COTA facebook

Question 1

A COTA is fabricating a thermoplastic splint as conservative treatment for a client who has early symptoms of cubital tunnel syndrome. What would be the PRIMARY purpose of this splint?

A. Substitute for absent muscle function.
B. Prevent elbow flexion during hours of sleep.
C. Block ring and small finger MCP joint hyperextension.
D. Minimize wrist flexion and extension during work.

Answer 1

Correct Answer: B

Rationale: Cubital Tunnel syndrome is a compression of the ulnar nerve at the elbow, which is typically aggravated by holding the elbow in a flexed position. A client wears a long-arm splint at night to prevent elbow flexion when sleeping.

Incorrect Responses: A: Muscle function is usually not affected during the early stages of cubital tunnel syndrome C: This is a late symptom of cubital tunnel syndrome. Conservative treatment is not indicated if the client has clawing of the ring and small fingers. D: This would be indicated for carpal tunnel syndrome.

Question 2

A patient in a rehabilitation facility has a C8 (ASIA A) spinal cord injury. Under optimal circumstances, which functional tasks would the patient be expected to complete independently by 1-year post injury?

Select the 3 best choices. 
A. Bowel care 
B. Pressure relief activities 
C. Sliding board transfers 
D. Upper body bathing 
E. Stand-pivot transfers  
F. Lower body dressing

Answer 2

Correct Answer: B, C, D

Rationale correct response options: These are the expected functional outcomes for someone who sustained an uncomplicated, complete spinal cord injury at the C8 spinal level.

Rationale incorrect response options: These are expected functional outcomes for someone who sustained a complete spinal cord injury below the C8 spinal level.

Question 3

Question:

An older adult client has glaucoma and mild dementia. The client lives alone and reports difficulty remembering to take prescription medications. Which compensatory option would be MOST BENEFICIAL for the COTA to teach the client to use for supporting success with personal medication management?

A. Medication journal for tracking daily dosages

B. Programmable talking prescription bottle with auto alert

C. Pill storage box pre-filled with weekly medication dosages

D. Alarm wristwatch pre-set to beep at a designated time

Answer 3

Correct Answer: B

Rationale: This option compensates for both the client’s visual and memory deficits.

Incorrect Responses: A: This option does not address the client’s visual deficit. C, D: This option does not address the client’s memory deficits.

Question 4

Question:

A client sustained a distal radius fracture 8 weeks ago. The client has been participating in outpatient OT 3 times per week for the past 6 weeks and has been making steady progress toward goals. During the past two sessions, the client has reported increased pain when completing functional tasks. What INITIAL action should the COTA take based on this information?

A. Reduce the intensity of the intervention activities used during scheduled sessions.
B. Ask the OTR to complete a reevaluation and update the intervention plan.
C. Decrease the frequency of the intervention sessions until the pain subsides.
D. Gather information from the client about symptoms and recent activity patterns.

Answer 4

Correct Answer: D

Rationale: This should be done in advance of changing any aspect of the intervention or informing the OTR.

Incorrect Responses: A, B, C: These may be done as indicated only after gathering information from the client about the symptoms and recent activity patterns.

Question 5

Question:

An OTR and COTA are collaboratively establishing an intervention plan for a 12-month-old infant who has Down syndrome. Evaluation results indicate the infant has a 6 month delay in achieving typical milestones. What should be the PRIMARY consideration when developing an intervention plan for this infant?

A. Selection of developmental goals based the infant’s environment and context
B. Activity selection consistent with the chronological age of the infant
C. Ability of the caregiver to provide carry-over of the intervention within the home

Answer 5

Correct Answer: A

Rationale: To promote optimal outcomes, the OTR and COTA must consider typical development in relation to the infant’s environment and context.

Incorrect Responses: B, C: These should be considered after an intervention plan has been developed in order to promote progress toward developmental goals.

Question 6

Question:

A client with myasthenia gravis wants to be independent with meal preparation. Which symptoms TYPICALLY associated with this condition would make this task difficult for the client to complete independently?

Select the 3 BEST choices. 
A. Ideomotor apraxia 
B. Lower extremity weakness 
C. Oculomotor ptosis 
D. Cognitive decline 
E. Upper extremity tremors 
F. Decreased activity tolerance

Answer 6

Correct Answer: B, C, F

Rationale correct response options: Typical symptoms of myasthenia gravis include ptosis, diplopia, limb weakness, and fatigue.

Rationale incorrect response options: These symptoms and functional impairments are not typically associated with myasthenia gravis.

Question 7

Question:

A resident in a long-term care facility has advanced dementia. Nursing staff report the resident is becoming increasingly more anxious when in the dining room, is disinterested in self-feeding and is dependent on staff during mealtimes. In addition to minimizing distractions in the dining environment, what technique should the COTA teach staff to use for initially supporting the resident’s engagement with self-feeding?

A. Bridging; by having the resident hold a utensil while the staff feeds the resident
B. Chaining; by using hand over hand guidance to move the resident’s hand to mouth
C. Re-directing; by using verbal cues to prompt the resident to eat the meal
D. Modulating; by providing graded sensory input at various intervals during each meal

Answer 7

Correct Answer: A

Rationale: This technique can help to focus the resident’s attention and decrease anxiety while supporting engagement in the task.

Incorrect Responses: B, C, D: Based on the resident’s current level of function, these techniques will not be as effective as bridging.

Question 8

Question:

An inpatient has a right transtibial amputation secondary to complications associated with type II diabetes mellitus. The patient uses a wheelchair for mobility and will be discharged to live at home with family. What education is MOST IMPORTANT to include as part of the patient’s pre-discharge sessions from acute care?

A. Skin and foot care of the residual lower limb and left lower extremity
B. Community transportation options for wheelchair users
C. Importance of engaging in preferred activities to reduce risk of depression
D. Mattress options for minimizing back pain associated with prolonged bedrest

Answer 8

Correct Answer: A

Rationale: This patient is at-risk for further life threatening complications due to the diabetes. Education about proper skin care of the lower extremities is critical at this stage of the patient’s treatment.

Incorrect Responses: B, C: These options are not as critical to address prior to discharge from acute and can be covered during follow-up OT sessions. D: This option may not need to be addressed since this patient is able to sit upright in a wheelchair.  

Question 9

Question:

A client was diagnosed with a brain tumor 2 weeks ago. Symptoms include mild physical and cognitive deficits. During an ADL session, the client stops the activity and begins to cry stating: “I really want to do this, but I am so upset about this diagnosis.” What actions should the COTA take in response to the client’s comment?

Select the 3 BEST choices.

A. Empathize and validate the client’s perceptions of the situation.
B. Advise the client that medication side effects often include emotional lability.
C. Collaborate to discuss current priorities for intervention activities.
D. Inform the client that participating in OT will resolve negative feelings.
E. Advocate the need for removing emotional barriers to performance.
F. Provide encouragement through the use of positive reinforcement.

Answer 9

Correct Answer: A, C, F

Rationale correct response options: These actions reflect the therapeutic use of self to support the client’s current emotional needs.

Rationale incorrect response options: These actions do not support the client’s current emotional needs.

Question 10

Question:

A COTA is planning a cooking group for several residents of a long-term care facility who are functioning at Allen Cognitive Level 4 (Goal-Directed Actions). What is the BEST way for the COTA to provide activity instructions considering the residents’ level of cognitive function?

A. Use sequential picture cards to reinforce each step of the cooking task.
B. Provide the residents with a simple written recipe to follow.
C. Demonstrate one-step of the meal preparation task at a time.

Answer 10

Correct Answer: C

Rationale: Residents functioning at this cognitive level will be most successful when verbal prompts are provided for a single step of an activity at a time.

Incorrect Responses: A, B: These options are not optimal for supporting engagement in activity for residents who are functioning at this cognitive level.  

Question 11

Question:

A COTA working in an acute care setting is preparing for an intervention session with a patient who had a CVA 3 days ago. Medical records indicate standard precautions should be implemented when providing care for this patient. Based on these requirements, which precautions MUST the COTA follow during the therapy session?

Select the 3 BEST choices.

A. Wear a surgical mask when in close proximity to the patient such as during transfer training.
B. Wash hands or use hand sanitizer before and after direct patient contact.
C. Place soiled clothing in a facility designated receptacle separate from routine laundry.
D. Don protective clothing including gown and gloves prior to entering the patient’s room.
E. Limit patient movement from the hospital room to other treatment areas in the hospital.
F. Clean and disinfect therapy equipment according to facility procedures.

Answer 11

Correct Answer: B, C, F

Rationale correct response options: These procedures are included in the standard precautions as outlined by the Center for Disease Control (CDC).

Rationale incorrect response options: These are transmission risk precautions and appropriate for use when specific risks have been identified.

Question 12

Question:

A COTA working in an early intervention setting is observing a parent feeding a toddler who has cerebral palsy. After the parent places a child-sized spoonful of chunky applesauce into the toddler’s mouth, the toddler coughs and make a gagging sound, then swallows the food. What INITIAL action should the COTA take in response to this observation?

A. Ensure the toddler is in a fully upright and chin-tuck position.
B. Apply the Heimlich maneuver to clear the toddler’s airway.
C. Mash the toddler’s food to a pureed consistency.
D. Recommend the parent give the toddler a drink of water.

Answer 12

Correct Answer: A

Rationale: The COTA should initially check to ensure the toddler is in an optimal position for facilitating safe swallowing.

Incorrect Responses: B, C, D: These actions are not indicated based on the toddler’s response.

Question 13

Question:

A COTA is providing a home program for a client who has early stage myasthenia gravis. What information is important to include in home program instructions for minimizing the impact of the disease on occupational performance?

A. Energy conservation methods
B. Perceptual-motor exercises
C. Visual scanning strategies

Answer 13

Correct Answer: A

Rationale: Myasthenia gravis is a neuromuscular disease affecting voluntary muscle. Typical symptoms include decreased muscle strength and fatigue. Energy conservation methods will help minimize the impact of this disease on occupational performance and should be included as part of a home program instruction.

Incorrect Responses: B, C: These options are not effective in minimizing the impact of myasthenia gravis on occupational performance.

Question 14

Question:

A COTA is working with a client who has muscle weakness secondary to a progressive neurological condition. The client wants to be able to get dressed independently but weakness interferes with the ability to get clothing from the closet, put on and take off clothing, and to manage clothing fasteners. Which method represents the use of the rehabilitation approach for improving the client’s ability to complete dressing activities?

Select the 3 BEST choices.
A. Using resistive activities to improve pinch strength needed for dressing
B. Teaching the client how to use assistive devices during ADL
C. Suggesting home modifications to support the client’s dressing routine
D. Having the client practice movement patterns associated with dressing
E. Providing the client with adaptive clothing options
F. Developing a restorative program to improve the client’s endurance

Answer 14

Correct Answer: B, C, E

Rationale: Consistent with the rehabilitation approach, these interventions aim to improve task performance and to minimize the effects of a progressive condition on task accomplishment.

Incorrect Response: These intervention methods are consistent with the biomechanical or motor learning approach.

Question 15

Question:

A service competent school-based COTA is collaborating with an OTR prior to the initial evaluation of a student who has a developmental delay. Which part of the student’s evaluation is within the scope of practice for the COTA to complete?

A. Documenting outcomes of unstructured parent interviews
B. Administering and scoring standardized handwriting assessments
C. Assessing fine motor patterns during classroom activities

Answer 15

Correct Answer: B

Rationale: Administering and scoring standardized assessments are within the scope of practice for a service competent school-based COTA practitioner.

Incorrect Responses: A, C: These options are outside the scope of practice of a COTA practitioner, although a COTA can contribute to discussions with the OTR on these areas

Question 16

Question:

An inpatient who had a right CVA one month ago is participating in a dressing session. The patient is able to complete adaptive dressing when each article of clothing is handed to the patient one at a time. If the clothing is placed on the bed to the left of the patient, the patient is unable to initiate the dressing task without verbal prompts. Which perceptual deficit does this represent?

A. Visual closure deficit
B. Unilateral neglect
C. Asomatognosia
D. Ideomotor apraxia

Answer 16

Correct Answer: B

Rationale: Unilateral neglect is a perceptual motor impairment in which messages from the hemiplegic side of the body are unable to be interpreted. It presents as ignoring the affected half of the body or space.

Incorrect Responses:
A: A deficit in visual closure presents as the inability to visualize a complete whole when given an incomplete image.
C: Asomatognosia is a deficit in body scheme which presents as a loss of awareness of a particular body part’s relationship to the rest of the body.
D: Ideomotor apraxia presents as the inability to perform a motor act on command, despite the ability to perform the act automatically.

Question 17

Question:

An inpatient had an uncomplicated total hip replacement, anterolateral approach one week ago. What movement of the affected hip is typically CONTRAINDICATED based on standard hip precautions?
A. Abduction beyond 25 degrees
B. Hip flexion to 90 degrees
C. External rotation

Answer 17

Correct Answer: C

Rationale: Total hip precautions for an anterolateral approach include the following movement restrictions: hip external rotation, hip flexion beyond 90°, crossing the operated leg over the unoperated leg, adduction of the operated leg.

Incorrect Responses: A: Lower extremity abduction is not contraindicated after a total hip replacement. B: Hip flexion up to 90o is acceptable, but hip flexion beyond 90° is contraindicated after a total hip replacement.

Question 18

Question:

A client has ataxia of both upper extremities secondary to a cerebellar brain tumor. One of the client’s goals is to be independent with self-feeding. Which assistive devices would be effective for supporting this goal?

Select the 3 BEST choices.

A. Plate guard 
B. Weighted utensils 
C. Plastic drinking mug 
D. Rocker knife 
E. Elongated plastic straw 
F. Combination spoon-fork

Answer 18

Correct Answer: A, B, E

Rationale: These assistive devices are beneficial for a client who has ataxic movements secondary to a central nervous system disorder such as a cerebellar brain tumor.

Incorrect Responses: These assistive devices are beneficial for a client who has problems with limited muscle strength or has use of only one upper extremity.

Question 19

Question:

An inpatient had open heart surgery 5 days ago and has just been transferred from the intensive care unit to the cardiac care unit. Medical records indicate it is safe for the patient to participate in activities requiring a maximum of 2 metabolic equivalents (METs). Which BADL activity is within the prescribed MET-level limitations?

A. Independent sponge-bathing of the face, bilateral upper extremities, and torso while semi-reclined in bed
B. Personal hygiene and grooming activities with minimal assistance while standing at the bathroom sink
C. Upper and lower body dressing while seated on the edge of the bed with stand-by assistance for balance

Answer 19

Correct Answer: A

Rationale: Simple hygiene in a semi-reclined sitting position uses 1-2 METs.

Incorrect Responses: B, C: These activities require more than the maximum allowable METs.

Question 20

Question:

A patient in a rehabilitation facility has a C8 (ASIA A) spinal cord injury. Under optimal circumstances, which functional tasks would the patient be expected to complete independently by 1-year post injury?

Select the 3 BEST choices. 
A. Bowel care 
B. Pressure relief activities 
C. Sliding board transfers 
D. Upper body bathing 
E. Stand-pivot transfers  
F. Lower body dressing

Answer 20

Correct Answer: B, C, D

Rationale: These are the expected functional outcomes for someone who sustained an uncomplicated, complete spinal cord injury at the C8 spinal level.

Incorrect Responses: These are expected functional outcomes for someone who sustained a complete spinal cord injury below the C8 spinal level.

Question 21

Question:

A client in the mid-stage of Alzheimer’s disease lives at home with a spouse as the primary caregiver. The spouse wants the client to remain at home as long as possible; despite a progressive decline in the client’s cognition. What strategy should be included in the recommendations for supporting the client’s aging-in-place?

A. Establish a routine schedule of familiar daily activities to encourage engagement.
B. Have the client use a variety of assistive devices to minimize task demands.
C. Plan most activities for the morning to avoid the effects of sundowning.

Answer 21

Correct Answer: A

Rationale: Maintaining a schedule of familiar daily activities is an effective technique for managing a client’s cognitive decline while maximizing engagement in tasks.

Incorrect Responses: B, C: These options do not emphasize the importance of familiarity and establishing routines; the adaptive technique from which a client with mid-stage Alzheimer’s disease would most benefit.