7/23/12 OTR Question: OTR Prep Question: A client who has a C7 spinal cord injury has been admitted

to an inpatient rehabilitation facility and is beginning OT. One of the clients goals is to be able to prepare family meals. After identifying the clients typical family mealtime routines and habits, what should the OTR do NEXT to most effectively promote progress toward the clients goal? Answer: A. Observe the client during a standardized meal preparation task. B. Assess current physical skills and abilities during a kitchen task. C. Discuss the lay-out and type of appliances in the clients home kitchen. D. Provide assistive devices typically used by clients who have quadriplegia. Correct response: B Rationale: After identifying the clients typical mealtime habits and routines, the OTR should conduct a screening by observing the client perform a kitchen task. This will assist the therapist to generate hypotheses regarding performance deficits. Incorrect responses: A: This stage would occur after generating hypotheses regarding performance deficits in order to quantify impairments or deficits flagged during a screening. C: This information is typically gathered during the initial interview as part of the process in identifying the clients typical meal preparation routines and habits. D: The OTR should collect information about the habits, routines, and environments the client is used to prior to providing assistive devices. 7/23/12 COTA Question: COTA Prep Question: An inpatient had an uncomplicated total hip replacement, anterolateral approach one week ago. What movement of the affected hip is typically CONTRAINDICATED based on standard hip precautions? Answer: A. Abduction beyond 25 B. Internal rotation C. Flexion to 90 D. External rotation Correct response: D Rationale: Total hip precautions for an anterolateral approach include the following movement restrictions: hip external rotation, hip extension, crossing the operated leg over the unoperated leg, adduction of the operated leg. Incorrect responses: A: Lower extremity abduction is not contraindicated after a total hip replacement. B: Hip internal rotation is contraindicated after a total hip replacement for a posterolateral approach but not for an anterolateral approach. C: Hip flexion up to 90o is acceptable, but hip flexion beyond 90 is contraindicated after a total hip replacement 8/3/12 OTR Prep Question: A client who has cognitive and motor deficits secondary to the onset of Huntington's disease is participating in OT. One of the client's goals is to be independent with dressing. Which intervention activity is BEST to include as part of the initial intervention plan?

Answer: A. Educate the client and caregivers about methods for adapting the fasteners on the clients clothing B. Teach the client to use a sequenced checklist to mark off tasks as they are completed during dressing C. Have the client practice using a button-hook and long-handled reacher when completing dressing tasks D. Use backward chaining methods and hand-over-hand assistance to teach adapted dressing skills Correct response: A Rationale: HD is a disorder characterized by progressive neurodegeneration. Symptoms typically include choreo-athetoid movements and alterations in behavior and cognitive functions. A client who is in the early stages of HD would most benefit from learning techniques to compensate for motor deficits Classification code: Domain 03, Task 01, Knowledge 01 Incorrect responses: B, D: These cognitive strategies may be indicated in the later stages of HD. Cognitive symptoms typically are not associated with onset HD C: These devices would not be helpful for the client due to the choreo-athetoid movements associated with HD 8/3/12 COTA Prep Question: A COTA is gathering information about the dressing skills of a 10-year-old child who has moderate cognitive and developmental delays secondary to autism. Which data-gathering method would provide the MOST OBJECTIVE information about the childs current dressing skills? Answer: A. Asking the parents to complete a questionnaire B. Observing the child during BADL routines C. Administering a functional independence screen D. Having the child complete a simple checklist Correct Response: B Rationale: B: Observation provides information about the childs actual BADL skills and abilities based on current routines. Incorrect Responses: A: This provides the parents perception of the childs skills and is not as objective as observing the child completing the task. C: A screening may provide preliminary information about dressing, but this method does not provide as much objective information as observing the child during a variety of dressing tasks. D: Considering the childs cognitive and developmental status, this would not be the most objective method for gathering the information. 8/6/12 OTR Prep Question: OTR Prep Question: During which home maintenance tasks would symptoms related to constructional apraxia be MOST EVIDENT? Answer: A. Washing the interior sides of single pane windows B. Using a roller brush to paint an interior wall of the home C. Vacuuming floors in the main living area of the home D. Following written instructions for installing curtain rods Correct Response: D

Rationale: D: Individuals who have constructional apraxia have difficulty constructing/assembling objects; as in following instructions for installing curtain rods. 8/16/12 OTR Prep Question: A 10-year-old child has cerebral palsy with moderate athetosis and age-appropriate cognition. The child currently requires moderate assistance with BADL. One of the childs goals is to be more independent with dressing. The OTR plans to use a cognitive approach during a dressing session with this child. Which method exemplifies this approach? Answer: A.Employing a top-down approach to encourage the child to problem solve when difficulties are encountered during the dressing task B.Incorporating a bottom-up method to enable the child to learn dressing tasks in a developmentally appropriate sequence C.Allowing the child to select preferred clothing in preparation for learning an age-appropriate dressing task D.Adapting the child's clothing and teaching compensatory strategies to use during a dressing task Correct Response: A Rationale: Top-down strategies are the cornerstone of a cognitive approach. They are characterized by interventions that incorporate cognitive strategies such as problem solving to improve overall task performance. 8/3/12 COTA Prep Question: A client sustained a work-related injury resulting in paraplegia. The client now uses a manual wheelchair to maneuver within an office workstation. According to the ADA Accessibility Guidelines, which accommodation is the employer required to provide to ensure the workstation meets accessibility standards? Answer: A.Tile or low-pile carpeting in open spaces B.Space to transfer from the wheelchair to a chair C.Turning radius of at least 60 inches (152.5 cm) D.Extenders to raise the desk height to 40 inches (101.6 cm) Correct Response: C Rationale: C: According to the ADA Accessibility Guidelines, a workstation should have a clear space of 60 in (152.5 cm) diameter to allow a wheelchair to make a 180-degree turn. Incorrect Responses:

8/24/12 OTR Prep Question: During an initial OT interview, a patient denies frequent cocaine use and cites a recent bonus as proof that work performance is not being negatively affected by substance use. The patient reports using cocaine only when under a deadline at work or when having to entertain business clients. The patients account indicates a lack of insight related to which of the following performance areas? Answer:

A. Leisure-time management B. Current values and interests C. Interpersonal and coping skills D. Problem-solving and ethical behavior Correct response: C Rationale: Based on the patients account, the dependence on cocaine use appears to be in direct relation to the patients inability to manage stress appropriately. These performance areas should be addressed by developing an intervention plan that facilitates effective interpersonal and coping skill acquisition with the goal of promoting participation in all areas of occupation. 8/24/12 COTA Prep Question: A client in the mid-stage of Alzheimers disease lives at home with a spouse as the primary caregiver. The spouse wants the client to remain at home as long as possible; despite a progressive decline in the clients cognition. What strategy should be included in the recommendations for supporting the clients aging-in-place? Answer: A. Establish a routine schedule of familiar daily activities to encourage engagement. B. Have the client use a variety of assistive devices to minimize task demands. C. Plan most activities for the morning to avoid the effects of sundowning. D. Encourage friends to visit the home to provide reality orientation activities. Correct Response: A Rationale: A: Maintaining a schedule of familiar daily activities is an effective technique for managing a clients cognitive decline while maximizing engagement in tasks. 8/31/12 OTR Prep Question: An OTR is facilitating a group for clients with polysubstance use. During the first group session, the OTR describes how trigger events and irrational thinking can lead to substance misuse. Which theoretical model does this approach exemplify? Answer: A. Cognitive-behavioral B. Psychodynamic C. Motivational D. Human occupation Correct Response: A Rationale: The premise behind cognitive-behavioral therapy is that the individual can change their behavior (substance misuse) by first challenging their negative assumptions (cognitions) relating to trigger events. 8/31/12 COTA Prep Question: What clinical symptom is typically present in the affected hand of a client who has severe carpal tunnel syndrome? Answer: A. Positive Tinels sign at the wrist B. Decreased light touch of all digits C. Numbness of the small finger

D. Atrophy of the extrinsic muscles Correct Response: A Rationale: A: The Tinels sign is a provocative test for nerve compression. In carpal tunnel syndrome (CTS), a positive Tinels sign elicits a sensation of tingling in the median nerve distribution. 9/10/12 OTR Prep Question: An OTR is completing a self-care assessment with a resident in a long term care facility. Nursing staff referred the resident to OT after observing a decline in the residents function following an exacerbation of COPD one month ago. Medical history is also significant for residual cerebellar symptoms secondary to an excision of a brain tumor 5 years ago. The client has Fair Plus (3+/5) functional strength of bilateral upper extremities. During the assessment, the OTR asks the resident to "pick up your shirt from the night stand." When reaching for the shirt, the resident has to stabilize the arm to prevent reaching beyond or short of the shirt. When documenting the session what term should the OTR use to BEST describe the residents action? Answer: A. Decreased motor planning B. Generalized weakness C. Dysmetria D. Dysdiadochokinesia Correct Answer: C Rationale: Dysmetria is a common side-effect of cerebellar dysfunction. It is characterized as overshooting or undershooting an intended target. 9/10/12 COTA Prep Question: A COTA is providing a home program for a client who has early stage myasthenia gravis. What information is important to include in home program instructions for minimizing the impact of the disease on occupational performance? Answer: A. Energy conservation methods B. Joint protection techniques C. Perceptual-motor exercises D. Visual scanning strategies Correct Response: A Rationale: Myasthenia gravis is a neuromuscular disease affecting voluntary muscle. Typical symptoms include decreased muscle strength and fatigue. Energy conservation methods will help minimize the impact of this disease on occupational performance and should be included as part of a home program instruction. 9/17/12 OTR Prep Question: OTR Exam Prep Question: Review this: http://www.nbcot.org/index.php?option=com_content&view=article&id=241 An OTR is evaluating the ROM of a client who has rheumatoid arthritis. Goniometric measurements of the long finger are as follows: What do the findings indicate? Answer:

A. Dorsal subluxation of the MCP joint B. Rupture of the flexor digitorum superficialis tendon C. Lengthening of the lateral slips of the extensor digitorum communis tendon D. Rupture of the central slip of the extensor digitorum communis tendon Correct Answer: D Rationale: "When documenting ROM measurements, a loss of full extension is represented by a minus sign. In this case, the -50 90 measurement for the PIP joint indicates a loss of 50 degrees extension (extension lag) and the ability to flex the PIP joint to 90 degrees. Hyperextension is documented using the plus sign (+): +30 40 degrees of DIP joint motion indicates there is 30 degrees of hyperextension and the joint is able to flex from 30 degrees of hyperextension to 40 degrees of flexion. These ROM measurements indicate a boutonniere deformity. This is characterized by flexion of the PIP joint and hyperextension of the DIP joint. It is typically caused by rupture or lengthening of the central slip of the extensor digitorum communis tendon. Incorrect Rationale: A: Dorsal subluxation of the MCP joint is not typically associated with the deformity described. B: Rupture of the flexor digitorum superficialis tendon may result in a swan neck deformity C: Lengthening of the lateral slips of the extensor digitorum communis tendon results in a swan neck deformity

9/17/12 COTA Prep Question: A COTA who has established service competency in the use of physical agent modalities is preparing to use ice massage as an adjunct to an intervention for a client who has an acute soft tissue injury. Which clinical application procedure is recommended for this form of cryotherapy? Answer: A. Move the ice on one area of the skin for 1-2 minutes. B. Use circular motions to move the ice on the skin for 4-5 minutes. C. Firmly rub the ice parallel to the muscle fiber for 10-15 minutes. D. Use retrograde motions with the ice until the client reports numbing. Correct Response: B Rationale: Ice massage is an effective modality to use on small and very targeted areas of soft tissue. To effectively achieve vasoconstriction and to avoid tissue damage, ice should be moved in circular motions to massage the area for approximately 4-5 minutes. 9/24/12 OTR Prep Question: The client enjoys cooking large family meals but pain in the MCP joints and wrist are interfering with the ability to cut meats and vegetables. In addition to recommending the use of an adapted cutting board, which type of knife would be beneficial for the client to use? Answer: A. Serrated knife with finger contoured handle B. Universal cuff attachment for standard slicing knife C. Wheel configured knife with non-slip padded grip D. Carving knife with handle set at 90 degree angle Correct Answer: D

Rationale: This type of grip minimizes ulnar forces against the MCP joints during cutting. 9/24/12 COTA Prep Question: A service competent school-based COTA is collaborating with an OTR prior to the initial evaluation of a student who has a developmental delay. Which part of the students evaluation is within the scope of practice for the COTA to complete? Answer: A. Determining the impact of social interactions on development B. Documenting outcomes of unstructured parent interviews C. Administering and scoring standardized handwriting assessments D. Assessing fine motor patterns during classroom activities Correct Response: C Rationale: Administering and scoring standardized assessments are within the scope of practice for a service competent school-based COTA practitioner. 10/1/12 OTR Prep Question: A client had a repair of the median nerve on the dominant upper extremity after sustaining a work-related laceration of the wrist 6 weeks ago. The client has been undergoing rehabilitation and resumed light work as a warehouse stocker several days ago. During a follow-up appointment, the OTR observes several blisters on the clients index finger. What INITIAL action should the OTR take based on this observation? Answer: A. Advise the client to file an incident report with the employer B. Teach the client protective sensory re-education strategies C. Contact the case manager to modify the clients job tasks D. Recommend strategies for minimizing the use of the index finger Correct Answer: B Rationale: It is important for the client to learn visual compensation techniques to reduce secondary injury or trauma due to the loss of sensation. 10/1/12 COTA Prep Question: An inpatient who had a right CVA one month ago is participating in a dressing session. The patient is able to complete adaptive dressing when each article of clothing is handed to the patient one at a time. If the clothing is placed on the bed to the left of the patient, the patient is unable to initiate the dressing task without verbal prompts. Which perceptual deficit does this represent? Answer: A. Visual closure deficit B. Unilateral neglect C. Asomatognosia D. Ideomotor apraxia Correct Response: B Rationale: Unilateral neglect is a perceptual motor impairment in which messages from the hemiplegic side of the body are unable to be interpreted. It presents as ignoring the affected half of the body or space.

10/8/12 OTR Prep Question: Scenario: An OTR attended a professional development activity on sensory integration strategies for children with autism spectrum disorder. During the seminar, the presenters discussed anecdotal evidence for the use of nutritional supplements to improve sensory processing. In researching the topic, the OTR reads a peer-reviewed article that indicates a correlation of 0.01 (r = 0.01) between the use of a specific nutritional supplement and sensory processing skills. The OTR is uncertain if nutritional supplements are within the professional standards of practice for the occupational therapy profession. MC1: Which organization should the OTR contact for obtaining the most up-to-date resources for resolving this uncertainty? A: National Board Certification in Occupational Therapy (NBCOT) B. National Autism Association (NAA) C. American Council on Occupational Therapy Education (ACOTE) D. American Occupational Therapy Association (AOTA)

MC2: What do the research findings from the peer-reviewed article indicate for the level of correlation? A. No correlation B. Low correlation C. High correlation D. Inverse correlation MC3: Which type of research should the OTR review to obtain the strongest level of evidence regarding this intervention? A. Case report with expert opinion B. Two-groups, non-randomized studies C. Single subject design, case series D. Systematic reviews, meta-analyses Answer: 1) D Rationale:The American Occupational Therapy Association (AOTA) publishes the Standards of Practice for Occupational Therapy and the Reference Manual of Official Documents of the American Occupational Therapy Association, Inc. These documents clarify and support occupational therapy practice and define the minimum standards for the practice of occupational therapy. 2) A Rationale: "When calculating correlation, the symbol representing correlation = r. The interpretation of the correlation coefficient is the strength of the relationship. The following is how values are typically interpreted 0 -.20 suggests a negligible correlation .20-.40 is a low correlation .40-.60 is a moderate correlation .60-.80 is a high correlation .80-1.00 is a very high correlation (Kielhofner, 2006, p. 263) 3)D Rationale: Systematic reviews are considered to be the strongest level of evidence because they provide an overall conclusion based on review of all the evidence available on the topic.

10/8/12 COTA Prep Question: An inpatient had a total knee replacement 3 days ago and is progressing without complication. The COTA will be supervising the patient during a self-care session. The patient has been cleared to use a walker to move from the bed to the bathroom with stand-by assistance. What amount of lower extremity weightbearing is TYPICALLY indicated during this phase of rehabilitation? Answer: A. Non-weight bearing B. Toe-touch weight bearing C. Partial weight bearing D. Weight bearing to tolerance Correct Answer: D Rationale: After an uncomplicated total knee replacement, patients are typically encouraged to weightbear to tolerance on the surgical leg. 10/16/12 OTR Exam Prep Question: SCENARIO: An OTR is preparing for a three-year multi-disciplinary case study and transition planning meeting for a student. The student has autism spectrum disorder and is attending the 11th grade in high school. The OTR has observed that the student participates alongside peers during age-appropriate social and academic group activities but does not initiate or sustain interaction with peers. The students language skills are above normal. When responding to direct questions, the student speaks very rapidly, and perseveration and finger-flapping motions become more pronounced. The teacher has observed that the student covers both ears, rocks back and forth, and occasionally has verbal outbursts when the noise level or activity level in the classroom increases. The student reads at the 8th grade level, is able to type on a computer keyboard using both hands with fair accuracy and speed, and plays beginner-level piano. Plans after high school include transitioning to structured work program. MC#1: What information about the student is MOST IMPORTANT for the OTR to provide to the Individualized Education Program team? A. Cognitive and academic progress made since the start of the current school year B. Current abilities and responses to environmental demands in a variety of contexts C. Life skills that the parents expect for their child to master prior to graduation D. Scores from standardized assessments of sensory processing and motor skills MC#2: Which method should the teachers use in the classroom to promote this students ability to transition from one classroom activity to another? A. Peer-mediated support and training B. Computer-based communications system C. Teacher and therapist verbal instructions D. Visual supports and structured schedules MC#3: Which job would provide a just right challenge based on the students current strengths and interests? A. Mail-sorter in a sheltered workshop B. Customer service clerk in a bulk grocery store C. Data entry clerk in a public library D. Food preparation employee at a fast food restaurant

Answer: 1 )Correct Answer: B Rationale: The Individuals with Disabilities Education Act (IDEA) requires school-to-adult life transition services. These services must begin by the time the student is 16 years old. Information about the students current functional abilities and responses to environmental demands in a variety of contexts would be of most importance to the team for planning the students transitional services. 2) Correct Answer: D rationale: These provide visual structure, visual organization, and visual clarity which are key elements of a structured-teaching approach for promoting function in a school setting. 3) Correct Answer: C Rationale: The social and environmental demands of this job are compatible with the students current level of function. 10/16/12 COTA Exam Prep Question: A COTA is fabricating a thermoplastic splint as conservative treatment for a client who has early symptoms of cubital tunnel syndrome. What would be the PRIMARY purpose of this splint? Answer: A. Substitute for absent muscle function. B. Prevent elbow flexion during hours of sleep. C. Block ring and small finger MCP joint hyperextension. D. Minimize wrist flexion and extension during work. Correct Answer: B Rationale: Cubital Tunnel syndrome is a compression of the ulnar nerve at the elbow, which is typically aggravated by holding the elbow in a flexed position. A client wears a long-arm splint at night to prevent elbow flexion when sleeping. 10/22/12 OTR Exam Prep Question: SCENARIO: A client has moderate hemiplegia, dysarthria and diplopia secondary to having had a CVA several weeks ago. An OTR and COTA in an outpatient setting are collaborating to initially evaluate the client using an ecological model. Records indicate the client is a single parent of an adolescent. The client plans to return to work as a librarian. MC#1: What is the FIRST step the OTR should take when evaluating this client? A. Assess deficits related to the clients performance skills and patterns. B. Observe specific client factors during a typical BADL task. C. Perform a standardized assessment of motor and process skills. D. Identify the areas of occupation the client wants or needs to do. Correct Answer: D Rationale: The practitioner should begin the evaluation process by learning what the client wants or needs to do. This information can then be used to help determine the type and focus of the remainder of the evaluation. MC#2: Which task-oriented approach would be MOST BENEFICIAL to include as part of the intervention plan for maximizing the clients physical abilities?

A. Augmentative communication B. Constraint-induced movement therapy C. Dominance retraining activities D. Visual attention and scanning exercises Correct Answer: B Rationale: Constraint-induced movement therapy is a task-oriented approach to motor control acquisition. This approach focuses on facilitating use of the affected arm during activities and helping the client overcome learned nonuse. MC#3: Which type of activity should be included as part of the INITIAL intervention to remediate the clients motor impairment? A. Repetitive practice of an occupational performance skill in context B. Training on the use of adaptive equipment to support an area of occupation C. Weight bearing through the affected upper extremity prior to an activity D. Dominance retraining during a variety of writing and drawing tasks Correct Answer: A Rationale: Evidence indicates that repetitive practice of a skill in context will help with cortical map reorganization for regaining functional use of the affected extremity. MC#4: Which assessment should be included as part of the initial evaluation and can be administered by the COTA? A. Functional Independence Measure (FIM) B. Bay Area Functional Performance Evaluation (BaFPE) C. Canadian Occupational Performance Measure (COPM) D. Allen Diagnostic Module (ADM) Correct Answer: C Rationale: The ecological model looks at the unique and dynamic relationship between people, environments, and occupations. The COPM is a client-centered tool that supports this model by addressing a clients perception of their performance in areas of occupation and their satisfaction with this performance across 3 key areas: self-care, productivity and leisure skills. This is a standardized assessment that a service competent COTA could administer.

10/2212 COTA Exam Prep Question: An inpatient who has been prescribed antipsychotic medication is attending an OT group. During one of the group sessions the patient begins to show symptoms of tardive dyskinesia. What action should the COTA take INITIALLY in response to this observation? Answer: A. Report the symptoms to the physician or charge nurse. B. Document changes in function due to the onset of symptoms. C. Observe the impact of symptoms on the patient's task performance. D. Monitor the duration of symptoms and the patient's reactions. Correct Answer: A Rationale: The physician or charge nurse should be notified immediately about the new onset of symptoms. The patient may develop permanent tardive dyskinesia if medication is not discontinued. 11/5/12 OTR Exam Prep Question:

Scenario: An entry-level OTR who works in a long term care facility is screening a resident who has amyotrophic lateral sclerosis and uses a wheelchair. The residents upper extremity functional strength is Trace (1/5) on the left and Poor Minus (2-/5) on the right. The resident wants to eat meals in the facility dining room but is embarrassed about frequently dropping assistive eating devices and having several incidences of coughing while eating. MC1: What care coordination task should the OTR complete FIRST based on the results of the screening? A. Advise the dietary staff to provide the resident with a room temperature clear liquid at every meal. B. Inform the dining staff to cut the residents food into small pieces and provide built-up utensils. C. Ask the physician to write an order for an immediate video fluoroscopy and a pureed diet. D. Coordinate with the multi-disciplinary team to identify specific feeding and swallowing objectives. MC2: Which symptoms is this resident MOST at risk for experiencing during a meal? A. Light-headedness when moving from a wheelchair to the dining chair B. Heavy sweating, flushed skin, and a pounding headache after eating C. Variation in voice quality or loss of voice after swallowing D. Regurgitation of food and liquids after swallowing MC3: Which factor is MOST IMPORTANT for the OTR to initially determine when considering if this resident would benefit from a mobile arm support? A. Staffs ability to set up the device for the resident B. Ability to attach the device to the patients wheelchair C. Amount of upper extremity passive joint mobility D. Presence of upper extremity athetoid movements Answer: 1) D Rationale: Screening results indicate the residents functional status may be declining. Care coordination with the multi-disciplinary team meets best practice standards. Independent evaluation and intervention of the residents swallowing difficulties is beyond the scope of practice for the entry-level OTR. 2) C Rationale: Amytrophic lateral sclerosis (ALS) is a progressive neurological disease. The residents symptoms of coughing while eating/swallowing could indicate dysphagia. A symptom associated with dysphagia is variation in voice quality or loss of voice after swallowing. 3) C Rationale: Amytrophic lateral sclerosis (ALS) is a progressive neurological disease. Screening results indicate this resident has significant weakness secondary to the disease. The resident must have sufficient passive ROM to effectively use a mobile arm support. 11/5/12 OTR Exam Prep Question: A COTA is gathering information about the dressing skills of a 10-year-old child who has moderate cognitive and developmental delays secondary to autism. Which data-gathering method would provide the MOST OBJECTIVE information about the childs current dressing skills? Answer: A. Asking the parents to complete a questionnaire B. Observing the child during BADL routines C. Administering a functional independence screen D. Having the child complete a simple checklist B

Rationale: Observation provides information about the childs actual BADL skills and abilities based on current routines 11/26/12 OTR Exam Prep Question: A 15-year-old adolescent inpatient has renal disease. The patient has been socially isolated as a consequence of the multiple medical procedures. One of the patients goals is to be with other kids. During an OT session, the patient begins to work on a simple task, but suddenly moves to a corner of the clinic to be alone, stating "the other kids can always do things better." Which intervention strategy would be MOST BENEFICIAL for meeting the patients emotional and social needs during task completion? Answer: A. Have the patient engage in a simple but competitive game with just one peer. B. Provide a group task experience with two or three peers of a similar skill level. C. Allow the patient to find a safe place in the clinic to work alone. D. Assist the patient to successfully complete key steps with the current task. Correct Answer: B Rationale: The OTR should grade the demands of the intervention to accommodate the patients current ability to deal with social isolation due to a chronic medical condition. This option allows the patient to participate in a social activity with peers of equal skill level in order to promote successful task completion. 11/26/12 COTA Exam Prep Question: An inpatient had open heart surgery 5 days ago and has just been transferred from the intensive care unit to the cardiac care unit. Medical records indicate it is safe for the patient to participate in activities requiring a maximum of 2 metabolic equivalents (METs). Which BADL activity is within the prescribed MET-level limitations? Answer: A. Independent sponge-bathing of the face, bilateral upper extremities, and torso while semi-reclined in bed B. Personal hygiene and grooming activities with minimal assistance while standing at the bathroom sink C. Ambulation from the bed to bathroom with contact-guard assistance of a one caregiver D. Upper and lower body dressing while seated on the edge of the bed with stand-by assistance for balance Correct Answer: A Rationale: Simple hygiene in a semi-reclined sitting position uses 1-2 METs. 12/03/12 OTR Exam Prep Question: View this link: http://www.nbcot.org/index.php?option=com_content&view=article&id=282 MC#1: Which instrument is BEST for measuring the characteristic or construct of balance A. Clinical Test of Sensory Interaction and Balance B. Tinetti Balance Test C. Berg Balance Scale D. Physical Performance Test Correct Answer: B Rationale: Construct validity indicates how well a test measures what it is intended to measure. The validity score for this test is 0.92 which is the highest validity rating of the tools examined

MC#2: Which word MOST ACCURATELY describes the test-retest reliability of the Physical Performance Test? A. Excellent B. Equivalent C. Fair D. Unstable Correct Answer: C Rationale: The closer the test-retest reliability value is to 1.0 the better. The test-retest reliability of this test is 0.70. This score indicates a better than average (0.50) chance that individuals would score the same each time the test is administered. MC#3: Which balance assessment instrument is the most valid and reliable tool that meets the criterion outlined by the OTR? A. Clinical Test of Sensory Interaction and Balance B. Tinetti Balance Test C. Timed "Up and Go" Test D. Functional Reach Test Correct Answer: B Rationale: This tool best meets the criterion considering administration time as well as reliability and validity characteristics. 12/03/12 COTA Exam Prep Question: A client sustained a work-related injury resulting in paraplegia. The client now uses a manual wheelchair to maneuver within an office workstation. According to the ADA Accessibility Guidelines, which accommodation is the employer required to provide to ensure the workstation meets accessibility standards? Answer: A. Tile or low-pile carpeting in open spaces B. Space to transfer from the wheelchair to a chair C. Turning radius of at least 60 inches (152.5 cm) D. Extenders to raise the desk height to 40 inches (101.6 cm) Correct Answer: C Rationale: According to the ADA Accessibility Guidelines, a workstation should have a clear space of 60 in (152.5 cm) diameter to allow a wheelchair to make a 180-degree turn. 1/07/12 OTR Exam Prep Question: An OTR employed at a university-based hospital hand therapy clinic is completing a research proposal investigating the effectiveness of copper tooling versus therapy putty for increasing pinch strength of patients attending the clinic. Which step should the OTR take NEXT as part of research process? Answer: A. Perform a small pilot study on similar subjects B. Obtain informed consent from the subjects C. Initiate the data collection procedures D. Submit the proposal to the facility review board Correct Response: D

Rationale: Prior to conducting research in a hospital setting the study must be approved by the facilitys Institutional Review Board (IRB). The IRB has a legal responsibility to approve and monitor the ethical conduct of research within the facility. 1/07/12 COTA Exam Prep Question: A high school aged student has a T9 spinal cord injury and will be transitioning to college. The student will live in an off-campus apartment and will be attending both day and night classes. The apartment is located several city blocks from the classroom buildings. The student plans to use a power wheelchair as the primary mode of transportation to class. What should the COTA recommend to the student for maximizing safety when navigating to classes? Answer: A. Register for on-line courses instead of in person night classes to eliminate the need to go out in the dark. B. Arrange for Para transit during nighttime hours to assist with travel to classes at night. C. Adhere reflective strips on the wheelchair and use strobe lights when traveling on streets at night. D. Hire an attendant to be available to accompany the student during travel to night classes. Correct Response: C Rationale: These adaptations will enable the student to be more visible to others when traveling on streets at night or during hours of low visibility. 1/14/12 OTR Exam Prep Question: An OTR is designing a wheelchair seating system for a student who has scoliosis secondary to spina bifida. Which feature should be considered FIRST for achieving optimal functional seating? Answer: A. Width and placement of lateral trunk supports B. Type and contour of the chair seat cushion C. Position and stability of the pelvis in the chair D. Configuration and attachment of chest harness Correct Response: C Rationale: Posture is directly linked to overall functional performance. The position and stability of the pelvis is critical in achieving optimal sitting posture. 1/14/12 COTA Exam Prep Question: An older adult client has glaucoma and mild dementia. The client lives alone and reports difficulty remembering to take prescription medications. Which compensatory option would be MOST BENEFICIAL for the COTA to teach the client to use for supporting success with personal medication management? Answer: A. Medication journal for tracking daily dosages B. Programmable talking prescription bottle with auto alert C. Pill storage box pre-filled with weekly medication dosages D. Alarm wristwatch pre-set to beep at a designated time Correct Response: B Rationale: This option compensates for both the clients visual and memory deficits. 1/22/12 OTR Exam Prep Question:

An OTR is planning a group for clients who have mild-moderate cognitive decline secondary to Alzheimer's disease. One of the group goals is for the clients to follow directions to complete a tile picture frame. The OTR plans to use a directive leadership style during the group. What strategy illustrates the use of this group leadership style? Answer: A. Inform the clients of the expected end product by showing them a completed frame at the start of the group. B. Provide examples of three different framing materials and give general guidelines for how the items could be used. C. Show the clients several pictures of completed frames and each client decide which frame to make. D. Place the project materials on the table and ask the clients to design a simple picture frame from materials provided. Correct Response: A Rationale: Clients with this diagnosis require guidance and direction. The OTR should limit choices and provide clear expectations and guidance throughout the activity. 1/22/12 COTA Exam Prep Question: A client who has mild to moderate memory deficits secondary to dementia recently started using prescription eyeglasses for near vision tasks. The client frequently misplaces the glasses. The family reports the client becomes frustrated and agitated when unable to locate the glasses. What option should the COTA initially recommend to the client for reducing the occurrence of this problem? Answer: A. Store the glasses in the drawer of a bedside table after each use. B. Purchase bifocal contact lenses for the client to wear instead of framed lenses. C. Fasten the eyeglass frames to an eyeglass chain to wear around the neck. D. Give the eyeglasses to a family member or caregiver to store after each use. Correct Response: C Rationale: This is the simplest option for helping the client remember where the glasses are located. 1/28/12 OTR Exam Prep Question: OTR Exam Prep: An 8-year-old student has fluctuant muscle tone and delayed postural responses due to cerebral palsy. The student has met all Individualized Education Program (IEP) goals and is performing school tasks at age level. After receiving weekly school-based OT for the past 5 years, the student is discharged from OT with recommendations for annual assessments. However, the students parents are questioning why OT has been discontinued. What explanation should the OTR provide to the students parents? Answer: A. Students who have received services in the public school system for 5 consecutive years are no longer eligible for OT. B. Students with physical disabilities are eligible for ongoing OT only if they are having difficulty with curriculum-based tasks. C. The students physical disabilities are not severe enough to warrant additional OT services. D. Progress has plateaued and the student will no longer benefit from OT services. Correct Response: B Rationale: Termination of school-based OT services is indicated if all goals have been achieved and the student is performing age-appropriate curriculum-based tasks.

1/28/12 COTA Exam Prep Question: COTA Exam Prep: A client sustained a distal radius fracture 8 weeks ago. The client has been participating in outpatient OT 3 times per week for the past 6 weeks and has been making steady progress toward goals. During the past two sessions, the client has reported increased pain when completing functional tasks. What INITIAL action should the COTA take based on this information? Answer A. Reduce the intensity of the intervention activities used during scheduled sessions. B. Ask the OTR to complete a reevaluation and update the intervention plan. C. Decrease the frequency of the intervention sessions until the pain subsides. D. Gather information from the client about symptoms and recent activity patterns.
Correct Response: D Rationale: This should be done in advance of changing any aspect of the intervention or informing the OTR

2/5/12 OTR Exam Prep Question: A client sustained a non-displaced distal radius fracture 8 weeks ago. The OTR receives a consult from the clients physician to initiate ultrasound and therapeutic exercise. The state regulatory board allows occupational therapists to use physical agent modalities (PAM), however, the OTR assigned to the client has not had PAM training. How should the OTR respond to this referral? Answer
A. Follow the protocol for ultrasound as outlined in the instruction manual. B. Refer the client to an occupational therapist who is experienced in ultrasound. C. Apply moist heat to the affected hand and wrist instead of ultrasound. D. Ask the physician to amend the clients treatment order. Correct Response: B Rationale: According to standards of practice for occupational therapy, the client should receive PAM administered by an OTR who has demonstrated service competency with each specific modality. This OTR should refer the client to an OT who is experienced in the use of ultrasound.

2/5/12 COTA Exam Prep Question: An OTR and COTA are collaboratively establishing an intervention plan for a 12-month-old infant who has Down syndrome. Evaluation results indicate the infant has a 6 month delay in achieving typical milestones. What should be the PRIMARY consideration when developing an intervention plan for this infant? Answer
A. Selection of developmental goals based the infants environment and context B. Activity selection consistent with the chronological age of the infant C. Environmental modifications needed to support developmental gains D. Ability of the caregiver to provide carry-over of the intervention within the home Correct Response: A Rationale: To promote optimal outcomes, the OTR and COTA must consider typical development in relation to the infants environment and context.

2/11/12 OTR Exam Prep Question: An adolescent-age student has athetoid cerebral palsy and has been participating in school-based OT since pre-school. After transitioning to the sixth grade in a new school, the teachers report the student is not using assistive devices, is sullen, and does not interact with peers. What INITIAL action should the OTR take in response to the teachers reports about this student? Answer
A. Revise the IEP goals to focus on student preferences.

B. Establish new goals to work toward self-sufficiency. C. Develop a transition plan for promoting autonomy. D. Complete an evaluation using a top-down approach. Correct Response: D Rationale: The OTR should first assess the students current function in relation to context and curriculum-based needs prior to considering changes to the students IEP.

2/11/12 COTA Exam Prep Question: A resident in a long-term care facility has advanced dementia. Nursing staff report the resident is becoming increasingly more anxious when in the dining room, is disinterested in self-feeding and is dependent on staff during mealtimes. In addition to minimizing distractions in the dining environment, what technique should the COTA teach staff to use for initially supporting the residents engagement with self-feeding? Answer
A. Bridging; by having the resident hold a utensil while the staff feeds the resident B. Chaining; by using hand over hand guidance to move the residents hand to mouth C. Re-directing; by using verbal cues to prompt the resident to eat the meal D. Modulating; by providing graded sensory input at various intervals during each meal Correct Response: A Rationale: This technique can help to focus the residents attention and decrease anxiety while supporting engagement in the task.