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NBCOT Prep B Questions and Answers
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B1. An occupational therapist provides consultation services to a psychogeriatric unit for individuals with moderately severe cognitive decline. In designing the activity program, which groups are best for the occupational therapist to include? a. Reality orientation. b. Sensory stimulation. c. Reminiscence.
d. Coping skills. ✔✔a
B2. The parents of a five-year-old with attention deficit with hyperactivity disorder (ADHD) express difficulty managing the child's aggressive behavior toward older siblings. Which is the most effective strategy for the occupational therapist to recommend to the parents? a. Allow the child to vent aggressive feelings on a stuffed animal or doll. b Redirect the child's energy into acceptable and safe play activities. c Provide consistent punishment for aggressive behavior.
d Send the child to stay with a family member or close friend for an extended "time-out." ✔✔b
B3. An individual with rheumatoid arthritis has developed several boutonniere deformities. Which of the following is the most accurate description for the occupational therapist to include in documentation of the individual's presenting signs? a Hyperextension of the PIP joint and flexion of the DIP joint. b Ulnar deviation and subluxation of the MCP joints. c Flexion of the PIP joint and hyperextension of the DIP joint. d Heberden's nodes at the DIP joints and Bouchard's nodes at the PIP joints. ✔✔c
B4. An occupational therapist receives a referral to provide home-based services to an older adult who lives alone in a fourth floor walk-up apartment. Upon entering the apartment, the therapist notes the sweltering heat. The apartment has no fans or air conditioners. The client's skin is hot,
dry, and red, and breathing is labored. The therapist offers the client a glass of water and places ice compresses on the arterial pressure points to help with cooling. Which is the most important action for the therapist to take next? a Cancel the intervention session and call for an ambulance to provide emergency medical services. b Proceed with the planned intervention session and include documentation about client's environmental conditions in the intervention report. c Contact the home health agency's case manager to report the client's environmental conditions and then proceed with the planned intervention session. d Cancel the intervention session and advise the client to speak to a doctor on how to best address the impact of hot weather on personal health. ✔✔a
B5. An occupational therapist observes a COTA® having difficulty transferring a client with athetoid movements from a mat to a wheelchair. Before the therapist can cross the room to help with the transfer, the COTA® slides with the client to the floor. The therapist assists the COTA® in safely returning the client to the wheelchair. They assess that the client appears to be unharmed and return the client to the unit for a medical evaluation. Which action should the therapist take next? a Counsel the COTA® on the need to ask for assistance with difficult transfers. b Require the COTA® to attend a transfer training inservice. c Document the COTA®'s unsafe actions in the personnel record.
d Complete an occurrence report according to facility standards. ✔✔d
B6. A teenager with spinal muscle atrophy shows decreased trunk balance and strength. Upper extremity strength and ROM are unchanged from the last evaluation. Which is the best recommendation for the occupational therapist to make? a A re-evaluation of the client be completed. b The client be referred to an orthotist for a soft spinal support. c The client be measured for a power wheelchair.
d A trunk strengthening program be initiated with the client. ✔✔a
B11. During a group session at an adult day care program, an older adult consistently complains that everyone is mumbling. After the group, which action should the occupational therapist take in response to these statements? a Notify the client's primary care physician that the person exhibited evidence of paranoia. b Collaborate with the program director to remove groups from the client's program plan. c Document objective data about the complaints in the person's chart.
d Notify the primary care physician that the person may need an audiological evaluation. ✔✔d
B12. The occupational therapist completes an intake interview for a work hardening program. As the individual is leaving, the person gives the therapist a hug and expresses much gratitude. The individual then tries to kiss the therapist on the lips. Which action is best for the therapist to take in response to this situation? a Forcibly push the individual away while telling the person that the behavior is inappropriate and unacceptable. b Say nothing but decline the person's admission to the work hardening program based upon the person's inappropriate behavior. c State that the individual's behavior oversteps professional boundaries and makes the therapist uncomfortable. d Tell the person the behavior is inappropriate and unacceptable and decline the person's admission
to the program. ✔✔c
B13. A person with a traumatic brain injury (TBI) is assessed to score a 6 on the Glasgow Coma Scale. Which should the occupational therapist use to initiate intervention with this person? a Demonstrated directions. b Sensory stimulation. c Verbal cues. d Hand-over-hand assistance. ✔✔b
B14. An occupational therapist working in an outpatient cardiac rehabilitation center develops an intervention plan for an individual who has entered Phase 2 of cardiac recovery. Which activities should the therapist recommend be included in this intervention plan? a Weeding a garden and doing low-impact aerobics. b Putting away groceries and keyboarding. c Washing dishes and playing tabletop board games.
d Carrying groceries upstairs and playing basketball. ✔✔a
B15. An individual recovering from an exacerbation of multiple sclerosis is referred by a primary care physician to an outpatient OT clinic. The referral requests that the occupational therapist complete a functional capacity evaluation. Which is the most likely reason for this referral? a Determination of cognitive level. b Determination of disability status. c Assessment of instrumental activities of daily living.
d Assessment of return-to-work capabilities. ✔✔d
B16. To develop social interaction skills, an occupational therapist implements a group program for students with autism spectrum disorder (ASD). Which group is best for the therapist to include in this program? a A directive group. b A topical group. c A developmental group.
d A task-oriented group. ✔✔c
B17. A home-care occupational therapist plans intervention for an individual with agoraphobia with panic attacks. The occupational therapist plans to use a cognitive-behavioral approach. Which approach is best for the therapist to use with the client during the intitial intervention session? a A token reward system. b Behavioral extinction. c Relaxation techniques.
d Systematic desensitization. ✔✔c
and ask the therapist to let them look at their parent's chart while they wait outside the room for the session to conclude. Which response is best for the therapist to make in response to this request? a Tell the family members that they must have the permission of their parent before they can look at the chart. b Commend the family members for their interest in their parent's status and give them the chart to read.
c Tell the family members to ask the unit's charge nurse for permission to look at the chart. ✔✔a
B22. An occupational therapist provides intervention for an individual with a swallowing disorder. To elicit a swallow reflex, the occupational therapist provides sensory input to the inferior facial arches. Which should the therapist use to provide this intervention? a A tongue depressor. b A moistened cotton swab. c A chilled dental examination mirror.
d A warmed metal teaspoon. ✔✔c
B23. A child with a diagnosis of traumatic brain injury (TBI) is evaluated by an occupational therapist. The child presents with extension of both upper extremities and flexion of both lower extremities following a stimulus of neck extension. When interpreting this observation, which statement is most accurate for the therapist to document? a The presence of + ATNR, which is "abnormal" and has reappeared after the TBI. b The presence of a + STNR, which is "normal" and not affected by the TBI. c The presence of a + ATNR, which is "normal" and not affected by the TBI. d The presence of a + STNR, which is "abnormal" and has reappeared after the TBI. ✔✔d
B24. An individual with moderate intellectual disability moves into a group home. An initial goal established for this resident is the development of socially acceptable table manners. The occupational therapist uses a behavior modification approach to achieve this goal. Which intervention technique is best for the therapist to include in the design of the group home dining experience? a Negative reinforcement for socially inappropriate behaviors.
b Clear explanations of behaviors expected during dining. c Clear explanations about the effects of inappropriate behaviors on others. d Rewards for socially appropriate dining behaviors. ✔✔d
B25. A toddler with severe congenital anomalies and an irreparable cleft palate has a do not resuscitate (DNR) order. While being fitted for a molded seat for a wheelchair, the child stops breathing and turns blue. The entry-level occupational therapist determines that the child has a brachial pulse. Which of the following is the first action the therapist should take in response to this situation? a Inform the physician about the situation and the child's DNR order. b Implement the facility's emergency procedure.
c Perform obstructed airway maneuver and monitor heart rate for five minutes. ✔✔b
B26. A seven-year-old child with spina bifida at the C7 level receives home-based occupational therapy services. Which ability is most relevant for the occupational therapist to focus on during intervention? a Dressing the lower body. b Dressing the upper body.
c Playing tabletop games. ✔✔a
B27. An OT administrator is designing a patient satisfaction questionnaire to be administered upon discharge from the OT program. The administrator designs the questionnaire so that individuals will indicate their level of agreement with a series of statements by circling a number with 1 = very dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, and 5 = very satisfied. Which method of data collection is the administrator using? a Gutman scale rank ordering. b A Likert scale. c A semantic differential. ✔✔b
with job performance and may result in the loss of a new TEP placement. Which is the therapist's best response to these expressed concerns? a Instruct the client to speak directly to the TEP supervisor about the right to receive reasonable accommodations. b Schedule a reevaluation of the client's work behaviors and skills. c Assure the client that it is natural to have initial difficulties at a new job.
d Schedule an appointment with the client and the TEP supervisor. ✔✔d
B32. In an acute inpatient psychiatric facility, an occupational therapist designs a therapeutic activity group for individuals with poor orientation to reality. Which is the best activity choice for the therapist to provide in this group? a A discussion of the effects of hospitalization on occupational roles. b The assembly of wooden toys for a children's unit. c Guided imagery for stress management.
d Structured verbalizations of personal assets and limitations. ✔✔b
B33. An occupational therapy professional education program provides an after-school play program for typically developing children to help students understand typical development. The students observe a child who is beginning to use blunt scissors to snip paper. The child opens and closes the scissors and moves them in a controlled forward motion, but the child cannot cut circles or figure shapes. At which age are these behaviors typical? a Two years old. b Three years old. c Four years old. d Five years old. ✔✔b
B34. An adult who incurred a severe traumatic brain injury (TBI) is entering the second week of care at a longterm TBI rehabilitation center. The patient's family visit regularly and frequently asks multiple questions of the treatment team. A team and family conference is planned to address family concerns. Which is the most important information for the team to share with the family? a Realistic and clear information about the individual's current status and care plan.
b Each team member's expert opinion about the expected prognosis and discharge recommendations. c Reimbursement information about each professional service to assist in determining treatment choices.
d Community resources that are available to support the family and provide respite care. ✔✔a
B35. An occupational therapist supervises a Level II Fieldwork student regarding the evaluation procedures of a work hardening program. The therapist explains that some individuals attending the program magnify their symptoms to retain benefits; therefore, the validity of some evaluation measures may be compromised. Which assessment tool does the therapist identify as providing the most valid results? a A volumeter. b A dynamometer (all five positions). c A standardized pegboard test.
d A total active motion (TAM) evaluation. ✔✔a
B36. Two COTAs working for a school district are assigned to two different schools. One school has a supervising occupational therapist, the other school does not. The COTA without a supervising therapist expresses concern to the COTA who is supervised about the lack of supervision. Which is the best response for the supervised COTA to take in response to this situation? a Report the situation to their OT supervisor. b Share information acquired during supervisory sessions with the unsupervised COTA. c Advise the unsupervised COTA to contact the state regulatory board. d Report the situation to the school district's administration. ✔✔a
B37. A single parent of two school-aged children is employed as a truck driver working the 11 p.m.-7 a.m. shift. The client was hospitalized for a major depressive episode following the sudden death of the client's spouse one year ago. The deceased spouse's primary role had been home maintainer. The client was rehospitalized this past weekend for another major depressive episode. Which skills are most relevant for the occupational therapist to evaluate?
c A side-stepper walker. d A standard walker. ✔✔b
B41. An individual with rheumatoid arthritis (RA) is currently in a stage of remission. During this inactive chronic phase of this disease, the occupational therapist works with the client to maintain range of motion (ROM) and muscle strength. Which of the following is most effective for the therapist to recommend the client include in a daily home exercise program? a Passive ROM. b Active ROM. c Isotonic exercises.
d Progressive resistance. ✔✔b
B42. An occupational therapist employed in a pediatric clinic participates in an initial performance appraisal. The supervisor identifies an area needing improvement as handling skills in working with children with various types of cerebral palsy. Which is the most effective way for the occupational therapist to improve handling skills? a. Observe an experienced occupational or physical therapist use handling techniques. b. Participate in an advanced-level experiential course on handling techniques.
c. Participate in a teleconference on handling techniques for children with cerebral palsy. ✔✔b
Questions B43 to B47 are based on the following information. An adult who incurred a traumatic brain injury three months ago is referred to a home care agency to receive OT services. The client's referral states that cognition is at Level VII of the Rancho Los Amigos scale and that grasp and shoulder mobility are limited. During the initial interview, the client reports being frustrated by the inability to independently engage in the previously enjoyed and personally meaningful activity of cooking. The client reports frequently losing place when reading recipes and an inability to "find" things in the kitchen. B43. Upon evaluation, the client exhibits difficulty with the letter cancellation task. Which visual deficit should the occupational therapist document as present? a Imagery. b Scanning.
c Cognition. d Memory. ✔✔b
Questions B43 to B47 are based on the following information. An adult who incurred a traumatic brain injury three months ago is referred to a home care agency to receive OT services. The client's referral states that cognition is at Level VII of the Rancho Los Amigos scale and that grasp and shoulder mobility are limited. During the initial interview, the client reports being frustrated by the inability to independently engage in the previously enjoyed and personally meaningful activity of cooking. The client reports frequently losing place when reading recipes and an inability to "find" things in the kitchen. B44. During meal preparation tasks, the client ignores items on the left side of the counter. The therapist decides to use a compensatory functional approach to improve the client's performance. Which is the most appropriate method for the therapist to use during intervention to develop meal preparation skills? a Encourage bilateral activities. b Place all items on the right side of the counter. c Practice scanning activities.
d Place a brightly colored placemat on the left side of the counter. ✔✔d
Questions B43 to B47 are based on the following information. An adult who incurred a traumatic brain injury three months ago is referred to a home care agency to receive OT services. The client's referral states that cognition is at Level VII of the Rancho Los Amigos scale and that grasp and shoulder mobility are limited. During the initial interview, the client reports being frustrated by the inability to independently engage in the previously enjoyed and personally meaningful activity of cooking. The client reports frequently losing place when reading recipes and an inability to "find" things in the kitchen. B45. The client responds well to the compensatory approach when performing countertop meal preparation tasks. The therapist decides to use a dynamic interactional approach as the theoretical foundation for cognitive perceptual intervention for other meal preparation activities. During a session to train the client in scanning strategies, the client accurately finds two items in a refrigerator. Which is the therapist's most appropriate initial response to the client's task success?
for suggestions to address this problem. Which is the most appropriate action for the occupational therapist to take in response to the client's request? a Advocate that the vocational program provide the client with a flexible start time. b Develop a visual chart with the client, depicting the necessary sequence of their morning activities. c Advise the client to call the vocational program to tell staff when they are running late.
d Advise the client to wake up one hour earlier on vocational rehabilitation program days. ✔✔b
B48. An occupational therapist works with adolescents with intellectual disabilities who are participating in a community integration program in an urban area. When implementing a community mobility group focused on the use of public transportation, which should the occupational therapist have the group do first? a Read a subway or bus map. b Take a subway or bus as a group. c Determine a destination. d Purchase a subway or bus fare card. ✔✔c
B49. The administrator of a large rehabilitation hospital reviews the occupational therapy staffing schedules. The administrator determines that of the 12 full-time therapists, six work full-time in the inpatient department, two work full-time in the outpatient department, two divide their hours equally between the inpatient and outpatient department, and two divide their hours equally between administrative/managerial work and direct care provision on the inpatient unit. Which is most accurate staffing for the administrator to document for the occupational therapy inpatient department in the annual report? a Twelve full-time equivalent employees. b Ten full-time equivalent employees. c Eight full-time equivalent employees. d Six full-time equivalent employees. ✔✔c
B50. A person recovering from a cerebral vascular accident has left-sided weakness and dysphagia. Which of the following is the most effective direct intervention approach to help the person successfully swallow ingested food? a Provide pureed, thick liquids. b Provide thermal stimulation to the inferior faucial arches. c Tilt the person's head back and toward the left side.
d Provide small, warm boluses. ✔✔d
B51. An individual cannot independently get from a supine position to a sitting position. The person has good scapular, shoulder, and elbow muscle strength. Which of the following should the occupational therapist recommend as most effective for the client to use to improve bed mobility? a A leg lifter. b A bed rail assist. c A log roll technique.
d A rope ladder. ✔✔d
B52. An adult diagnosed with bipolar disorder has been taking lithium for five years. Prior to a weekly occupational therapy vocational planning group, the client reports noticeable functional changes since the last group session. In describing these changes, the client reports symptoms that may be indicative of a possible lithium overdose. With the client's permission, the therapist contacts the psychiatrist to describe the client's concerns. Which symptom would the therapist most likely report as indicative of this problem? a Reduction in mood swing. b Gross hand tremors. c Decreased velocity of speech.
d Fine hand tremors. ✔✔b
B53. A school-based occupational therapist is teaching orientation and mobility skills to an adolescent with a degenerative visual disorder. Which is the most effective motivational technique for the therapist to use with this student?
b Discussion of typical areas of concern addressed by OT practitioners. c Demonstration of different types of developmental assessments. d Discussion of the Individual Family Service Plan (IFSP). ✔✔b
B57. Several adolescents with behavior problems attend a school-based after-school program. They work at an egocentric-cooperative level in a group dealing with issues related to school performance and peer pressure. Which of the following would be most likely for the occupational therapist to observe the participants doing in the group? a Actively taking on roles such as energizer, coordinator, or opinion giver. b Focusing on the group tasks rather than the feelings of the participants.
c Making decisions with minimal to no supervision from the group leader. ✔✔b
B58. An occupational therapist leads a social skills group for children aged 10-12 with conduct disorders. One of the children complains that the group activity is stupid and boring. Which is the most effective response for the occupational therapist to provide in response to this complaint? a Encourage the child to complete the activity with the group. b Allow the child to leave the group since they are uninterested. c Allow the child to suggest a different group activity.
d Tell the child the complaint will be discussed at the next family meeting. ✔✔a
B59. The occupational therapist plans intervention for a client with a recent diagnosis of complex regional pain syndrome (CRPS) Type I. Which intervention approach is most effective to use to reduce pain and increase function? a Hot packs. b Biofeedback. c Paraffin.
d Passive range of motion. ✔✔b
B60. Several newly homeless veterans with a variety of mental health diagnoses attend an occupational therapy community reentry group conducted in a community-based shelter. Which should be the primary focus of the initial group session?
a Development of home management skills such as meal preparation. b Determination of financial assets and money management skills. c Identification of local resources such as soup kitchens and thrift stores.
d Exploration of vocational interests and employment possibilities. ✔✔c
B61. An occupational therapist provides home-based services to a home maintainer who incurred a right CVA eight months ago. The individual and the therapist have chosen to focus on kitchen activities during the intervention session. The therapist has the client stand in front of the counter with an open dishwasher to the left. The therapist asks the client to put the clean dishes into an overhead cabinet to the right of the client using the affected UE. By setting up the activity in this manner, which proprioceptive neuromuscular facilitation (PNF) technique is the therapist using? a Heavy work/mobility superimposed on stability. b Reciprocal inhibition/innervation. c Diagonal patterns of D2 flexion/extension.
d Diagonal patterns of D1 flexion/extension. ✔✔d
B62. An occupational therapist conducts a sensory evaluation of an individual recovering from a left cerebral vascular accident. The individual has right hemiplegia and expressive aphasia. During the evaluation of stereognosis, which should the therapist have the client use to identify responses to the testing stimuli? a Pictures of the objects. b A set of identical objects. c Cards with "one" and "two" printed on them. d Cards with "yes" and "no" printed on them. ✔✔b
B63. A young adult with a T9-T10 spinal cord injury wishes to engage in sports activities. Which wheelchair features are best for the occupational therapist to recommend to this client? a A heavy-duty foldable frame with a high back. b An ultra-light foldable frame with a high back. c An ultra-light rigid frame with a low back.
d A heavy-duty rigid frame with a low back. ✔✔c
