2024 Edition

Occupational Therapist Practice Test

Take this free occupational therapist practice test to get an idea of what is on the NBCOT exam.

The NBCOT certification exam tests the requisite knowledge, skills and abilities essential to occupational therapists and occupational therapy students. Certification in addition to any state licensure requirements are the key to career success in the occupational therapy field.

The actual exam tests your knowledge, skills and abilities in the areas of: Evaluation and Assessment; Analysis and Interpretation; Intervention Management; and Competency and Practice Management with a total of 3 clinical simulation test (CST) items and 170 multiple choice questions. The total time of the test is four hours.

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Evaluation/Assessment

1.	A therapist is evaluating a twelve-month-old in a clinical setting. Which of the following milestones are unlikely to have emerged?
		a. Moves from seated into prone
		b. Controls walking by starting and stopping with intention
		c. Uses a pincer grasp
		d. Intentionally releases a small item from their grasp
While a 12-month-old may be learning to take her first steps, the ability to control them emerges around 15 months. At 12 months, many babies have mastered moving from seated into prone (6-11 months), using a pincer grasp (10 months), and releasing a small item (around eight months). Incorrect answer. Please choose another answer.

2.	A complete T5 spinal cord injury client is referred for an occupational therapy evaluation. What is most important to assess in this client?
		a. Ability to propel a manual wheelchair
		b. Level of assistance needed for toileting
		c. Safety with swallowing
		d. Seated balance
An individual with a complete T5 injury will have full motor control of their body from the chest up. Therefore they can use their arms to propel a wheelchair and swallow without difficulty. Answer B is incorrect because with a complete T5 injury, bowel and bladder motor control is lost. It is essential to assess seated balance as this patient will have decreased control of their trunk muscles. Incorrect answer. Please choose another answer.

3.	A young adult client in a psychiatric rehabilitation unit has declined participation in group and individual activities. Which assessment should the occupational therapist select to gain baseline data about the client's roles and use the results to create motivating goals?
		a. Activity Card Sort (ACS)
		b. Canadian Occupational Performance Measure (COPM)
		c. Allen Cognitive Level Screen-5 (ACLS-5)
		d. Mini-Mental State Evaluation (MMSE)
Both the Activity Card Sort and COPM consider a client's roles and activity preference. The COPM, however, transfers the answers into objective data that can be used for treatment planning and tracking progress. The ACLS-5 is an activity-based assessment tool that measures cognitive levels. The MMSE is a quick cognitive screen. Incorrect answer. Please choose another answer.

4.	An occupational therapist evaluates a five-month-old who was born at 34 weeks gestation and stayed 3 weeks in the NICU. The therapist holds the infant under his shoulders in a vertical plane. The infant positions his head upright when she tilts the baby to the front, side, and back. Which positive reflex is the infant demonstrating?
		a. Labyrinthine
		b. Prone tilting
		c. Forward parachute
		d. Landau
This infant demonstrates a positive labyrinthine (optical righting) reflex. This reflex develops between birth and two months and persists throughout life. Prone tilting is tested in a prone position, and the infant curving their spine indicates the positive response. The forward parachute reflex is also known as protective extension. It occurs when the infant is suddenly tipped forward, extends their arms and neck, and opens their hands. The landau reflex is tested in a suspended prone position and results in extensor tone. Incorrect answer. Please choose another answer.

5.	A supervisor asks her level II fieldwork student in a mental health placement to view a client case with the Ecology of Human Performance (EHP) Model as a frame of reference. Which intervention method best represents this model?
		a. Select activities based on the client's identified cognitive level
		b. Use a weighted blanket
		c. Modify the social environment by limiting the size of groups
		d. Select activities based on volition
The EHP Model focuses on the interaction between the client and their environment (including social, cultural, and temporal). Answer A is an example of an intervention based on the Cognitive Disabilities frame of reference. A weighted blanket would be an approach used under a sensory model. The Model of Human Occupation focuses on volition in both evaluation and intervention. Incorrect answer. Please choose another answer.

6.	An occupational therapist who works in an outpatient clinic evaluates an individual who works in a call center. The patient reports tingling and numbness in her right forearm and hand after reaching for her desktop phone multiple times per day. Which test should the occupational therapist perform?
		a. Tinel's sign at the wrist
		b. Tinel's sign at the forearm
		c. Tinel's sign at the elbow
		d. Froment's sign
The act of reaching for a desktop phone, using it, and replacing it several times a day requires pronation and supination. The therapist should suspect pronator teres syndrome and conduct a Tinel's sign at the forearm to confirm. A positive Tinel's sign at the wrist indicates carpal tunnel, while the positive sign at the elbow indicates cubital tunnel syndrome. A positive Froment's sign (the paper pinch test) indicates an ulnar nerve palsy. Incorrect answer. Please choose another answer.

7.	A home health occupational therapist is evaluating an 82-year-old man with dementia. Which of the following is MOST essential to assess so that the therapist can make appropriate recommendations for activity participation between therapy sessions?
		a. Level of independence with toileting
		b. Current and potential systems of support
		c. Potential fall hazards in the home environment
		d. Ability to safely prepare meals
While all of the above options will provide valuable information to the therapist, the OT must determine if the patient with dementia has a support system or caregiver. This information will help guide intervention and carryover safety recommendations. Incorrect answer. Please choose another answer.

8.	Sam, a 30-year-old, is being evaluated following an exacerbation of multiple sclerosis symptoms. The occupational therapist plans to create a thorough occupational profile with an expanded focus on performance skills. Which of the following is an example of a performance skill?
		a. Routines
		b. Values
		c. Muscle tone
		d. Ability to pace
Performance skills are motor, process, and social actions. Routines are part of performance patterns. Values and muscle tone are client factors. Incorrect answer. Please choose another answer.

Analysis/Interpretation

9.	Sara is a five-year-old in a preschool setting. She was recently evaluated for occupational therapy and scored two deviations below the mean on a standardized test measuring visual-motor skills. What would be an appropriate goal given this information?
		a. Sara will hold a pencil with a static tripod grasp
		b. Sara will transfer ten pegs into a pegboard
		c. Sara will use shapes to draw representational pictures
		d. Sara will locate five items on a search and find image
Drawing representational pictures is a visual motor skill that is a precursor to writing and appropriate for a five-year-old. Holding a pencil involves grasp only; transferring pegs is activity-based and too specific to generalize to other areas; locating pictures involves visual perception. Incorrect answer. Please choose another answer.

10.	While peer-reviewing a coworker's documentation, an OT reviews a goal about an older client s/p hip fracture who had a recent fall. It states: "Carla will transfer to and from her toilet, given a walker and grab bars, with minimum assistance in 4/4 trials within three days." Which SMART goal criteria is lacking in this goal?
		a. Specific
		b. Relevant
		c. Attainable
		d. Measurable
Given her older age and recent fall, this goal may not be attainable within the time given. The specific activity of toileting provides sufficient context for the goal. Since toileting is an ADL, and even without Carla's complete occupational profile, the goal is relevant to meet Carla's basic needs. The goal measures the amount of assistance that Carla will need to meet it and the accuracy expected. Incorrect answer. Please choose another answer.

11.	An occupational therapist is planning treatment for an adolescent with an intellectual disability. The client shared that he would like to use public transportation to get groceries by himself. Which of the following interventions would NOT be appropriate for this client?
		a. Roleplaying with money in different scenarios
		b. Practicing problem-solving at the train and bus stations
		c. Education and practice using paper maps and phone GPS applications
		d. Creating a detailed list of all the steps necessary to accomplish the task.
Regarding safety, this individual needs to generalize skills to different scenarios. The first three options focus on building skills that can transfer to various situations. Creating a detailed list is too rigid and unhelpful when a change occurs. Incorrect answer. Please choose another answer.

12.	A school-based occupational therapist consults with a teacher about an eight-year-old recently diagnosed with autism spectrum disorder and is in the school's RTI (response to intervention) program. The teacher explains that she is concerned about his short-term attention span, lack of positive interaction with peers, and sensory-seeking behavior. Which Tier 2 setting would be most appropriate for the therapist to conduct intervention?
		a. A STEM-focused construction group with five children
		b. At recess, with all grade-level classrooms
		c. In the sensory room with 1:1 support
		d. In the classroom with 1:1 support
Tier 2 interventions involve small groups so that children at risk can receive extra targeted support. An intervention at recess with all children in the grade level would be considered a Tier 3 (universal) intervention. Answers C and D are examples of Tier 1 interventions. Incorrect answer. Please choose another answer.

13.	An occupational therapist creates goals for an adolescent softball pitcher who has a suspected overuse injury. Which goal is most appropriate?
		a. Increase the strength of the rotator cuff muscles to 5/5
		b. Increase ROM (shoulder extension and abduction)
		c. Report no more than 3/10 on a pain scale when engaged in approved softball drills
		d. Engage in a home exercise program 3x per week
This goal is both measurable and activity-based. The other options may be appropriate objectives but are not appropriate goals within the occupational therapy scope of practice. Incorrect answer. Please choose another answer.

14.	An occupational therapist is providing recommendations to a school team following a sensory assessment of a 6-year-old student named Kevin. The student is overresponsive to auditory and tactile input and seeks proprioceptive input. Which accommodation would be appropriate to support Kevin's classroom participation?
		a. Removal of visual clutter in the classroom such as busy posters and images
		b. Physical cues (ex. a tap on the shoulder) for attention
		c. Engaging in a heavy work break every two hours
		d. Participating in an unstructured musical instrument exploration time
Heavy work stimulates the proprioceptive system, and scheduled opportunities can help Kevin improve classroom participation. Removal of visual clutter is a strategy for children who are overresponsive to visual input. Physical cues are contraindicated since Kevin is overresponsive to tactile input. Unstructured music time could feel alarming with Kevin's sensory profile. Incorrect answer. Please choose another answer.

15.	An occupational therapist recently evaluated Mr. Garcia, an older gentleman who has experienced age-related musculoskeletal degeneration. He recently used a rolling walker but can no longer transfer from sit to stand without supervision. The occupational therapist has no concerns about Mr. Garcia's cognition. Given this information, which wheelchair would be most appropriate?
		a. Tilt-in-space wheelchair with hip and knee joints maintained at 90 degrees
		b. Power wheelchair with fluid pressure release cushion
		c. Manual lightweight chair with contoured seat
		d. Manual wheelchair with displaced rear axle and pneumatic tires
A manual lightweight wheelchair would be manageable for Mr. Garcia since he most recently used a rolling walker. The ability to propel himself will help maintain his upper body strength. The tilt-in-space and power wheelchair are not indicated and would likely contribute to further muscle degeneration. Option D describes a wheelchair for a bariatric client. Incorrect answer. Please choose another answer.

Intervention Management

16.	A therapist is selecting a physical agent modality for a patient with Raynaud's disease ahead of preparing a meal. Which modality is contraindicated?
		a. Paraffin
		b. Fluidotherapy
		c. Cryotherapy
		d. Ultrasound
Raynaud's disease is characterized by decreased blood circulation, especially to the hands. Cryotherapy is contraindicated for individuals with Raynaud's disease or other circulation impairments. The other modalities can be used in preparation for activity participation for individuals with Raynaud's disease. Incorrect answer. Please choose another answer.

17.	A preschooler is receiving push-in OT services in their early education classroom. When a fire alarm goes off, the child starts screaming and running in circles around the classroom. From a sensory perspective, which tool could the therapist use at that moment?
		a. Giving the child a tight hug and hand squeezes
		b. Directing the child to a 'cozy corner'
		c. Telling the child to spin around 10 times
		d. Offering a transition item
Giving the child pressure input is one tool that could help a child feel calm and safe. The therapist should help the child exit the room during this safety procedure. Therefore, using an area with decreased stimulation would not be helpful. Spinning activates the vestibular system and can add to the child's dysregulation. Offering a transition item is a behavioral strategy. Incorrect answer. Please choose another answer.

18.	A 44-year-old woman recently fell on ice, resulting in a Colles fracture. The fracture is healed, but she now presents with complex regional pain syndrome in the affected wrist and hand. Which of the following interventions is NOT indicated?
		a. Passive range of motion
		b. Use of a compression glove to manage edema
		c. Weightbearing activities
		d. Splinting to prevent contractures
Passive range of motion could result in increased localized pain and swelling for a patient with CRPS. Active range of motion is preferred. The other options are appropriate interventions for decreasing pain and maintaining engagement in daily activities. Incorrect answer. Please choose another answer.

19.	An entry-level occupational therapist in a rehabilitation center is assessing a patient with an L1 spinal cord injury. While conducting the interview portion of the evaluation, the OT discovers that the patient is interested in resuming sexual activity. Which of the following interventions is appropriate for an entry-level OT to provide?
		a. Introduction of energy conservation methods
		b. Catheter and hygiene management
		c. Education about safe positioning
		d. All of the above
All of the above are correct. Sex is an ADL, and intervention is within the scope of occupational therapy. An occupational therapist should make a referral if the need for medical intervention arises or if further needs arise for a referral to a marriage counselor or specialist. Incorrect answer. Please choose another answer.

20.	An occupational therapist is consulting with an architecture company about designing a new community building. They need to construct a ramp that raises the user 16 inches. In order to ensure this building is accessible, the occupational therapist should recommend which of the following wheelchair ramps?
		a. An 8-foot ramp
		b. A 16-foot ramp
		c. A 4-foot ramp
		d. A 12-foot ramp
For every inch of rise, at least 12 inches of the ramp are required. Otherwise, the slope can be too steep for wheelchair users to navigate. The 16-foot ramp meets the 1:12 requirement. Incorrect answer. Please choose another answer.

21.	An occupational therapist is providing fall prevention education to the staff at a long-term care facility. Which of the following client factors puts residents at risk for falls?
		a. Fear of falling
		b. Vertigo
		c. Presbyopia
		d. All of the above
Fear of falling can result in an individual decreasing their mobility, resulting in losing strength and mobility in the musculoskeletal system. Vertigo and presbyopia (decreased visual acuity) can directly lead to falls. Incorrect answer. Please choose another answer.

22.	Melissa, an outpatient client, and transcriptionist with a history of carpal tunnel syndrome, has transferred to a job that involves working remotely. She is concerned about the ergonomics of her new workstation. Which of the following recommendations is the best?
		a. Knees should be bent at a 70-degree angle
		b. For seated typing, the work surface should be no more than 35" high
		c. Wrists should be positioned in neutral
		d. The screen should be placed above eye level so that the neck is in slight extension
The workstation should be adjusted so that wrists are neutrally positioned. Knees should be at a 90 degree angle and the surface height for typing should not be more than 28 inches when a person is seated. The neck should also be in a neutral position. Incorrect answer. Please choose another answer.

23.	An occupational therapist plans to fabricate a splint for an individual with wrist drop following a radial nerve injury. Which splint is most appropriate?
		a. C-bar
		b. Dynamic extension
		c. MCP Flexion block splint
		d. Dorsal protection
The therapist needs to position the client's wrist into a functional position while allowing for both support and strengthening. A C-bar splint maintains the first web space by placing the thumb into opposition. An MCP flexion block splint is used with ulnar nerve injuries such as claw hand deformity. A dorsal protection splint is utilized in flexor tendon injuries. Incorrect answer. Please choose another answer.

24.	An occupational therapist in a long-term care facility meets with the medical team about Mrs. Stevens, a new intake who had a stroke three weeks ago. In her prior setting, she was on a level two dysphagia diet due to the risk of aspiration. Which of the following should the team identify as unsafe for Mrs. Stevens?
		a. Scrambled eggs and cottage cheese
		b. Watermelon cubes and oatmeal
		c. Pureed turkey and cooked carrots
		d. Bread and butter with avocado
Bread is considered an advanced food since it requires more chewing than other soft foods. The rest of the food combinations are approved for a level two dysphagia diet. Incorrect answer. Please choose another answer.

25.	A 28-year-old male with a recent above-the-elbow amputation is eager to return to driving. He has full use of his non-dominant upper extremity and is not using a prosthetic on the impaired side. Which adaptive equipment is appropriate to recommend?
		a. Round spinning knob
		b. Wheel cuff
		c. Wheel ring
		d. Reduced effort steering
The round spinning knob is appropriate for individuals who can functionally use one arm. The wheel cuff is an accommodation for drivers who have reduced grasp. A wheel ring is used in conjunction with a prosthesis. Reduced effort steering is appropriate for individuals who do not have the strength or endurance to operate the standard resistance of a steering wheel. Incorrect answer. Please choose another answer.

26.	A level II fieldwork student is working on a cardiopulmonary rehabilitation unit. While reviewing a patient chart, the student notices that the patient can participate in MET level 2 activities. Which therapeutic intervention is appropriate for the student to select?
		a. Showering
		b. Brushing teeth while standing
		c. Meal preparation
		d. Water aerobics
The student should only select activities at or below the patient's MET level. Brushing teeth while standing is considered a MET level 2. The other activities require more energy expenditure and are not appropriate at this rehabilitation stage. Incorrect answer. Please choose another answer.

Competency and Practice Management

27.	A patient in an acute care setting becomes unresponsive following a transfer to her hospital bed. What should the occupational therapist do first?
		a. Begin administering compressions
		b. Clear the patient's airway
		c. Contact the emergency response team
		d. Provide mouth-to-mouth breaths
When a client has a cardiac or neurological event that causes them to become unresponsive, the medical team will need to intervene immediately. It is best to call for help and then administer CPR: first with compressions, then clearing the airway, and then providing air. Incorrect answer. Please choose another answer.

28.	An occupational therapist in an emerging area decides to collect data in a level II empirical study. Which of the following is NOT required for the therapist to proceed?
		a. Presence of a third party to ensure compliance
		b. Institutional Review Board (IRB) review
		c. Full risk disclosure
		d. Informed consent
Research must be approved by an IRB, disclose any potential risks, and give participants informed consent. Other requirements for conducting ethical research include voluntary participation, full disclosure of the study purpose, and confidentiality. Incorrect answer. Please choose another answer.

29.	A rehabilitation manager is reviewing her clinical documentation standards for the unit to ensure that they are compliant with all standards. Which of the following is not sufficient to adhere to standards for reimbursement?
		a. Patient identification, date of birth, and diagnosis
		b. OT or COTA signature
		c. A medical necessity statement
		d. ICD and CPT codes
Since a COTA operates under supervision of an OT, the supervising OT must cosign COTA documentation. The other items are all required under a medical model. Incorrect answer. Please choose another answer.

30.	An occupational therapist is assigned to a unit where two isolated individuals have C. diff. Which precaution is necessary for the OT when visiting the affected patient's room to limit spread to themselves and others?
		a. Use any available cleaner on all high-touch surfaces
		b. Don gown and gloves, remove and discard in the patient's room when finished, washing hands before leaving
		c. Wear gloves and a mask, remove and discard before leaving the patient's room when finished, washing hands before leaving
		d. Don gown and gloves, remove PPE after leaving the isolation room, and immediately washing hands
C. diff spreads by contact, and therefore a gown and gloves are required. Anyone who enters the isolation room will need to wear a gown and gloves and should discard the used PPE in the room to prevent spread. Only approved anti-microbial cleaners should be used for disinfecting the patient's room. Incorrect answer. Please choose another answer.

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