hit a ball with a bat. The COTA decides to use shaping as an intervention strategy. Which technique describes shaping as a teaching strategy? A. The COTA teaches successive approximations of the task such as picking up the bat, swinging the bat, and tapping a ball with the bat. B. The COTA teaches the child each prerequisite step of the activity in a systematic fashion and asks the child to combine each step, for example, holding the bat and then swinging the bat. C. The COTA helps the child hold the bat and swing the bat and then allows the child to hit the ball independently. D. The COTA systematically demonstrates to the child how to swing the bat, instructs the child to "swing the bat," and implements a time delay before a ball is pitched to learn the new skill.

A. The COTA teaches successive approximations of the task such as picking up the bat, swinging the bat, and tapping a ball with the bat. Successively approximating or learning intermediate behaviors that are prerequisite components of the final behavior is part of the shaping technique.

A COTA® is working on the playground with a child who has sensory integration dysfunction. The COTA® is trying to foster an adaptive response, which is best described by which statement? A. The behavioral manifestation of optimal sensory organization that results in an efficient goal-directed action B. Engagement in rough-and-tumble play and other activities that provide the child with muscle resistance C. A reflection on primitive neural functions in children with sensory processing problems D. An individualized plan that provides a specific child with optimal sensory experiences

A. The behavioral manifestation of optimal sensory organization that results in an efficient goal-directed action An adaptive response is the result of optimal organization and leads to efficient goal-directed action. As tasks become more complicated and children continue to demonstrate adaptive response, their sensory integration becomes more effective and efficient. Adaptive responses are thought to lead to changes at the neuronal synaptic level; these changes alter the brain through a process called neural plasticity.

A COTA® is working with an 8-year-old client with developmental coordination disorder (DCD) in an outpatient clinic. Which option reflects the difficulty that this child may experience at school as a result of this condition? A. The child may have difficulty with handwriting because of limited fine motor skills. B. The child may have difficulty socializing with peers as a result of limited language skills. C. The child may have difficulty attending to instruction because of limited self-regulation skills. D. The child may have difficulty locating a word in the dictionary because of limited visual-perceptual skills.

A. The child may have difficulty with handwriting because of limited fine motor skills. Children with DCD have difficulty with fine and gross motor skills and often require accommodations and modification for written language.

A COTA® was informed by the supervising OTR® that an evaluation was just completed on a client who has recently experienced traumatic brain injury. The client's chart lists a Glasgow Coma Scale (GCS) score of 7. What does this score imply? A. The client has experienced a severe head injury and will provide minimal feedback. B. The client has experienced a moderate head injury and may not be able to provide discernible feedback. C. The client has experienced a mild head injury and may be confused but able to follow simple commands. D. The client has experienced an extreme head injury and will provide minimal feedback.

A. The client has experienced a severe head injury and will provide minimal feedback. *RATIONALE: Severe head injuries include GCS scores of 8 or less

A factory worker is seen by a COTA® in an outpatient occupational therapy program to address difficulties with organizing and performing work duties because of depression. The OTR® working in the outpatient OT program recommends a job site analysis to facilitate the client's return to work. How does the focus of intervention change in the transition from outpatient services to the workplace? A. The focus moves from the individual client to the work environment. B. The focus moves from the client to the employer's policies for task completion. C. The focus moves from outpatient setting supports to workplace design. D. The focus moves from client-centered to employer-focused needs and goals.

A. The focus moves from the individual client to the work environment. *RATIONALE: supports facilitate the client's return to work.

A COTA® is working with a child with a developmental disability on feeding. The child presents with an exaggerated, uncontrolled pushing of food out of the mouth. Which term BEST describes this child's presentation? A. Tongue thrust B. Tongue protrusion C. Tongue hypotonia D. Tongue lateralization

A. Tongue thrust Tongue thrust is an exaggerated, uncontrolled pushing of food or liquid out of the mouth.

The spouse of a client with Alzheimer's dementia tells the COTA® that the client has become more agitated, wanders, resists care, and displays inappropriate and sometimes destructive behavior. The spouse confides that feelings of stress have begun to feel overwhelming. Which occupational therapy intervention is most appropriate? A. Training the spouse to provide simple, one-step directions and avoid abstractions B. Role playing with the spouse and the client ways of providing explanations that will clarify the client's confusion. C. Assertiveness training with the spouse D. Conflict resolution sessions between the spouse and client

A. Training the spouse to provide simple, one-step directions and avoid abstractions Reducing the complexity of activities and directions can reduce negative behaviors.

A COTA® is working with a 2½-year-old child on age-appropriate fine motor skills. Which activity would be most appropriate to support development? A. Unbuttoning large buttons B. Lacing a shoe C. Cutting out shapes with scissors D. Drawing shapes

A. Unbuttoning large buttons *RATIONALE: A 2½-year-old child would likely be working on unbuttoning large buttons.

A COTA&#174; is treating a client who is in a vegetative state after a traumatic brain injury (TBI). The OTR®; has identified the need to use restorative strategies with the client. Which restorative strategy is MOST appropriate for this client? A. Upright positioning strategies in a wheelchair to normalize muscle tone and facilitate arousal B. Sensory stimluation program to facilitate simple command following C. Self-feeding program that simplifies the task and provides success for the client D. Behavioral reinforcement program to reinforce the client's on-task performance

A. Upright positioning strategies in a wheelchair to normalize muscle tone and facilitate arousal Positioning a client with a TBI upright in a wheelchair provides optimal positioning to minimize abnormal tone and increase stimulation to the client's visual and vestibular systems.

A COTA® is working with a patient who has spastic hemiplegia and decreased trunk control secondary to a CVA. The patient is beginning to ambulate using a quad cane with standby assistance. The COTA® observes that the patient has decreased trunk stability during dressing activities. Which activity would promote increased trunk control during a dressing task while seated? A. Using the unaffected arm to reach for clothing positioned next to the affected side B. Putting the affected arm in a shirt sleeve while looking into a mirror C. Reaching with the unaffected arm to pick up a shoe from the floor D. Weight-bearing on the affected arm while buttoning a front-opening shirt with the unaffected hand

A. Using the unaffected arm to reach for clothing positioned next to the affected side *RATIOANLE: Reaching across the body with the unaffected arm while the affected side provides weight-bear support will facilitate trunk control in the client with a CVA.

A client with age-related macular degeneration arrives at the therapy session without glasses. Which recommendation would be MOST beneficial for this client? A. Wear prescribed glasses to therapy to provide best corrected vision B. See a medical professional to remove the existing lens and replace it C. Consult with a medical professional who can cure age-related macular degeneration D. Obtain eye drops for treatment of age-related macular degeneration

A. Wear prescribed glasses to therapy to provide best corrected vision *RATIONALE: Clients with low vision must use glasses that provide the best corrected vision when receiving occupational therapy services.

A client with age-related macular degeneration arrives at the therapy session without glasses. Which recommendation would be MOST beneficial for this client? A. Wear prescribed glasses to therapy to provide best corrected vision B. See a medical professional to remove the existing lens and replace it C. Consult with a medical professional who can cure age-related macular degeneration D. Obtain eye drops for treatment of age-related macular degeneration

A. Wear prescribed glasses to therapy to provide best corrected vision Clients with low vision must use glasses that provide the best corrected vision when receiving occupational therapy services.

An OTR® completes a work tolerance screening with a worker at a manufacturing plant. What information would the COTA® assigned to treat the client expect to be included in the screening documentation? A. Weight limits for various job tasks B. Worker's statements to remain in the job C. Worker's ability to perform IADLs at the job site D. Financial issues the worker currently experiences

A. Weight limits for various job tasks Work tolerance screenings identify limitations in the worker's ability to meet the activity demands of essential job functions, such as weights, distances, forces, angles, repetitions, and tools.

A COTA® is working with a client with C5 spinal cord injury. The OTR® asked the COTA® to make a splint for the client. What is the BEST position in which to splint the wrist to prevent deformity in the acute stage of injury? A. Wrist extension, thumb opposition B. Wrist neutral, thumb opposition C. Wrist extension, thumb adduction D. Wrist extension, thumb free

A. Wrist extension, thumb opposition When splinting in acute spinal cord injury, the wrist should be extended with thumb opposition to preserve web space and prevent deformity