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NBCOT COTA study materials
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NBCOT COTA practice questions

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Question 1Evaluation and Referral

During an OT evaluation, which task falls within the COTA's scope when working under the supervision of an OTR?

  1. Administering delegated assessments and gathering performance data Correct answer.
  2. Determining whether skilled OT services are medically necessary for admission
  3. Interpreting evaluation results to establish the OT diagnosis
  4. Selecting the evaluation battery without OTR input

Explanation

The COTA contributes to the evaluation by administering delegated assessments and collecting performance data. The OTR interprets results, establishes the OT diagnosis, and determines the need for skilled services. Selection of the evaluation battery is a collaborative decision that requires OTR oversight.

Question 2Evaluation and Referral

What is the primary purpose of an OT screening?

  1. Determining whether a full evaluation is warranted Correct answer.
  2. Diagnosing a swallowing disorder affecting oral intake
  3. Prescribing a modified diet texture for safety
  4. Establishing long-term treatment goals for the patient

Explanation

A screening is a brief process used to identify whether a person needs a comprehensive evaluation. It does not establish long-term goals or diagnose specific conditions. Findings are used to make referral and evaluation decisions.

Question 3Evaluation and Referral

A referral for a patient after hip replacement asks the COTA to evaluate ADLs and upper extremity function. Before beginning, the COTA should first:

  1. Begin ADL training immediately with standing transfers
  2. Schedule the discharge date before the evaluation
  3. Review the referral, chart, and weight-bearing precautions Correct answer.
  4. Order adaptive equipment from the vendor before assessment

Explanation

Before initiating evaluation, the COTA must verify the referral and review the medical record for orders, precautions, and contraindications. Hip replacement precautions directly affect transfer and ADL assessment. Equipment and discharge decisions follow assessment, not precede it.

Question 4Evaluation and Referral

A patient appears confused and cannot explain the purpose of the evaluation. What is the COTA's best action?

  1. Document refusal and stop all OT services for the patient
  2. Proceed because the referral form was signed by the physician
  3. Follow facility policy to obtain consent from a representative Correct answer.
  4. Skip the evaluation and begin treatment activities instead

Explanation

Informed consent requires that the patient understand the purpose and nature of the evaluation. When the patient lacks capacity, the COTA should follow facility policy to obtain consent from an authorized representative. A signed referral does not replace informed consent.

Question 5Evaluation and Referral

Which documentation entry is objective and measurable?

  1. Completed 10 shoulder flexion repetitions with minimal assistance Correct answer.
  2. Patient states that pain is 5/10 at rest and requests medication
  3. Patient appeared frustrated and frequently sighed during the session
  4. Patient had a good day and participated well overall

Explanation

Objective documentation describes observable, measurable performance, such as repetitions and level of assistance. Patient statements are subjective data, while descriptions of appearance and vague summaries are interpretive. Clear measurable language supports reliable progress tracking.

Question 6Evaluation and Referral

Which landmark is used as the axis for measuring shoulder flexion with a goniometer?

  1. Radial styloid process
  2. Lateral epicondyle of the humerus
  3. Olecranon process
  4. Acromion process Correct answer.

Explanation

For shoulder flexion, the goniometer axis is placed over the acromion process. The stationary arm aligns with the midline of the thorax, and the moving arm aligns with the lateral humerus. Using the correct landmarks improves measurement consistency.

Question 7Evaluation and Referral

Manual muscle test grade 3 indicates that the patient can:

  1. Produce no visible muscle contraction
  2. Move through full range against gravity and maximal resistance
  3. Move through full available range against gravity without added resistance Correct answer.
  4. Produce a trace contraction without joint motion

Explanation

Grade 3 indicates movement through the full available range against gravity without additional resistance. Grade 0 indicates no contraction, grade 1 indicates a trace contraction, and grade 5 indicates normal movement against gravity and maximal resistance. Accurate grading guides intervention planning.

Question 8Evaluation and Referral

Which tool is a brief cognitive screening instrument commonly used during OT evaluation?

  1. Goniometer
  2. Mini-Mental State Examination Correct answer.
  3. Fugl-Meyer Assessment
  4. Barthel Index

Explanation

The Mini-Mental State Examination is a brief cognitive screening tool that samples orientation, memory, attention, and language. The Barthel Index measures ADL independence, the Fugl-Meyer assesses motor recovery, and a goniometer measures joint range. Selecting the right tool depends on the construct being screened.

Question 9Evaluation and Referral

An older adult with rheumatoid arthritis and low vision needs an ADL evaluation. Which approach is most appropriate?

  1. Observe prioritized ADLs with usual and adaptive equipment Correct answer.
  2. Administer a cognitive screening instead of an ADL assessment
  3. Measure upper extremity strength only with a dynamometer
  4. Rely only on the patient's self-report of independence

Explanation

Performance-based observation of prioritized ADLs using the patient's actual equipment provides the most valid information about function. Self-report alone may overestimate independence, and cognitive or strength measures do not substitute for ADL assessment. Observation also reveals safety and environmental fit.

Question 10Evaluation and Referral

During a standardized assessment, the patient becomes fatigued and cannot continue. What is the most appropriate action?

  1. Substitute a different test without documenting the change
  2. Continue all items to preserve the standardized administration
  3. Stop, follow manual guidance, and document the limitation Correct answer.
  4. Change the instructions to make each item easier for the patient

Explanation

Standardized tests must be administered according to the manual, including rules for discontinuing or partial administration. When fatigue limits testing, the COTA should stop appropriately, document the limitation, and report findings to the OTR. Altering instructions or substituting tests without documentation invalidates results.

Question 11Evaluation and Referral

A screening tool gives the same score each time but does not measure the skill it claims to measure. This tool is:

  1. Both reliable and valid
  2. Valid but not reliable
  3. Neither reliable nor valid
  4. Reliable but not valid Correct answer.

Explanation

Reliability refers to consistency of results across repeated administrations, while validity refers to measuring the intended construct. A tool that is consistent but measures the wrong construct is reliable but not valid. Both properties matter when selecting assessments.

Question 12Evaluation and Referral

What is the best method for obtaining accurate ADL information from a patient with mild cognitive impairment?

  1. Interview the caregiver only and omit the patient interview
  2. Observe a single ADL once and generalize to all ADLs
  3. Interview the patient only, without any caregiver input
  4. Combine interview, caregiver report, and observation Correct answer.

Explanation

Using multiple sources improves accuracy when cognition is mildly impaired. A structured interview, caregiver corroboration, and direct observation together reduce the risk of over- or underestimating independence. No single source is sufficient for all ADLs.

Question 13Evaluation and Referral

During a home safety evaluation, which area should be assessed first because it presents a high fall risk?

  1. Entry access and bathroom transfers Correct answer.
  2. Recommend major structural renovations
  3. Order durable medical equipment before assessment
  4. Teach energy conservation before inspecting the home

Explanation

Entry access and bathroom transfers are high-risk areas for falls and should be assessed early. Recommendations for renovations or equipment should follow the assessment findings. Energy conservation teaching is important but does not replace inspection of fall hazards.

Question 14Evaluation and Referral

A teacher refers a student with handwriting difficulties. What is the COTA's best initial action under OT supervision?

  1. Recommend that the student be retained in the current grade
  2. Screen fine motor, visual-motor, and postural factors Correct answer.
  3. Diagnose a specific learning disability affecting written expression
  4. Change the student's curriculum to eliminate handwriting tasks

Explanation

The COTA can screen performance components related to handwriting, such as fine motor control, visual-motor integration, and posture. Diagnosing a learning disability and making educational placement decisions are outside the OT scope. Findings are reported to the OTR and team for further planning.

Question 15Evaluation and Referral

A patient develops new foot drop and reddened skin over the heel. What should the COTA do?

  1. Independently adjust the patient's ankle-foot orthosis for better fit
  2. Wait until the next scheduled reassessment to report the findings
  3. Document findings and notify the OTR and team promptly Correct answer.
  4. Apply a heating pad to the reddened heel area to improve circulation

Explanation

New neurologic findings and skin redness require prompt communication with the OTR and appropriate team members. Applying heat to reddened skin can cause further tissue damage, and orthosis adjustments should follow orders and assessment. Documentation and timely reporting protect patient safety.

Question 16Evaluation and Referral

A patient lives alone and needs 24-hour supervision. What is the COTA's role in discharge planning?

  1. Report safety concerns and help the team identify support options Correct answer.
  2. Arrange home health services independently without team involvement
  3. Recommend discharge to home alone because the patient prefers independence
  4. Tell the family to make the discharge decision without team input

Explanation

The COTA contributes assessment data about safety and function and participates in team discharge planning. Recommending an unsafe discharge or arranging services independently exceeds the role. The team, patient, and family work together to identify appropriate support.

Question 17Evaluation and Referral

Which method best measures progress in dressing over time?

  1. Measure shoulder flexion strength with a dynamometer each week
  2. Ask the patient whether dressing has improved since the last session
  3. Observe dressing consistently, recording assistance level and time Correct answer.
  4. Review the chart for nursing notes about dressing performance

Explanation

Consistent observation of dressing with recorded assistance level and time provides a reliable performance measure. Self-report, nursing notes, and strength measurements are indirect and may not reflect actual dressing ability. Standardized data collection supports accurate progress tracking.

Question 18Evaluation and Referral

When measuring a doorway for wheelchair access, the COTA should record:

  1. Wall-to-wall distance including the door thickness
  2. Hallway length only
  3. Threshold height only
  4. Clear opening width Correct answer.

Explanation

Wheelchair passage depends on the clear opening width, which is the narrowest usable space between the door and frame. Wall-to-wall distance includes obstacles and does not reflect the actual opening. Length and threshold height do not establish whether the wheelchair can pass through.

Question 19Evaluation and Referral

To screen for unilateral neglect after a right-hemisphere stroke, which is most appropriate?

  1. Measuring vital capacity with a spirometer
  2. Goniometric measurement of wrist extension range of motion
  3. Line bisection and double simultaneous stimulation Correct answer.
  4. Manual muscle testing of the upper extremities

Explanation

Line bisection and double simultaneous stimulation are standard bedside methods for screening unilateral neglect. Range of motion, strength, and vital capacity assess different body functions. Screening results guide further evaluation and safety planning.

Question 20Evaluation and Referral

During evaluation, the COTA identifies complex seating and positioning needs beyond basic equipment. What is the best action?

  1. Fabricate a custom cushion independently without further assessment
  2. Tell the family to purchase a cushion based on the COTA's opinion
  3. Refer the concern to the OTR for further evaluation Correct answer.
  4. Document the finding and take no further action

Explanation

Complex seating and positioning require OTR evaluation and may involve additional team members. The COTA should document findings and communicate them to the OTR. Independent fabrication or equipment recommendations without assessment are not appropriate.

Question 21Evaluation and Referral

Before using a new standardized assessment, the most important step is to:

  1. Use it with every patient regardless of the patient's diagnosis
  2. Review the manual for reliability, validity, and population fit Correct answer.
  3. Ask a colleague whether the test is popular with staff members
  4. Choose the shortest test to reduce administration time

Explanation

Test selection requires evidence that the instrument is reliable, valid, and appropriate for the patient population being assessed. Popularity and administration time are secondary considerations. Using a test with all patients regardless of diagnosis may produce meaningless results.

Question 22Evaluation and Referral

An interpreter is needed for an evaluation. What is the best practice?

  1. Give written instructions in English only and proceed
  2. Use a trained medical interpreter and follow test guidelines Correct answer.
  3. Use a family member to interpret so the patient feels comfortable
  4. Skip the interview and rely on the medical record notes

Explanation

A trained medical interpreter supports accurate communication and protects confidentiality. Family members may alter meaning or omit information, and written English instructions may not be understood. Test administration should follow guidelines for language and cultural adaptation.

Question 23Evaluation and Referral

During delegated evaluation data collection, the patient's pain increases with activity and limits testing. What is the best action?

  1. Modify testing within protocol, document the limitation, and notify the OTR Correct answer.
  2. Stop all OT services permanently and discharge the patient from therapy
  3. Continue every item to complete the standardized protocol exactly as written
  4. Refer the patient to physical therapy only and end the OT evaluation

Explanation

The COTA should modify the approach within the test protocol and clinical scope, document the pain and limitation, and report to the OTR. Completing all items despite increasing pain may be unsafe and unnecessary. Permanent discharge or ending the evaluation is premature.

Question 24Evaluation and Referral

A family asks the COTA to share evaluation results before the OTR has reviewed them. What is the best response?

  1. Provide the full evaluation report immediately so the family can review it
  2. Refuse to speak with the family at all and leave the room
  3. Explain that the team will review results and refer questions to the OTR Correct answer.
  4. Give a verbal diagnosis and prognosis to help the family plan care

Explanation

Interpretation of evaluation results and diagnostic conclusions are OTR responsibilities. The COTA can explain the process and ensure the family's questions reach the OTR. Sharing incomplete results or offering a diagnosis may misinform the family.

Question 25Evaluation and Referral

Which is a functional outcome measure appropriate for tracking ADL independence?

  1. Mini-Mental State Examination
  2. Barthel Index Correct answer.
  3. Numeric pain rating scale
  4. Goniometer measurement of elbow flexion

Explanation

The Barthel Index measures independence in basic ADLs and is used to track functional outcomes. A goniometer measures range of motion, the MMSE screens cognition, and a pain scale measures symptoms. The measure selected should match the outcome being tracked.

Question 26Evaluation and Referral

An occupational therapy evaluation for a newly admitted patient in an acute care hospital is initiated when the COTA receives which of the following?

  1. A physician's order for occupational therapy Correct answer.
  2. The patient's insurance authorization
  3. A verbal request from the patient's family
  4. The unit nurse's shift report

Explanation

Occupational therapy services require a referral or order from a physician or other practitioner authorized by state law and facility policy; the COTA then collects evaluation data under the supervising OTR. Family requests and nursing reports are useful information but do not authorize services. Insurance authorization determines payment, not whether an evaluation may begin.

Question 27Evaluation and Referral

The occupational profile completed during the evaluation process is designed primarily to:

  1. describe the client's roles, routines, and priorities Correct answer.
  2. compare the client's test scores with age-matched peers
  3. determine the reimbursement level for therapy services
  4. quantify the client's muscle strength and joint motion

Explanation

The occupational profile gathers information about who the client is, what occupations matter to the client, and the contexts in which performance occurs. Measurement of underlying skills belongs to the analysis of occupational performance, which follows the profile.

Question 28Evaluation and Referral

An assessment that compares a child's score with the scores of a large sample of typically developing peers of the same age is best described as:

  1. criterion-referenced
  2. performance-based observation
  3. a client-centered interview
  4. norm-referenced Correct answer.

Explanation

Norm-referenced tests compare an individual's score with the distribution of scores from a defined reference sample, usually peers of similar age. Criterion-referenced tests instead compare performance with a predetermined standard of mastery.

Question 29Evaluation and Referral

During an ADL evaluation the COTA documents that the client "requires moderate assistance to don a shirt." This statement describes the client's:

  1. ability to sequence the task
  2. level of assistance Correct answer.
  3. endurance during the task
  4. quality of the completed movement

Explanation

Terms such as independent, supervision, minimal, moderate, and maximal assistance describe the amount of help a client needs to complete an occupation. This is a measure of performance independence rather than endurance, sequencing, or movement quality.

Question 30Evaluation and Referral

A Semmes-Weinstein monofilament is used during an upper extremity evaluation to assess:

  1. proprioception at the wrist
  2. two-point discrimination
  3. vibration sense
  4. light touch threshold Correct answer.

Explanation

Monofilaments apply a calibrated force to the skin to determine the threshold at which a client detects light touch. Different tools are required for two-point discrimination, vibration, and position sense.

Question 31Evaluation and Referral

Two COTAs independently administer the same dressing assessment to the same patient on the same morning and obtain scores that differ by 8 points. This finding most directly raises a concern about:

  1. predictive validity
  2. inter-rater reliability Correct answer.
  3. the client's motivation
  4. content validity

Explanation

Inter-rater reliability is the consistency of scores when different examiners administer the same instrument to the same client. Validity concerns whether the tool measures what it claims or predicts future performance, and motivation is not the issue when two examiners differ systematically.

Question 32Evaluation and Referral

On the Modified Ashworth Scale, a grade of 1+ is documented when the examiner observes:

  1. a marked increase in tone through most of the range, with the limb still easily moved
  2. rigidity of the limb in flexion or extension
  3. no increase in muscle tone through the full range
  4. a catch, then minimal resistance through less than half the range Correct answer.

Explanation

Grade 1+ describes a catch followed by minimal resistance through less than half of the remaining range. Grade 1 is a catch and release or resistance at the end of the range, grade 2 is more marked increase through most of the range, and grade 4 is rigid.

Question 33Evaluation and Referral

A standardized ADL assessment was normed on community-dwelling older adults, and the COTA is asked to use it with adults with severe intellectual disability in a group home. The most appropriate action is to:

  1. administer the test as written and interpret the score using the published norms
  2. modify the test items and still report the total norm-referenced score
  3. decline to gather any data because the test is unsuitable for this client
  4. select a tool whose norms match the client or report results descriptively Correct answer.

Explanation

Norm-referenced scores are meaningful only when the client resembles the normative sample. When the population differs substantially, the COTA should choose an instrument with appropriate norms or report performance descriptively without peer comparison. Modifying standardized items invalidates the published score.

Question 34Evaluation and Referral

A client with expressive aphasia is being interviewed during the initial evaluation. Which approach best supports accurate data collection?

  1. Postpone all client interviewing until speech therapy discharges the client
  2. Complete the interview with the family only and skip the client
  3. Ask closed questions and offer a consistent yes/no response method Correct answer.
  4. Speak loudly and repeat each question until the client answers

Explanation

Expressive aphasia limits verbal output but not necessarily comprehension or the ability to make choices. Closed questions with a reliable yes/no signal, plus visual supports, allow the client to contribute valid information. Relying only on family report substitutes another person's perspective for the client's own goals and preferences.

Question 35Evaluation and Referral

During an evaluation, a client with a recent stroke coughs and has a changed voice after swallowing a sip of water. The COTA should:

  1. teach the client a chin-tuck maneuver and resume the meal
  2. continue the evaluation and document the observation at the end of treatment
  3. record the event as an allergic reaction to the beverage
  4. stop the task and report the finding to the OTR for a swallowing referral Correct answer.

Explanation

Coughing and voice change after swallowing are warning signs of possible aspiration and must be addressed before any further oral intake. The COTA discontinues the task and reports to the OTR, who arranges a swallowing evaluation by speech-language pathology. Swallowing intervention is outside the COTA's scope.

Question 36Evaluation and Referral

Which statement best distinguishes screening from evaluation in occupational therapy?

  1. Screening produces a medical diagnosis, while evaluation produces only a baseline score
  2. Screening requires standardized testing, while evaluation relies mainly on interview
  3. Screening is performed only by the OTR, while evaluation may be delegated
  4. Screening indicates the need for further assessment; evaluation guides intervention Correct answer.

Explanation

Screening is a brief process used to determine whether a client needs further, more comprehensive assessment. Evaluation is the comprehensive process that produces the data used to plan intervention.

Question 37Evaluation and Referral

Elbow passive range of motion is 0 to 140 degrees, but active motion stops at 90 degrees. This discrepancy most likely indicates:

  1. a joint capsular restriction limiting motion in both active and passive directions
  2. impaired muscle function or tendon integrity limiting active motion Correct answer.
  3. normal variability between active and passive testing
  4. a bony block at the olecranon

Explanation

When passive motion exceeds active motion, the joint and capsule can be moved but the client cannot produce the motion, pointing to muscle weakness, pain inhibition, or tendon disruption. Capsular and bony restrictions limit both active and passive motion.

Question 38Evaluation and Referral

To assess stereognosis, the COTA asks the client to:

  1. report the direction of a small passive finger movement
  2. identify a number traced on the palm with vision occluded
  3. distinguish between one and two points on the fingertip
  4. name an object placed in the hand with vision occluded Correct answer.

Explanation

Stereognosis is the ability to recognize an object by touch and manipulation without vision, so the client names or describes a familiar object placed in the hand. Graphesthesia, two-point discrimination, and proprioception are separate tests.

Question 39Evaluation and Referral

While evaluating a client's home stairs before discharge, the COTA should record:

  1. step count, riser height, tread depth, and handrails Correct answer.
  2. the color of the treads and the surrounding wall covering
  3. the distance from the stairs to the nearest hospital
  4. the client's preferred time of day for using the stairs

Explanation

Stair safety depends on measurable features: how many steps there are, how high each riser is, how deep each tread is, and whether stable handrails are present. These dimensions determine whether the client can negotiate the stairs and what modifications are needed.

Question 40Evaluation and Referral

When selecting an assessment for a client who recently immigrated and does not read English, the most important consideration is whether the instrument:

  1. takes less than 30 minutes to administer
  2. produces a numeric score that is easy to explain to the team
  3. is available in the client's language with appropriate norms Correct answer.
  4. is inexpensive for the facility to purchase

Explanation

Test results are interpretable only when the client can understand the items and when the reference sample resembles the client. Language availability and appropriate norms are therefore the priority considerations. Administration time, cost, and scoring format are secondary practical factors.

Question 41Evaluation and Referral

During a kitchen task, a client with a traumatic brain injury gathers all ingredients but cannot order the steps and repeatedly returns to the start. This performance most directly suggests a deficit in:

  1. sensory discrimination
  2. sustained attention
  3. fine motor coordination and dexterity
  4. executive function and sequencing Correct answer.

Explanation

Planning, organizing, and carrying out steps in the correct order are executive functions. The client demonstrated the physical ability to gather items but could not organize the task, which is a problem-solving and sequencing deficit rather than a motor one.

Question 42Evaluation and Referral

A functional capacity evaluation is used primarily to:

  1. measure hand dexterity for splint fabrication
  2. assess driving readiness after neurological injury
  3. determine the client's cognitive level for academic planning
  4. compare the worker's abilities with the job's demands Correct answer.

Explanation

A functional capacity evaluation measures a worker's physical abilities and compares them with the demands of a specific job, often for return-to-work or disability determinations. It is not a cognitive, hand-skill, or driving assessment.

Question 43Evaluation and Referral

Confrontation testing during an occupational therapy evaluation is used to screen for:

  1. contrast sensitivity
  2. visual field loss Correct answer.
  3. oculomotor pursuit speed
  4. visual acuity for near tasks

Explanation

Confrontation testing compares the client's peripheral field with the examiner's by presenting targets in the outer quadrants, identifying field cuts such as hemianopsia. Acuity, contrast sensitivity, and pursuit movements are screened with other methods.

Question 44Evaluation and Referral

Which of the following is an example of objective data in an evaluation report?

  1. Grip strength is 12 lb on the right and 45 lb on the left Correct answer.
  2. The client appears unmotivated and tearful during the session
  3. The client's spouse reports that he seems frustrated
  4. The client states, "My hand feels clumsy all day"

Explanation

Objective data are observable, measurable findings such as instrumented strength values that another examiner could reproduce. Client statements, family reports, and clinical impressions are subjective or interpretive information.

Question 45Evaluation and Referral

The Human Activity Assistive Technology (HAAT) model guides the COTA to consider which four elements in an assistive technology assessment?

  1. cost, durability, portability, and cosmetic appearance
  2. task, environment, caregiver, and training
  3. diagnosis, prognosis, age, and insurance coverage
  4. activity, human, context, and assistive technology Correct answer.

Explanation

The HAAT model frames assistive technology use around the activity being performed, the human performing it, the context in which it occurs, and the assistive technology itself. Equipment features, funding, and diagnoses are considered within that framework rather than as its core elements.

Question 46Evaluation and Referral

A client 3 months after a stroke reports he has resumed driving to the store. The COTA's best action is to:

  1. alert the OTR and recommend a driving evaluation Correct answer.
  2. advise the client to avoid highways but allow local trips
  3. document the report and take no further action
  4. confirm that driving is safe because the client is independent in dressing

Explanation

Driving after a neurological event requires a specialized driving evaluation that assesses vision, cognition, and reaction time; independence in self-care does not establish fitness to drive. The COTA reports the information to the OTR so the appropriate referral and safety counseling can occur.

Question 47Evaluation and Referral

Which finding during an evaluation most strongly suggests that a client who lives alone cannot return home without supports?

  1. The client cannot toilet or cook and has no reliable caregiver Correct answer.
  2. The client's home has two steps at the entry without a handrail
  3. The client requires adaptive equipment to put on socks
  4. The client needs verbal cues to complete a 10-item grooming sequence

Explanation

Discharge safety depends on the ability to perform essential daily tasks combined with the availability of help. Dependence in toileting and meal preparation with no caregiver support creates an unmanageable risk, whereas cuing, equipment, and a handrail are addressable through training or modification.

Question 48Evaluation and Referral

A 3-year-old is referred for feeding difficulties. Which combination gives the most complete initial information?

  1. Parent report collected by telephone only
  2. A review of the child's growth chart only
  3. Caregiver interview plus observation of a mealtime Correct answer.
  4. A standardized self-feeding test administered once in the clinic

Explanation

Young children's feeding performance is highly context-dependent, so combining a structured caregiver interview with direct observation of a typical mealtime yields both the family's perspective and objective performance data. A single clinic test and chart review each capture only part of the picture.

Question 49Evaluation and Referral

A client with rheumatoid arthritis is being evaluated for a wrist immobilization splint. Which measurements are most important to obtain?

  1. Bilateral shoulder and elbow range of motion
  2. Wrist range of motion, edema, and pain Correct answer.
  3. Two-point discrimination and stereognosis
  4. Grip and pinch strength only

Explanation

A wrist orthosis must accommodate joint position and swelling while relieving painful motion, so wrist range, edema, and pain guide the design. Strength alone, proximal joint motion, and sensory testing do not determine the splint's wrist angle or fit.

Question 50Evaluation and Referral

The COTA is asked to begin an evaluation with a new patient who has not yet been informed about the purpose of the assessment. Which action is most appropriate?

  1. Begin testing and explain the purpose as the session proceeds
  2. Explain the purpose and obtain the patient's agreement first Correct answer.
  3. Proceed because the physician's referral implies consent
  4. Ask the patient's spouse to sign the consent form

Explanation

Clients have the right to understand the purpose of an assessment and to agree to participate before data collection begins. A physician's referral does not substitute for the client's informed agreement, and another person cannot consent on an adult client's behalf.