NBCOT Occupational Therapist Exam — Questions and Answers

Question 1: A 72-year-old man with right hemiplegia following a stroke is referred for OT evaluation. The occupational therapist administers the Functional Independence Measure (FIM). Which domain does the FIM primarily assess?

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

Correct answer: Motor and cognitive functional independence in daily activities

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

Question 2: Which of the following does "Maslow's self actualization theory" not consider to be a characteristic of "optimal people"?

Spontaneous, autonomous, Independent
In tune with themselves, their inner beings
Open to experience with full concentration and total absorption
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 3: A client with PTSD avoids leaving home and attending appointments. Which OT intervention is MOST appropriate?

Recommending permanent home-based employment only
Graded community reintegration with sensory coping strategies (Correct answer)
Restricting all community participation until trauma is processed
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 4: A client with C6 spinal cord injury (complete) has preserved wrist extension but no finger flexion. Which adapted technique allows this client to perform basic grasp?

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

Correct answer: Tenodesis grasp

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

Question 5: Hand-knee gait is frequently caused by:

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

Correct answer: Weakness of quadriceps

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

Question 6: Under Medicare Part B, an OT working in an outpatient setting must demonstrate 'skilled care' in documentation. Which statement BEST supports medical necessity?

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

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 7: 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 8: 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
Provide a social skills workbook for the adolescent to complete independently
Use interest-based activities in a naturalistic social group to build genuine peer interaction skills (Correct answer)
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 9: Which joint protection principle is MOST important to teach a patient with rheumatoid arthritis who presents with ulnar drift?

Maximizing joint use throughout the entire day
Using large muscle groups and larger joints whenever possible
Avoiding all hand-based activities
Avoiding activities that promote ulnar deviation of fingers (Correct answer)

Correct answer: Avoiding activities that promote ulnar deviation of fingers

Avoiding activities that create ulnar deviation forces at the MCP joints is critical to preventing progression of ulnar drift in rheumatoid arthritis.

Question 10: An OT is treating a client with Swan neck deformity. Which joint positions characterize this deformity?

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

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

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

Correct answer: Asymmetrical Tonic Neck Reflex (ATNR)

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

Question 12: A client with spastic cerebral palsy has difficulty with eating due to involuntary arm movements. Which adaptive equipment is MOST helpful?

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

Correct answer: Weighted utensils and non-slip plate guard

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

Question 13: Which assessment is standardized and used to evaluate sensory processing in school-age children?

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

Correct answer: Sensory Profile 2 (SP2)

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

Question 14: A burn patient is in the remodeling phase of wound healing. The OT's PRIORITY during this phase is to:

Debride necrotic tissue
Apply compressive garments and stretching to minimize hypertrophic scarring (Correct answer)
Protect the wound from infection
Begin passive range of motion only

Correct answer: Apply compressive garments and stretching to minimize hypertrophic scarring

During the remodeling phase, compressive garments and stretching exercises are used to align collagen fibers and reduce hypertrophic scar formation.

Question 15: A child scores below the 16th percentile on the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2). This indicates:

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

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

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

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

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

Question 17: Which pressure-relieving wheelchair cushion type is MOST appropriate for a client at HIGH risk for pressure injuries?

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

Correct answer: Air-filled alternating pressure cushion

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

Question 18: Which reflex, when retained past 6 months of age, can interfere with a child's ability to develop independent hand use and rolling?

Asymmetrical Tonic Neck Reflex (ATNR) (Correct answer)
Plantar grasp reflex
Rooting reflex
Moro 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 19: Which is heavier, cancellous bone or compact bone? Then why?

Traction (distraction)
CMCJ of Thumb
A. Compact. B. Because it's less porous (more dense). (Correct answer)
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 20: An OT working in a neonatal intensive care unit (NICU) is implementing developmental care for a 32-week premature infant. Which intervention is MOST aligned with the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) principles?

Providing vigorous tactile stimulation to promote sensory system development
Encouraging maximal alert wakefulness periods to promote social interaction
Maintaining a bright, stimulating environment to support visual system maturation
Clustering care activities to minimize disruptions and providing containment (hands-on swaddling) during procedures (Correct answer)

Correct answer: Clustering care activities to minimize disruptions and providing containment (hands-on swaddling) during procedures

NIDCAP principles include individualized, neurodevelopmentally supportive care: clustering cares to reduce stimulation stress and using containment/swaddling during handling to support self-regulation.

Question 21: Under IDEA 2004, OT services in schools must be provided in the:

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

Correct answer: Least restrictive environment (LRE)

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

Question 22: Which type of muscle fiber predominates in postural muscles like the soleus?

Type I (slow-twitch oxidative) (Correct answer)
Type IIb (fast-twitch glycolytic)
Type IIa (fast-twitch oxidative)
Type IIx (intermediate)

Correct answer: Type I (slow-twitch oxidative)

Type I slow-twitch fibers predominate in postural muscles like the soleus because they are fatigue-resistant and rely on oxidative metabolism for sustained contractions.

Question 23: A child with a brachial plexus birth injury (Erb's palsy) presents with a 'waiter's tip' posture. OT intervention should FIRST focus on:

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

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 24: 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?

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

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

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

Question 25: A client with borderline personality disorder is admitted to inpatient psychiatry. The OT's INITIAL assessment should focus on:

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

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 26: When treating a client with cerebellar ataxia, which adaptive strategy is MOST helpful for improving upper extremity control?

Eye patching to reduce visual input
Vibration therapy to affected muscles
Elastic resistance bands for strengthening
Weighted utensils and wrist weights (Correct answer)

Correct answer: Weighted utensils and wrist weights

Weighted utensils and wrist weights add proprioceptive input that helps dampen ataxic tremor during functional tasks.

Question 27: 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 28: Which muscle grade on the Manual Muscle Testing (MMT) scale indicates movement through full range against gravity with some resistance?

Grade 3 (Fair)
Grade 5 (Normal)
Grade 2 (Poor)
Grade 4 (Good) (Correct answer)

Correct answer: Grade 4 (Good)

Grade 4 (Good) on MMT indicates the muscle moves through full range against gravity and tolerates some but not full resistance.

Question 29: A child with ADHD struggles with transitions in the classroom. Which OT strategy is MOST effective?

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

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 30: Concave

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

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

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

Question 31: A client with ALS (amyotrophic lateral sclerosis) presents with progressive upper and lower extremity weakness. The OT's PRIORITY should be:

Sensory re-education for neuropathy
Strengthening exercises to rebuild lost muscle
Energy conservation and adaptive equipment to maintain independence (Correct answer)
Balance training for fall prevention only

Correct answer: Energy conservation and adaptive equipment to maintain independence

ALS is progressive and irreversible, so OT focuses on energy conservation and adaptive equipment to extend functional independence.

Question 32: What number of muscles connect to the talus?

Zero (Correct answer)
Three
Two
One

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

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

Correct answer: Tibialis anterior and posterior

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

Question 34: A therapist performing a task analysis of meal preparation identifies that a client skips steps and loses track of ingredients. This suggests difficulty with which executive function?

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

Correct answer: Working memory and task initiation

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

Question 35: A school-based OT is working with a 7-year-old who cannot button a shirt. The MOST appropriate school-based justification for OT services is:

The child needs occupational therapy only in a clinical setting
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)

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 36: Which positioning strategy is RECOMMENDED for a client with severe spasticity in a supine position to reduce extensor tone?

Neutral spine with hips and knees slightly flexed (Correct answer)
Prone position with arms at sides
Sitting upright at 90 degrees immediately
Head hyperextension with legs straight

Correct answer: Neutral spine with hips and knees slightly flexed

Neutral spinal alignment with slight hip and knee flexion reduces extensor synergy patterns and inhibits excessive extensor tone in individuals with spasticity.

Question 37: A client with rheumatoid arthritis is taught joint protection principles. Which strategy is MOST appropriate?

Turning door knobs with a closed fist
Using small joints to carry heavy loads
Using a larger, stronger joint to substitute for a weaker one (Correct answer)
Gripping objects tightly for prolonged periods

Correct answer: Using a larger, stronger joint to substitute for a weaker one

Joint protection principles direct clients to use stronger, larger joints to reduce stress on inflamed smaller joints.

Question 38: Which nerve innervates the thenar muscles and is most commonly compressed in carpal tunnel syndrome?

Median nerve (Correct answer)
Ulnar nerve
Radial nerve
Musculocutaneous nerve

Correct answer: Median nerve

The median nerve innervates the thenar muscles (except adductor pollicis) and travels through the carpal tunnel where it is prone to compression.

Question 39: The 'close-packed' position of the glenohumeral joint, which provides maximum bony stability, is:

Full abduction with external rotation (Correct answer)
Full flexion with internal rotation
0° abduction in anatomical position
90° abduction with neutral rotation

Correct answer: Full abduction with external rotation

The glenohumeral joint is in close-packed position at full abduction combined with external rotation, maximizing congruence of joint surfaces.

Question 40: Which management approach is MOST consistent with a client-centered practice philosophy in an OT department?

Efficiency-driven scheduling that maximizes therapist productivity
Collaborative goal-setting involving clients in prioritizing occupational outcomes (Correct answer)
Standardized treatment protocols applied uniformly to all diagnoses
Hierarchical top-down decision-making by the department director

Correct answer: Collaborative goal-setting involving clients in prioritizing occupational outcomes

Client-centered practice requires that clients actively participate in identifying and prioritizing goals relevant to their occupational performance.

Question 41: Which assessment evaluates role performance and occupational history using a semi-structured interview format in OT mental health practice?

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

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 42: During a home health evaluation, an OT observes that a 78-year-old man with moderate dementia is at significant risk for falls during toileting. Which environmental modification would MOST directly address this safety concern?

Place signs on all doors to help the client orient to room locations
Educate the caregiver to accompany the client to the bathroom at all times
Install grab bars beside the toilet, raise the toilet seat height, and clear obstacles in the path to the bathroom (Correct answer)
Recommend a commode at the bedside to eliminate bathroom navigation

Correct answer: Install grab bars beside the toilet, raise the toilet seat height, and clear obstacles in the path to the bathroom

Grab bars (stability support), raised toilet seat (easier sit-to-stand), and clear pathways (obstacle removal) are the evidence-based environmental modifications that directly reduce fall risk during toileting.

Question 43: A client with bipolar disorder in a manic phase needs OT intervention. The PRIORITY is:

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

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 44: 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?

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

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

Sensory integration therapy
Bottom-up remediation approach
Neurodevelopmental treatment
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 46: According to AOTA's Occupational Therapy Practice Framework (OTPF), 'rest and sleep' are categorized under which occupation domain?

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

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 47: 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
Values
Routines
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 48: Before cooking a meal, a therapist chooses a physical agent modality for a patient with Raynaud's illness. What modality is not recommended?

Paraffin
Fluidotherapy
Cryotherapy (Correct answer)
Ultrasound

Correct answer: Cryotherapy

Raynaud's phenomenon is characterized by vasospasm, leading to decreased blood flow and heightened sensitivity to cold in the extremities. Cryotherapy (cold therapy) causes vasoconstriction, which would exacerbate Raynaud's symptoms and is therefore contraindicated. Modalities like fluidotherapy and paraffin provide warmth, promoting vasodilation and improving circulation, which would be beneficial for individuals with Raynaud's.

Question 49: A 3-year-old child is being evaluated for fine motor delays. Which assessment is MOST appropriate?

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

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

Goal and task orientation
Relationship and task orientation (Correct answer)
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 51: 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)
Social demands of the activity
Cultural meaning of the activity
Timing and sequencing of steps

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

Deep partial-thickness burn
Full-thickness (third-degree) burn (Correct answer)
Superficial (first-degree) burn
Superficial partial-thickness 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 53: Which standardized assessment tool is used to measure sensory processing patterns in adults?

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

Correct answer: Sensory Profile 2 (Adult)

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

Question 54: A client with major depressive disorder declines to participate in morning ADL routines. The BEST OT strategy is:

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

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 55: 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
Lateral pterygoid
Temporalis
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 56: 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:

Compensatory scanning training using systematic left-field anchor techniques
Metacognitive strategy training to improve self-monitoring and awareness of performance (Correct answer)
Errorless learning to prevent consolidation of incorrect responses
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 57: Which structure connects the two cerebral hemispheres and is critical for interhemispheric communication?

Corpus callosum (Correct answer)
Thalamus
Basal ganglia
Internal capsule

Correct answer: Corpus callosum

The corpus callosum is the largest white matter commissure, containing approximately 200–300 million axons that relay information between the left and right cerebral hemispheres.

Question 58: During forearm supination, which two muscles are primarily responsible for the motion?

Extensor carpi radialis and brachialis
Supinator and biceps brachii (Correct answer)
Pronator teres and pronator quadratus
Brachioradialis and anconeus

Correct answer: Supinator and biceps brachii

The supinator and biceps brachii are the primary supinators of the forearm, with the biceps being more active against resistance.

Question 59: In which bone is the olecranon fossa located?

Humerus (Correct answer)
Radius
Fibula
Ulna

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

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

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 61: the syndrome of autosomal recessive family cancer is

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

Correct answer: Ataxia-telangiectasia

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

Question 62: An OT is working with a child with autism spectrum disorder who has difficulty tolerating clothing textures. This is BEST addressed using:

Sensory Integration (SI) intervention (Correct answer)
Cognitive Behavioral Therapy
Neurodevelopmental Treatment (NDT)
Constraint-Induced Movement Therapy

Correct answer: Sensory Integration (SI) intervention

Sensory Integration intervention, developed by Jean Ayres, directly addresses atypical sensory processing including tactile hypersensitivity that affects clothing tolerance.

Question 63: When modifying an activity to grade its difficulty downward for a client with limited endurance, the OT MOST likely would:

Increase the speed at which the task must be completed
Reduce the duration or physical demand of the activity (Correct answer)
Introduce a new, unfamiliar activity
Add more steps to the task to increase challenge

Correct answer: Reduce the duration or physical demand of the activity

Grading an activity downward involves reducing complexity, duration, or physical demands to match the client's current functional capacity.

Question 64: Which assessment tool is used to evaluate two-point discrimination following peripheral nerve injury?

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

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 65: A therapist uses dynamic splinting for a client with a flexion contracture at the PIP joint. The PRIMARY goal of dynamic splinting in this case is:

Apply low-load prolonged stretch to increase passive range of motion (Correct answer)
Immobilize the joint to reduce inflammation
Provide resistance for strengthening
Correct spasticity through inhibitory pressure

Correct answer: Apply low-load prolonged stretch to increase passive range of motion

Dynamic splinting applies low-load, prolonged stretch to remodel connective tissue and increase passive range of motion in contractured joints.

Question 66: A pediatric OT is implementing sensory diet strategies. Which activity provides proprioceptive input that is typically calming and organizing?

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

Correct answer: Carrying a heavy backpack

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

Question 67: Which instrument is the gold standard for measuring grip strength in hand rehabilitation?

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

Correct answer: Jamar dynamometer

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

Question 68: Which muscle is the primary hip flexor and is commonly assessed in OT when a client has difficulty rising from a chair?

Iliopsoas (Correct answer)
Gluteus maximus
Rectus femoris
Sartorius

Correct answer: Iliopsoas

The iliopsoas is the primary hip flexor and is critical for the sit-to-stand transfer assessed in OT practice.

Question 69: The brachial plexus originates from which spinal cord levels?

C5–T1 (Correct answer)
C3–C7
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 70: Make pencil marks on 25 cents at 6:00 and 12:00. Flatten the $5 bill out. Which arthorkinematic motion will you need to make in order to reach the end of the flat 5 by 12:00 if you roll the 25 across it starting from the 6:00 position with the edge of the 25?

Concave
Glide (slide) (Correct answer)
The BOS of a wheelchair during a "wheelie" is very narrow. To maintain balance the person must keep the body's COG w/in that BOS. The BOS is very wide when the wheelchair is resting on all 4 wheels & it's easy to keep the body's COG within it.
Osteokinematic

Correct answer: Glide (slide)

The scenario describes rolling a coin across a flat surface. For the 12:00 mark on the coin to reach the end of the bill while the coin is rolling, the coin must simultaneously rotate and translate across the surface. The translation component, where the contact point on the coin moves across the bill, is an example of a glide or slide arthrokinematic motion.

Question 71: Which positioning is recommended to prevent pressure injuries in a client who is seated in a wheelchair?

90-90-90 position with a pressure-relief cushion (Correct answer)
Leaning to one side with a rolled towel support
Seated with hips at 120° flexion
Reclined to 30° with legs fully extended

Correct answer: 90-90-90 position with a pressure-relief cushion

The 90-90-90 position (hips, knees, ankles at 90°) with a pressure-relief cushion distributes weight evenly and reduces ischial pressure.

Question 72: When performing a home assessment for fall prevention in an older adult, which environmental modification is considered HIGHEST priority?

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

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

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

Correct answer: Sensory seeking

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

Question 74: Which OT model specifically guides understanding of how habits and routines support mental health recovery?

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

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

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

Correct answer: Pelvis and trunk stabilization with proper hip angle

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

Question 76: A client with C6 spinal cord injury retains wrist extension but lacks active grasp. Which tenodesis principle allows functional pick-up?

Wrist extension drives active finger flexion via active tendons
Wrist flexion passively opens the hand; wrist extension passively closes the fingers (Correct answer)
Gravity-assisted wrist flexion produces active MCP extension
Wrist extension passively opens the hand; wrist flexion passively closes the fingers

Correct answer: Wrist flexion passively opens the hand; wrist extension passively closes the fingers

In tenodesis grasp, active wrist extension causes passive finger flexion due to finger flexor tightness, while wrist flexion allows the fingers to open passively.

Question 77: The scapula is not attached to which of the following muscles?

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

Correct answer: Triceps brachii, lateral head

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

Question 78: Under IDEA 2004, occupational therapy services in schools must be provided in the:

Most restrictive environment possible
Least restrictive environment (LRE) (Correct answer)
Separate therapy clinic only
Hospital outpatient setting

Correct answer: Least restrictive environment (LRE)

IDEA mandates that students with disabilities receive services in the least restrictive environment, promoting inclusion with non-disabled peers to the maximum extent appropriate.

Question 79: Social issues affecting the disabled

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

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

The mass of the segment
The moment arm length (Correct answer)
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 81: Which sensory system does Ayres Sensory Integration (ASI) theory consider MOST foundational for higher-level skill development?

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

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 82: A client demonstrates a Trendelenburg gait pattern. Which muscle group is most likely weak?

Hip abductors on the stance limb (Correct answer)
Hip extensors on the swing limb
Hip flexors on the stance limb
Knee extensors on the stance limb

Correct answer: Hip abductors on the stance limb

Weakness of hip abductors (primarily gluteus medius) on the stance limb causes the pelvis to drop on the contralateral side during single-leg stance.

Question 83: Which legislation requires employers to provide reasonable accommodations for employees with disabilities?

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

Correct answer: Americans with Disabilities Act (ADA)

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

Question 84: A hospital-based OT department wants to track patient outcomes to justify staffing levels to administration. Which type of outcome measure is MOST appropriate?

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

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

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

Question 85: Following a sensory evaluation of Ryan, a 6-year-old pupil, an occupational therapist is making recommendations to the school team. The pupil craves proprioceptive input and is too sensitive to auditory and tactile stimuli. Which modification would be suitable to support Ryan's involvement in the classroom?

Participating in an unstructured musical instrument exploration time
Physical cues (ex. a tap on the shoulder) for attention
Removal of visual clutter in the classroom such as busy posters and images
Engaging in a heavy work break every two hours (Correct answer)

Correct answer: Engaging in a heavy work break every two hours

Ryan craves proprioceptive input, and heavy work activities provide deep pressure and joint compression, which are excellent sources of proprioceptive input. Regular heavy work breaks can help regulate his sensory system, improve attention, and reduce sensory-seeking behaviors, making him more available for learning in the classroom. The other options either address different sensory needs or may exacerbate his sensitivities.

Question 86: The robotic equipment used for upper limb rehabilitation is which of the following?

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

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

Hypovolemic Shock (Correct answer)
Anaphylaxis
Anaemia
Cardiogenic shock

Correct answer: Hypovolemic Shock

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

Question 88: Which OT assessment tool is specifically designed to evaluate the daily living skills of adults with psychiatric disabilities?

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

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

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

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 90: The Constraint-Induced Movement Therapy (CIMT) approach for stroke rehabilitation is based on which principle?

Learned non-use reversal (Correct answer)
Bilateral training
Sensory integration
Proprioceptive neuromuscular facilitation

Correct answer: Learned non-use reversal

CIMT reverses learned non-use by restraining the unaffected limb and forcing use of the affected extremity.

Question 91: The COPM (Canadian Occupational Performance Measure) is most useful in mental health OT because it:

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

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 92: 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 93: The Glasgow Coma Scale (GCS) is used by OTs primarily to:

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

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 94: There are how many pairs of ribs in the thoracic cavity?

Thirteen
Ten
Seven
Twelve (Correct answer)

Correct answer: Twelve

The human thoracic cavity typically contains 12 pairs of ribs, totaling 24 individual ribs. These ribs articulate with the thoracic vertebrae posteriorly and, for most, connect to the sternum anteriorly, either directly or indirectly. This number is a standard anatomical count.

Question 95: 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?

Allen Cognitive Level Screen-5 (ACLS-5)
Mini-Mental State Evaluation (MMSE)
Canadian Occupational Performance Measure (COPM) (Correct answer)
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 96: The zona pellucida is associated with which anatomical structure?

Adrenal cortex
Kidney nephron
Ovarian follicle/oocyte (Correct answer)
Liver lobule

Correct answer: Ovarian follicle/oocyte

The zona pellucida is a glycoprotein layer surrounding the oocyte and early embryo, playing a critical role in fertilization and implantation.

Question 97: 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
Patient identification, date of birth, and diagnosis
OT or COTA signature (Correct answer)
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 98: Which frame of reference guides OT practice for clients with mental illness by focusing on the relationship between occupation and mental health?

Model of Human Occupation (MOHO) (Correct answer)
Biomechanical Frame of Reference
Neurodevelopmental Treatment
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 99: Mr. Perez, an elderly man with age-related musculoskeletal degeneration, was recently assessed by an occupational therapist. He lately utilized a wheeled walker, but he can no longer stand up without help. Regarding Mr. Perez's cognition, the occupational therapist seems unconcerned. Which wheelchair would be best suited in light of this information?

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

Correct answer: Manual lightweight chair with contoured seat

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

Question 100: A pediatric OT clinic receives a grant to study sensory processing interventions. Which study design provides the HIGHEST level of evidence?

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

Correct answer: Randomized controlled trial (RCT)

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

Question 101: Which work rehabilitation approach is used when a client with mental illness needs to build work skills in a real, paid employment setting?

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

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

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

Question 102: A client with C4 complete SCI wants to control a computer independently. The MOST appropriate interface is:

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

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 103: Under the Americans with Disabilities Act (ADA), an employer asks an OT to determine if a job applicant with a disability can perform essential job functions. The OT should FIRST:

Recommend the applicant be denied the position to avoid liability
Administer a comprehensive neuropsychological battery
Conduct a functional capacity evaluation (FCE) matched to the specific essential job functions (Correct answer)
Prescribe adaptive equipment before evaluating the applicant's abilities

Correct answer: Conduct a functional capacity evaluation (FCE) matched to the specific essential job functions

An FCE matched to the job's essential functions determines whether the applicant can meet those requirements with or without reasonable accommodation.

Question 104: A 5-year-old cannot yet copy a cross (+). According to developmental norms, this indicates:

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

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 105: During evaluation of a 5-year-old child with sensory processing disorder, the OT notices the child is hypersensitive to light touch but seeks out deep pressure. Using Ayres' Sensory Integration framework, this pattern most likely indicates:

Auditory processing disorder requiring therapeutic listening programs
Vestibular hyposensitivity requiring linear movement activities
Dyspraxia with poor bilateral integration and sequencing
Sensory modulation dysfunction with tactile defensiveness and proprioceptive seeking (Correct answer)

Correct answer: Sensory modulation dysfunction with tactile defensiveness and proprioceptive seeking

Tactile hypersensitivity (defensiveness) combined with proprioceptive seeking is a classic sensory modulation dysfunction pattern in Ayres' SI framework.

Question 106: An OT is completing a cognitive assessment for a client post-TBI using the Allen Cognitive Level Screen (ACLS). A score of level 4.0 indicates the client:

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

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

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

Question 107: The objective of rehabilitation is

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

Correct answer: All of the above

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

Question 108: Sensory processing issues are common in people with autism spectrum disorder.

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

Correct answer: 80-90%

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

Question 109: A therapist is conducting a group session using the Directive Group model. The PRIMARY goal of this group type is to:

Teach complex leisure skills
Develop advanced vocational skills
Increase awareness of reality and basic functioning in low-functioning clients (Correct answer)
Address interpersonal communication in high-functioning adults

Correct answer: Increase awareness of reality and basic functioning in low-functioning clients

The Directive Group model is designed for low-functioning individuals and targets orientation, attention, and basic purposeful behavior in a structured group setting.

Question 110: Under the Assistive Technology Act, assistive technology is defined as any item that is used to:

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

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

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

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 112: Lateral (external)

Putting your right ankle on your left knee involves what type of hip rotation? (Correct answer)
Sitting in a chair, a man turns around to look behind him. What type of force is being applied to the vertebral column?
In terms of BOS, why is it more difficult for a person in a wheelchair to balance on only the back wheels ("wheelie's") rather than on all 4 wheels?
When a football is kicked through the goalposts, what type of motion is being demonstrated by A.) the football____? B.) by the kicker_____?

Correct answer: Putting your right ankle on your left knee involves what type of hip rotation?

Placing your right ankle on your left knee requires the right hip to move into a position of abduction and external (lateral) rotation. This specific movement pattern is a common way to assess or describe hip external rotation. The other options do not directly elicit or describe a 'lateral (external)' movement in the same context.

Question 113: The 'just-right challenge' in occupational therapy intervention refers to:

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

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

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

Question 114: A client with Parkinson's disease has difficulty with handwriting. Which OT intervention is MOST evidence-based?

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

Correct answer: LSVT BIG (Lee Silverman Voice Treatment)

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

Question 115: Under IDEA (Individuals with Disabilities Education Act), OT services for school-age children must be documented in which plan?

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

Correct answer: Individualized Education Program (IEP)

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

Question 116: At the age of -, the Asymmetrical Tonic Neck Reflex (ATNR) vanishes.

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

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

Proximal interphalangeal joint of the index finger
Carpometacarpal joint of the thumb
Metacarpophalangeal joint of the index finger (Correct answer)
Interphalangeal 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 118: Which principle of motor learning suggests that practice should vary across multiple contexts to promote skill generalization?

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

Correct answer: Variable practice

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

Question 119: An OT clinic wants to implement a new group therapy program but lacks evidence for its effectiveness. What is the BEST first step in evidence-based practice?

Formulate a PICO question and conduct a systematic literature search (Correct answer)
Use the program from the most respected OT textbook available
Begin the program and evaluate outcomes after 6 months
Survey therapists in similar clinics about their practices

Correct answer: Formulate a PICO question and conduct a systematic literature search

Formulating a PICO question and conducting a literature search is the foundational step in evidence-based practice before implementing any new intervention.

Question 120: The SIPT (Sensory Integration and Praxis Tests) primarily assesses:

Gross motor coordination in preschoolers
Sensory processing and praxis abilities in children ages 4-8 (Correct answer)
Reading readiness and phonological awareness
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 121: When writing a letter of medical necessity for a power wheelchair, the OT must document:

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

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

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

Question 122: Which of the following best describes the term "locomotor disability"?

A person’s inability to participate in social activities
A person’s inability to execute distinctive activities associated with movement of self and objects resulting from affliction of musculoskeletal or nervous system or both (Correct answer)
A person’s inability to fulfil his responsibilities
A person’s inability to perform daily activities

Correct answer: A person’s inability to execute distinctive activities associated with movement of self and objects resulting from affliction of musculoskeletal or nervous system or both

Locomotor disability specifically refers to an impairment that affects a person's ability to move themselves or objects due to issues with their musculoskeletal system, nervous system, or both. This definition accurately captures the physical and functional limitations related to movement, distinguishing it from broader social participation challenges or general inability to perform daily activities.

Question 123: In handwriting intervention, the PRINT Tool is used to assess:

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

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 124: All are included in the Dietz stages of cancer rehabilitation, excluding:

Preventive rehabilitation
Supportive rehabilitation
Compensatory rehabilitation Boat (Correct answer)
Restorative rehabilitation

Correct answer: Compensatory rehabilitation Boat

The Dietz stages of cancer rehabilitation are well-established and include Preventive, Restorative, and Supportive rehabilitation. These stages address different points in the cancer journey, from preventing disability to restoring function and providing ongoing support. Compensatory rehabilitation, while a valid concept in general rehabilitation, is not explicitly recognized as one of the distinct stages within the Dietz model for cancer rehabilitation.

Question 125: An OT is reviewing the Occupational Therapy Practice Framework (OTPF-4) to guide evaluation of a 45-year-old woman with multiple sclerosis. Which of the following best describes an 'occupation' as defined by OTPF-4?

Movements and physical actions that achieve a functional goal
Any task performed during a therapy session to improve motor function
Standardized procedures used to assess performance skills
Activities that have personal meaning and purpose and support participation in life (Correct answer)

Correct answer: Activities that have personal meaning and purpose and support participation in life

OTPF-4 defines occupations as activities with personal meaning and purpose that support participation in everyday life — the core domain of OT practice.

Question 126: Early intervention services under IDEA Part C are designed for children aged:

Birth to 3 years (Correct answer)
3 to 5 years
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 127: 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?

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

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 128: An OT working in a neonatal intensive care unit (NICU) promotes development by recommending:

Prolonged prone positioning without monitoring
High-stimulation play environments to accelerate development
Early introduction of solid foods
Individualized, developmentally supportive care and handling (Correct answer)

Correct answer: Individualized, developmentally supportive care and handling

NICU OTs apply Newborn Individualized Developmental Care and Assessment Program (NIDCAP) principles, providing individualized, supportive handling to protect neurological development.

Question 129: Social skills training groups in OT mental health practice MOST effectively use:

One-on-one therapist coaching without peer interaction
Written social skills workbooks completed independently
Lecture-based instruction about social etiquette rules
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 130: A 28-year-old man who recently had an above-the-elbow amputation is ready to start driving again. He does not wear a prosthetic on the side that is affected and can fully use his non-dominant upper extremity. Which adaptive equipment should be recommended?

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

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 131: 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?

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

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

Task-oriented approach (CO-OP) focusing on strategy use (Correct answer)
Stretching and passive range of motion
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 133: Which occupational therapy practice model views the client as an open system interacting with environment through input, throughput, and output?

Occupational Adaptation Model
Ecology of Human Performance (EHP)
Model of Human Occupation (MOHO) (Correct answer)
Person-Environment-Occupation (PEO) Model

Correct answer: Model of Human Occupation (MOHO)

MOHO conceptualizes the person as an open system with subsystems (volition, habituation, performance capacity) continuously interacting with the environment.

Question 134: According to the Occupational Therapy Practice Framework (OTPF-4), 'habits' are BEST defined as:

Automatic behaviors integrated into daily routines (Correct answer)
The skills needed to perform an occupation
Internalized roles that guide occupational behavior
Values and beliefs that motivate action

Correct answer: Automatic behaviors integrated into daily routines

The OTPF-4 defines habits as acquired, automatic tendencies to respond in certain ways in familiar contexts and situations.

Question 135: Which standardized assessment is most appropriate for evaluating upper extremity function in a stroke patient?

Fugl-Meyer Assessment (Correct answer)
Barthel Index
Berg Balance Scale
Mini-Mental State Examination

Correct answer: Fugl-Meyer Assessment

The Fugl-Meyer Assessment specifically measures motor recovery and upper extremity function following stroke.

Question 136: A client with obsessive-compulsive disorder spends 3 hours on morning grooming rituals. OT intervention should:

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

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 137: A client with lateral epicondylitis has pain with which motion that stretches the common extensor origin?

Forearm supination with elbow extended
Wrist extension with elbow flexion
Shoulder internal rotation
Wrist flexion with elbow extension (Correct answer)

Correct answer: Wrist flexion with elbow extension

Wrist flexion with elbow extension places maximal tension on the common extensor tendon origin at the lateral epicondyle, provoking pain in lateral epicondylitis.

Question 138: 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)
Avoiding all physical activity
Completing all tasks at once to minimize transitions

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

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

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

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

Question 140: In the OT practice framework (OTPF), 'habits' are classified under which aspect of the domain?

Client factors
Occupations
Performance patterns (Correct answer)
Performance skills

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

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

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 142: Which frame of reference emphasizes the role of sensory processing in occupational performance and is commonly used with children who have sensory integration difficulties?

Cognitive behavioral frame of reference
Biomechanical frame of reference
Model of Human Occupation
Sensory integration frame of reference (Correct answer)

Correct answer: Sensory integration frame of reference

The sensory integration frame of reference, developed by A. Jean Ayres, addresses how the brain processes sensory input and its impact on function and behavior.

Question 143: In a patient with C6 spinal cord injury, which muscle function is preserved that allows tenodesis grasp?

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

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 144: 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)
Finger extension splint
Ulnar gutter splint
Wrist cock-up 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 145: 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
Ulnar nerve at the wrist (Correct answer)
Median nerve at the wrist
Median nerve at the elbow

Correct answer: Ulnar nerve at the wrist

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

Question 146: 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?
Name the bone markings that can be classified as projections or processes that fit into joints:
Identify the 11 degrees of freedom of the upper extremity:
What joint structure surrounds & encases the joint & protects the articular surfaces? (Correct answer)

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

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

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

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

Correct answer: Current and potential systems of support

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

Question 149: An OT administers the Mini-Mental State Examination (MMSE) to an 80-year-old woman and obtains a score of 20/30. Based on this result, which area of performance is MOST likely to be impaired and should guide OT intervention planning?

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

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

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

Question 150: What on the list below does not belong to the sternum?

Manubrium
Zygomatic process (Correct answer)
Body
Xiphoid process

Correct answer: Zygomatic process

The sternum, or breastbone, consists of three main parts: the manubrium, body, and xiphoid process. The zygomatic process, however, is a bony projection found on the temporal and zygomatic bones, forming part of the cheekbone. It is not associated with the sternum.

Question 151: Long bones have cancellous bone in the metaphysis and epiphysis but compact bone in the diaphysis. (Also discovered between compact bone's layers)

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

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

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

Question 152: Which occupational therapy practice area focuses on enabling returning veterans with PTSD to re-engage in meaningful daily roles?

Ergonomics and industrial rehabilitation
Pediatric sensory integration
Acute care hand therapy
Mental health and community reintegration OT (Correct answer)

Correct answer: Mental health and community reintegration OT

Mental health and community reintegration OT addresses psychosocial barriers and uses occupation-based interventions to support veterans with PTSD in resuming daily roles.

Question 153: In a partial hospitalization program, OT groups MOST appropriately focus on:

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

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

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

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

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

Question 155: Which recovery-oriented principle should guide OT practice in mental health settings?

OT establishes goals based on diagnostic criteria
Institutionalization supports safety in recovery
Recovery requires full symptom elimination before function is addressed
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 156: Sensory modulation rooms in psychiatric inpatient units are used primarily to:

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

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

Identify personal wellness strategies and early warning signs of relapse (Correct answer)
Complete vocational interest inventories for employment
Design home modification plans for physical disabilities
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 158: An OT is treating a client with lateral epicondylitis. Which activity modification would BEST reduce symptom aggravation?

Increasing grip force during tasks
Performing repetitive wrist flexion exercises
Using ergonomic tools with larger diameter handles (Correct answer)
Using a wrist splint in full extension during all activities

Correct answer: Using ergonomic tools with larger diameter handles

Larger diameter tool handles reduce the grip force required, decreasing stress on the common extensor tendon origin.

Question 159: Which occupational analysis framework focuses on the transaction between the person, environment, and occupation to understand performance?

Cognitive Disabilities Model
Sensory Integration Theory
Person-Environment-Occupation (PEO) Model (Correct answer)
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 160: Which ethical principle is MOST at issue when a client refuses a recommended OT intervention?

Beneficence
Autonomy (Correct answer)
Nonmaleficence
Justice

Correct answer: Autonomy

Autonomy is the client's right to self-determination and to refuse treatment, even against professional recommendations.

Question 161: Which model emphasizes volition, habituation, and performance capacity as key components influencing occupational participation?

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

Correct answer: Model of Human Occupation (MOHO)

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

Question 162: Which play assessment evaluates the child's internal motivation and degree of playfulness rather than skill level?

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

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

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

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 164: In a mental health placement, a supervisor requests her level II fieldwork student to use the Ecology of Human Performance (EHP) Model to frame a client case. Which type of intervention best fits this model?

Select activities based on the client's identified cognitive level
Select activities based on volition
Use a weighted blanket
Modify the social environment by limiting the size of groups (Correct answer)

Correct answer: Modify the social environment by limiting the size of groups

The Ecology of Human Performance (EHP) model emphasizes the dynamic relationship between the person, their context (environment), and the task. Interventions within EHP often focus on altering the context to support performance. Modifying the social environment by limiting group size is a direct application of the EHP model's 'alter' or 'adapt/modify' intervention strategies, aiming to create a more supportive context for the client's participation.

Question 165: Which type of reasoning does an OT use when generating multiple hypotheses about a client's presenting problems and then testing them through evaluation?

Diagnostic reasoning (Correct answer)
Interactive reasoning
Pragmatic reasoning
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 166: The Functional Independence Measure (FIM) includes:

15 activities
20 activities
18 activities (Correct answer)
10 activities

Correct answer: 18 activities

The Functional Independence Measure (FIM) is a widely used assessment tool in rehabilitation to measure a patient's level of disability and how much assistance they require to perform basic life activities. It comprises 18 specific activities across six domains: self-care, sphincter control, mobility, locomotion, communication, and social cognition. Each activity is scored on a 7-point scale, indicating the level of independence.

Question 167: Which splint is most appropriate for a client with median nerve injury at the wrist?

Anti-spasticity splint
Dynamic finger extension splint
Thumb spica splint (Correct answer)
Resting hand splint with wrist in neutral

Correct answer: Thumb spica splint

Median nerve injury at the wrist affects thumb opposition and intrinsic muscles, and a thumb spica splint maintains the thumb web space.

Question 168: When using the Neurodevelopmental Treatment (NDT) approach, the OT's primary goal is to:

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

Correct answer: Inhibit abnormal tone and facilitate normal movement patterns

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

Question 169: 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?

Specific
Relevant
Measurable
Attainable (Correct answer)

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 170: A client has difficulty extending the wrist and fingers following a humeral shaft fracture. Which nerve is most likely injured?

Radial nerve (Correct answer)
Ulnar nerve
Median nerve
Musculocutaneous nerve

Correct answer: Radial nerve

The radial nerve winds in the spiral groove of the humerus and is vulnerable to injury with humeral shaft fractures, causing wrist drop and loss of finger extension.

Question 171: Which standardized assessment measures a client's ability to perform instrumental activities of daily living in real-world contexts?

Barthel Index
Performance Assessment of Self-Care Skills (PASS) (Correct answer)
Canadian Occupational Performance Measure (COPM)
Functional Independence Measure (FIM)

Correct answer: Performance Assessment of Self-Care Skills (PASS)

The PASS assesses IADL performance directly in the client's natural environment using observation-based scoring.

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%

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