NBCOT Ethics and Professional Practice 5 — Questions and Answers
Question 1: An OT student observes their clinical supervisor documenting a treatment session that did not occur. What is the student's ethical obligation?
- Stay silent to protect the supervisory relationship and their grade
- Immediately report to NBCOT without consulting anyone
- Discuss the concern with the supervisor first, then escalate if unresolved (Correct answer)
- Assume the supervisor had a legitimate reason and proceed with training
Correct answer: Discuss the concern with the supervisor first, then escalate if unresolved
Students share the obligation to address unethical conduct; starting with a direct conversation and then escalating if needed follows both the AOTA Code of Ethics and appropriate professional process.
Question 2: Which best describes 'scope of practice' in occupational therapy ethics?
- The range of billable services approved by Medicare
- The boundaries of competent practice defined by education, experience, and regulation (Correct answer)
- The number of clients an OT is allowed to treat per day
- Services limited to those covered by the facility's liability insurance
Correct answer: The boundaries of competent practice defined by education, experience, and regulation
Scope of practice refers to the domain of competent practice determined by professional preparation, demonstrated competency, and applicable laws and regulations.
Question 3: An OT learns that a client is being financially exploited by a family member. The client asks the OT to keep this secret. What should the OT do?
- Honor the client's confidentiality request above all other duties
- Report to Adult Protective Services as mandated by law, explaining the reporting obligation to the client (Correct answer)
- Confront the family member directly on the client's behalf
- Document only in the chart and take no further action
Correct answer: Report to Adult Protective Services as mandated by law, explaining the reporting obligation to the client
Elder and vulnerable adult financial abuse is a mandatory reporting situation in most U.S. states; the OT must report and should inform the client of this legal obligation.
Question 4: The principle of 'nonmaleficence' in OT ethics most directly requires a practitioner to:
- Advocate for clients' right to make their own choices
- Avoid causing harm or imposing unnecessary risk on clients (Correct answer)
- Provide services fairly without discrimination
- Be truthful with clients about their prognosis
Correct answer: Avoid causing harm or imposing unnecessary risk on clients
Nonmaleficence means 'do no harm' and obligates OTs to avoid actions that could injure, exploit, or place clients at unnecessary risk.
Question 5: An OT is treating a client who mentions plans to harm a specific coworker. What is the OT's obligation under the duty to warn (Tarasoff principle)?
- Maintain confidentiality because there is no exception for threats of violence
- Warn the identified potential victim and notify appropriate authorities (Correct answer)
- Document the threat and continue therapy without breaking confidentiality
- Transfer the client to a mental health professional and take no further action
Correct answer: Warn the identified potential victim and notify appropriate authorities
The Tarasoff principle establishes a duty to protect identifiable third parties from credible threats of serious harm, which may require breaching confidentiality.
Question 6: An OT working in home health realizes a client's prescribed home modifications exceed what Medicare will cover. What is the most ethical course of action?
- Provide only the Medicare-covered modifications and say nothing about the rest
- Bill for all modifications and absorb the uncovered costs without informing the client
- Inform the client of the coverage limits, discuss priorities, and explore alternative funding sources (Correct answer)
- Discontinue services until full funding is secured
Correct answer: Inform the client of the coverage limits, discuss priorities, and explore alternative funding sources
Veracity and beneficence require the OT to be transparent about coverage limitations while actively helping the client explore all available resources to meet their needs.
Question 7: Which action by an OT would constitute a violation of the ethical principle of veracity?
- Declining to share a prognosis that is uncertain
- Documenting functional gains that did not actually occur to justify continued services (Correct answer)
- Recommending adaptive equipment a client cannot currently afford
- Providing intervention outside the standard care guidelines when evidence supports it
Correct answer: Documenting functional gains that did not actually occur to justify continued services
Veracity requires truthfulness and honesty; fabricating or inflating documentation to secure reimbursement is fraud and a direct violation of this principle.
NBCOT Ethics and Professional Practice 5
An OT student observes their clinical supervisor documenting a treatment session that did not occur.
What is the student's ethical obligation?