A 72-year-old client in inpatient rehabilitation had a right middle cerebral artery stroke 10 days ago. He keeps trying to stand from his wheelchair without locking the brakes and says he is ready to walk home. Which impairment pattern BEST explains this behavior?

Impulsivity and poor safety awareness typical of a right hemisphere lesion

Slow, cautious behavior and fear of falling typical of a right hemisphere lesion

Receptive aphasia that keeps him from understanding the safety instructions

Ideational apraxia typical of a left hemisphere lesion affecting tool use

A client in inpatient cardiac rehabilitation is 5 days after coronary artery bypass grafting through a median sternotomy. While practicing toilet transfers, he pushes up hard on both armrests to stand. What should the COTA teach him to do instead?

Hug a pillow to his chest, scoot forward and rise using mainly his leg muscles

Pull up on the wall grab bar with both hands so his legs do less of the work

Reach overhead to a trapeze bar and pull himself up into a standing position

A client with right hemiparesis after a left CVA needs minimal assistance for a stand-pivot transfer from the bed to a wheelchair. Where should the COTA position the wheelchair?

On the client's left side, angled about 45 degrees to the bed, brakes locked

On the client's right side so the weaker leg leads the pivot, brakes locked

On the client's left side, parallel to the bed, with both footrests in place

Directly facing the client at the bedside, with brakes released for adjusting

A client with a C4 complete spinal cord injury lives at home and wants to control the lights, television and thermostat without waiting for a caregiver. He has clear speech and good head control. Which device BEST matches his abilities and goal?

Voice-activated environmental control system linked to the home devices

Universal cuff with a typing stick for pressing standard remote buttons

Large-button remote control placed on a tray in front of his lap

Mobile arm supports so that he can reach and press the wall switches himself

A client in inpatient rehabilitation had a left hemisphere stroke. During grooming he cannot show the COTA how to brush his hair when asked, but a few minutes later he picks up the brush and smoothly brushes his hair on his own. Which deficit does this BEST illustrate?

Ideomotor apraxia, a common finding after left hemisphere damage

Left unilateral neglect, a common finding after left hemisphere damage

Expressive aphasia, a loss of the ability to understand spoken words

Ideational apraxia, a loss of knowing what objects are used for

A client in inpatient rehabilitation had open reduction and internal fixation of a left ankle fracture and is toe-touch weight bearing on the left leg. While standing at the sink with a walker to brush her teeth, she shifts her weight evenly onto both feet. What should the COTA do?

Cue her to shift weight to the right leg and walker, resting only her left toes down

Have her lift the left foot fully off the floor and balance on the right leg for the task

Let her continue, because even weight on both legs improves balance during grooming tasks

A resident in a skilled nursing facility weighs 380 lb, cannot bear weight and cannot assist with transfers. Which bed-to-chair transfer method should the COTA use?

A mechanical lift rated for the resident's weight, with two staff

A two-person stand-pivot transfer using a gait belt and a firm count

A sliding board transfer with one staff member guarding from the front

A home health client with Parkinson disease freezes in the doorway between the bedroom and the hall. Which strategy should the COTA teach?

Use a rhythmic cue, such as counting aloud, to restart the steps

Take smaller and faster steps to squeeze through the doorway

Have a caregiver pull the client forward by the arm to break it

A client with T10 complete paraplegia has passed a driving evaluation with a certified driver rehabilitation specialist. He asks the COTA which vehicle adaptation will let him operate the gas and brake. Which adaptation is typical?

Hand controls for the gas and brake, used with a steering spinner knob

Pedal extensions that bring the gas and brake pedals closer

Left-foot accelerator with the standard brake pedal left in its usual place

Spinner knob on the steering wheel with no other adaptations

NBCOT COTA Certified Occupational Therapy Assistant Test

Free NBCOT COTA Practice Questions

10 sample questions for the NBCOT COTA Certified Occupational Therapy Assistant Test, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Conditions and Influences on Occupational Performance, The Occupational Profile, Assessment and Activity Analysis, Collaboration, Supervision and Monitoring the Intervention, ADLs, IADLs, Feeding, Eating and Functional Mobility, Motor, Neurological and Physiological Interventions, Orthotics and Prosthetics, Assistive Technology, Seating, Mobility and Environmental Modification, Evidence-Based Practice, Safety and Risk Management, Documentation, Reimbursement, Law and Ethics.

Question 1 · Conditions and Influences on Occupational Performance
A 72-year-old client in inpatient rehabilitation had a right middle cerebral artery stroke 10 days ago. He keeps trying to stand from his wheelchair without locking the brakes and says he is ready to walk home. Which impairment pattern BEST explains this behavior?
- A.Slow, cautious behavior and fear of falling typical of a right hemisphere lesion
- B.Receptive aphasia that keeps him from understanding the safety instructions
- C.Ideational apraxia typical of a left hemisphere lesion affecting tool use
- D.Impulsivity and poor safety awareness typical of a right hemisphere lesion
Show answer and explanation
Answer: D. Impulsivity and poor safety awareness typical of a right hemisphere lesion
Right hemisphere strokes commonly cause left hemiplegia with impulsivity, reduced insight and poor safety awareness, so clients overestimate what they can do. Receptive aphasia and apraxia are linked with left hemisphere lesions, and slow, cautious behavior is the typical left hemisphere pattern.
Question 2 · Collaboration, Supervision and Monitoring the Intervention
A client in inpatient cardiac rehabilitation is 5 days after coronary artery bypass grafting through a median sternotomy. While practicing toilet transfers, he pushes up hard on both armrests to stand. What should the COTA teach him to do instead?
- A.Pull up on the wall grab bar with both hands so his legs do less of the work
- B.Reach overhead to a trapeze bar and pull himself up into a standing position
- C.Hug a pillow to his chest, scoot forward and rise using mainly his leg muscles
Show answer and explanation
Answer: C. Hug a pillow to his chest, scoot forward and rise using mainly his leg muscles
Sternal precautions limit pushing, pulling and resisted reaching with the arms while the sternum heals, so he should splint his chest and use his legs to stand. Pulling on a grab bar or an overhead trapeze places the same stress on the healing sternum as pushing.
Question 3 · ADLs, IADLs, Feeding, Eating and Functional Mobility
A client with right hemiparesis after a left CVA needs minimal assistance for a stand-pivot transfer from the bed to a wheelchair. Where should the COTA position the wheelchair?
- A.On the client's right side so the weaker leg leads the pivot, brakes locked
- B.On the client's left side, parallel to the bed, with both footrests in place
- C.Directly facing the client at the bedside, with brakes released for adjusting
- D.On the client's left side, angled about 45 degrees to the bed, brakes locked
Show answer and explanation
Answer: D. On the client's left side, angled about 45 degrees to the bed, brakes locked
Setting the chair on the stronger side at an angle shortens the pivot and lets the client lead with the stronger leg; brakes are locked and footrests removed or swung away. Leading with the weaker side increases fall risk. Unlocked brakes and footrests left in place are common safety errors.

Question 4 · Motor, Neurological and Physiological Interventions

The COTA gathered screening data on four outpatients with chronic stroke whom the OTR is considering for constraint-induced movement therapy.

Client	Active wrist extension	Active finger extension	Cognition and balance
Ms. Ortiz	25 degrees	12 degrees	Intact cognition, good standing balance
Mr. Chen	10 degrees	0 degrees	Intact cognition, good standing balance
Ms. Banks	30 degrees	15 degrees	Severe memory loss, falls twice a week
Mr. Hale	0 degrees	5 degrees	Mild memory loss, fair standing balance

Based on the data, which client BEST matches the usual criteria for constraint-induced movement therapy?

A.Mr. Hale
B.Mr. Chen
C.Ms. Banks
D.Ms. Ortiz

Show answer and explanation

Answer: D. Ms. Ortiz

Common criteria include at least about 20 degrees of active wrist extension and 10 degrees of finger extension, intact cognition and good balance, because the stronger hand is restrained for most waking hours. Ms. Ortiz meets each one. Ms. Banks has enough movement, but severe memory loss and frequent falls make wearing a restraint unsafe, and the other two lack the needed active extension.

Question 5 · Assistive Technology, Seating, Mobility and Environmental Modification
A client with a C4 complete spinal cord injury lives at home and wants to control the lights, television and thermostat without waiting for a caregiver. He has clear speech and good head control. Which device BEST matches his abilities and goal?
- A.Universal cuff with a typing stick for pressing standard remote buttons
- B.Large-button remote control placed on a tray in front of his lap
- C.Mobile arm supports so that he can reach and press the wall switches himself
- D.Voice-activated environmental control system linked to the home devices
Show answer and explanation
Answer: D. Voice-activated environmental control system linked to the home devices
Feature matching pairs the client's reliable abilities, here clear speech, with a device that meets his goal of independent control of the environment, so a voice-activated environmental control unit fits best. At C4 he lacks the shoulder and elbow strength for mobile arm supports to be functional, and cuff, stick or button methods all require arm movement he does not have.
Question 6 · Conditions and Influences on Occupational Performance
A client in inpatient rehabilitation had a left hemisphere stroke. During grooming he cannot show the COTA how to brush his hair when asked, but a few minutes later he picks up the brush and smoothly brushes his hair on his own. Which deficit does this BEST illustrate?
- A.Left unilateral neglect, a common finding after left hemisphere damage
- B.Expressive aphasia, a loss of the ability to understand spoken words
- C.Ideational apraxia, a loss of knowing what objects are used for
- D.Ideomotor apraxia, a common finding after left hemisphere damage
Show answer and explanation
Answer: D. Ideomotor apraxia, a common finding after left hemisphere damage
In ideomotor apraxia the client cannot perform a movement on command but may do it automatically, and it is common after left hemisphere lesions. He used the brush correctly, which rules out ideational apraxia; left neglect follows right hemisphere damage, and expressive aphasia affects speech output, not comprehension.
Question 7 · Collaboration, Supervision and Monitoring the Intervention
A client in inpatient rehabilitation had open reduction and internal fixation of a left ankle fracture and is toe-touch weight bearing on the left leg. While standing at the sink with a walker to brush her teeth, she shifts her weight evenly onto both feet. What should the COTA do?
- A.Have her lift the left foot fully off the floor and balance on the right leg for the task
- B.Cue her to shift weight to the right leg and walker, resting only her left toes down
- C.Let her continue, because even weight on both legs improves balance during grooming tasks
Show answer and explanation
Answer: B. Cue her to shift weight to the right leg and walker, resting only her left toes down
Toe-touch weight bearing allows the toes to rest on the floor for balance without bearing weight, so the COTA cues the client back within her precaution. Even weight on both feet breaks the order, and holding the foot fully off the floor is non-weight bearing, which is more restrictive than ordered and less stable.
Question 8 · ADLs, IADLs, Feeding, Eating and Functional Mobility
A resident in a skilled nursing facility weighs 380 lb, cannot bear weight and cannot assist with transfers. Which bed-to-chair transfer method should the COTA use?
- A.A two-person stand-pivot transfer using a gait belt and a firm count
- B.A mechanical lift rated for the resident's weight, with two staff
- C.A sliding board transfer with one staff member guarding from the front
Show answer and explanation
Answer: B. A mechanical lift rated for the resident's weight, with two staff
A dependent client who cannot bear weight or help needs a mechanical lift, and the lift and sling must be rated for the client's weight. A stand-pivot requires weight bearing, and a sliding board requires upper body strength and some trunk control; both expose the resident and staff to injury.
Question 9 · Motor, Neurological and Physiological Interventions
A home health client with Parkinson disease freezes in the doorway between the bedroom and the hall. Which strategy should the COTA teach?
- A.Take smaller and faster steps to squeeze through the doorway
- B.Use a rhythmic cue, such as counting aloud, to restart the steps
- C.Have a caregiver pull the client forward by the arm to break it
Show answer and explanation
Answer: B. Use a rhythmic cue, such as counting aloud, to restart the steps
Rhythmic auditory cues, such as counting or a metronome beat, help restart gait during freezing. Pulling the client forward risks a fall because the feet stay planted. Small, fast steps resemble festination and tend to worsen freezing; large, deliberate steps are encouraged.
Question 10 · Assistive Technology, Seating, Mobility and Environmental Modification
A client with T10 complete paraplegia has passed a driving evaluation with a certified driver rehabilitation specialist. He asks the COTA which vehicle adaptation will let him operate the gas and brake. Which adaptation is typical?
- A.Pedal extensions that bring the gas and brake pedals closer
- B.Left-foot accelerator with the standard brake pedal left in its usual place
- C.Spinner knob on the steering wheel with no other adaptations
- D.Hand controls for the gas and brake, used with a steering spinner knob
Show answer and explanation
Answer: D. Hand controls for the gas and brake, used with a steering spinner knob
With no functional leg control, the client needs hand controls (such as push-pull controls) to operate the gas and brake, usually paired with a spinner knob so one hand can steer. A left-foot accelerator and pedal extensions both require leg control, and a spinner knob alone does not address the pedals.

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