NBCOT Occupational Therapist Exam — Questions and Answers

Question 1: Which sensory integration concept describes a child's tendency to seek out intense sensory experiences?

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

Correct answer: Sensory seeking

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

Question 2: Which frame of reference guides OT practice for clients with mental illness by focusing on the relationship between occupation and mental health?

Neurodevelopmental Treatment
Biomechanical Frame of Reference
Model of Human Occupation (MOHO) (Correct answer)
Sensory Integration 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 3: A 6-year-old child with developmental coordination disorder (DCD) has difficulty learning to ride a bike. The OT decides to use the Cognitive Orientation to daily Occupational Performance (CO-OP) approach. Which technique is CENTRAL to CO-OP intervention?

Providing manual guidance and hand-over-hand assistance to shape the movement pattern
Practicing bike-riding skills in progressively more challenging environments using repetition
Teaching the child a global problem-solving strategy ('Goal-Plan-Do-Check') and guided discovery of task-specific strategies (Correct answer)
Sensory integration activities to improve vestibular and proprioceptive processing needed for balance

Correct answer: Teaching the child a global problem-solving strategy ('Goal-Plan-Do-Check') and guided discovery of task-specific strategies

CO-OP's core mechanism is the global cognitive strategy Goal-Plan-Do-Check, through which the child discovers task-specific strategies via guided discovery rather than being taught movements directly.

Question 4: A client with rheumatoid arthritis asks about joint protection during kitchen tasks. Which principle reflects BEST practice for joint protection?

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

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

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

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 6: Which model emphasizes volition, habituation, and performance capacity as key components influencing occupational participation?

Model of Human Occupation (MOHO) (Correct answer)
Person-Environment-Occupation Model
Canadian Model of Occupational Performance
Ecology of Human Performance

Correct answer: Model of Human Occupation (MOHO)

MOHO, developed by Gary Kielhofner, conceptualizes occupation through volition (motivation), habituation (routines/roles), and performance capacity.

Question 7: Which sensory system does Ayres Sensory Integration (ASI) theory consider MOST foundational for higher-level skill development?

Auditory and visual systems
Tactile, vestibular, and proprioceptive systems (Correct answer)
Visual and proprioceptive systems only
Olfactory and gustatory systems

Correct answer: Tactile, vestibular, and proprioceptive systems

ASI theory identifies the tactile, vestibular, and proprioceptive systems as the foundational triad for building adaptive responses and higher skills.

Question 8: A 5-year-old cannot yet copy a cross (+). According to developmental norms, this indicates:

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

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 9: Which of the following describes an occupation-based neurobehavioral evaluation with an ADL focus?

Activity card sort
The Assessment of Motor and Process skills (AMPS) (Correct answer)
Amadottir Occupational Therapy Neurobehavioural Evaluation (A-One)
Amm Motor Ability test

Correct answer: The Assessment of Motor and Process skills (AMPS)

The Assessment of Motor and Process Skills (AMPS) is a standardized, occupation-based evaluation tool that directly assesses the quality of a person's performance in instrumental and personal activities of daily living (ADLs). It specifically measures motor and process skills, which are fundamental neurobehavioral components, as they are applied during the performance of meaningful, everyday tasks. This makes AMPS an excellent fit for an occupation-based neurobehavioral evaluation with an ADL focus.

Question 10: The elbow is distal to which of the following structures?

Wrist (Correct answer)
Shoulder
Biceps brachii
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 11: Which group therapy format is MOST consistent with OT's occupational therapy process in a community mental health setting?

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

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 12: In biomechanics, what is the mechanical advantage (MA) of a second-class lever?

MA is always less than 1
MA equals exactly 1
MA varies and can be less or greater than 1
MA is always greater than 1 (Correct answer)

Correct answer: MA is always greater than 1

Second-class levers always have the resistance between the fulcrum and effort, resulting in a mechanical advantage greater than 1 (force-efficient).

Question 13: 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?

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)
Compression (Correct answer)
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 14: Hemispatial neglect following right hemisphere stroke is BEST addressed using which OT strategy?

Prism adaptation therapy as the only intervention
Visual scanning training from left to right (Correct answer)
Strengthening of the right arm
Proprioceptive training of the lower extremities

Correct answer: Visual scanning training from left to right

Visual scanning training teaches clients to actively scan toward the neglected left side to compensate for hemispatial neglect.

Question 15: A client who is blind requires a computer access solution. Which OT intervention is MOST appropriate?

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

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 16: An OT is treating a 50-year-old man with a traumatic below-elbow (transradial) amputation. The patient is being fitted for a body-powered prosthesis with a voluntary-opening terminal device. To operate the terminal device, the patient must perform which movement?

Wrist extension to mechanically extend the hook fingers
Humeral flexion and/or scapular abduction to activate the control cable and open the hook (Correct answer)
Elbow flexion of the sound limb to provide power transfer
Shoulder internal rotation and depression to open the terminal device

Correct answer: Humeral flexion and/or scapular abduction to activate the control cable and open the hook

Body-powered prostheses use a figure-8 harness and control cable activated by shoulder flexion and/or scapular abduction (biscapular spread) to open the voluntary-opening terminal device.

Question 17: An occupational therapist in a developing field decides to do a level II empirical investigation. Which of the following is NOT necessary for the therapist to continue?

Informed consent
Full risk disclosure
Presence of a third party to ensure compliance (Correct answer)
Institutional Review Board (IRB) review

Correct answer: Presence of a third party to ensure compliance

For a Level II empirical investigation, which involves human subjects, informed consent, full risk disclosure, and Institutional Review Board (IRB) review are all essential ethical and regulatory requirements. These measures protect participants and ensure the study's integrity. While oversight is important, the 'presence of a third party to ensure compliance' is not a universally mandated or specific requirement for all research, unlike the other options.

Question 18: Which frame of reference is BEST suited for a client with schizophrenia who needs to develop community living skills?

Neurodevelopmental Treatment (NDT)
Psychodynamic
Biomechanical
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 19: A client with schizophrenia demonstrates negative symptoms. Which negative symptom is most commonly addressed by OT?

Hallucinations
Delusions of grandeur
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 20: When conducting a task analysis for a client with limited grip strength, which activity demand should the OT assess FIRST?

Required actions and performance skills (Correct answer)
Cultural meaning of the activity
Timing and sequencing of steps
Social demands of the activity

Correct answer: Required actions and performance skills

Required actions and performance skills directly capture the physical demands — including grip — that must be matched to the client's current abilities.

Question 21: An elderly client with low vision wants to continue cooking independently. The BEST OT approach is to:

Refer exclusively to a vision specialist
Modify the environment with high-contrast markings and adaptive techniques (Correct answer)
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.

Question 22: Which legislation requires employers to provide reasonable accommodations for employees with disabilities?

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

Correct answer: Americans with Disabilities Act (ADA)

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

Question 23: A child with developmental coordination disorder (DCD) MOST benefits from which OT approach?

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

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

Case study
Expert opinion
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 25: A state's OT practice act requires licensure for all OT services. An OT supervisor allows an unlicensed aide to perform skilled OT interventions. The MOST serious consequence is:

A minor administrative fine for the department
License revocation for the supervising OT and potential criminal liability (Correct answer)
Mandatory peer review of department practices
Required additional training for the aide

Correct answer: License revocation for the supervising OT and potential criminal liability

Allowing unlicensed practice of a licensed profession violates state practice acts, which can result in license revocation and criminal charges against the supervising OT.

Question 26: A 68-year-old woman with Parkinson's disease is experiencing difficulty with meal preparation. The OT observes bradykinesia, rigidity, and postural instability during the kitchen evaluation. Which adaptive strategy would be MOST beneficial for improving her safety and independence?

Intensive repetitive practice of fine motor tasks to rebuild automatic movement patterns
Prescription of a standard walker to address postural instability during cooking
Use of weighted utensils, non-slip mats, loop scissors, and a high stool at the counter (Correct answer)
Referral to a neurologist to adjust dopaminergic medication before beginning OT

Correct answer: Use of weighted utensils, non-slip mats, loop scissors, and a high stool at the counter

Adaptive equipment (weighted utensils for tremor, non-slip mats, loop scissors for weak grip, high stool for fatigue/instability) directly compensates for PD motor symptoms during meal prep.

Question 27: What muscle, positioned in the middle of the sole of the foot and supplied by the medial plantar nerve, is laterally to the abductor hallucis?

Flexor digiti minimi brevis
Flexor digitorum brevis (Correct answer)
Flexor hallucis brevis
Abductor digiti minimi

Correct answer: Flexor digitorum brevis

The Flexor digitorum brevis is a superficial muscle in the sole of the foot, positioned centrally. It lies immediately lateral to the abductor hallucis and medial to the abductor digiti minimi, making it centrally located. This muscle is responsible for flexing the lateral four toes and receives its innervation from the medial plantar nerve.

Question 28: Which feeding intervention is evidence-based for children with autism who have severely restricted diets?

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

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 29: The objective of rehabilitation is

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

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

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

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 31: A client with schizophrenia has difficulty engaging in group activities due to disorganized thinking. Which OT group approach is MOST appropriate?

Projective group with abstract art tasks
Verbal psychotherapy group
Insight-oriented group
Task-oriented group with structured, concrete activities (Correct answer)

Correct answer: Task-oriented group with structured, concrete activities

Task-oriented groups with structured, concrete, and simple activities reduce cognitive demands and promote successful participation for clients with disorganized thinking.

Question 32: 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 33: The Glasgow Coma Scale (GCS) is used by OTs primarily to:

Determine need for adaptive equipment
Measure spasticity severity
Establish baseline level of consciousness for treatment planning (Correct answer)
Assess ADL independence in acute care

Correct answer: Establish baseline level of consciousness for treatment planning

GCS scores eye opening, verbal, and motor responses to establish a baseline and track consciousness recovery.

Question 34: What in directional anatomy does the term "lateral" mean?

In between the midline and the dermis
Away from the latissimus dorsi muscle
Away from the midline of the body (Correct answer)
Close to the latissimus dorsi muscle

Correct answer: Away from the midline of the body

In anatomical terminology, 'lateral' describes a position or direction that is further away from the midline of the body. Conversely, 'medial' refers to a position closer to the midline. For example, the ears are lateral to the nose, and the arms are lateral to the torso.

Question 35: A therapist practicing from the Model of Human Occupation (MOHO) completes a Worker Role Interview. This assessment primarily addresses:

Upper extremity strength and grip
Vestibular and proprioceptive processing
Cognitive screening and memory
Psychosocial factors influencing the worker role (Correct answer)

Correct answer: Psychosocial factors influencing the worker role

The Worker Role Interview (WRI) is a MOHO-based semi-structured interview that examines psychosocial and environmental factors affecting a client's return to work.

Question 36: The robotic equipment used for upper limb rehabilitation is which of the following?

Both 1 and 2 (Correct answer)
MIT-MANUS
ARMin robot
Lokomat

Correct answer: Both 1 and 2

Robotic rehabilitation devices are increasingly used to assist in motor recovery, particularly for the upper limbs. The MIT-MANUS and ARMin robot are two prominent examples of such equipment designed for upper limb therapy. These robots provide repetitive, high-intensity, and task-specific training, which can enhance motor learning and functional outcomes for patients with neurological impairments.

Question 37: An occupational therapist formulates goals for a young softball pitcher who has a possible overuse injury. Which objective is the most suitable?

Increase ROM (shoulder extension and abduction)
Increase the strength of the rotator cuff muscles to 5/5
Report no more than 3/10 on a pain scale when engaged in approved softball drill (Correct answer)
Engage in a home exercise program 3x per week

Correct answer: Report no more than 3/10 on a pain scale when engaged in approved softball drill

For an overuse injury, managing pain during activity is a primary and functional goal for a pitcher. This objective is client-centered, measurable, and directly relates to the client's ability to participate in their desired occupation (softball) without excessive pain. While ROM and strength are important, pain management during functional activity is often the most immediate and relevant outcome for an overuse injury.

Question 38: Which standardized assessment measures a child's self-care, mobility, and social function using a caregiver report format?

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

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 39: The saphenous nerve, a branch of the femoral nerve, provides sensory innervation to which area?

Lateral thigh
Medial leg and foot (Correct answer)
Dorsum of the foot
Posterior calf

Correct answer: Medial leg and foot

The saphenous nerve is the terminal sensory branch of the femoral nerve, supplying the medial aspect of the leg from the knee to the medial foot.

Question 40: Which precaution is MOST important for an OT to follow when applying a physical agent modality (PAM)?

Apply PAMs without prior frame of reference training
Use PAMs as a standalone intervention without activity
Avoid documenting PAM use in the medical record
Ensure the client is fully awake and can report sensations (Correct answer)

Correct answer: Ensure the client is fully awake and can report sensations

The client must be alert and able to report sensations (e.g., burning, discomfort) to prevent tissue damage during PAM application.

Question 41: When teaching energy conservation to a patient with osteoarthritis, which principle is MOST important?

Working through pain to maintain function
Pacing activities and taking planned rest breaks throughout the day (Correct answer)
Completing all tasks at once to minimize transitions
Avoiding all physical activity

Correct answer: Pacing activities and taking planned rest breaks throughout the day

Pacing activity with scheduled rest breaks prevents fatigue-induced joint stress, reduces pain flares, and allows sustained participation in meaningful occupations.

Question 42: A twelve-month-old is being evaluated by a therapist in a clinical setting. Which of the following landmarks is not likely to have materialized?

Uses a pincer grasp
Moves from seated into prone
Intentionally releases a small item from their grasp
Controls walking by starting and stopping with intention (Correct answer)

Correct answer: Controls walking by starting and stopping with intention

While a 12-month-old may begin to take a few independent steps, controlling walking by starting and stopping with intention is a more advanced gross motor skill that typically develops later, often closer to 15-18 months or even beyond. At 12 months, pincer grasp, moving from seated to prone, and intentional release are generally established developmental milestones.

Question 43: Which of the following BEST describes the role of occupational justice in OT practice?

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

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 44: Which type of reasoning does an OT use when generating multiple hypotheses about a client's presenting problems and then testing them through evaluation?

Interactive reasoning
Pragmatic reasoning
Diagnostic reasoning (Correct answer)
Narrative reasoning

Correct answer: Diagnostic reasoning

Diagnostic reasoning involves forming and testing hypotheses about the nature of a client's functional problems, similar to clinical problem-solving.

Question 45: Which cranial nerve provides motor innervation to the muscles of facial expression?

Cranial nerve V (trigeminal)
Cranial nerve VII (facial) (Correct answer)
Cranial nerve IX (glossopharyngeal)
Cranial nerve XII (hypoglossal)

Correct answer: Cranial nerve VII (facial)

The facial nerve (CN VII) provides motor innervation to all muscles of facial expression; damage causes ipsilateral facial paralysis (Bell's palsy).

Question 46: 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)
L5-S1
T12-L1
C7-T1

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 47: A patient with C5 spinal cord injury wants to feed themselves independently. Which adaptive equipment would be MOST beneficial?

Universal cuff with utensil slot (Correct answer)
Rocker knife
Built-up handle spoon
Plate guard only

Correct answer: Universal cuff with utensil slot

A universal cuff compensates for the absent hand grip at C5 level, allowing utensil use without active finger flexion.

Question 48: During apoptosis

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

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

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

Correct answer: Independent wheelchair propulsion with tenodesis grip

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

Question 50: In handwriting intervention, the PRINT Tool is used to assess:

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

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 51: Concerning the creation of a new community building, an occupational therapist is working with an architectural firm. They must build a ramp that elevates the user by 16 inches. Which of the following wheelchair ramps does the occupational therapist advise installing in this building to ensure accessibility?

An 8-foot ramp
A 12-foot ramp
A 4-foot ramp
A 16-foot ramp (Correct answer)

Correct answer: A 16-foot ramp

According to Americans with Disabilities Act (ADA) guidelines, the maximum slope for a wheelchair ramp is 1:12. This means for every 1 inch of vertical rise, there must be at least 12 inches (or 1 foot) of horizontal run. For a 16-inch elevation, the minimum ramp length required is 16 inches * 12 = 192 inches, which is equivalent to 16 feet.

Question 52: Which assessment tool is used to measure functional independence in basic ADLs for neurologically impaired clients in inpatient rehab?

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

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 53: A therapist uses the Canadian Occupational Performance Measure (COPM). This tool primarily measures:

Client-perceived performance and satisfaction with occupations (Correct answer)
Muscle strength and ROM
Cognitive status and orientation
Sensory processing patterns

Correct answer: Client-perceived performance and satisfaction with occupations

The COPM is a client-centered outcome measure that captures self-perception of performance and satisfaction across self-care, productivity, and leisure occupations.

Question 54: A therapist uses the Canadian Occupational Performance Measure (COPM). The primary purpose of this assessment is to:

Measure standardized functional independence scores
Identify the client's self-perceived occupational performance priorities (Correct answer)
Screen for cognitive deficits affecting daily living
Assess motor and process skills during task performance

Correct answer: Identify the client's self-perceived occupational performance priorities

The COPM is a client-centered outcome measure that uses a semi-structured interview to identify the client's self-perceived priorities in occupational performance.

Question 55: Under the Assistive Technology Act, assistive technology is defined as any item that is used to:

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

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 56: An OT conducting a driving rehabilitation evaluation should FIRST:

Teach adaptive driving techniques
Complete a comprehensive clinical evaluation of vision, cognition, and motor skills (Correct answer)
Begin on-road evaluation immediately
Recommend license revocation

Correct answer: Complete a comprehensive clinical evaluation of vision, cognition, and motor skills

The clinical evaluation — assessing vision, cognition, perception, and motor function — must precede on-road testing to establish baseline abilities and ensure safety.

Question 57: A therapist is documenting in SOAP note format. A statement about the client's subjective complaint of pain with writing belongs in which section?

S (Subjective) (Correct answer)
A (Assessment)
P (Plan)
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 58: Which of the following back muscles does not belong to the superficial group?

Rhomboid minor
Trapezius
Subscapularis (Correct answer)
Latissimus dorsi

Correct answer: Subscapularis

The superficial back muscles, such as the trapezius, latissimus dorsi, and rhomboid minor, are primarily involved in movements of the upper limb and scapula. The subscapularis muscle, however, is located on the anterior surface of the scapula and is one of the four muscles of the rotator cuff, making it a deep shoulder muscle rather than a superficial back muscle.

Question 59: Which assessment is standardized and used to evaluate sensory processing in school-age children?

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

Correct answer: Sensory Profile 2 (SP2)

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

Question 60: Which work rehabilitation approach is used when a client with mental illness needs to build work skills in a real, paid employment setting?

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

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 61: In analyzing lifting tasks for ergonomic OT intervention, the NIOSH lifting equation calculates a Recommended Weight Limit (RWL). Which factor has the greatest potential to reduce RWL from its maximum?

Frequency of lifts per minute
Asymmetry angle of the lift
Vertical height of the lift origin
Horizontal distance of the load from the body (Correct answer)

Correct answer: Horizontal distance of the load from the body

Horizontal distance (H) is the most influential multiplier in the NIOSH equation because torque on the lumbar spine increases dramatically as load moves away from the body.

Question 62: 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
Strengthening shoulder abductors with resistive exercise
Scar management and compression garments
Passive range of motion and positioning to prevent contracture (Correct answer)

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 63: In the context of hand therapy, the A1 pulley is located at the level of which structure?

Proximal phalanx
Metacarpophalangeal joint (Correct answer)
Middle phalanx
Distal interphalangeal joint

Correct answer: Metacarpophalangeal joint

The A1 pulley overlies the metacarpophalangeal joint and is the site most commonly involved in trigger finger (stenosing tenosynovitis).

Question 64: In a partial hospitalization program, OT groups MOST appropriately focus on:

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

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

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

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 66: During normal gait, which phase accounts for approximately 60% of the gait cycle?

Swing phase
Pre-swing phase
Stance phase (Correct answer)
Double support phase

Correct answer: Stance phase

Stance phase (foot contact with ground) comprises approximately 60% of the gait cycle, while swing phase accounts for the remaining 40%.

Question 67: What number of muscles connect to the talus?

Two
One
Three
Zero (Correct answer)

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 68: Which ethical principle requires an OT to tell a client truthfully about their prognosis, even if the news is difficult?

Veracity (Correct answer)
Beneficence
Justice
Nonmaleficence

Correct answer: Veracity

Veracity is the ethical obligation to provide accurate and honest information to clients, even when the truth is difficult to share.

Question 69: During normal standing, the line of gravity relative to the knee joint falls:

Anterior to the knee, keeping it extended passively (Correct answer)
Directly through the knee axis with no moment arm
Posterior to the knee, requiring active quadriceps contraction
Medial to the knee, stressing the lateral collateral ligament

Correct answer: Anterior to the knee, keeping it extended passively

The body's line of gravity passes anterior to the knee joint axis during relaxed standing, creating an extension moment that keeps the knee locked without significant muscle effort.

Question 70: Rankin Scale Modified Level 2 Devotees -

Severe disability
Moderate disability
Slight disability (Correct answer)
No significant disability

Correct answer: Slight disability

The Modified Rankin Scale (mRS) is a common tool used to measure the degree of disability or dependence in daily activities for people who have experienced a stroke or other neurological conditions. A score of Level 2 on the mRS indicates 'Slight disability; unable to carry out all previous activities, but able to manage own affairs without assistance.' This means they can live independently but may have some limitations in complex tasks.

Question 71: Which splint is MOST appropriate for a patient diagnosed with de Quervain's tenosynovitis?

Thumb spica splint immobilizing the CMC and MCP joints of the thumb (Correct answer)
Wrist cock-up splint
Finger extension splint
Ulnar gutter splint

Correct answer: Thumb spica splint immobilizing the CMC and MCP joints of the thumb

A thumb spica splint immobilizes the first CMC and MCP joints to rest the abductor pollicis longus and extensor pollicis brevis tendons that are inflamed in de Quervain's tenosynovitis.

Question 72: Which of the following muscles has its origins on the pubis and is one of three that inserts into the "pes anserinus," or anteromedial aspect, of the tibia?

Gracilis (Correct answer)
Vastus lateralis
Adductor brevis
Tensor fasciae latae

Correct answer: Gracilis

The Gracilis muscle originates from the inferior ramus of the pubis and inserts onto the anteromedial surface of the proximal tibia. This insertion point is part of the 'pes anserinus,' a common tendon shared with the Sartorius and Semitendinosus muscles. The Gracilis is unique among the adductors as it crosses both the hip and knee joints.

Question 73: An OT client presents with 'claw hand' deformity affecting the ring and little fingers. Which nerve injury is most likely?

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

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 74: An OT is using the Dynamic Interactional Model (Toglia) with a stroke patient who has unilateral neglect. The therapist asks the patient to cross out all stars on a page and then asks 'How many do you think you missed?' This technique is BEST described as:

Errorless learning to prevent consolidation of incorrect responses
Metacognitive strategy training to improve self-monitoring and awareness of performance (Correct answer)
Compensatory scanning training using systematic left-field anchor techniques
Cognitive retraining using tabletop tasks to remediate neglect directly

Correct answer: Metacognitive strategy training to improve self-monitoring and awareness of performance

Asking patients to predict and self-evaluate their performance is a metacognitive strategy training technique central to Toglia's Dynamic Interactional Model.

Question 75: Which vertebral level corresponds to the umbilicus dermatome, useful for assessing thoracic spinal cord injury?

T12
T6
T10 (Correct answer)
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 76: Thermometer sterilization is best accomplished using:

Gamma radiation
Autoclave
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 77: A billing audit reveals that an OT has been routinely billing for 97530 (therapeutic activities) when providing skilled teaching for home management tasks. This is BEST described as:

Upcoding (Correct answer)
Downcoding
Unbundling
Medically unnecessary billing

Correct answer: Upcoding

Upcoding means billing a higher-reimbursing code than the service actually rendered, which is a form of healthcare fraud.

Question 78: 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 79: An OT is interpreting the results of a sensory evaluation for a 9-year-old child. The Sensory Profile 2 (Dunn's model) shows the child scores in the 'Bystander' quadrant with high registration thresholds and passive self-regulation. Which clinical presentation would you MOST expect?

The child overreacts to ordinary sounds and textures with emotional meltdowns
The child actively avoids sensory input by withdrawing from group activities and wearing minimal clothing
The child is constantly moving, seeking intense sensory experiences to meet high thresholds
The child appears slow to notice sensory stimuli, seems 'in their own world,' and misses social cues and instructions (Correct answer)

Correct answer: The child appears slow to notice sensory stimuli, seems 'in their own world,' and misses social cues and instructions

Dunn's Bystander pattern: high neurological threshold + passive self-regulation = the child does not receive enough sensory information and appears passive, misses stimuli, and seems inattentive.

Question 80: Which of the following statements about the knee joint's Q-angle is clinically most relevant in OT?

A Q-angle greater than 15–18° in females may predispose to patellofemoral dysfunction (Correct answer)
A smaller Q-angle increases risk of iliotibial band syndrome
A larger Q-angle in males increases risk of patellar subluxation
Q-angle has no bearing on lower extremity alignment or function

Correct answer: A Q-angle greater than 15–18° in females may predispose to patellofemoral dysfunction

Women typically have a larger Q-angle (>15–18°) due to wider pelvis, which increases lateral pull on the patella and risk of patellofemoral pain syndrome.

Question 81: Which rotator cuff muscle is most commonly torn in overhead occupational tasks?

Supraspinatus (Correct answer)
Infraspinatus
Subscapularis
Teres minor

Correct answer: Supraspinatus

The supraspinatus tendon passes under the acromion and is most vulnerable to impingement and tearing during overhead activities.

Question 82: Which anatomical landmark is used to locate the median nerve at the wrist for carpal tunnel assessment?

Ulnar styloid process
Flexor carpi radialis tendon
Palmaris longus tendon (Correct answer)
Pisiform bone

Correct answer: Palmaris longus tendon

The median nerve lies just radial (lateral) to the palmaris longus tendon at the wrist; this tendon serves as a reliable surface landmark for nerve localization.

Question 83: During a home evaluation, an OT notices a client with hemiplegia cannot safely transfer from the toilet. The FIRST intervention priority should be:

Recommending a power wheelchair
Initiating constraint-induced movement therapy
Prescribing ankle-foot orthoses
Installing grab bars and a raised toilet seat (Correct answer)

Correct answer: Installing grab bars and a raised toilet seat

Safety during toilet transfers is a critical ADL concern, and grab bars with a raised toilet seat provide immediate, evidence-based environmental modification to reduce fall risk.

Question 84: Which of the following does "Maslow's self actualization theory" not consider to be a characteristic of "optimal people"?

Spontaneous, autonomous, Independent
Open to experience with full concentration and total absorption
In tune with themselves, their inner beings
Accepts conformity to the culture (Correct answer)

Correct answer: Accepts conformity to the culture

Maslow's theory of self-actualization describes individuals who have reached their full potential. These 'optimal people' are characterized by traits like spontaneity, autonomy, independence, and a deep connection to their inner selves. They tend to be non-conformist and resistant to enculturation, prioritizing personal growth and authenticity over societal expectations or cultural norms.

Question 85: Push-in OT treatments are being provided to a preschooler in their early education classroom. The kid starts screaming and runs around the classroom when the fire alarm goes off. Which tool could the therapist utilize at that time from a sensory perspective?

Giving the child a tight hug and hand squeezes (Correct answer)
Directing the child to a 'cozy corner'
Offering a transition item
Telling the child to spin around 10 times

Correct answer: Giving the child a tight hug and hand squeezes

The child is likely experiencing sensory overload and dysregulation due to the sudden, loud fire alarm. Deep pressure input, such as a tight hug and hand squeezes, provides proprioceptive input that can be calming and organizing for the nervous system. This type of input helps to regulate arousal levels, reduce sensory defensiveness, and offer immediate comfort, helping the child regain emotional and behavioral control.

Question 86: The SIPT (Sensory Integration and Praxis Tests) primarily assesses:

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

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

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

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 88: 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%
25%
100%
50% (Correct answer)

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 89: Samuel, a 30-year-old man, is being assessed after his multiple sclerosis symptoms worsened. A comprehensive occupational profile with a stronger emphasis on performance skills will be developed by the occupational therapist. Which of the following is a performance skill example?

Muscle tone
Routines
Values
Ability to pace (Correct answer)

Correct answer: Ability to pace

Performance skills are observable, goal-directed actions that a person uses to engage in daily life occupations. The 'ability to pace' is a process skill, which is a category of performance skills, reflecting how an individual manages their energy, effort, and timing during an activity. In contrast, values are client factors, routines are performance patterns, and muscle tone is a client factor (body function), not an observable action.

Question 90: 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?

For seated typing, the work surface should be no more than 35" high
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)
Wrists should be positioned in neutral

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 91: A young adult patient in a mental health rehab facility has rejected to take part in group and one-on-one activities. Which evaluation ought the occupational therapist to choose in order to establish a baseline for the client's roles and use the information to produce goals that are motivating?

Mini-Mental State Evaluation (MMSE)
Canadian Occupational Performance Measure (COPM) (Correct answer)
Allen Cognitive Level Screen-5 (ACLS-5)
Activity Card Sort (ACS)

Correct answer: Canadian Occupational Performance Measure (COPM)

The COPM is a client-centered, individualized outcome measure that helps clients identify and prioritize their occupational performance issues. It is ideal for establishing a baseline of roles and identifying motivating goals because it directly asks the client about their perceived performance and satisfaction in areas they want to address. This approach respects client autonomy and can increase engagement, especially for a reluctant client.

Question 92: Which of the following statements about Gower's sign is accurate?

Seen in Facioscapulohumeral muscular dystrophy
The patient usually assumes a four-point stance on knees and hands
Patients with proximal weakness involving the pelvic girdle muscles
Both 1 and 2 (Correct answer)

Correct answer: Both 1 and 2

Gower's sign is a classic indicator of proximal muscle weakness, particularly affecting the pelvic girdle and lower extremities. Patients exhibit this sign by using their hands to 'walk up' their legs to achieve an upright standing position from a prone or sitting position. This compensatory maneuver is necessary because their weak hip and thigh muscles cannot extend the trunk directly.

Question 93: A client with C4 complete SCI wants to control a computer independently. The MOST appropriate interface is:

Trackball mouse
Foot mouse
Standard keyboard with wrist supports
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 94: In a patient with C6 spinal cord injury, which muscle function is preserved that allows tenodesis grasp?

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

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 95: When using a top-down assessment approach, the OT FIRST evaluates:

Range of motion and muscle strength
Occupational roles and participation (Correct answer)
Neurological reflexes
Cognitive and perceptual skills

Correct answer: Occupational roles and participation

A top-down approach begins by identifying the client's occupational roles and areas of participation before examining underlying performance components.

Question 96: 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
Dynamic extension (Correct answer)
Dorsal protection
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 97: The Wellness Recovery Action Plan (WRAP) tool used in OT mental health practice helps clients:

Design home modification plans for physical disabilities
Identify personal wellness strategies and early warning signs of relapse (Correct answer)
Complete vocational interest inventories for employment
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 98: Which rotator cuff muscle is most commonly torn and is responsible for initiating shoulder abduction from 0–15 degrees?

Teres minor
Supraspinatus (Correct answer)
Subscapularis
Infraspinatus

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

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

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 100: Which is heavier, cancellous bone or compact bone? Then why?

CMCJ of Thumb
A. Compact. B. Because it's less porous (more dense). (Correct answer)
Traction (distraction)
Anterior/ventral

Correct answer: A. Compact. B. Because it's less porous (more dense).

Compact bone, also known as cortical bone, is denser and less porous than cancellous (spongy) bone. Its tightly packed structure makes it heavier and stronger, providing rigidity and resistance to bending. Cancellous bone, with its trabecular network, is lighter due to its porous nature, offering strength without excessive weight.

Question 101: When analyzing torque in a therapeutic exercise, which variable, if doubled, would have the greatest effect on increasing torque?

The moment arm length (Correct answer)
The mass of the segment
The angle of muscle pull
The velocity of movement

Correct answer: The moment arm length

Torque = Force × moment arm; doubling the moment arm doubles the torque, making it the most direct way to increase rotational force in joint mechanics.

Question 102: An OT department is implementing the Kawa (River) Model for assessment. This model is MOST useful for:

Quantifying functional independence for insurance billing
Understanding occupational performance through a culturally relevant, metaphorical narrative (Correct answer)
Measuring fine motor coordination deficits precisely
Analyzing biomechanical demands of work tasks

Correct answer: Understanding occupational performance through a culturally relevant, metaphorical narrative

The Kawa Model uses a river metaphor to explore how cultural context, life circumstances, and personal assets shape occupational flow and meaning.

Question 103: Causes of severe acute respiratory syndrome include:

RSV
Corona virus type (Correct answer)
HINI
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 104: 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:

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

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 105: What trunk joint motion is involved in picking up a pencil from the floor next to your chair?

Torsional
Ipsilateral
Concave
Lateral Bending (Correct answer)

Correct answer: Lateral Bending

Picking up a pencil from the floor next to your chair typically involves bending the trunk sideways towards the object. This movement is specifically known as lateral bending or lateral flexion of the trunk. It occurs in the frontal plane, allowing the body to reach to one side.

Question 106: 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?

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

Correct answer: Required body functions

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

Question 107: Which of the following best describes the 'force couple' that produces scapular upward rotation during shoulder elevation?

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

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

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

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

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

Rooting reflex
Asymmetrical Tonic Neck Reflex (ATNR) (Correct answer)
Moro reflex
Palmar grasp 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 111: Which lung lobe is most commonly affected by aspiration pneumonia in a supine patient?

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

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 112: The role of OT in an assistive technology evaluation is BEST described as:

Assess client needs and match to AT devices; train in use and monitor outcomes (Correct answer)
Delegate all AT decisions to a rehabilitation engineer
Program and repair AT devices exclusively
Prescribe AT devices and bill under medical equipment codes

Correct answer: Assess client needs and match to AT devices; train in use and monitor outcomes

OT's AT role spans assessment, feature matching, trial, prescription justification, training, and follow-up to ensure functional outcomes.

Question 113: Which play assessment evaluates the child's internal motivation and degree of playfulness rather than skill level?

Hawaii Early Learning Profile (HELP)
Bayley Scales of Infant Development
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 114: A pediatric OT recommends a pencil grip adapter for a child with developmental coordination disorder (DCD). This is an example of which intervention approach from the OTPF?

Restore
Prevent
Modify (Compensate) (Correct answer)
Establish/Create

Correct answer: Modify (Compensate)

The Modify/Compensate approach uses adaptive strategies or tools to allow performance despite impairments; a pencil grip adapter compensates for poor fine motor control.

Question 115: The brain's Brodmann's region No. 4 stands for -

Primary motor cortex area (Correct answer)
Primary sensory area
Premotor area
Sensory somatic association area

Correct answer: Primary motor cortex area

Brodmann's area 4 is anatomically known as the primary motor cortex (M1). Located in the precentral gyrus of the frontal lobe, this region is critically involved in planning and executing voluntary movements. It contains large pyramidal neurons that project directly to the spinal cord, controlling fine motor skills and muscle contractions throughout the body.

Question 116: A 35-year-old construction worker is recovering from a traumatic brain injury (TBI) and reports difficulty returning to work. The OT uses the Model of Human Occupation (MOHO) to guide evaluation. Which MOHO concept BEST explains why the worker's strong prior work identity is an asset in rehabilitation?

Occupational identity, which motivates engagement and goal-directed behavior (Correct answer)
Habituation, which refers to automatic routines that organize daily behavior
Performance capacity based on objective musculoskeletal abilities
Volition, specifically personal causation related to skill belief

Correct answer: Occupational identity, which motivates engagement and goal-directed behavior

MOHO's occupational identity represents one's cumulative sense of who one is as an occupational being, providing motivational drive for rehabilitation.

Question 117: 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 cuff
Wheel ring
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 118: 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?

Measurable
Attainable (Correct answer)
Relevant
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 119: 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
Desensitization using a vibrating toothbrush starting at cheeks, then gums (Correct answer)
Recommending dental sedation for all cleanings
Eliminating toothbrushing and substituting mouthwash

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 120: Which occupational analysis framework focuses on the transaction between the person, environment, and occupation to understand performance?

Person-Environment-Occupation (PEO) Model (Correct answer)
Sensory Integration Theory
Cognitive Disabilities Model
Biomechanical Frame of Reference

Correct answer: Person-Environment-Occupation (PEO) Model

The PEO Model examines the dynamic transaction among person, environment, and occupation to identify where performance issues arise.

Question 121: Which burn classification requires skin grafting and results in minimal pain due to nerve destruction?

Full-thickness (third-degree) burn (Correct answer)
Deep partial-thickness burn
Superficial partial-thickness burn
Superficial (first-degree) burn

Correct answer: Full-thickness (third-degree) burn

Full-thickness burns destroy all skin layers including nerves, causing minimal pain but requiring skin grafting for wound closure.

Question 122: Which assessment tool is used to evaluate two-point discrimination following peripheral nerve injury?

Semmes-Weinstein monofilament testing
Grip strength dynamometry
Disk-Criminator or aesthesiometer (Correct answer)
Active range of motion goniometry

Correct answer: Disk-Criminator or aesthesiometer

Two-point discrimination is assessed with a Disk-Criminator or aesthesiometer, which measures the minimum distance at which two simultaneous touch stimuli are perceived as separate.

Question 123: At the age of -, the Asymmetrical Tonic Neck Reflex (ATNR) vanishes.

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

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

Lecture-based instruction about social etiquette rules
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)

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

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

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

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

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 127: Which of the following statements about neuropraxia is accurate?

Complete disruption of the axon and all supporting connective tissue structure, whereby the endoneurium, perineurium, and epineurium are no longer in continuity
Severance of entire nerve
Mild degree of neural insult that results in blockage of impulse conduction across the affected segment
Specific type of nerve injury where only the axon is physically disrupted, with preservation of the enveloping endoneurial and other supporting connective issue structures (Correct answer)

Correct answer: Specific type of nerve injury where only the axon is physically disrupted, with preservation of the enveloping endoneurial and other supporting connective issue structures

This statement accurately defines axonotmesis, a type of nerve injury where the axon is severed, but the surrounding connective tissue sheaths (endoneurium, perineurium, epineurium) remain intact. This preservation allows for potential regeneration of the axon along its original pathway. While the question asks about 'neuropraxia,' which is a temporary conduction block without structural damage, the provided correct answer describes axonotmesis.

Question 128: Joint Capsule

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?
What joint structure surrounds & encases the joint & protects the articular surfaces? (Correct answer)
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 129: An occupational therapy examination is requested for a patient with a full T5 spinal cord damage. What about this client needs to be evaluated the most?

Ability to propel a manual wheelchair
Safety with swallowing
Seated balance (Correct answer)
Level of assistance needed for toileting

Correct answer: Seated balance

A T5 spinal cord injury results in paralysis below the mid-thoracic level, meaning the trunk muscles below T5 are affected. This significantly impacts trunk control and seated balance, which are crucial for all functional activities performed from a seated position, such as dressing, eating, and wheelchair mobility. Evaluating seated balance is therefore a primary concern for this client.

Question 130: 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:

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

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 131: 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)
A physician-prescribed intervention plan
A medical necessity in the student's health record
An optional enrichment activity approved by parents

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 132: An individual who works in a call center is assessed by an occupational therapist who practices in an outpatient clinic. After repeatedly reaching for her desktop phone throughout the day, the patient complains of tingling and numbness in her right forearm and hand. Which test ought to be conducted by the occupational therapist?

Tinel's sign at the wrist
Froment's sign
Tinel's sign at the elbow (Correct answer)
Tinel's sign at the forearm

Correct answer: Tinel's sign at the elbow

Tingling and numbness in the forearm and hand, especially with repetitive reaching, suggests potential nerve compression. Tinel's sign at the elbow specifically tests for ulnar nerve irritation or compression at the cubital tunnel, which is a common site for such symptoms related to repetitive elbow flexion and extension. The ulnar nerve supplies sensation to parts of the forearm and hand, making this the most appropriate diagnostic test for the described symptoms.

Question 133: Which type of aphasia is characterized by fluent speech with paraphasias, poor auditory comprehension, and poor repetition?

Wernicke's aphasia (Correct answer)
Conduction aphasia
Broca's aphasia
Global aphasia

Correct answer: Wernicke's aphasia

Wernicke's aphasia presents with fluent but meaningless speech (jargon/paraphasias), severely impaired comprehension, and poor repetition.

Question 134: Which reflex, when retained past 6 months of age, can interfere with a child's ability to develop independent hand use and rolling?

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

Correct answer: Asymmetrical Tonic Neck Reflex (ATNR)

A retained ATNR causes the arm to extend when the head turns to that side, disrupting midline hand use, rolling, and bilateral coordination.

Question 135: A 3-year-old child is being evaluated for fine motor delays. Which assessment is MOST appropriate?

FIM (Functional Independence Measure)
AMPS (Assessment of Motor and Process Skills)
COPM (Canadian Occupational Performance 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 136: When recommending a power wheelchair, the seating evaluation MUST address which factor FIRST?

Joystick location and sensitivity
Battery range and charging requirements
Postural support and pressure relief needs (Correct answer)
Seat cushion color preference

Correct answer: Postural support and pressure relief needs

Postural support and pressure relief are foundational; without adequate positioning, the client cannot access controls or prevent pressure injuries.

Question 137: A client with rheumatoid arthritis asks about joint protection. Which instruction reflects correct joint protection principles?

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

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 138: Which intrinsic foot muscle, important for arch support during standing activities in OT, is often targeted in foot orthotic interventions?

Flexor digitorum longus
Extensor digitorum brevis
Abductor hallucis (Correct answer)
Tibialis anterior

Correct answer: Abductor hallucis

The abductor hallucis supports the medial longitudinal arch and is frequently weakened in clients with pes planus, making it a target for strengthening and orthotic support.

Question 139: 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 140: Which muscle is the primary responsible for the 'power' phase of the jaw during mastication and is assessed when evaluating cranial nerve V function in OT?

Medial pterygoid
Temporalis
Lateral pterygoid
Masseter (Correct answer)

Correct answer: Masseter

The masseter is the most powerful jaw-closing muscle and is the primary muscle producing biting force, innervated by the mandibular branch of CN V.

Question 141: When the teeth are clenched or when the mouth is slightly open, is the TMJ (jaw) in the close-packed position?

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)
A. Compact. B. Because it's less porous (more dense).
When the teeth are clenched (Correct answer)
Diaphysis

Correct answer: When the teeth are clenched

The close-packed position of a joint is where the joint surfaces are maximally congruent and the ligaments are most taut, providing maximum stability. For the temporomandibular joint (TMJ), this occurs when the teeth are clenched, as the condyle is fully seated in the mandibular fossa and the articular disc is compressed.

Question 142: Which intervention is CONTRAINDICATED during the acute inflammatory phase of a musculoskeletal injury?

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

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 143: An OT is treating a client with Swan neck deformity. Which joint positions characterize this deformity?

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

Correct answer: PIP hyperextension and DIP flexion

Swan neck deformity presents with PIP joint hyperextension and DIP joint flexion, commonly caused by intrinsic muscle tightness or volar plate laxity.

Question 144: A child scores below the 16th percentile on the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2). This indicates:

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

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

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

Correct answer: Shorten the duration of the activity

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

Question 146: Which recovery-oriented principle should guide OT practice in mental health settings?

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

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

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

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 148: 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?

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

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

Caregiver-managed medication administration
Automated pill dispenser with alarm
Large-print pill organizer with tactile labels (Correct answer)
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 150: A client with moderate dementia is unable to initiate dressing. Which OT strategy is MOST appropriate?

Provide written step-by-step instructions
Provide full physical assistance and complete dressing for the client
Encourage the client to problem-solve independently
Use hand-over-hand guidance and verbal cues in a consistent routine (Correct answer)

Correct answer: Use hand-over-hand guidance and verbal cues in a consistent routine

Hand-over-hand guidance with verbal cues and consistent routine supports procedural memory and promotes remaining independence in clients with dementia.

Question 151: Social issues affecting the disabled

Poor implementation of policies and schemes
Inadequate data and statistics
Discrimination
All of the above (Correct answer)

Correct answer: All of the above

Individuals with disabilities often face a multitude of social issues that hinder their full participation and well-being. These include a lack of comprehensive data and statistics, poor implementation of existing policies and schemes, and pervasive societal discrimination. All these factors create significant barriers to their inclusion and equal opportunities.

Question 152: The brachial plexus originates from which spinal cord levels?

C3–C7
C5–T1 (Correct answer)
C6–T2
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 153: In which bone is the olecranon fossa located?

Fibula
Humerus (Correct answer)
Ulna
Radius

Correct answer: Humerus

The olecranon fossa is a deep depression located on the posterior aspect of the distal humerus. This fossa serves as a crucial anatomical feature, accommodating the olecranon process of the ulna when the elbow joint is fully extended. This interaction allows for the complete extension of the forearm.

Question 154: A client with major depressive disorder declines to participate in morning ADL routines. The BEST OT strategy is:

Postpone intervention until the client's mood improves
Begin with brief, achievable tasks within the client's capacity and build gradually (Correct answer)
Provide complete ADL assistance to prevent exhaustion
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 155: The COPM (Canadian Occupational Performance Measure) is most useful in mental health OT because it:

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

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 156: An OT is analyzing a client's pinch strength. Which joint is primarily stabilized by the first dorsal interosseous muscle during lateral (key) pinch?

Metacarpophalangeal joint of the index finger (Correct answer)
Proximal interphalangeal joint of the index finger
Interphalangeal joint of the thumb
Carpometacarpal joint of the thumb

Correct answer: Metacarpophalangeal joint of the index finger

The first dorsal interosseous abducts the index finger and stabilizes its MCP joint, providing the radial force necessary for lateral pinch against the thumb.

Question 157: Which approach emphasizes modifying the task or environment rather than remediating the child's underlying impairment?

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

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 158: 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 safe to resume immediately as it requires less than 1 MET
The OT cannot address this topic; only the cardiologist can provide sexual activity guidelines
Sexual activity requires 8–10 METs and should be avoided for 6 months after MI
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)

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 159: In the OT practice framework (OTPF), 'habits' are classified under which aspect of the domain?

Client factors
Performance skills
Performance patterns (Correct answer)
Occupations

Correct answer: Performance patterns

Habits, along with routines, rituals, and roles, are classified as performance patterns in the OTPF, reflecting automatic behaviors that support or interfere with function.

Question 160: Which OT model specifically guides understanding of how habits and routines support mental health recovery?

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

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

Assess caregiver burden and connect them with support resources (Correct answer)
Ignore the caregiver and focus solely on the client
Discharge the client to a facility
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 162: A new OT manager wants to reduce staff burnout. According to organizational management theory, which strategy is MOST evidence-supported?

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

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 163: An OT receives a referral for a 16-year-old with autism spectrum disorder (ASD, Level 2) to address social participation. The MOST occupation-based approach would be to:

Focus solely on sensory processing to reduce behaviors that interfere with social participation
Use interest-based activities in a naturalistic social group to build genuine peer interaction skills (Correct answer)
Provide a social skills workbook for the adolescent to complete independently
Conduct discrete trial training (DTT) drills for greeting and turn-taking behaviors in a therapy room

Correct answer: Use interest-based activities in a naturalistic social group to build genuine peer interaction skills

Occupation-based OT practice uses the client's interests in naturalistic contexts — not decontextualized drills — to build meaningful social participation skills.

Question 164: Which of the following does the Tibialis Anterior not perform?

Inversion of the foot
Dorsiflexion of the foot
Maintains lateral longitudinal arch of the foot (Correct answer)
Keep the leg vertical while walking on an uneven ground

Correct answer: Maintains lateral longitudinal arch of the foot

The Tibialis Anterior muscle is a primary dorsiflexor and invertor of the foot. It plays a crucial role in lifting the foot during the swing phase of gait and controlling foot placement on uneven ground. While it contributes to maintaining the medial longitudinal arch, it does not primarily maintain the lateral longitudinal arch, which is supported more by muscles like the fibularis (peroneus) longus and brevis.

Question 165: A client post-TBI demonstrates confabulation. The OT should:

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

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 166: A collaborative leader must carry out these two tasks to ensure that the team can effectively collaborate on care and generate synergy:

Relationship and task orientation (Correct answer)
Goal and task orientation
Objective and goal orientation
Relationship and goal orientation

Correct answer: Relationship and task orientation

Effective collaborative leadership requires a balance between focusing on the tasks at hand (task orientation) and fostering positive interpersonal relationships within the team (relationship orientation). Task orientation ensures that goals are met and work is completed efficiently, while relationship orientation builds trust, communication, and cohesion, which are vital for synergy and effective teamwork in healthcare.

Question 167: An OT completing a job demands analysis for a worker with a rotator cuff injury should PRIMARILY assess which factor?

The frequency, duration, and intensity of overhead reaching required by the job (Correct answer)
The worker's educational background and training history
The worker's job satisfaction and morale
The employer's financial capacity for workplace modifications

Correct answer: The frequency, duration, and intensity of overhead reaching required by the job

For a rotator cuff injury, assessing overhead reaching demands directly determines whether the job is safe to return to and what modifications are needed.

Question 168: According to AOTA's Occupational Therapy Practice Framework (OTPF), 'rest and sleep' are categorized under which occupation domain?

Leisure
Instrumental Activities of Daily Living (IADL)
Health Management
Occupations — Rest and Sleep (Correct answer)

Correct answer: Occupations — Rest and Sleep

The OTPF 4th edition identifies Rest and Sleep as a distinct occupational domain alongside ADLs, IADLs, education, work, play, leisure, and social participation.

Question 169: Under Medicare Part B, an OT working in an outpatient setting must demonstrate 'skilled care' in documentation. Which statement BEST supports medical necessity?

The diagnosis alone justifies the services provided
The patient's family requests continued treatment
The patient's condition requires the expertise of a licensed therapist to achieve measurable functional goals (Correct answer)
The patient enjoys the treatment sessions

Correct answer: The patient's condition requires the expertise of a licensed therapist to achieve measurable functional goals

Medicare requires documentation showing that the patient's condition necessitates skilled OT to achieve specific, measurable functional outcomes.

Question 170: Early intervention services under IDEA Part C are designed for children aged:

3 to 5 years
Birth to 3 years (Correct answer)
Birth to 5 years
5 to 21 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 171: Which ethical principle is violated when an OT shares a client's protected health information with a non-treating family member without the client's consent?

Non-maleficence
Beneficence
Confidentiality (Fidelity) (Correct answer)
Justice

Correct answer: Confidentiality (Fidelity)

Sharing protected health information without consent violates confidentiality, an ethical and legal obligation upheld under both AOTA's Code of Ethics and HIPAA.

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

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds