NBCOT OT Exam Domain Knowledge Flashcards

An OT is treating a 55-year-old woman after a total hip replacement (posterior approach) who needs to dress her lower extremities. Which precaution must guide the OT's intervention during dressing training?

Answer: Avoid hip flexion beyond 90°, adduction past midline, and internal rotation

Posterior approach THA precautions prohibit hip flexion >90°, adduction past midline, and internal rotation to prevent posterior dislocation of the prosthetic hip.

A school-based OT is evaluating a 7-year-old with difficulty writing legibly. The teacher reports the child presses very hard with the pencil, fatigues quickly, and has trouble maintaining proper pencil grasp. Which assessment would provide the MOST useful information for intervention planning?

Answer: Evaluation of Written Language (ETCH) for legibility plus sensory processing assessment for proprioceptive feedback issues

ETCH measures functional handwriting legibility, while proprioceptive assessment explains the hard pressing and fatigue — both are needed for a complete picture.

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

Answer: Independent manual wheelchair propulsion with gloves and hand rim modifications

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

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

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

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

A 28-year-old woman with rheumatoid arthritis reports severe morning stiffness and joint pain in her hands. Using the biomechanical frame of reference and joint protection principles, which recommendation should the OT prioritize?

Answer: Use larger, stronger joints for tasks; avoid sustained grip; use adaptive equipment to reduce joint stress during morning routines

Joint protection principles in RA include using larger/stronger joints, avoiding sustained grip, and reducing mechanical stress — all while respecting pain and inflammation limits.

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:

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.

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:

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.