NBCOT Occupational Therapist Exam — Questions and Answers

Question 1: Which feeding intervention is evidence-based for children with autism who have severely restricted diets?

Applied behavior analysis punishment procedures
Forced exposure to new foods
Elimination of all preferred foods first
Sequential Oral Sensory (SOS) Approach to Feeding (Correct answer)

Correct answer: Sequential Oral Sensory (SOS) Approach to Feeding

The SOS Approach uses systematic, play-based food exploration to gradually expand food acceptance in children with feeding difficulties.

Question 2: The science of society, human social behavior, social relationship patterns, social interaction, and elements of everyday culture is:

Sociology (Correct answer)
Psychology
Anthropology
Psychiatry

Correct answer: Sociology

Sociology is the academic discipline dedicated to the systematic study of human society. It examines social behavior, social relationship patterns, social interaction, and the various elements that constitute everyday culture. This field analyzes how social structures, institutions, and groups influence individuals and vice versa.

Question 3: A client post-TBI demonstrates confabulation. The OT should:

Gently redirect without arguing and use memory aids (Correct answer)
Provide written corrections of all inaccurate statements
Avoid all memory-dependent activities
Confront the client to promote insight

Correct answer: Gently redirect without arguing and use memory aids

Gently redirecting and using memory aids supports safety and function without causing distress or power struggles.

Question 4: Which approach is MOST appropriate for treating complex regional pain syndrome (CRPS) in occupational therapy?

Aggressive passive range of motion to break down adhesions
Complete rest and immobilization to reduce sympathetic activity
Splinting the extremity in maximum extension to maintain length
Desensitization, stress loading, and graded active movement (Correct answer)

Correct answer: Desensitization, stress loading, and graded active movement

CRPS treatment emphasizes desensitization to normalize sensory processing, stress loading (weight-bearing/carrying) to stimulate normal limb use, and active movement to reduce sympathetic hypersensitivity.

Question 5: Which assessment evaluates role performance and occupational history using a semi-structured interview format in OT mental health practice?

GAF (Global Assessment of Functioning)
PHQ-9
PANSS (Positive and Negative Syndrome Scale)
OPHI-II (Occupational Performance History Interview) (Correct answer)

Correct answer: OPHI-II (Occupational Performance History Interview)

OPHI-II uses semi-structured interview to explore a client's occupational history, identity, competence, and environmental impact.

Question 6: The brachial plexus originates from which spinal cord levels?

C3–C7
C6–T2
C5–T1 (Correct answer)
C4–C8

Correct answer: C5–T1

The brachial plexus is formed from the ventral rami of spinal nerves C5 through T1, innervating the upper extremity.

Question 7: Which group therapy format is MOST consistent with OT's occupational therapy process in a community mental health setting?

Skills training group using actual ADL tasks (Correct answer)
Diagnostic education group focusing on DSM criteria
Pharmacology education group led by a pharmacist
Insight-oriented verbal psychotherapy group

Correct answer: Skills training group using actual ADL tasks

OT groups in community mental health use actual task performance to develop and practice functional daily living skills.

Question 8: Laterally, but a little lower to the greater side of the angle

Flex the shoulder from an extended position:Is the humerus moving on the scapula, or is the scapula moving on the humerus?
What is the resultant force of the sternal & clavicular portions of the pectoralis major? ( > shape) (Correct answer)
Is the humerus part of the axial or appendicular skeleton?
A person bends down to touch the floor in the sagittal plane: What type of force is applied to the posterior part of the vertebra?

Correct answer: What is the resultant force of the sternal & clavicular portions of the pectoralis major? ( > shape)

The pectoralis major has two main heads: clavicular and sternal. When these portions contract, their individual lines of pull combine to create a resultant force. This resultant force is typically described as acting laterally and slightly inferiorly, or 'a little lower to the greater side of the angle,' reflecting the combined vector of the muscle fibers.

Question 9: Which standardized assessment measures a child's self-care, mobility, and social function using a caregiver report format?

Bruininks-Oseretsky Test of Motor Proficiency
Bayley Scales of Infant Development
Pediatric Evaluation of Disability Inventory (PEDI) (Correct answer)
Peabody Developmental Motor Scales

Correct answer: Pediatric Evaluation of Disability Inventory (PEDI)

The PEDI uses caregiver questionnaire and clinical observation to measure functional capabilities in children aged 6 months to 7.5 years.

Question 10: Environmental Control Units (ECUs) are MOST beneficial for clients with:

Severe physical limitations who need to operate home appliances independently (Correct answer)
Mild cognitive impairment affecting memory
Mild upper extremity weakness with preserved hand function
Low vision requiring auditory output

Correct answer: Severe physical limitations who need to operate home appliances independently

ECUs enable clients with severe physical limitations to control lights, TV, thermostat, and other appliances through switches or voice control.

Question 11: Which frame of reference is BEST suited for a client with schizophrenia who needs to develop community living skills?

Neurodevelopmental Treatment (NDT)
Biomechanical
Psychodynamic
Model of Human Occupation (MOHO) (Correct answer)

Correct answer: Model of Human Occupation (MOHO)

MOHO emphasizes occupational adaptation and volition, making it ideal for community reintegration in psychiatric populations.

Question 12: the syndrome of autosomal recessive family cancer is

Ataxia-telangiectasia (Correct answer)
Cowden syndrome
Neurofibromatosis
Tuberous sclerosis

Correct answer: Ataxia-telangiectasia

Ataxia-telangiectasia (A-T) is an autosomal recessive disorder characterized by progressive cerebellar ataxia, oculocutaneous telangiectasias, and immunodeficiency. It is also recognized as a familial cancer syndrome due to a high predisposition to various cancers, particularly lymphomas and leukemias, resulting from mutations in the ATM gene which plays a critical role in DNA repair.

Question 13: A school-based OT is working with a 7-year-old who cannot button a shirt. The MOST appropriate school-based justification for OT services is:

The child needs occupational therapy only in a clinical setting
Buttoning affects independence in self-care during school transitions (Correct answer)
Buttoning is a home-based ADL outside OT's school scope
Strengthening is needed before functional skills can be addressed

Correct answer: Buttoning affects independence in self-care during school transitions

School OT must justify services in terms of educational participation; self-care during school transitions is a valid educational need.

Question 14: A client with major depressive disorder declines to participate in morning ADL routines. The BEST OT strategy is:

Provide complete ADL assistance to prevent exhaustion
Postpone intervention until the client's mood improves
Begin with brief, achievable tasks within the client's capacity and build gradually (Correct answer)
Require full ADL completion before allowing leisure activities

Correct answer: Begin with brief, achievable tasks within the client's capacity and build gradually

Starting with manageable tasks builds self-efficacy and provides positive reinforcement, which is essential in treating depression.

Question 15: At the age of -, the Asymmetrical Tonic Neck Reflex (ATNR) vanishes.

15 months
3 weeks
4months (Correct answer)
3 months

Correct answer: 4months

The Asymmetrical Tonic Neck Reflex (ATNR) is a primitive reflex observed in infants, typically present from birth. It is characterized by the 'fencing posture' where the head turns to one side, the arm and leg on that side extend, and the opposite arm and leg flex. This reflex normally integrates and disappears around 4 to 6 months of age, allowing for more voluntary and symmetrical movements.

Question 16: Which of the following best describes the 'force couple' that produces scapular upward rotation during shoulder elevation?

Upper trapezius and lower trapezius acting in opposite directions on the scapula
Upper trapezius pulling superiorly and serratus anterior pulling the inferior angle anteriorly (Correct answer)
Serratus anterior acting alone on the inferior angle
Rhomboids and middle trapezius working together

Correct answer: Upper trapezius pulling superiorly and serratus anterior pulling the inferior angle anteriorly

Scapular upward rotation is produced by a force couple: upper trapezius elevates the AC joint while serratus anterior pulls the inferior angle forward and upward.

Question 17: You spot a woman with a "clawed hand" in the mall. Her distal phalanges are flexible. The injured nerve and most likely area are both .

the median nerve in the carpal tunnel
the radial nerve, near the anatomical snuffbox
the ulnar nerve, lateral to the pisiform bone (Correct answer)
the ulnar nerve, near the medial epicondyle of the humerus

Correct answer: the ulnar nerve, lateral to the pisiform bone

A 'clawed hand' with flexible distal phalanges indicates an ulnar nerve lesion distal to the innervation of the flexor digitorum profundus (FDP) to digits 4 and 5. This suggests the injury is at Guyon's canal, which is lateral to the pisiform bone. A more proximal lesion (e.g., at the medial epicondyle) would typically affect the FDP, resulting in less flexibility of the distal phalanges.

Question 18: A client with schizophrenia demonstrates negative symptoms. Which negative symptom is most commonly addressed by OT?

Delusions of grandeur
Hallucinations
Thought disorganization
Avolition (lack of motivation to initiate tasks) (Correct answer)

Correct answer: Avolition (lack of motivation to initiate tasks)

Avolition is a negative symptom that directly impairs ADL initiation; OT uses structured routines and motivation-building interventions.

Question 19: In handwriting intervention, the PRINT Tool is used to assess:

Keyboarding skills as an alternative
Visual acuity for near tasks
Print legibility components including letter formation, size, spacing, and alignment (Correct answer)
Pencil grip strength

Correct answer: Print legibility components including letter formation, size, spacing, and alignment

The PRINT Tool evaluates specific handwriting legibility components to guide targeted printing intervention.

Question 20: Which reflex, if persistent beyond 6 months in infants, interferes with rolling and bilateral hand use?

Palmar grasp reflex
Asymmetrical Tonic Neck Reflex (ATNR) (Correct answer)
Moro reflex
Rooting reflex

Correct answer: Asymmetrical Tonic Neck Reflex (ATNR)

Persistent ATNR beyond 6 months prevents midline crossing and bilateral hand use, interfering with developmental milestones.

Question 21: When an OT grades muscle strength as 3/5 (Fair) using the Medical Research Council (MRC) scale, this means the muscle can:

Produce only a palpable contraction with no visible movement
Move the limb through full range of motion with gravity eliminated
Move the limb through full range against gravity with some resistance
Move the limb through full range of motion against gravity only (Correct answer)

Correct answer: Move the limb through full range of motion against gravity only

An MRC grade of 3/5 indicates the muscle can complete full ROM against gravity but cannot tolerate any additional resistance beyond body weight.

Question 22: An OT client presents with 'claw hand' deformity affecting the ring and little fingers. Which nerve injury is most likely?

Median nerve at the wrist
Radial nerve at the elbow
Ulnar nerve at the wrist (Correct answer)
Median nerve at the elbow

Correct answer: Ulnar nerve at the wrist

Ulnar nerve injury at the wrist causes clawing of the ring and little fingers due to loss of intrinsic muscle function, with hyperextension at MCP and flexion at IP joints.

Question 23: Which gait phase places the greatest demand on the quadriceps to control knee flexion and prevent buckling?

Pre-swing
Terminal swing
Loading response (Correct answer)
Initial contact (heel strike)

Correct answer: Loading response

During loading response, the knee flexes to absorb shock, requiring eccentric quadriceps activation to prevent excessive knee collapse under body weight.

Question 24: The Wellness Recovery Action Plan (WRAP) tool used in OT mental health practice helps clients:

Design home modification plans for physical disabilities
Complete vocational interest inventories for employment
Identify personal wellness strategies and early warning signs of relapse (Correct answer)
Establish ADL schedules for inpatient programming only

Correct answer: Identify personal wellness strategies and early warning signs of relapse

WRAP empowers clients to identify their own wellness tools, triggers, and action plans for maintaining recovery and managing crises.

Question 25: What is the PRIMARY purpose of a dynamic splint in hand therapy?

To reduce edema through static compression
To prevent all movement at the targeted joint
To immobilize the joint during acute tissue healing
To provide a low-load prolonged stretch to increase range of motion (Correct answer)

Correct answer: To provide a low-load prolonged stretch to increase range of motion

Dynamic splints apply low-load prolonged stress to remodel connective tissue and increase passive range of motion through creep and stress relaxation.

Question 26: Which recovery-oriented principle should guide OT practice in mental health settings?

Self-determination and client-directed goal setting (Correct answer)
OT establishes goals based on diagnostic criteria
Institutionalization supports safety in recovery
Recovery requires full symptom elimination before function is addressed

Correct answer: Self-determination and client-directed goal setting

Recovery-oriented OT practice centers on self-determination, empowering clients to direct their own goals and recovery process.

Question 27: An occupational therapist takes part in a study to find out how noise level affects the capacity to do a physical skill. Noise is the:

Extraneous variable
Criterion variable
Dependent variable
Independent variable (Correct answer)

Correct answer: Independent variable

In a research study, the independent variable is the factor that is manipulated or changed by the researcher to observe its effect on another variable. In this scenario, the noise level is being varied to see how it influences the capacity to do a physical skill. Therefore, noise is the independent variable, while the capacity to do a physical skill would be the dependent variable.

Question 28: A client with spastic cerebral palsy has difficulty with eating due to involuntary arm movements. Which adaptive equipment is MOST helpful?

Swivel spoon for tremor
Weighted utensils and non-slip plate guard (Correct answer)
Universal cuff for utensil hold
Extended-handle spoon

Correct answer: Weighted utensils and non-slip plate guard

Weighted utensils dampen involuntary movements in spasticity and athetosis while a plate guard prevents food from being pushed off the plate.

Question 29: During apoptosis

Cellular content is intact (Correct answer)
Cell size is enlarged
Invariably pathologic
Plasma membrane is disrupted

Correct answer: Cellular content is intact

Apoptosis, or programmed cell death, is a highly regulated process where the cell shrinks and its chromatin condenses. Crucially, the plasma membrane remains intact, preventing the release of cellular contents into the surrounding tissue. This controlled dismantling avoids an inflammatory response, distinguishing it from necrosis where the cell membrane ruptures.

Question 30: What is the PRIMARY purpose of retrograde massage in hand therapy?

To decrease edema by moving fluid proximally toward the lymphatic system (Correct answer)
To increase muscle strength in intrinsic muscles
To improve joint passive range of motion
To desensitize hypersensitive tissue

Correct answer: To decrease edema by moving fluid proximally toward the lymphatic system

Retrograde massage uses distal-to-proximal strokes to mechanically move interstitial fluid toward lymphatic drainage channels, reducing edema in the hand.

Question 31: A client with ALS who has lost hand function wants to continue using a smartphone. Which AT solution should OT explore FIRST?

Voice control (Apple Siri or Google Assistant) with accessibility settings enabled (Correct answer)
Custom 3D-printed finger splint for touchscreen use
Eye-gaze tablet computer replacement
Stylus mounted to head orthosis

Correct answer: Voice control (Apple Siri or Google Assistant) with accessibility settings enabled

Voice control is a built-in, low-cost first-line AT solution that leverages preserved speech in early-to-mid ALS to maintain smartphone access.

Question 32: Which principle of motor learning suggests that practice should vary across multiple contexts to promote skill generalization?

Distributed practice
Massed practice
Variable practice (Correct answer)
Blocked practice

Correct answer: Variable practice

Variable practice exposes clients to changing conditions, which promotes flexible skill retention and transfer to real-world environments.

Question 33: A client with low vision needs help with medication management. The MOST appropriate low-tech AT solution is:

Large-print pill organizer with tactile labels (Correct answer)
Automated pill dispenser with alarm
Caregiver-managed medication administration
Standard pill bottle with pharmacist label

Correct answer: Large-print pill organizer with tactile labels

A large-print organizer with tactile labels enables independent medication sorting without high cost or caregiver dependence.

Question 34: Under the Assistive Technology Act, assistive technology is defined as any item that is used to:

Provide entertainment and leisure opportunities
Increase, maintain, or improve functional capabilities of individuals with disabilities (Correct answer)
Substitute for caregiver assistance in all circumstances
Replace medical treatment for chronic conditions

Correct answer: Increase, maintain, or improve functional capabilities of individuals with disabilities

The AT Act defines assistive technology as any device or service that increases, maintains, or improves functional capabilities of people with disabilities.

Question 35: Which positioning technique best prevents shoulder subluxation in a hemiplegic upper extremity?

Sling worn during all activities
Ice application every hour
Arm trough on wheelchair (Correct answer)
Overhead pulley stretching

Correct answer: Arm trough on wheelchair

An arm trough supports the hemiplegic limb in the wheelchair, maintaining joint alignment and preventing subluxation.

Question 36: An OT is evaluating a child's handwriting difficulties. Which standardized assessment would be MOST appropriate?

Evaluation Tool of Children's Handwriting (ETCH) (Correct answer)
Sensory Profile 2
Peabody Developmental Motor Scales (PDMS-2)
Bruininks-Oseretsky Test (BOT-2)

Correct answer: Evaluation Tool of Children's Handwriting (ETCH)

The ETCH is specifically designed to evaluate handwriting legibility and speed in school-age children.

Question 37: When conducting a task analysis, the OT breaks down an occupation into its component steps to identify where performance breaks down. This process is MOST useful for:

Determining insurance reimbursement rates
Identifying specific points of intervention to restore or compensate for function (Correct answer)
Writing a client's discharge summary
Selecting standardized assessment tools

Correct answer: Identifying specific points of intervention to restore or compensate for function

Task analysis pinpoints the specific subtasks or skill components where breakdown occurs, allowing targeted intervention planning.

Question 38: An OT working in hand therapy documents a grip strength of 15 kg on the right and 30 kg on the left in a right-handed client. The right grip strength represents approximately what percentage of the norm?

75%
50% (Correct answer)
25%
100%

Correct answer: 50%

The right grip (15 kg) is 50% of the left grip (30 kg), indicating significant deficit; the expected dominant-to-nondominant ratio is approximately 10% greater.

Question 39: In sensory re-education following peripheral nerve injury, what is the RECOMMENDED sequence?

Begin with fine two-point discrimination before protective sensation
Focus exclusively on pain sensitivity throughout rehab
Begin with moving touch stimuli before static touch
Begin with protective sensation, then progress to discriminative sensation (Correct answer)

Correct answer: Begin with protective sensation, then progress to discriminative sensation

Sensory re-education follows a hierarchical sequence: first restoring protective sensation (pain, temperature, moving touch) before progressing to discriminative sensation (static two-point discrimination).

Question 40: A client demonstrates 'boutonnière deformity' of the finger. Which positional pattern defines this deformity?

MCP hyperextension and PIP flexion
MCP flexion and DIP extension
PIP flexion and DIP hyperextension (Correct answer)
PIP hyperextension and DIP flexion

Correct answer: PIP flexion and DIP hyperextension

Boutonnière deformity involves PIP flexion and DIP hyperextension, caused by disruption of the central slip allowing the lateral bands to migrate volarly.

Question 41: A hospital-based OT department wants to track patient outcomes to justify staffing levels to administration. Which type of outcome measure is MOST appropriate?

Standardized norm-referenced assessments
Patient satisfaction surveys only
Functional Independence Measure (FIM) or similar functional status tools (Correct answer)
Therapist productivity logs

Correct answer: Functional Independence Measure (FIM) or similar functional status tools

Functional status tools like the FIM demonstrate change in patients' ability to perform daily activities and directly support staffing justification arguments.

Question 42: Which legislation requires employers to provide reasonable accommodations for employees with disabilities?

Olmstead Act
Rehabilitation Act Section 504
Americans with Disabilities Act (ADA) (Correct answer)
Individuals with Disabilities Education Act (IDEA)

Correct answer: Americans with Disabilities Act (ADA)

The ADA Title I requires covered employers to provide reasonable accommodations for qualified individuals with disabilities.

Question 43: Which splint is the STANDARD treatment for an acute mallet finger injury in OT?

Dynamic traction splint
DIP extension splint worn continuously for 6–8 weeks (Correct answer)
Wrist immobilization splint to reduce extensor tension
Buddy taping to the adjacent finger

Correct answer: DIP extension splint worn continuously for 6–8 weeks

A DIP extension splint (Stack splint or custom thermoplastic) worn continuously for 6–8 weeks allows the disrupted extensor mechanism to heal with the joint in full extension.

Question 44: Which assessment tool is used to measure functional independence in basic ADLs for neurologically impaired clients in inpatient rehab?

MOHOST
FIM (Functional Independence Measure) (Correct answer)
AMPS (Assessment of Motor and Process Skills)
COPM (Canadian Occupational Performance Measure)

Correct answer: FIM (Functional Independence Measure)

The FIM is the standard tool used in inpatient rehabilitation to rate independence across motor and cognitive ADL tasks.

Question 45: An occupational therapist intends to create a splint for a patient who has wrist drop as a result of radial nerve damage. Which splint is the best option?

C-bar
Dorsal protection
Dynamic extension (Correct answer)
MCP Flexion block splint

Correct answer: Dynamic extension

Wrist drop, caused by radial nerve damage, results in the inability to extend the wrist and fingers. A dynamic extension splint is the best option because it provides passive extension to the wrist and metacarpophalangeal (MCP) joints while allowing active flexion. This supports functional use of the hand, prevents overstretching of denervated muscles, and maintains functional alignment during nerve recovery.

Question 46: An OT is leading a task-oriented group for adults with schizophrenia in a community mental health setting. A client becomes agitated and begins yelling at another group member. What is the MOST therapeutically appropriate immediate response from the OT?

Immediately terminate the group session and document the incident as a safety concern
Ask all group members to share their feelings about the conflict to use it as a therapeutic learning moment
Calmly redirect the agitated client using a quiet, non-confrontational tone, acknowledge feelings, and offer to step out briefly if needed (Correct answer)
Ignore the behavior to avoid reinforcing it and allow the group to self-regulate

Correct answer: Calmly redirect the agitated client using a quiet, non-confrontational tone, acknowledge feelings, and offer to step out briefly if needed

De-escalation using a calm, non-confrontational approach, emotional validation, and a brief timeout option is the appropriate immediate therapeutic response to agitation.

Question 47: The SIPT (Sensory Integration and Praxis Tests) primarily assesses:

Social-emotional development in toddlers
Gross motor coordination in preschoolers
Reading readiness and phonological awareness
Sensory processing and praxis abilities in children ages 4-8 (Correct answer)

Correct answer: Sensory processing and praxis abilities in children ages 4-8

The SIPT evaluates sensory integration and praxis in children ages 4 to 8 years 11 months to identify processing deficits.

Question 48: A 3-year-old child is being evaluated for fine motor delays. Which assessment is MOST appropriate?

AMPS (Assessment of Motor and Process Skills)
COPM (Canadian Occupational Performance Measure)
FIM (Functional Independence Measure)
Peabody Developmental Motor Scales-2 (PDMS-2) (Correct answer)

Correct answer: Peabody Developmental Motor Scales-2 (PDMS-2)

PDMS-2 is a norm-referenced tool standardized for children from birth through 5 years assessing gross and fine motor skills.

Question 49: Early intervention services under IDEA Part C are designed for children aged:

5 to 21 years
Birth to 3 years (Correct answer)
Birth to 5 years
3 to 5 years

Correct answer: Birth to 3 years

IDEA Part C covers early intervention services for infants and toddlers from birth through 36 months (3 years).

Question 50: Which vertebral level corresponds to the umbilicus dermatome, useful for assessing thoracic spinal cord injury?

T10 (Correct answer)
T12
T6
T8

Correct answer: T10

The T10 dermatome corresponds to the umbilicus level; preservation of sensation here indicates at least partial thoracic cord function at T10.

Question 51: An OT is completing a cognitive assessment for a client post-TBI using the Allen Cognitive Level Screen (ACLS). A score of level 4.0 indicates the client:

Cannot initiate any purposeful activity
Is fully independent in all ADLs
Can learn by rote repetition only and needs supervision (Correct answer)
Functions at a normal cognitive level

Correct answer: Can learn by rote repetition only and needs supervision

Allen Cognitive Level 4 (Goal-Directed Activity) indicates the client can follow demonstrated steps but needs supervision for safety and problem-solving.

Question 52: During occupation-based intervention, a therapist has a client with stroke practice buttoning a shirt. This activity PRIMARILY targets which performance skill?

Cognitive skills — organization
Sensory-perceptual skills — stereognosis only
Motor skills — fine motor coordination and manipulation (Correct answer)
Communication and interaction skills

Correct answer: Motor skills — fine motor coordination and manipulation

Buttoning a shirt requires fine motor coordination and manipulation, which are motor performance skills targeted during post-stroke upper extremity rehabilitation.

Question 53: In an extended position, flex the shoulder and check to see if the scapula's glenoid fossa has a concave or convex joint surface.

Concave (Correct answer)
Convex
Crest, Epicondyle, Line, Spine,Trochanter, Tuberosity, Tubercle
Endosteum

Correct answer: Concave

The glenoid fossa of the scapula is characterized by its shallow, concave articular surface. This concavity articulates with the convex head of the humerus, forming the glenohumeral joint. This shape allows for a wide range of motion while providing a socket for the humeral head.

Question 54: A client with borderline personality disorder is admitted to inpatient psychiatry. The OT's INITIAL assessment should focus on:

Occupational functioning, daily routine, and coping skill repertoire (Correct answer)
Muscle strength and range of motion
Cognitive deficits using standardized cognitive battery
Social history only, deferring all assessment to psychiatry

Correct answer: Occupational functioning, daily routine, and coping skill repertoire

OT's initial psychiatric assessment focuses on occupational functioning, daily routines, and current coping strategies to guide group and individual intervention.

Question 55: When using the Neurodevelopmental Treatment (NDT) approach, the OT's primary goal is to:

Strengthen weak muscles through resistive exercise
Inhibit abnormal tone and facilitate normal movement patterns (Correct answer)
Improve endurance through aerobic conditioning
Compensate for deficits using adaptive equipment

Correct answer: Inhibit abnormal tone and facilitate normal movement patterns

NDT focuses on inhibiting abnormal tone patterns and facilitating more normal, coordinated movement.

Question 56: Which rotator cuff muscle is most commonly torn and is responsible for initiating shoulder abduction from 0–15 degrees?

Supraspinatus (Correct answer)
Teres minor
Infraspinatus
Subscapularis

Correct answer: Supraspinatus

The supraspinatus initiates shoulder abduction and is the most frequently torn rotator cuff muscle due to its vulnerable position under the acromion.

Question 57: A pediatric OT clinic receives a grant to study sensory processing interventions. Which study design provides the HIGHEST level of evidence?

Single-subject experimental designs
Cohort study without a control group
Randomized controlled trial (RCT) (Correct answer)
Expert opinion and case reports

Correct answer: Randomized controlled trial (RCT)

Randomized controlled trials are at the top of the evidence hierarchy because randomization controls for confounding variables and reduces bias.

Question 58: Which OT assessment tool is specifically designed to evaluate the daily living skills of adults with psychiatric disabilities?

KELS (Kohlman Evaluation of Living Skills) (Correct answer)
Nine-Hole Peg Test
Sensory Profile
AMPS

Correct answer: KELS (Kohlman Evaluation of Living Skills)

KELS assesses basic living skills including self-care, safety, money management, and community access in adults with psychiatric conditions.

Question 59: Which muscle group is responsible for producing inversion of the foot?

Peroneus longus and brevis
Tibialis anterior and posterior (Correct answer)
Gastrocnemius and soleus
Extensor digitorum longus

Correct answer: Tibialis anterior and posterior

The tibialis anterior (dorsiflexion + inversion) and tibialis posterior (plantarflexion + inversion) are the primary inverters of the foot.

Question 60: A client with Parkinson's disease has difficulty with handwriting. Which OT intervention is MOST evidence-based?

LSVT BIG (Lee Silverman Voice Treatment) (Correct answer)
Bilateral task training only
Occupational rest and activity avoidance
Weighted pen and adaptive writing surface

Correct answer: LSVT BIG (Lee Silverman Voice Treatment)

LSVT BIG uses high-amplitude movement training to improve motor function including handwriting in Parkinson's disease.

Question 61: Which part of the nephron is primarily responsible for reabsorption of glucose and amino acids?

Proximal convoluted tubule (Correct answer)
Distal convoluted tubule
Loop of Henle (descending)
Collecting duct

Correct answer: Proximal convoluted tubule

The proximal convoluted tubule reabsorbs approximately 65% of filtered sodium, water, glucose, and amino acids via active transport mechanisms.

Question 62: What bone has the moniker "atlas"?

The first thoracic vertebra
The clavicle
The first cervical vertebra (Correct answer)
The second cervical vertebra

Correct answer: The first cervical vertebra

The first cervical vertebra (C1) is commonly known as the atlas. It is named after the mythological figure Atlas, who supported the heavens, reflecting its role in supporting the skull. This vertebra is unique for lacking a vertebral body and spinous process, instead forming a ring that articulates with the occipital condyles.

Question 63: Which splint position is MOST appropriate for a client with acute carpal tunnel syndrome?

Wrist in 45° extension
Wrist in neutral position (0°) (Correct answer)
Wrist in 30° extension
Wrist in 20° flexion

Correct answer: Wrist in neutral position (0°)

A neutral wrist splint minimizes carpal tunnel pressure and is the evidence-based position for conservative management of carpal tunnel syndrome.

Question 64: In OT practice, the 'length-tension relationship' of muscle means that a muscle produces maximum active force when:

It is maximally stretched beyond resting length
It is at its shortest (fully contracted) length
Force is independent of muscle length
It is at a length slightly greater than its resting length (Correct answer)

Correct answer: It is at a length slightly greater than its resting length

Maximum active force production occurs near or slightly above the resting length where actin-myosin cross-bridge overlap is optimal.

Question 65: Joint Capsule

What joint structure surrounds & encases the joint & protects the articular surfaces? (Correct answer)
Place a pencil mark on 25¢ at the 6:00 & 12:00 positions. Lay the 5¢ piece flat. Roll the 25¢ across the flat 5¢ w/the edge of the 25¢ starting @ the 6:00 position: will it reach the end of the 5¢ before reaching 12:00?
Identify the 11 degrees of freedom of the upper extremity:
Name the bone markings that can be classified as projections or processes that fit into joints:

Correct answer: What joint structure surrounds & encases the joint & protects the articular surfaces?

The term 'Joint Capsule' refers to a fibrous connective tissue structure that completely encloses a synovial joint, forming a sealed cavity. The correct answer, 'What joint structure surrounds & encases the joint & protects the articular surfaces?', accurately defines the function and location of a joint capsule. It highlights its role in providing stability, containing synovial fluid, and protecting internal joint structures.

Question 66: A therapist is documenting in SOAP note format. A statement about the client's subjective complaint of pain with writing belongs in which section?

P (Plan)
A (Assessment)
S (Subjective) (Correct answer)
O (Objective)

Correct answer: S (Subjective)

The S (Subjective) section of a SOAP note contains the client's own reported experiences, complaints, and perceptions, such as self-reported pain.

Question 67: Causes of severe acute respiratory syndrome include:

HINI
RSV
Corona virus type (Correct answer)
Parainfluenza virus

Correct answer: Corona virus type

Severe Acute Respiratory Syndrome (SARS) was caused by a specific type of coronavirus, known as SARS-CoV. The term 'Corona virus type' broadly refers to the family of viruses responsible for this severe respiratory illness. While other viruses can cause respiratory infections, SARS is specifically associated with this particular viral family.

Question 68: A client with rheumatoid arthritis asks about joint protection during kitchen tasks. Which principle reflects BEST practice for joint protection?

Perform tasks only with the dominant hand to ensure precision
Use the largest joint available to distribute force and avoid small joint stress (Correct answer)
Use the smallest joint available to avoid fatiguing large muscles
Avoid any kitchen tasks during flare-ups

Correct answer: Use the largest joint available to distribute force and avoid small joint stress

Joint protection principles direct clients to use larger, stronger joints (e.g., elbow instead of fingers) to distribute mechanical stress and protect vulnerable small joints.

Question 69: An OT is working with a 65-year-old man who had a myocardial infarction 5 days ago. He is in Phase I cardiac rehabilitation and asks when he can resume sexual activity. Using MET-level guidelines for cardiac rehabilitation, which response is MOST appropriate?

Sexual activity is equivalent to climbing two flights of stairs (3–5 METs) and can typically resume in 4–6 weeks when you can perform this comfortably without symptoms (Correct answer)
The OT cannot address this topic; only the cardiologist can provide sexual activity guidelines
Sexual activity is safe to resume immediately as it requires less than 1 MET
Sexual activity requires 8–10 METs and should be avoided for 6 months after MI

Correct answer: Sexual activity is equivalent to climbing two flights of stairs (3–5 METs) and can typically resume in 4–6 weeks when you can perform this comfortably without symptoms

Sexual activity averages 3–5 METs (equivalent to climbing stairs) and can typically resume 4–6 weeks post-MI when the patient can perform equivalent activities symptom-free, per established cardiac rehab guidelines.

Question 70: A 28-year-old man who recently had an above-the-elbow amputation is ready to start driving again. He does not wear a prosthetic on the side that is affected and can fully use his non-dominant upper extremity. Which adaptive equipment should be recommended?

Wheel ring
Wheel cuff
Reduced effort steering
Round spinning knob (Correct answer)

Correct answer: Round spinning knob

For a driver with one functional upper extremity, a round spinning knob (spinner knob) attached to the steering wheel is the most appropriate adaptive equipment. This allows the driver to maintain control of the steering wheel with one hand, facilitating smooth and efficient turning, especially during maneuvers like parking or navigating curves. The other options are typically for different types of physical limitations.

Question 71: Which play assessment evaluates the child's internal motivation and degree of playfulness rather than skill level?

Bayley Scales of Infant Development
Hawaii Early Learning Profile (HELP)
Peabody Developmental Motor Scales
Test of Playfulness (ToP) (Correct answer)

Correct answer: Test of Playfulness (ToP)

The Test of Playfulness measures intrinsic motivation, internal control, and framing during play rather than developmental skill level.

Question 72: Concave

With 2 Pringles at opposite angles (Fig 13-2): Is the A/P shape of the top surface of the bottom chip concave or convex? (Correct answer)
Diarthroidal, synovial, triaxial, & ball-&-socket are all terms to describe which joint in the upper extremities? B.) Could these same terms apply to a joint in the lower extremity? C.) What joint would this be?
Diarthrodial, synovial, biaxial, & saddle are all terms that could be used to describe which joint?
Place a pencil mark on 25¢ at the 6:00 & 12:00 positions. Lay the 5¢ piece flat. Roll the 25¢ across the flat 5¢ w/the edge of the 25¢ starting @ the 6:00 position: which arthorkinematic motion will you need to reach the end of the 5¢ at 12:00?

Correct answer: With 2 Pringles at opposite angles (Fig 13-2): Is the A/P shape of the top surface of the bottom chip concave or convex?

Pringles chips are designed with a saddle shape, meaning they are concave in one direction (e.g., anterior-posterior) and convex in the perpendicular direction (e.g., medial-lateral). When two Pringles are placed at opposite angles, the top surface of the bottom chip, viewed from anterior to posterior, would present a concave shape. This question tests understanding of anatomical shapes and how they are described.

Question 73: When writing a letter of medical necessity for a power wheelchair, the OT must document:

Insurance cost comparison between models
Only physician diagnosis without functional justification
The client's preference and cosmetic choice of chair
Functional mobility limitations, failed trials of less-technology alternatives, and how the chair enables participation (Correct answer)

Correct answer: Functional mobility limitations, failed trials of less-technology alternatives, and how the chair enables participation

Medicare and most insurers require documentation of functional need, failed alternatives, and how the device restores participation for AT coverage.

Question 74: Which type of AAC (Augmentative and Alternative Communication) device uses pre-programmed vocabulary organized by topic pages?

PECS (Picture Exchange Communication System)
Speech-generating device (SGD) with dynamic display (Correct answer)
Unaided communication system
Low-tech letter board

Correct answer: Speech-generating device (SGD) with dynamic display

SGDs with dynamic displays allow topic-page navigation and computer-generated speech output for complex communication needs.

Question 75: Flex the shoulder from an extended posture and check to see if the humerus is moving on the scapula or the other way around.

Humerus is moving on the scapula (Correct answer)
Yes
Proximal is convex
A.) Shoulder joint B.) yes C.)Hip joint

Correct answer: Humerus is moving on the scapula

During shoulder flexion, particularly from an extended posture, the primary movement involves the head of the humerus moving within the glenoid fossa of the scapula. While the scapula also contributes to the movement through scapulohumeral rhythm, the direct action of lifting the arm involves the humerus articulating on the scapula.

Question 76: A patient with a C6 spinal cord injury is expected to achieve which hand function?

Full manual dexterity with intrinsic and extrinsic muscle control
No functional hand use due to complete paralysis below the injury
Active intrinsic hand function with fine lateral pinch
Tenodesis grasp using active wrist extension to passively flex the fingers (Correct answer)

Correct answer: Tenodesis grasp using active wrist extension to passively flex the fingers

At C6 level, wrist extensors (ECRL/ECRB) are innervated, allowing a tenodesis grasp where extending the wrist passively closes the fingers into a functional grip pattern.

Question 77: A productivity-based compensation model rewards OTs based on units billed per day. Which unintended consequence is MOST likely to occur?

Pressure to overtreat or up-code to maximize billable units (Correct answer)
Improved patient satisfaction scores
Stronger interdisciplinary collaboration
Reduced documentation burden for therapists

Correct answer: Pressure to overtreat or up-code to maximize billable units

Productivity-based pay creates financial incentives that can pressure therapists to bill more units than clinically justified, risking ethical and legal violations.

Question 78: Social skills training groups in OT mental health practice MOST effectively use:

One-on-one therapist coaching without peer interaction
Written social skills workbooks completed independently
Modeling, role-play, coaching, and feedback within group interactions (Correct answer)
Lecture-based instruction about social etiquette rules

Correct answer: Modeling, role-play, coaching, and feedback within group interactions

Active practice through modeling, role-play, and feedback is more effective for skill generalization than didactic instruction alone.

Question 79: A client with obsessive-compulsive disorder spends 3 hours on morning grooming rituals. OT intervention should:

Provide extra time and adaptive equipment for extended grooming
Eliminate all grooming tasks from the daily schedule
Focus only on hygiene education and ignore ritual duration
Collaborate with the treatment team on timed routines and exposure with response prevention (Correct answer)

Correct answer: Collaborate with the treatment team on timed routines and exposure with response prevention

OT collaborates on exposure with response prevention (ERP) to reduce ritual time and restore a functional morning routine.

Question 80: Which muscle group must be STRONGEST for a person with C5 tetraplegia to perform a pressure relief using a wheelchair push-up?

Wrist extensors
Shoulder depressors (triceps and latissimus dorsi) (Correct answer)
Finger flexors
Elbow flexors

Correct answer: Shoulder depressors (triceps and latissimus dorsi)

Shoulder depressors, including triceps and latissimus dorsi, are required to lift the body off the seat during a wheelchair push-up pressure relief.

Question 81: An OT working in a school setting observes that a student's fine motor deficits impact handwriting. To comply with IDEA, the OT's intervention must be documented as:

A related service supporting the student's educational goals in the IEP (Correct answer)
An optional enrichment activity approved by parents
A medical necessity in the student's health record
A physician-prescribed intervention plan

Correct answer: A related service supporting the student's educational goals in the IEP

Under IDEA, OT in schools is a related service and must be documented within the Individualized Education Program (IEP) tied to educational goals.

Question 82: What kind of force is exerted to the front section of the vertebra when a person squats down to touch the ground in the sagittal plane?

Compression (Correct answer)
A. Angular motion by the person to turn the wheels on the wheelchair. B. Linear when the person is crossing the room in the wheelchair.
The smaller push rim will travel a greater distance with a single push although it will require greater force. (demonstrates the concept of the wheel & axle)
Appendicular

Correct answer: Compression

When a person squats down to touch the ground, the trunk flexes forward in the sagittal plane. This forward flexion places a significant compressive force on the anterior (front) aspects of the vertebral bodies and intervertebral discs. The posterior elements of the spine, conversely, experience distraction.

Question 83: Which splint design is MOST appropriate for a client with a radial nerve injury resulting in wrist drop?

Thumb spica splint
Wrist cock-up splint (wrist extension splint) (Correct answer)
Resting hand splint
Ulnar gutter splint

Correct answer: Wrist cock-up splint (wrist extension splint)

A wrist cock-up splint positions the wrist in extension to compensate for the lost wrist extensor function caused by radial nerve injury.

Question 84: An 82-year-old man with dementia is being evaluated by an occupational therapist in home health care. Which of the following has to be evaluated the MOST in order for the therapist to offer the right suggestions for activity involvement in between therapy sessions?

Level of independence with toileting
Current and potential systems of support (Correct answer)
Ability to safely prepare meals
Potential fall hazards in the home environment

Correct answer: Current and potential systems of support

For an individual with dementia in home health, the ability to safely and consistently engage in activities between therapy sessions is heavily dependent on the support available. Dementia impacts memory, judgment, and safety, making independent activity planning challenging. Evaluating current and potential systems of support (e.g., family, caregivers, community resources) is crucial for the therapist to develop realistic, safe, and sustainable activity recommendations that can be implemented effectively.

Question 85: Which pressure-relieving wheelchair cushion type is MOST appropriate for a client at HIGH risk for pressure injuries?

Gel-only cushion for comfort
Solid seat insert
Air-filled alternating pressure cushion (Correct answer)
Standard foam cushion

Correct answer: Air-filled alternating pressure cushion

Air-filled alternating pressure cushions provide dynamic pressure redistribution, making them appropriate for high-risk individuals when foam or gel is insufficient.

Question 86: Thumb CMCJ

What is the purpose of a sesamoid bone?
What type of joint structure pads & protects areas of great friction?
The femur is _____ to the tibia.
Diarthrodial, synovial, biaxial, & saddle are all terms that could be used to describe which joint? (Correct answer)

Correct answer: Diarthrodial, synovial, biaxial, & saddle are all terms that could be used to describe which joint?

The carpometacarpal (CMC) joint of the thumb is a classic example of a saddle joint. Saddle joints are diarthrodial (freely movable) and synovial, characterized by two reciprocal concave-convex surfaces. This unique structure allows for biaxial movement, including flexion/extension, abduction/adduction, and opposition/reposition, contributing to the thumb's dexterity.

Question 87: Which of the following does not describe a femur feature?

Linea aspera
Malleolus (Correct answer)
Patellar surface
Medial condyle

Correct answer: Malleolus

The malleolus, specifically the medial and lateral malleoli, are prominent bony projections found at the ankle joint, belonging to the tibia and fibula, respectively. The femur, or thigh bone, features include the patellar surface, linea aspera, and medial/lateral condyles, but not a malleolus.

Question 88: After being transferred to her hospital bed, a patient in an acute care setting loses consciousness. What should the occupational therapist carry out first?

Begin administering compressions
Provide mouth-to-mouth breaths
Clear the patient's airway
Contact the emergency response team (Correct answer)

Correct answer: Contact the emergency response team

In an acute care setting, when a patient loses consciousness, the immediate priority is to alert the medical emergency response team. This ensures that trained personnel and necessary equipment are brought to the patient quickly to assess the situation and provide appropriate medical intervention. While other actions might follow, calling for help is the crucial first step.

Question 89: A pediatric OT is implementing sensory diet strategies. Which activity provides proprioceptive input that is typically calming and organizing?

Watching colorful moving objects
Jumping on a trampoline
Spinning on a therapy swing
Carrying a heavy backpack (Correct answer)

Correct answer: Carrying a heavy backpack

Heavy work activities like carrying a weighted backpack provide proprioceptive input to joints and muscles, which is generally organizing and calming for the nervous system.

Question 90: An OT performing a work conditioning evaluation on a 38-year-old warehouse worker with a lumbar disc herniation needs to assess functional work capacity. Which assessment is MOST appropriate?

Standard isometric strength testing of lumbar extensors via dynamometer
Modified Oswestry Disability Index to quantify pain-related disability
DASH questionnaire only to capture self-reported upper extremity function
Functional Capacity Evaluation (FCE) including lifting analysis, positional tolerances, and work simulation tasks (Correct answer)

Correct answer: Functional Capacity Evaluation (FCE) including lifting analysis, positional tolerances, and work simulation tasks

An FCE provides a comprehensive, objective measurement of safe functional work capacity including lifting, carrying, positional tolerances, and work-simulated activities — essential for RTW decisions.

Question 91: The 'just-right challenge' in occupational therapy intervention refers to:

Giving the client the easiest task to ensure success
Providing tasks that are just barely within the client's legal abilities
Matching task difficulty to slightly exceed the client's current skill level (Correct answer)
Letting the client choose any task they prefer

Correct answer: Matching task difficulty to slightly exceed the client's current skill level

The just-right challenge optimizes therapeutic gain by presenting tasks slightly beyond current ability to promote skill development.

Question 92: Mr. Perez, an elderly man with age-related musculoskeletal degeneration, was recently assessed by an occupational therapist. He lately utilized a wheeled walker, but he can no longer stand up without help. Regarding Mr. Perez's cognition, the occupational therapist seems unconcerned. Which wheelchair would be best suited in light of this information?

Manual wheelchair with displaced rear axle and pneumatic tires
Manual lightweight chair with contoured seat (Correct answer)
Tilt-in-space wheelchair with hip and knee joints maintained at 90 degrees
Power wheelchair with fluid pressure release cushion

Correct answer: Manual lightweight chair with contoured seat

Mr. Perez can no longer stand without help, indicating a need for a wheelchair. Since his cognition is unconcerned, a manual wheelchair is appropriate, allowing him to propel himself for independence and activity. A lightweight chair is easier to maneuver, and a contoured seat provides pressure relief and postural support, which is important for someone with musculoskeletal degeneration who will be seated for extended periods.

Question 93: A new OT manager wants to reduce staff burnout. According to organizational management theory, which strategy is MOST evidence-supported?

Rotating staff between departments quarterly
Providing autonomy, meaningful work, and professional development opportunities (Correct answer)
Increasing financial incentives alone
Reducing workload by eliminating documentation requirements

Correct answer: Providing autonomy, meaningful work, and professional development opportunities

Autonomy, meaningful work, and professional growth are core drivers of intrinsic motivation and job satisfaction, shown to reduce burnout.

Question 94: The lumbrical muscles of the hand perform which unique combination of joint actions?

MCP flexion and IP extension (Correct answer)
MCP extension and IP flexion
MCP and IP flexion simultaneously
MCP and IP extension simultaneously

Correct answer: MCP flexion and IP extension

Lumbricals flex the MCP joints while simultaneously extending the IP joints via their attachment to the extensor expansion, enabling intrinsic-plus hand posture.

Question 95: Under IDEA 2004, OT services in schools must be provided in the:

Least restrictive environment (LRE) (Correct answer)
One-on-one therapy room exclusively
Most restrictive environment available
Clinic-based setting only

Correct answer: Least restrictive environment (LRE)

IDEA mandates services in the least restrictive environment, promoting inclusion alongside peers without disabilities.

Question 96: In a patient with C6 spinal cord injury, which muscle function is preserved that allows tenodesis grasp?

Wrist extensors (ECRL/ECRB) (Correct answer)
Intrinsic hand muscles
Finger flexors (FDP)
Thumb opposition (opponens pollicis)

Correct answer: Wrist extensors (ECRL/ECRB)

C6 SCI preserves wrist extension, enabling passive finger flexion through tenodesis as the wrist extends, allowing a functional grasp without active finger flexors.

Question 97: What number of muscles connect to the talus?

Zero (Correct answer)
Three
One
Two

Correct answer: Zero

The talus is a unique tarsal bone in the ankle because it has no direct muscle attachments. Its surface is almost entirely covered by articular cartilage, facilitating smooth movement within the ankle joint. Instead of muscles, it is held in place and supported by strong ligaments.

Question 98: An OT is working with a 42-year-old man with C6 spinal cord injury (complete) in an inpatient rehabilitation setting. Which functional skill is MOST realistic as an independent goal for this level of injury?

Independent manual wheelchair propulsion with gloves and hand rim modifications (Correct answer)
Independent bowel and bladder management without any assistive devices
Independent feeding using a standard spoon without adaptive equipment
Independent ambulation with bilateral ankle-foot orthoses (AFOs)

Correct answer: Independent manual wheelchair propulsion with gloves and hand rim modifications

C6 SCI preserves wrist extensors (ECRB), enabling tenodesis grip and manual wheelchair propulsion with modified hand rims — a realistic independence goal.

Question 99: A client with spinal cord injury at C6 would MOST likely retain which functional ability?

Full bladder and bowel control
Independent wheelchair propulsion with tenodesis grip (Correct answer)
Full hand grasp for writing
Independent ambulation with ankle-foot orthoses

Correct answer: Independent wheelchair propulsion with tenodesis grip

C6 SCI preserves wrist extension, enabling tenodesis grip for functional tasks and wheelchair propulsion.

Question 100: Which intervention is CONTRAINDICATED during the acute inflammatory phase of a musculoskeletal injury?

Gentle active range of motion
Ice application
Elevation of the affected extremity
Resistive strengthening exercises (Correct answer)

Correct answer: Resistive strengthening exercises

Resistive strengthening during acute inflammation increases mechanical stress on damaged tissue, prolonging the inflammatory response and risking further injury.

Question 101: An occupational therapist (OT) checks a goal regarding an elderly client with a recent fall and a hip fracture while she peers reviews a coworker's documentation. "Lucy will transfer to and from her toilet, provided a walker and grasp bars, with minimal assistance in 4/4 trials within three days," the statement reads. Which SMART goal requirement does this goal not meet?

Relevant
Attainable (Correct answer)
Measurable
Specific

Correct answer: Attainable

The goal states Lucy will achieve minimal assistance with toilet transfers in 4/4 trials within three days of a hip fracture. This timeframe is highly unrealistic and potentially unsafe for an elderly client recovering from a recent hip fracture, making the goal not attainable. Recovery from a hip fracture typically requires a longer period for bone healing, pain management, and strength regaining before achieving such independence.

Question 102: The COPM (Canadian Occupational Performance Measure) is most useful in mental health OT because it:

Provides a standardized psychiatric diagnosis
Measures cognitive status objectively
Rates ADL function on a 7-point FIM scale
Identifies client-perceived occupational performance problems and satisfaction (Correct answer)

Correct answer: Identifies client-perceived occupational performance problems and satisfaction

COPM is client-centered, allowing individuals to identify their own priority occupational issues and rate performance and satisfaction.

Question 103: Which evidence level is considered HIGHEST in the evidence-based practice hierarchy?

Expert opinion
Case study
Systematic review of RCTs (Correct answer)
Randomized controlled trial (RCT)

Correct answer: Systematic review of RCTs

Systematic reviews and meta-analyses of multiple RCTs represent the highest level of evidence because they synthesize rigorous controlled data across multiple studies.

Question 104: During activity analysis, an OT identifies that cooking requires color discrimination to determine when food is properly cooked. This is categorized under which activity demand?

Sequencing and timing
Objects and their properties
Social demands
Required body functions (Correct answer)

Correct answer: Required body functions

Color discrimination is a sensory body function, which is categorized under required body functions within OTPF activity demands.

Question 105: Which standardized assessment tool is used to measure sensory processing patterns in adults?

Purdue Pegboard Test
Sensory Profile 2 (Adult) (Correct answer)
Bruininks-Oseretsky Test of Motor Proficiency
Box and Block Test

Correct answer: Sensory Profile 2 (Adult)

The Sensory Profile 2 Adult version is a self-report measure that identifies sensory processing patterns and their impact on daily life in adults.

Question 106: A child with autism spectrum disorder is unable to tolerate toothbrushing due to oral sensitivity. The FIRST OT intervention should be:

Forcing brushing to habituate the child
Eliminating toothbrushing and substituting mouthwash
Recommending dental sedation for all cleanings
Desensitization using a vibrating toothbrush starting at cheeks, then gums (Correct answer)

Correct answer: Desensitization using a vibrating toothbrush starting at cheeks, then gums

Gradual desensitization starting at less sensitive areas like cheeks before approaching the mouth is the evidence-based sensory approach.

Question 107: Which lung lobe is most commonly affected by aspiration pneumonia in a supine patient?

Right upper lobe
Left upper lobe
Left lower lobe
Right lower lobe (posterior segment) (Correct answer)

Correct answer: Right lower lobe (posterior segment)

In supine patients, gravity directs aspirated material to the posterior segment of the right lower lobe due to the more vertical angle of the right main bronchus.

Question 108: A client with bipolar disorder in a manic phase needs OT intervention. The PRIORITY is:

Challenging cognitive tasks to build insight
Increasing social interactions and group activities
Structure, routine, and reducing environmental stimulation (Correct answer)
High-complexity new learning activities to engage hyperfocus

Correct answer: Structure, routine, and reducing environmental stimulation

During mania, OT prioritizes reducing stimulation and providing structure to prevent overstimulation and support behavioral regulation.

Question 109: A client with PTSD avoids leaving home and attending appointments. Which OT intervention is MOST appropriate?

Restricting all community participation until trauma is processed
Recommending permanent home-based employment only
Graded community reintegration with sensory coping strategies (Correct answer)
Flooding the client with maximum community exposure immediately

Correct answer: Graded community reintegration with sensory coping strategies

Graded exposure with sensory coping strategies gradually rebuilds community participation tolerance consistent with trauma-informed OT practice.

Question 110: A client with C6 spinal cord injury (complete) has preserved wrist extension but no finger flexion. Which adapted technique allows this client to perform basic grasp?

Cock-up splint only
Power grip training
Tenodesis grasp (Correct answer)
Universal cuff

Correct answer: Tenodesis grasp

Tenodesis grasp uses preserved wrist extension to passively flex the fingers, enabling functional pinch and grasp without active finger flexor function.

Question 111: During a home visit, an OT notices a client's caregiver appears exhausted and overwhelmed. The OT's PRIMARY responsibility is to:

Discharge the client to a facility
Assess caregiver burden and connect them with support resources (Correct answer)
Ignore the caregiver and focus solely on the client
Report the caregiver to adult protective services immediately

Correct answer: Assess caregiver burden and connect them with support resources

Assessing caregiver burden and facilitating access to respite or support services falls within OT's holistic, client-and-family-centered practice.

Question 112: The HAAT (Human Activity Assistive Technology) model considers which four components?

Hard technology, aided AAC, audiology, and therapeutic supports
Human, activity, assistive technology, and context (Correct answer)
Health, assessment, application, and therapy
Hands, arms, adaptive tools, and therapist

Correct answer: Human, activity, assistive technology, and context

The HAAT model's four components—Human, Activity, AT, and Context—guide holistic AT evaluation and selection.

Question 113: Recently, a 44-year-old woman slipped on some ice and fractured her Colles. She now has complex regional pain syndrome in the damaged wrist and hand even though the fracture has healed. What intervention from the list below is NOT recommended?

Weightbearing activities
Splinting to prevent contractures
Passive range of motion (Correct answer)
Use of a compression glove to manage edema

Correct answer: Passive range of motion

For Complex Regional Pain Syndrome (CRPS), interventions should prioritize pain management, desensitization, and active movement. Passive range of motion (PROM) can be highly painful and exacerbate symptoms by increasing nerve irritation and inflammation in a hypersensitive limb. Gentle active range of motion, weight-bearing, compression, and splinting for contracture prevention are generally recommended, but PROM is typically avoided due to the risk of increasing pain and sympathetic nervous system activation.

Question 114: A client with rheumatoid arthritis asks about joint protection. Which instruction reflects correct joint protection principles?

Use the smallest joint available for tasks
Distribute load over larger or multiple joints (Correct answer)
Avoid all upper extremity activity
Grip objects tightly to maintain control

Correct answer: Distribute load over larger or multiple joints

Joint protection principles include distributing forces over larger or multiple joints to reduce stress on individual vulnerable joints affected by RA.

Question 115: A child with a brachial plexus birth injury (Erb's palsy) presents with a 'waiter's tip' posture. OT intervention should FIRST focus on:

Splinting in shoulder adduction
Scar management and compression garments
Passive range of motion and positioning to prevent contracture (Correct answer)
Strengthening shoulder abductors with resistive exercise

Correct answer: Passive range of motion and positioning to prevent contracture

Early OT for Erb's palsy prioritizes passive ROM and positioning to prevent contracture of shoulder internal rotators and elbow flexors.

Question 116: During a dynamic systems theory approach to motor development, which factor is considered the RATE LIMITER for a skill such as walking?

The weakest or least developed component system needed for the task (Correct answer)
Age and developmental milestones
Genetic programming alone
Cortical maturation only

Correct answer: The weakest or least developed component system needed for the task

Dynamic systems theory identifies the rate limiter as the subsystem that is least developed, which constrains emergence of the new motor skill.

Question 117: A client with Parkinson's disease is having difficulty walking through doorways due to freezing of gait. Which OT cueing strategy is MOST effective?

Visual field reduction
Verbal instructions to slow down
Rhythmic auditory cueing (metronome or music) (Correct answer)
Proprioceptive taping of the lower extremities

Correct answer: Rhythmic auditory cueing (metronome or music)

Rhythmic auditory cues provide an external timing signal that bypasses the disrupted basal ganglia circuitry and helps initiate and maintain gait in Parkinson's disease.

Question 118: Two vertebral bodies, a disc, facet joints, and ligaments make up the smallest functional spinal unit at each level of the spine, with the exception of -

C1-C2 (Correct answer)
T12-L1
C7-T1
L5-S1

Correct answer: C1-C2

The typical functional spinal unit consists of two adjacent vertebral bodies, the intervertebral disc between them, facet joints, and ligaments. However, the C1 (atlas) and C2 (axis) vertebrae are unique. They articulate differently, lacking an intervertebral disc and having specialized joints (atlanto-occipital and atlanto-axial) that allow for head rotation, thus not forming a typical functional spinal unit.

Question 119: During elbow flexion, which muscle is the primary mover when the forearm is in neutral (mid-pronation/supination) position?

Biceps brachii
Brachioradialis
Coracobrachialis
Brachialis (Correct answer)

Correct answer: Brachialis

The brachialis is the most consistent elbow flexor regardless of forearm position, as it inserts on the ulnar tuberosity rather than the radius.

Question 120: A client who is blind requires a computer access solution. Which OT intervention is MOST appropriate?

Magnification software at 300% zoom
High-contrast display settings only
Large-print keyboard overlay
Screen reader software training (e.g., JAWS or NVDA) (Correct answer)

Correct answer: Screen reader software training (e.g., JAWS or NVDA)

Screen reader software converts visual information to auditory output, enabling full computer access for individuals who are blind.

Question 121: The quickest method to resynthesize ATP while exercising is -

Glycogenolysis
Glycolysis
TCA Cycle
Phosphocreatine breakdown (Correct answer)

Correct answer: Phosphocreatine breakdown

During intense, short bursts of exercise, the phosphocreatine (PCr) system provides the most rapid means of ATP resynthesis. Creatine kinase catalyzes the transfer of a phosphate group from phosphocreatine to ADP, quickly regenerating ATP. This system is crucial for immediate energy needs, allowing for rapid muscle contraction before other metabolic pathways can contribute significantly.

Question 122: A long-term care facility's occupational therapist meets with the medical staff to discuss Mrs. Smith, a new admission who suffered a stroke three weeks earlier. Due to the risk of aspiration in her previous environment, she was on a level two dysphagia diet. Which of the following should the team flag as risky for Mrs. Smith?

Scrambled eggs and cottage cheese
Watermelon cubes and oatmeal
Bread and butter with avocado (Correct answer)
Pureed turkey and cooked carrots

Correct answer: Bread and butter with avocado

A Level 2 dysphagia diet typically involves mechanically altered foods, meaning soft-textured, moist, and easily chewable items. Bread, especially dry bread, can be difficult to chew and form into a cohesive bolus, posing a significant choking and aspiration risk. Avocado, while soft, can also be slippery or crumbly depending on its preparation, making the combination particularly risky for someone with dysphagia.

Question 123: Susan, a transcriptionist with a history of carpal tunnel disease and an outpatient client, has been relocated to a position requiring remote work. She worries about how ergonomically sound her new workplace is. Which of the aforementioned suggestions is the ideal one?

Wrists should be positioned in neutral
The screen should be placed above eye level so that the neck is in slight extension
Knees should be bent at a 70-degree angle (Correct answer)
For seated typing, the work surface should be no more than 35" high

Correct answer: Knees should be bent at a 70-degree angle

Maintaining wrists in a neutral position is a fundamental ergonomic principle crucial for preventing and managing carpal tunnel syndrome, as it minimizes pressure on the median nerve. Other options describe incorrect ergonomic setups: the work surface height should allow elbows at 90 degrees with wrists neutral, the screen should be at or slightly below eye level to avoid neck extension, and knees should be bent at a 90-degree angle with feet flat, not 70 degrees.

Question 124: Which assessment is standardized and used to evaluate sensory processing in school-age children?

Vineland Adaptive Behavior Scales
Beery VMI
Sensory Profile 2 (SP2) (Correct answer)
Peabody Developmental Motor Scales

Correct answer: Sensory Profile 2 (SP2)

The Sensory Profile 2 is a caregiver-completed standardized measure assessing sensory processing patterns in children.

Question 125: A client with Parkinson's disease shows freezing of gait. Which OT strategy is MOST evidence-based to address this?

Prescribing a power wheelchair immediately
Using visual or auditory cues (e.g., lines on floor, metronome) (Correct answer)
Reducing walking speed to zero when freezing occurs
Teaching backward walking exclusively

Correct answer: Using visual or auditory cues (e.g., lines on floor, metronome)

External rhythmic cues (visual floor markings, auditory beats) bypass deficient internal timing mechanisms in Parkinson's to reduce freezing episodes.

Question 126: Which nerve is compressed in pronator teres syndrome, producing forearm pain and median nerve symptoms?

Ulnar nerve
Median nerve (Correct answer)
Radial nerve
Anterior interosseous nerve

Correct answer: Median nerve

Pronator teres syndrome involves compression of the median nerve between the two heads of the pronator teres muscle in the proximal forearm.

Question 127: An OT is treating a child with spastic diplegic cerebral palsy. Which seating modification is MOST important for improving upper extremity function?

Headrest to support neck in neutral
Shoulder harness to prevent forward lean
Foot rests elevated to reduce hamstring pull
Pelvis and trunk stabilization with proper hip angle (Correct answer)

Correct answer: Pelvis and trunk stabilization with proper hip angle

Proper pelvic and trunk stabilization provides the proximal stability that allows for improved distal upper extremity function.

Question 128: What is the normal range of MCP joint flexion measured with a goniometer?

60–70°
45–50°
85–90° (Correct answer)
100–110°

Correct answer: 85–90°

Normal MCP joint flexion ranges from approximately 85–90°, with full fist formation requiring adequate ROM at the MCP, PIP, and DIP joints together.

Question 129: Which approach emphasizes modifying the task or environment rather than remediating the child's underlying impairment?

Bottom-up remediation approach
Top-down compensatory approach (Correct answer)
Neurodevelopmental treatment
Sensory integration therapy

Correct answer: Top-down compensatory approach

The top-down compensatory approach modifies tasks, tools, or environments to enable function without fixing the underlying impairment.

Question 130: The staff at a long-term care facility is receiving fall prevention training from an occupational therapist. Which of the following resident characteristics increases the likelihood of falls?

Presbyopia
Fear of falling
All of the above (Correct answer)
Vertigo

Correct answer: All of the above

All the listed characteristics significantly increase the likelihood of falls in older adults. Vertigo directly impairs balance and spatial orientation. Presbyopia, an age-related vision impairment, makes it difficult to perceive environmental hazards accurately. Fear of falling, while psychological, often leads to reduced activity, muscle deconditioning, and an altered, less stable gait pattern, paradoxically increasing the actual risk of falls.

Question 131: Which work rehabilitation approach is used when a client with mental illness needs to build work skills in a real, paid employment setting?

Supported Employment (Individual Placement and Support model) (Correct answer)
Vocational evaluation only before any work trial
Sheltered workshop with unpaid work samples
Pre-vocational skills training in a simulated classroom

Correct answer: Supported Employment (Individual Placement and Support model)

The IPS model of Supported Employment places clients in competitive integrated employment immediately with ongoing job coaching support.

Question 132: A rehabilitation manager is checking the unit's clinical documentation requirements to make sure they adhere to all criteria. Which of the following does not meet the requirements for reimbursement?

A medical necessity statement
ICD and CPT codes
OT or COTA signature (Correct answer)
Patient identification, date of birth, and diagnosis

Correct answer: OT or COTA signature

ICD and CPT codes, a medical necessity statement, and patient identification with diagnosis are all direct content requirements that justify the service and allow for billing. While an OT or COTA signature is absolutely essential for validating the documentation and ensuring accountability, it is an authentication requirement rather than a direct content requirement that describes the service or medical need for reimbursement.

Question 133: An OT administers the Mini-Mental State Examination (MMSE) to an 80-year-old woman and obtains a score of 20/30. Based on this result, which area of performance is MOST likely to be impaired and should guide OT intervention planning?

Social participation and community integration
Basic self-care tasks such as bathing and grooming
Physical mobility and transfer skills
Higher-level IADLs such as medication management and financial tasks (Correct answer)

Correct answer: Higher-level IADLs such as medication management and financial tasks

An MMSE score of 20–23 suggests mild cognitive impairment, which most directly impacts complex IADLs requiring intact executive function and memory.

Question 134: During activity analysis, an OT determines that a client's ability to sequence steps in meal preparation is impaired. Which domain area of the Occupational Therapy Practice Framework (OTPF) is most directly affected?

Social interaction skills
Process skills (Correct answer)
Sensory-perceptual skills
Motor skills

Correct answer: Process skills

Process skills, including sequencing and adapting, are performance skills within the OTPF that directly affect multi-step task completion.

Question 135: Thermometer sterilization is best accomplished using:

Autoclave
Gamma radiation
Alcohol (Correct answer)
Hot air oven

Correct answer: Alcohol

Alcohol, typically 70% isopropyl alcohol, is commonly used for thermometer sterilization in clinical settings. It acts as a disinfectant by denaturing proteins and dissolving lipids, effectively killing most bacteria, fungi, and viruses on the surface. While other methods like autoclaving provide higher levels of sterilization, alcohol is a practical and quick method for surface disinfection of non-critical items like thermometers.

Question 136: When performing a home assessment for fall prevention in an older adult, which environmental modification is considered HIGHEST priority?

Placing a bath chair in the shower
Adding a stair lift
Installing brighter light bulbs
Removing throw rugs (Correct answer)

Correct answer: Removing throw rugs

Removing throw rugs eliminates a leading trip hazard and is a low-cost, high-impact intervention for fall prevention.

Question 137: A 5-year-old cannot yet copy a cross (+). According to developmental norms, this indicates:

Normal development for age 5
A delay, as cross-copying is expected by age 4 (Correct answer)
Only a fine motor concern, not a perceptual one
A sign of visual agnosia

Correct answer: A delay, as cross-copying is expected by age 4

Copying a cross is a developmental milestone typically achieved by age 4, so a 5-year-old who cannot is showing a delay.

Question 138: A child scores below the 16th percentile on the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2). This indicates:

Performance is within normal limits
Eligibility for special education services is automatically established
Performance is below average and warrants further evaluation (Correct answer)
The child has a confirmed diagnosis of DCD

Correct answer: Performance is below average and warrants further evaluation

Scores below the 16th percentile on BOT-2 indicate below-average motor performance warranting further clinical evaluation.

Question 139: A client with C4 complete SCI wants to control a computer independently. The MOST appropriate interface is:

Standard keyboard with wrist supports
Trackball mouse
Foot mouse
Sip-and-puff switch with scanning software (Correct answer)

Correct answer: Sip-and-puff switch with scanning software

At C4, voluntary respiratory control is intact, making sip-and-puff switching a reliable computer access method for clients with no hand function.

Question 140: Sensory processing issues are common in people with autism spectrum disorder.

50-60%
80-90% (Correct answer)
60-70%
70-80%

Correct answer: 80-90%

Research indicates that a very high percentage of individuals with Autism Spectrum Disorder (ASD) experience significant sensory processing issues. These challenges can manifest as hypersensitivity (over-responsiveness) or hyposensitivity (under-responsiveness) to various sensory stimuli, including sounds, textures, lights, and tastes. These sensory differences profoundly impact their daily functioning and engagement with the environment.

Question 141: Which frame of reference is MOST appropriate for a client with a traumatic brain injury who has difficulty with sequencing daily tasks?

Cognitive Disabilities (Allen) (Correct answer)
Biomechanical
Model of Human Occupation
Person-Environment-Occupation

Correct answer: Cognitive Disabilities (Allen)

Allen's Cognitive Disabilities frame of reference specifically addresses cognitive processing levels and is widely used with TBI clients to match task demands to current cognitive capacity.

Question 142: The following complications are anticipated in a hospitalized patient with severe burns:

Anaphylaxis
Cardiogenic shock
Hypovolemic Shock (Correct answer)
Anaemia

Correct answer: Hypovolemic Shock

Severe burns cause significant fluid loss from the damaged skin and into the interstitial space, leading to a rapid decrease in circulating blood volume. This massive fluid shift results in hypovolemia. If not adequately replaced, this can quickly progress to hypovolemic shock, a life-threatening condition due to insufficient blood flow to vital organs.

Question 143: Special sensory cranial nerve components are not connected to:

Facial nerve
Trigeminal nerve
Olfactory nerve
Vagus nerve (Correct answer)

Correct answer: Vagus nerve

Special sensory cranial nerves are primarily associated with senses like smell, taste, vision, and hearing. While the Olfactory nerve (CN I) is purely special sensory for smell, and the Facial nerve (CN VII) carries taste, the Vagus nerve (CN X) is predominantly known for its extensive motor and parasympathetic innervation to visceral organs. Although it does carry a minor component of taste sensation from the epiglottis, its primary roles are not special sensory, making it distinct from nerves whose main function is special sensation.

Question 144: Which anatomical structure separates the anterior and posterior compartments of the thigh?

Fascia lata
Lateral and medial intermuscular septa (Correct answer)
Inguinal ligament
Iliotibial band

Correct answer: Lateral and medial intermuscular septa

The lateral and medial femoral intermuscular septa extend from the fascia lata to the femur, separating the anterior, posterior, and medial thigh compartments.

Question 145: Sensory modulation rooms in psychiatric inpatient units are used primarily to:

Help clients self-regulate arousal levels and reduce use of seclusion and restraint (Correct answer)
Assess vestibular and proprioceptive processing disorders
Replace pharmacological management of agitation
Provide recreational distraction from symptoms

Correct answer: Help clients self-regulate arousal levels and reduce use of seclusion and restraint

Sensory modulation rooms provide self-regulation tools that research shows reduce the need for seclusion and restraint in psychiatric settings.

Question 146: The elbow is distal to which of the following structures?

Biceps brachii
Wrist (Correct answer)
Shoulder
Sternum

Correct answer: Wrist

In directional anatomy, 'distal' refers to a point further away from the trunk or the point of origin of a body part. The elbow is located on the arm, and the wrist is further down the arm, away from the shoulder (which is closer to the trunk). Therefore, the wrist is distal to the elbow.

Question 147: The scapula is not attached to which of the following muscles?

Biceps brachii, short head
Triceps brachii, lateral head (Correct answer)
Triceps brachii, long head
Biceps brachii, long head

Correct answer: Triceps brachii, lateral head

The lateral head of the triceps brachii originates from the posterior surface of the humerus, superior to the radial groove. In contrast, the long head of the triceps brachii originates from the infraglenoid tubercle of the scapula. Therefore, the lateral head is the only option listed that does not attach to the scapula.

Question 148: The hypothalamus regulates body temperature primarily through which effector mechanism during overheating?

Releasing thyroid hormone
Activating sweat glands and cutaneous vasodilation (Correct answer)
Triggering shivering thermogenesis
Increasing metabolic rate

Correct answer: Activating sweat glands and cutaneous vasodilation

When core temperature rises, the hypothalamus activates eccrine sweat glands and promotes cutaneous vasodilation to dissipate heat through evaporation and radiation.

Question 149: A therapist performing a task analysis of meal preparation identifies that a client skips steps and loses track of ingredients. This suggests difficulty with which executive function?

Fine motor dexterity
Visual acuity
Working memory and task initiation (Correct answer)
Long-term memory consolidation

Correct answer: Working memory and task initiation

Skipping steps and losing track of materials during a multi-step task reflects deficits in working memory and sustained initiation, both executive functions.

Question 150: Which OT model specifically guides understanding of how habits and routines support mental health recovery?

Biomechanical Frame of Reference
Allen Cognitive Levels Model
Motor Relearning Programme
Model of Human Occupation (MOHO) — habituation subsystem (Correct answer)

Correct answer: Model of Human Occupation (MOHO) — habituation subsystem

MOHO's habituation subsystem explains how habits and internalized roles support daily routine and occupational participation in recovery.

Question 151: In a partial hospitalization program, OT groups MOST appropriately focus on:

Medication management and psychiatric diagnosis education
Physical rehabilitation of neurological conditions
Community living skills, coping strategies, and daily routine development (Correct answer)
Individual psychoanalytic therapy

Correct answer: Community living skills, coping strategies, and daily routine development

OT in partial hospitalization programs focuses on restoring daily function, community skills, and coping to support the transition back to community living.

Question 152: A private OT practice is considering hiring a certified occupational therapy assistant (COTA). Which supervision requirement must the OTR fulfill under AOTA guidelines?

Routine and general supervision appropriate to setting and COTA competency (Correct answer)
Supervision only during the initial 90-day probationary period
Supervision is not required once competency is established
Daily on-site supervision for all tasks

Correct answer: Routine and general supervision appropriate to setting and COTA competency

AOTA guidelines require OTRs to provide routine and general supervision of COTAs, with intensity varying by setting, task complexity, and COTA experience.

Question 153: The objective of rehabilitation is

Minimize disability
All of the above (Correct answer)
Minimize Handicap trad
Lead to a useful life within his/her limitation

Correct answer: All of the above

The objective of rehabilitation is comprehensive, aiming to maximize an individual's functional independence and quality of life. This includes minimizing the impact of disability by restoring function, reducing handicap by addressing environmental and societal barriers, and ultimately enabling the individual to lead a useful and fulfilling life within their capabilities. Therefore, all the listed options contribute to this overarching goal.

Question 154: Jane is five years old and attends a preschool. She just underwent an occupational therapy evaluation and received a score on a standardized test assessing visual-motor skills that was two deviations under the mean. Given this knowledge, what would be a suitable objective?

Jane will use shapes to draw representational pictures (Correct answer)
Jane will transfer ten pegs into a pegboard
Jane will hold a pencil with a static tripod grasp
Jane will locate five items on a search and find image

Correct answer: Jane will use shapes to draw representational pictures

Jane's visual-motor skills are significantly below age-level expectations, indicated by a score two deviations under the mean. Using shapes to draw representational pictures is a developmentally appropriate visual-motor task for a five-year-old that directly addresses this area of deficit. This objective targets the underlying skill of integrating visual perception with motor output, which is crucial for pre-writing and drawing.

Question 155: Long bones have cancellous bone in the metaphysis and epiphysis but compact bone in the diaphysis. (Also discovered between compact bone's layers)

What are 3 types of joints that allow little or no motion?
Give one example of compact bone & one of cancellous bone. (Correct answer)
When touching the left shoulder with the left hand, is a person using the contra- or ipsi-lateral hand?
When cracking an almond with a nutcracker, will the almond be easier to crack if it is closer to the axis or closer to the end of the handles? Why?

Correct answer: Give one example of compact bone & one of cancellous bone.

The prompt describes the anatomical distribution of compact and cancellous bone within a long bone: compact bone in the diaphysis and cancellous bone in the metaphysis and epiphysis. The correct answer, 'Give one example of compact bone & one of cancellous bone,' is a logical follow-up question that directly relates to the provided statement, testing the understanding of these bone types.

Question 156: Which of the following phrases best depicts a crack in a bone, particularly the skull?

Foramen (Correct answer)
Arches
Grooves
Articulations

Correct answer: Foramen

A foramen is a natural opening or passage in a bone, such as those found in the skull for nerves and blood vessels. It is a pre-existing anatomical structure, distinct from a 'crack,' which refers to a fracture or break in the bone. Therefore, a foramen does not depict a crack; they are fundamentally different anatomical concepts.

Question 157: Following Zone II flexor tendon repair, when is RESISTIVE hand activity typically introduced?

2–3 weeks post-repair
12 weeks post-repair for all activity types
1 week post-repair
6–8 weeks post-repair (Correct answer)

Correct answer: 6–8 weeks post-repair

Resistive activity is generally introduced at 6–8 weeks after Zone II flexor tendon repair, once adequate tendon tensile strength has been achieved.

Question 158: Which frame of reference guides OT practice for clients with mental illness by focusing on the relationship between occupation and mental health?

Model of Human Occupation (MOHO) (Correct answer)
Sensory Integration Frame of Reference
Neurodevelopmental Treatment
Biomechanical Frame of Reference

Correct answer: Model of Human Occupation (MOHO)

MOHO explains how volition, habituation, and performance capacity interact with the environment to influence occupational participation and mental health.

Question 159: A 72-year-old man with right hemiplegia following a stroke is referred for OT evaluation. The occupational therapist administers the Functional Independence Measure (FIM). Which domain does the FIM primarily assess?

Sensory processing abilities and perceptual skills
Muscle strength and range of motion of the affected limb
Motor and cognitive functional independence in daily activities (Correct answer)
Psychological adjustment to disability and quality of life

Correct answer: Motor and cognitive functional independence in daily activities

The FIM assesses 18 items across motor (13) and cognitive (5) domains to measure the level of assistance required for daily activities.

Question 160: Which sensory integration concept describes a child's tendency to seek out intense sensory experiences?

Sensory seeking (Correct answer)
Tactile defensiveness
Gravitational insecurity
Sensory modulation disorder

Correct answer: Sensory seeking

Sensory seeking describes a child who craves and actively pursues intense sensory input to meet their neurological threshold.

Question 161: A child with ADHD struggles with transitions in the classroom. Which OT strategy is MOST effective?

Removing all stimulating classroom decorations
Visual schedules and advance warning of transitions (Correct answer)
Increasing sit-down seatwork to improve attention
Reward systems for ignoring transition difficulties

Correct answer: Visual schedules and advance warning of transitions

Visual schedules and advance warnings prepare the child with ADHD for upcoming transitions, reducing anxiety and behavioral dysregulation.

Question 162: When performing a functional capacity evaluation (FCE), the OT is PRIMARILY determining:

The client's ability to perform work-related tasks safely (Correct answer)
Medication adjustments needed for pain management
A client's eligibility for Social Security Disability
The diagnosis causing functional limitations

Correct answer: The client's ability to perform work-related tasks safely

An FCE objectively measures a client's safe physical work capacity, informing return-to-work decisions and matching abilities to job demands.

Question 163: Which of the following BEST describes the role of occupational justice in OT practice?

Ensuring all clients receive the same treatment protocol
Focusing only on individual client impairments
Prioritizing productivity occupations over leisure
Advocating for equitable access to meaningful occupations for all people (Correct answer)

Correct answer: Advocating for equitable access to meaningful occupations for all people

Occupational justice recognizes that all people have the right to engage in meaningful occupations and challenges societal barriers that prevent this.

Question 164: Under IDEA (Individuals with Disabilities Education Act), OT services for school-age children must be documented in which plan?

Individualized Education Program (IEP) (Correct answer)
Individual Family Service Plan (IFSP)
504 Plan
Transition Plan only

Correct answer: Individualized Education Program (IEP)

OT services for school-age children under IDEA are documented in the IEP, which outlines educational goals and related services.

Question 165: When training a client in use of a new powered mobility device, OT should FIRST address:

Maximum speed settings to determine driving capability
Indoor navigation and safety in low-risk environments before progressing to complex settings (Correct answer)
Funding documentation before any driving practice
Outdoor community navigation immediately to assess real-world performance

Correct answer: Indoor navigation and safety in low-risk environments before progressing to complex settings

Training begins in controlled, low-risk indoor environments to build basic driving competency and safety before advancing to complex settings.

Question 166: When grading an activity for a client with low endurance, an OT would MOST likely:

Increase task complexity
Use heavy resistance
Remove all adaptive equipment
Shorten the duration of the activity (Correct answer)

Correct answer: Shorten the duration of the activity

Shortening task duration reduces metabolic demand and allows gradual building of endurance over time.

Question 167: A child with developmental coordination disorder (DCD) MOST benefits from which OT approach?

Task-oriented approach (CO-OP) focusing on strategy use (Correct answer)
Stretching and passive range of motion
Behavioral reward charts without motor practice
Sensory integration therapy exclusively

Correct answer: Task-oriented approach (CO-OP) focusing on strategy use

The Cognitive Orientation to daily Occupational Performance (CO-OP) uses strategy discovery to improve motor skill acquisition in DCD.

Question 168: Which instrument is the gold standard for measuring grip strength in hand rehabilitation?

Semmes-Weinstein monofilament
Pinch gauge
Jamar dynamometer (Correct answer)
Goniometer

Correct answer: Jamar dynamometer

The Jamar dynamometer is the gold standard for measuring grip strength due to its reliability and validity across multiple handle positions.

Question 169: A client with a radial nerve injury at the spiral groove presents with which primary deficit relevant to hand function?

Loss of wrist extension and finger extension (wrist drop) (Correct answer)
Loss of finger abduction and adduction
Loss of wrist flexion and finger flexion
Loss of thumb opposition and palmar sensation

Correct answer: Loss of wrist extension and finger extension (wrist drop)

Radial nerve injury at the spiral groove results in wrist drop due to paralysis of wrist and finger extensors, impairing functional grasp patterns.

Question 170: Hand-knee gait is frequently caused by:

Weakness of hamstring muscle
Weakness of quadriceps (Correct answer)
Weakness of plantar flexors
Lack of balance on that side

Correct answer: Weakness of quadriceps

Hand-knee gait, also known as quadriceps gait or genu recurvatum gait, is a compensatory walking pattern. It occurs when there is significant weakness in the quadriceps muscles, which are essential for knee extension and stabilizing the knee during the stance phase of gait. Patients compensate by hyperextending the knee and often pressing on the thigh with their hand to prevent the knee from buckling.

Question 171: An elderly client with low vision wants to continue cooking independently. The BEST OT approach is to:

Modify the environment with high-contrast markings and adaptive techniques (Correct answer)
Refer exclusively to a vision specialist
Recommend meal delivery services only
Discourage cooking for safety reasons

Correct answer: Modify the environment with high-contrast markings and adaptive techniques

OT promotes occupational engagement through environmental modification and adaptive techniques; high-contrast markings and adapted methods support safe cooking with low vision.

NBCOT Occupational Therapist Exam

The NBCOT Occupational Therapist Exam (OTR) tests knowledge required for entry-level occupational therapy practice, covering neurological rehabilitation, pediatric OT, mental health practice, and occupational therapy foundations.

170

Questions

240 min

Time Limit

70%

To Pass

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