Cota Test

Front 1

A 7-year-old child has a shunt to control hydrocephaly secondary to spina bifida. The child uses a wheelchair for mobility. During a school-based gross motor activity the child begins to feel ill, complains of a pounding headache, and appears flushed. Which action should the COTA take immediately after stopping the activity?
A. Elevate the legs of the wheelchair and contact the school nurse.
B. Lay the child in a supine and activate emergency procedures.
C. Place a cool moist cloth on the child’s forehead until symptoms resolve.
D. Reschedule the session and advise the teacher of the occurrence.

Back 1

Correct Answer: B

Rationale: The child should be placed in supine and emergency procedures should be initiated IMMEDIATELY. The child’s symptoms are indicative of a possible blocked shunt.
A, C, D: These are not appropriate responses to this medical emergency situation.

Classification: Domain 02 Task 05 Knowledge 05

Reference: Solomon J, O’Brien J. (2006). Pediatric Skills for Occupational Therapy Assistants (2nd ed.). St. Louis, MO: Elsevier Mosby. Pages: 276-278

Front 2

A COTA who has established service competency in the use of physical agent modalities is preparing to use ice massage as an adjunct to an intervention for a client who has an acute soft tissue injury. Which clinical application procedure is recommended for this form of cryotherapy?
A. Move the ice on one area of the skin for 1-2 minutes.
B. Use circular motions to move the ice on the skin for 4-5 minutes.
C. Firmly rub the ice parallel to the muscle fiber for 10-15 minutes.
D. Use retrograde motions with the ice until the client reports numbing.

Back 2

Correct Response: B
Rationale: Ice massage is an effective modality to use on small and very targeted areas of soft tissue. To effectively achieve vasoconstriction and to avoid tissue damage, ice should be moved in circular motions to massage the area for approximately 4-5 minutes.
Reference:
Early, M. B. (2006). Physical Dysfunction: Practice Skills for the Occupational Therapy Assistant (2nd ed.). St. Louis, MO: Elsevier Mosby. Page: 225-226
Classification Code: Domain 02, Task 01, Knowledge 07
Incorrect Responses:
A: 1-2 minutes is not long enough for the client to experience analgesia at the site of application.
C & D: These options are too long to perform ice massage and could potentially lead to further tissue damage.

Front 3

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. Determining the impact of social interactions on development
B. Documenting outcomes of unstructured parent interviews
C. Administering and scoring standardized handwriting assessments
D. Assessing fine motor patterns during classroom activities

Back 3

Correct Response: C
Rationale: Administering and scoring standardized assessments are within the scope of practice for a service competent school-based COTA practitioner.
Classification Code: Domain 01 Task 01, Knowledge 02
References: Solomon, J.W., O’Brien, J.C. (2011). Pediatric Skills for Occupational Therapy Assistants (3rd ed.). St. Louis, MO: Elsevier Mosby. Page: 6-7.
Case-Smith, J (2006). Physical Dysfunction: Practice Skills for the Occupational Therapy Assistant (2nd ed.). St. Louis, MO: Elsevier Mosby. Page: 226.
Incorrect Responses:
A, B, & D: 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.

Front 4

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°
B. Internal rotation
C. Flexion to 90°
D. External rotation

Back 4

Correct response: D
Rationale: Total hip precautions for an anterolateral approach include the following movement restrictions: hip external rotation, hip extension, crossing the operated leg over the unoperated leg, adduction of the operated leg.
Reference: Early MB, (2006). Physical Dysfunction: Practice Skills for the Occupational Therapy Assistant (2nd ed.). St. Louis, MO: Elsevier Mosby. Page: 616
Classification code: Domain 01, Task 01, Knowledge 04
Incorrect responses: A: Lower extremity abduction is not contraindicated after a total hip replacement.
B: Hip internal rotation is contraindicated after a total hip replacement for a posterolateral approach but not for an anterolateral approach.
C: Hip flexion up to 90o is acceptable, but hip flexion beyond 90° is contraindicated after a total hip replacement

Front 5

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.
D. Encourage friends to visit the home to provide reality orientation activities.

Back 5

Classification Code: Domain 02, Task 04, Knowledge 01
Correct Response: A
Reference: Byers-Connon, S., Lohman, H., Padilla, RL. (2012). Occupational Therapy with Elders: Strategies for the COTA (3rd ed.). St. Louis, MO: Elsevier Mosby. Page 282-284
Bonder B, Bello-Haas V. (2009). Functional Performance in Older Adults (3rd ed). Philadelphia, PA: F.A. Davis. Page 236
Rationale:
A: 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, & D: 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.

Front 6

What clinical symptom is typically present in the affected hand of a client who has severe carpal tunnel syndrome?
A. Positive Tinel’s sign at the wrist
B. Decreased light touch of all digits
C. Numbness of the small finger
D. Atrophy of the extrinsic muscles

Back 6

Classification Code: Domain 01, Task 01, Knowledge 04
Correct Response: A
Reference:
Early, M.B. (2006). Physical Dysfunction: Practice Skills for the Occupational Therapy Assistant (2nd ed.). St. Louis, MO: Elsevier Mosby. Page: 394, 590, 602-604, 607-609
Rationale:
A: The Tinel’s sign is a provocative test for nerve compression. In carpal tunnel syndrome (CTS), a positive Tinel’s sign elicits a sensation of tingling in the median nerve distribution.
Incorrect Responses:
B, C: The median nerve supplies sensation to the tips and palmar aspects of the thumb, index finger, long finger and radial half of the ring finger with sparing of the palm, small finger and ulnar half of the ring finger.
D: A symptom of severe CTS is atrophy of the intrinsic thenar muscles at the base of the thumb.

Front 7

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

Back 7

Correct Response: 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.

Classification Code: Domain 02 Task 01, Knowledge 01

Reference: Early, M. B. (2006). Physical Dysfunction: Practice Skills for the Occupational Therapy Assistant (2nd ed.). St. Louis, MO: Elsevier Mosby. Page: 169, 472.

Front 8

An inpatient who has been prescribed antipsychotic medication is attending an OT group. During one of the group sessions the patient begins to show symptoms of tardive dyskinesia. What action should the COTA take INITIALLY in response to this observation?
A. Report the symptoms to the physician or charge nurse.
B. Document changes in function due to the onset of symptoms.
C. Observe the impact of symptoms on the patient's task performance.
D. Monitor the duration of symptoms and the patient's reactions.

Back 8

Correct Answer: A
Rationale: The physician or charge nurse should be notified immediately about the new onset of symptoms. The patient may develop permanent tardive dyskinesia if medication is not discontinued.

Front 9

A COTA is gathering information about the dressing skills of a 10-year-old child who has moderate cognitive and developmental delays secondary to autism. Which data-gathering method would provide the MOST OBJECTIVE information about the child’s current dressing skills?
A. Asking the parents to complete a questionnaire
B. Observing the child during BADL routines
C. Administering a functional independence screen
D. Having the child complete a simple checklist

Back 9

Correct Answer: B
Rationale:
B: Observation provides information about the child’s actual BADL skills and abilities based on current routines.

Incorrect Responses:
A: This provides the parents perception of the child’s skills and is not as objective as observing the child completing the task.
C: A screening may provide preliminary information about dressing, but this method does not provide as much objective information as observing the child during a variety of dressing tasks.
D: Considering the child’s cognitive and developmental status, this would not be the most objective method for gathering the information

Classification Code: Domain 01, Task 01, Knowledge 01

References: Solomon, J.W., O’Brien, J.C. (2011). Pediatric Skills for Occupational Therapy Assistants (3rd ed.). St. Louis, MO: Elsevier Mosby. Page: 212

DeLany J, Pendzick M. (2009). Working with Children and Adolescents: A Guide for the Occupational Therapy Assistant. Upper Saddle River, NJ: Pearson-Prentice Hall.

Front 10

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. Ambulation from the bed to bathroom with contact-guard assistance of a one caregiver
D. Upper and lower body dressing while seated on the edge of the bed with stand-by assistance for balance

Back 10

Correct Answer: A

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

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

Classification: Domain 01 Task 02, Knowledge 03

Reference: Reference:
Byers-Connon, S., Lohman, H., Padilla, RL. (2012). Occupational Therapy with Elders: Strategies for the COTA (3rd ed.). St. Louis, MO: Elsevier Mosby. Page 315-317