Castleport Test Prep

Free NBCOT COTA Practice Test (50 Questions)

Fifty original, unofficial questions in the current COTA item formats: 40 single-answer questions and 10 "select three of six" items, spread across NBCOT's three domains. Every answer comes with an explanation of each option and a link to its source—no signup.

Practice questions

Question 1 of 50

Domain 2 · Select and Implement Interventions · COTA-015

A client with multiple sclerosis wants to keep doing her own housework but is exhausted by Saturday afternoon. Which change best applies energy conservation?

  • A. Do all the heavy chores on Saturday morning so the rest of the week is free
  • B. Spread heavy chores across the week, and plan the hardest ones for when she usually has the most energy
  • C. Push through fatigue so her endurance builds
  • D. Stop doing housework altogether
Show answer and explanation

Answer: B.

Energy conservation rests on planning, prioritizing and pacing: spreading demanding tasks out instead of stacking them, and scheduling hard tasks for when energy is highest. That keeps her doing the occupation she values.

  • A Stacking every heavy chore into one session concentrates the demand instead of spreading it out.
  • C Working through fatigue is the opposite of pacing.
  • D Giving up a valued occupation isn't the goal when it can be modified.

Source: MS Trust, MS fatigue (Using your energy effectively); Working life (How can I look after myself at work?).
Read the source: MS Trust, MS fatigue · MS Trust, Working life

Show all answers (opens every explanation for reading or printing)

Question 2 of 50

Domain 1 · Collaborate and Gather Information · COTA-004

Before a standing grooming session, the COTA measures a client's blood pressure: 134/80 after 5 minutes lying down, and 110/76 after 3 minutes of standing. The client says she feels light-headed. What does this reading show?

  • A. A 24 mm Hg systolic drop within 3 minutes, which meets the usual definition of orthostatic hypotension; sit her down and report it
  • B. A normal response, because the diastolic pressure fell by less than 10 mm Hg
  • C. A normal response, because her standing systolic pressure is still above 100
Show answer and explanation

Answer: A.

Orthostatic hypotension is clinically defined as a sustained drop in systolic pressure of at least 20 mm Hg or diastolic pressure of at least 10 mm Hg within 3 minutes of standing, after lying down for at least 5 minutes. 134 − 110 = 24 mm Hg systolic, and she has symptoms. Sitting her down protects her from a fall; the OTR and nursing need the numbers.

  • B Either criterion is enough. The diastolic drop doesn't cancel a 24-point systolic drop.
  • C The definition is the change on standing, not whether the standing number looks acceptable.

Source: American Heart Association, Orthostatic Hypotension in Adults With Hypertension (2024); CDC STEADI, Measuring Orthostatic Blood Pressure and Postural Hypotension (2017).
Read the source: American Heart Association, Orthostatic Hypotension in Adults With Hypertension (2024) · CDC STEADI, Measuring Orthostatic Blood Pressure (2017) · CDC STEADI, Postural Hypotension (2017)

Question 3 of 50

Domain 2 · Select and Implement Interventions · COTA-019

A client with mild carpal tunnel syndrome wakes at night with numb fingers. Which orthosis approach is consistent with AAOS guidance?

  • A. Wear an orthosis at night that holds the wrist bent well back in extension
  • B. Wear an orthosis only during the day and take it off at night
  • C. Rest the wrist bent forward on a pillow overnight
  • D. Wear a wrist orthosis at night that keeps the wrist straight (neutral)
Show answer and explanation

Answer: D.

AAOS says a brace or splint worn at night keeps the wrist from bending during sleep, and that keeping it straight or neutral reduces pressure on the median nerve. It may also help to wear it during daytime activities that bring on symptoms.

  • A AAOS notes that prolonged extreme flexion or extension raises pressure on the nerve.
  • B Night symptoms are the problem; the night orthosis is the core recommendation.
  • C A flexed wrist is one of the positions that aggravates symptoms.

Source: AAOS OrthoInfo, Carpal Tunnel Syndrome (Nonsurgical Treatment).
Read the source: AAOS OrthoInfo, Carpal Tunnel Syndrome

Question 4 of 50

Domain 3 · Uphold Professional Standards and Responsibilities · COTA-042

During a seated session in an outpatient gym, a client loses awareness, slumps to the floor and begins jerking all four limbs. A colleague is activating the facility's emergency response. After clearing the space around him, what should the COTA do?

  • A. Hold his arms down to stop the movements
  • B. Put a rolled washcloth between his teeth
  • C. Turn him gently onto his side, put something soft under his head, and time the seizure
  • D. Give him sips of water to calm him
Show answer and explanation

Answer: C.

CDC's first aid for a generalized seizure: ease the person to the floor, turn them onto one side with the mouth pointing down to keep the airway clear, cushion the head, remove eyeglasses, loosen anything at the neck, and time it. Call 911 if it lasts longer than 5 minutes, or for the other triggers CDC lists. The colleague activates the facility's emergency response while the COTA provides first aid.

  • A CDC says not to hold the person down.
  • B CDC says not to put anything in the mouth.
  • D CDC says not to give food or water until the person is fully alert.

Source: CDC, First Aid for Seizures (Extra steps for generalized seizures; What to avoid).
Read the source: CDC, First Aid for Seizures

Question 5 of 50

Domain 1 · Collaborate and Gather Information · COTA-012

During an initial evaluation in a skilled nursing facility, which three tasks can the COTA appropriately perform? Select the three best answers.

  • A. Give the OTR a written report of the client's performance on a delegated assessment
  • B. Decide whether the client needs OT services
  • C. Administer an assessment the OTR delegated, after establishing service competence
  • D. Interpret the evaluation data and develop the intervention plan
  • E. Decide which assessment tasks to delegate
  • F. Report observations of the client's capacities during an ADL task to the OTR
Show answer and explanation

Answers: A, C, F.

AOTA's guidelines say the OTR directs the evaluation: determining the need for service, deciding what to delegate, interpreting the data and developing the plan. The COTA contributes by carrying out delegated assessments and giving the OTR verbal and written reports of assessments, performance and client capacities.

  • A, C, F are the COTA's contributions named in the guidelines.
  • B, D, E are OTR responsibilities.

Source: AOTA Supervision Guidelines (2020), Evaluation items 1–5.
Read the source: AOTA, Guidelines for Supervision, Roles, and Responsibilities (2020)

Question 6 of 50

Domain 2 · Select and Implement Interventions · COTA-023

A client with left neglect after a stroke wants to read the activity board in his unit's dayroom on his own. Which intervention best builds attention to the left side?

  • A. Move the activity board to his right side
  • B. Have staff read the board aloud to him each day
  • C. Put a bright vertical line along the board's left edge, and teach him to find it before reading each line
  • D. Enlarge the print on the board
Show answer and explanation

Answer: C.

Visual scanning training teaches the person to look deliberately into the neglected side. A bright anchor on the left edge gives him a target to find before each line, so he practices the scan himself. The anchor is a compensatory scanning strategy: it gives him a consistent place to begin and check his scan.

  • A Moving the board may help him find it now, but it doesn't practice scanning to the left.
  • B Having someone read it doesn't practice his own reading or leftward scan.
  • D Larger print doesn't address ignoring the left side.

Source: American Stroke Association, Visual Disturbances (Visual Spatial Inattention or Neglect); van Kessel et al. (2013), visual scanning and anchoring.
Read the source: American Stroke Association, Visual Disturbances · van Kessel et al., Visual Scanning Training for Neglect after Stroke (2013)

Question 7 of 50

Domain 1 · Collaborate and Gather Information · COTA-001

After six weeks of outpatient sessions, a client has met two of three goals and has stopped improving on the third. She asks the COTA whether she can be discharged. What should the COTA do?

  • A. Discharge her, because most of her goals are met
  • B. Write a replacement goal for the stalled one and continue treatment
  • C. Tell her the OTR makes that decision, and give the OTR documentation of her progress and her request
  • D. Keep following the current plan without mentioning her request
Show answer and explanation

Answer: C.

AOTA's supervision guidelines give the OTR responsibility for deciding whether to continue, modify or discontinue services. The COTA contributes by exchanging information with the OTR and documenting the client's responses during intervention. The client's request is information the OTR needs.

  • A Discharge is a discontinue decision, which belongs to the OTR.
  • B The OTR has overall responsibility for the intervention plan. A COTA gives input; it doesn't rewrite goals alone.
  • D Sitting on a client's stated wish leaves the OTR deciding without key information.

Source: AOTA Supervision Guidelines (2020), Intervention Review.
Read the source: AOTA, Guidelines for Supervision, Roles, and Responsibilities (2020)

Question 8 of 50

Domain 2 · Select and Implement Interventions · COTA-027

A client's front door is 24 inches above the walkway. Using the 2010 ADA Standards' maximum running slope of 1:12 as a benchmark, what is the minimum horizontal run, excluding landings?

  • A. 12 feet
  • B. 18 feet
  • C. 24 feet
  • D. 36 feet
Show answer and explanation

Answer: C.

At 1:12, every inch of rise needs 12 inches of horizontal run: 24 in × 12 = 288 in = 24 feet, excluding landings. The Standards also cap a single ramp run at a 30-inch rise, so a 24-inch rise can be one run (landings still apply). This question uses the ADA slope as a home-ramp benchmark; a real design also needs to meet the applicable local requirements and the client's needs.

  • A 12 ft is a 1:6 slope, twice as steep.
  • B 18 ft is a 1:9 slope, steeper than the stated benchmark.
  • D 36 ft would meet this slope limit but is longer than the minimum horizontal run.

Source: U.S. Access Board, Guide to the ADA Standards, Ramps (Slope and Cross Slope; Rise; Landings; §§405.2, 405.6, 405.7).
Read the source: U.S. Access Board, Guide to the ADA Standards: Ramps

Question 9 of 50

Domain 2 · Select and Implement Interventions · COTA-037

A client with COPD gets short of breath during her morning routine. Which three strategies apply energy conservation? Select the three best answers.

  • A. Sit on a shower chair to wash
  • B. Hold her breath while bending to put on socks
  • C. Gather clothes and grooming items within easy reach before starting
  • D. Do the hardest tasks back to back to finish sooner
  • E. Stand at the sink for grooming to build endurance
  • F. Plan rest breaks between tasks
Show answer and explanation

Answers: A, C, F.

Energy conservation combines sitting for tasks, organizing supplies within reach, and pacing with planned rests.

  • B MedlinePlus says not to hold your breath; pursed-lip breathing during bending is the better choice.
  • D Stacking hard tasks is the opposite of pacing.
  • E Standing costs more energy than sitting for the same task.

Source: Leeds Teaching Hospitals, Energy conservation and daily activities (2025); MedlinePlus, How to breathe when you are short of breath (2026).
Read the source: Leeds Teaching Hospitals, Energy conservation and daily activities · MedlinePlus, How to Breathe When You Are Short of Breath

Question 10 of 50

Domain 3 · Uphold Professional Standards and Responsibilities · COTA-045

A COTA is treating a client on contact precautions for C. difficile. Which approach matches current CDC hand hygiene guidance?

  • A. Wear a gown and gloves, remove the gloves carefully, and clean hands afterward; during an outbreak, wash with soap and water after care
  • B. Never use alcohol-based hand sanitizer anywhere on the unit
  • C. Skip hand hygiene after removing gloves, because gloves kept the hands clean
Show answer and explanation

Answer: A.

CDC says that when caring for a patient with C. difficile, the priority is wearing gloves and a gown and removing gloves carefully. Unless hands are visibly soiled, alcohol-based sanitizer is still generally preferred, but during outbreaks CDC encourages soap and water after caring for patients with known or suspected infection. Hands are always cleaned after glove removal.

  • B CDC says access to alcohol sanitizer shouldn't be restricted.
  • C CDC says gloves don't replace hand hygiene.

Source: CDC, Hand Hygiene for Healthcare Workers (C. difficile section; Gloves).
Read the source: CDC, Clinical Safety: Hand Hygiene for Healthcare Workers

Question 11 of 50

Domain 2 · Select and Implement Interventions · COTA-020

A client with C6 tetraplegia has strong wrist extensors but no active finger flexion. His therapist has confirmed a usable tenodesis grasp. How can he pick up a light foam cup?

  • A. Actively extend his wrist so his fingers passively close around the cup
  • B. Flex his wrist to make his fingers close
  • C. Squeeze with his finger flexors around a built-up cup
Show answer and explanation

Answer: A.

This is tenodesis. When the wrist extends, the finger flexor tendons tighten and the fingers curl passively; when the wrist drops into flexion, the fingers open. Wrist extensors are the C6 key muscle group on the ISNCSCI worksheet, while the finger flexors are C8, so he can use tenodesis for a light grasp.

  • B Wrist flexion opens the fingers, which is how he'd release the cup.
  • C He has no active finger flexion to squeeze with.

Source: ISNCSCI worksheet, key muscles (REV 04/19); Cambridge University Hospitals, wrist tenodesis movement in Hand Therapy following Extensor tendon repair Zones 4–7 (2025).
Read the source: ISNCSCI worksheet (REV 04/19) · Cambridge University Hospitals, Hand Therapy following Extensor tendon repair Zones 4–7: ICAM regime

Question 12 of 50

Domain 1 · Collaborate and Gather Information · COTA-006

The OTR has delegated the Timed Up and Go (TUG) to the COTA, who gives it to an 82-year-old using CDC STEADI directions. She uses her usual walker and takes 15 seconds. How should the COTA report the result?

  • A. As normal, because the cutoff is 20 seconds for anyone using a walker
  • B. As evidence she will fall within the next month
  • C. As a result at or above CDC's 12-second flag for fall risk, for the OTR to use in fall-risk planning
Show answer and explanation

Answer: C.

CDC's STEADI TUG directions let the client use her usual walking aid, and they flag 12 seconds or more as a sign of fall risk. Fifteen seconds meets that flag. The COTA reports the result and observations; the OTR interprets them as part of the evaluation.

  • A STEADI doesn't use a 20-second cutoff, and it doesn't change the threshold for walker users.
  • B A TUG time flags risk. It doesn't predict a specific fall on a timeline.

Source: CDC STEADI, Assessment: Timed Up & Go (2017); AOTA Supervision Guidelines (2020), Evaluation.
Read the source: CDC STEADI, Timed Up & Go · AOTA, Guidelines for Supervision, Roles, and Responsibilities (2020)

Question 13 of 50

Domain 2 · Select and Implement Interventions · COTA-031

The plan calls for a seated meal-preparation task. Today the client tires halfway through. What can the COTA do?

  • A. Grade the task within the plan, for example fewer steps or rest breaks, then document her response and share it with the OTR
  • B. Rewrite her long-term goals to match today's tolerance
  • C. Discontinue her OT services
Show answer and explanation

Answer: A.

AOTA's guidelines say the COTA, in collaboration with the OTR, selects, implements and modifies interventions in line with the client's goals and the COTA's competence. Grading today's task is that kind of modification. The OTR needs to hear how she responded.

  • B The OTR has overall responsibility for the plan and goals.
  • C Discontinuing services is the OTR's decision.

Source: AOTA Supervision Guidelines (2020), Intervention Implementation item 4; Intervention Review.
Read the source: AOTA, Guidelines for Supervision, Roles, and Responsibilities (2020)

Question 14 of 50

Domain 3 · Uphold Professional Standards and Responsibilities · COTA-047

After a community outing group, a COTA wants to post a group photo on a personal social media account. Two clients' faces are clearly visible. Under the NBCOT Candidate/Certificant Code of Conduct, what has to happen first?

  • A. Nothing, because it's a personal account rather than the clinic's
  • B. Each identifiable client gives written consent to the posting
  • C. The supervising OTR approves the post
Show answer and explanation

Answer: B.

NBCOT's Code of Conduct, Principle 8, bars electronically posting information or photos that may reveal a client's identity or their relationship with the practitioner without the client's written consent. It applies on personal accounts too.

  • A The account type doesn't change the rule.
  • C A supervisor's approval isn't the client's written consent.

Source: NBCOT Candidate/Certificant Code of Conduct (revised May 2024), Principle 8.
Read the source: NBCOT, Candidate/Certificant Code of Conduct

Question 15 of 50

Domain 2 · Select and Implement Interventions · COTA-024

Six months after a traumatic brain injury, a client who lives alone can explain his weekly routine in therapy. At home he forgets which day the trash goes out and loses his place when cooking. Which intervention best fits?

  • A. Quiz him on his weekly routine at the start of each session
  • B. Have him stop using written notes so his memory gets more practice
  • C. Set up phone calendar reminders for trash day and a written step-by-step checklist he follows while cooking
  • D. Drop cooking from his goals until his memory improves
Show answer and explanation

Answer: C.

The difficulty occurs during tasks at home, so the aids need to be available there. MSKTC recommends memory aids such as calendar reminders on a phone and writing step-by-step instructions for tasks. The COTA outline also lists memory aids among compensatory strategies.

  • A Quizzing alone doesn't provide a reminder at the point of use.
  • B Removing aids works against the recommended approach.
  • D Dropping cooking from his goals doesn't address his difficulty following the steps.

Source: MSKTC, Cognitive Problems After TBI; 2022 COTA outline, Domain 2 Task 2.
Read the source: MSKTC, Cognitive Problems After Traumatic Brain Injury · NBCOT, 2022 COTA Examination Content Outline

Question 16 of 50

Domain 1 · Collaborate and Gather Information · COTA-013

A client is two days out from a posterior-approach total hip replacement, and the surgeon ordered standard posterior hip precautions. During a dressing session, which three actions should the COTA stop and cue the client to correct? Select the three best answers.

  • A. Using a reacher to pull her pants over her feet
  • B. Crossing the operated leg over the other knee to reach her foot
  • C. Sitting in a raised chair so her hips stay higher than her knees
  • D. Leaning forward from a low chair to pick a sock up off the floor
  • E. Using a sock aid to put on her socks
  • F. Turning the operated foot inward as she pivots to stand
Show answer and explanation

Answers: B, D, F.

Standard posterior hip precautions restrict hip flexion past 90°, crossing the legs (adduction past midline) and internally rotating the operated hip. Crossing the leg, bending forward from a low seat and turning the foot inward each break one of those. Always follow the surgeon's specific orders.

  • A, C, E are ways to keep the precautions: a reacher and sock aid avoid bending, and a raised seat limits hip flexion.

Source: AAOS OrthoInfo, Activities After Total Hip Replacement (Dos and Don'ts); Cambridge University Hospitals, Total hip replacement – for those following hip precautions (2023), Hip precautions and Dressing.
Read the source: AAOS OrthoInfo, Activities After Total Hip Replacement · Cambridge University Hospitals, Total hip replacement—for those following hip precautions

Question 17 of 50

Domain 2 · Select and Implement Interventions · COTA-033

A client with rheumatoid arthritis gets painful finger joints carrying full grocery bags by the handles. Which joint-protection change fits best?

  • A. Carry the bags hooked on her fingers, but make more trips
  • B. Grip the handles more tightly so the bags don't slip
  • C. Carry the bags over her forearm or in a backpack, spreading the load over larger joints
  • D. Avoid grocery shopping
Show answer and explanation

Answer: C.

Joint protection means using larger, stronger joints and spreading the load instead of loading small finger joints, and avoiding tight grips. A forearm carry or backpack does both.

  • A keeps the load on the same small joints.
  • B A tight grip adds strain.
  • D Dropping a valued task isn't needed when it can be done differently.

Source: Versus Arthritis, Joint Protection (2022).
Read the source: Arthritis UK (formerly Versus Arthritis), What is joint protection? (2022)

Question 18 of 50

Domain 1 · Collaborate and Gather Information · COTA-002

A 70-year-old woman recently moved into her daughter's home after a hospital stay. The COTA is updating her occupational profile. Which question best gathers profile information?

  • A. "What do you need and want to do each day here, and what's getting in the way?"
  • B. "Can you squeeze this dynamometer as hard as you can?"
  • C. "Which of your medications were changed in the hospital?"
Show answer and explanation

Answer: A.

The OTPF-4 describes the occupational profile as a summary of the client's occupational history and experiences, daily life patterns, interests, values, needs and relevant contexts. A question about what she needs and wants to do in her new setting, and what's in the way, goes straight to that.

  • B Grip strength is a client-factor measurement, part of analyzing performance, not the profile.
  • C Medication changes matter to the team, but a medication list isn't the occupational profile.

Source: AOTA, Evaluation & Assessment (occupational profile and analysis of occupational performance, based on OTPF-4); 2022 COTA outline, Domain 1 Task 2.
Read the source: AOTA, Evaluation & Assessment (OTPF-4) · NBCOT, 2022 COTA Examination Content Outline

Question 19 of 50

Domain 2 · Select and Implement Interventions · COTA-038

The OTR has approved a hot pack before a hand session. The facility uses the linked SESLHD heat-safety protocol. Which three steps fit that protocol? Select the three best answers.

  • A. Have the client lie on top of the pack to keep it in place
  • B. Check that the client can tell hot from cold on that skin before the first use
  • C. Apply heat to a wrist sprained yesterday to speed healing
  • D. Wrap the pack as directed so it never touches the skin directly
  • E. Leave it on for 40 minutes so the heat penetrates
  • F. Check the skin after the first 5 minutes, then regularly
Show answer and explanation

Answers: B, D, F.

The guideline calls for a thermal sensitivity test at the first treatment, wrapping the pack so it never touches the skin, and checking the skin after 5 minutes and regularly afterward. Use the pack according to its manufacturer's instructions too.

  • A The guideline says the patient shouldn't lie on a heat pack.
  • C Acute musculoskeletal injury is listed as a contraindication to heat.
  • E Continuous application shouldn't exceed 20 minutes.

Source: SESLHD Guideline 073, version 2.1 (Oct 3, 2024), §2 Principles, §2.2.3–2.2.5 and §2.5.
Read the source: SESLHD, Application of Heat or Cold Therapy

Source access note: when we rechecked sources on November 4, 2026, this link to the cited SESLHD guideline PDF returned a page-not-found error, so this specific document could not be rechecked. The original citation is retained as used.

Question 20 of 50

Domain 3 · Uphold Professional Standards and Responsibilities · COTA-043

In a cooking group, an adult client with diabetes who uses insulin says she feels shaky. Her meter reads 62 mg/dL. She's alert and can swallow. Following the American Diabetes Association's 15-15 rule, what should happen?

  • A. Give her a protein bar and recheck in an hour
  • B. Wait 30 minutes and recheck before doing anything
  • C. Have her take extra insulin
  • D. Give 15 grams of fast-acting carbohydrate and recheck in 15 minutes
Show answer and explanation

Answer: D.

ADA defines low blood glucose as usually below 70 mg/dL and uses the 15-15 rule: 15 g of fast-acting carbohydrate, then recheck after 15 minutes. If her meter still reads below 70 mg/dL, repeat with another 15 g and recheck after 15 minutes. Facility protocol and nursing notification apply too.

  • A Protein and fat can slow glucose absorption, and waiting an hour delays the recheck.
  • B ADA says to treat lows quickly because they can become dangerous.
  • C Insulin lowers glucose further.

Source: American Diabetes Association, Signs, Symptoms, and Treatment for Hypoglycemia (15-15 Rule; What are fast acting carbs?).
Read the source: American Diabetes Association, Signs, Symptoms, and Treatment for Hypoglycemia

Question 21 of 50

Domain 2 · Select and Implement Interventions · COTA-016

A COTA is teaching a client with COPD to use pursed-lip breathing while climbing stairs. Which instruction matches MedlinePlus guidance?

  • A. Breathe in through pursed lips and out quickly through the nose
  • B. Breathe in through the nose for about 2 counts, then out slowly through pursed lips for 4 or more counts, without forcing the air out
  • C. Take a deep breath and hold it for each step, then exhale at the landing
Show answer and explanation

Answer: B.

MedlinePlus describes pursed-lip breathing as inhaling slowly through the nose for 2 counts, then exhaling slowly through pursed lips for 4 or more counts. It says not to force air out and not to hold your breath. It also lists climbing stairs, bending and lifting as times to use it.

  • A reverses the technique.
  • C Breath-holding is exactly what the guidance says to avoid.

Source: MedlinePlus, How to Breathe When You Are Short of Breath (reviewed Jan 2026).
Read the source: MedlinePlus, How to Breathe When You Are Short of Breath

Question 22 of 50

Domain 1 · Collaborate and Gather Information · COTA-009

A client had a right-hemisphere stroke. Which observation from a morning self-care session most supports the COTA's report to the OTR of possible left neglect?

  • A. He coughs after sips of thin liquid
  • B. He shaves only the right side of his face and says he's finished
  • C. He takes a long time to button his shirt with his affected hand
  • D. He can't name the razor when asked
Show answer and explanation

Answer: B.

Neglect after right-hemisphere stroke typically shows up as ignoring the left side of space and the body. The American Stroke Association describes missing the left side of the face while shaving as an example. Saying he's finished suggests he's unaware of the gap. The COTA reports the observation; the OTR interprets it.

  • A Coughing with thin liquids points to a swallowing concern.
  • C Slow buttoning with the affected hand fits motor weakness.
  • D Trouble naming an object points toward a language or recognition problem; it does not specifically show inattention to the left side.

Source: American Stroke Association, Visual Disturbances (Visual Spatial Inattention or Neglect) and Spatial Neglect.
Read the source: American Stroke Association, Visual Disturbances · American Stroke Association, Spatial Neglect

Question 23 of 50

Domain 2 · Select and Implement Interventions · COTA-021

During a skin check, the COTA sees a sacral pressure injury with full-thickness skin loss. Fat is visible in the wound bed. No fascia, muscle, tendon, ligament, cartilage or bone is exposed or directly palpable, and slough or eschar does not hide the extent of tissue loss. Which NPIAP stage does this match?

  • A. Stage 1
  • B. Stage 2
  • C. Stage 3
  • D. Stage 4
Show answer and explanation

Answer: C.

NPIAP's Stage 3 is full-thickness skin loss in which fat is visible, with no exposed fascia, muscle, tendon, ligament, cartilage or bone. The COTA reports it right away; wound care follows the team's plan.

  • A Stage 1 is intact skin with non-blanchable redness.
  • B Stage 2 is partial-thickness loss with exposed dermis; fat isn't visible.
  • D Stage 4 has exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone.

Source: NPIAP Pressure Injury Stages (2016).
Read the source: NPIAP, Pressure Injury Stages

Question 24 of 50

Domain 3 · Uphold Professional Standards and Responsibilities · COTA-048

A COTA searching for evidence on joint-protection education finds four sources. Using the Oxford Centre for Evidence-Based Medicine (OCEBM) levels for treatment benefits, which study design starts at the highest level?

  • A. An expert opinion article
  • B. A single case report
  • C. A systematic review of randomized controlled trials
  • D. A case series of 12 clients
Show answer and explanation

Answer: C.

In the OCEBM 2011 table, a systematic review of randomized trials is Level 1 for treatment benefits. That starting level can be downgraded for poor study quality, imprecision or poor applicability; the design alone does not settle whether the findings fit a client.

  • A An opinion article isn't a study. The lowest OCEBM level for treatment benefits is mechanism-based reasoning.
  • B and D Case reports and case series rank below randomized trials.

Source: OCEBM 2011 Levels of Evidence, version 2.1 (Treatment Benefits row and footnote); Introductory Document, p. 2.
Read the source: OCEBM, 2011 Levels of Evidence Table, version 2.1 · OCEBM, 2011 Levels of Evidence: Introductory Document

Question 25 of 50

Domain 2 · Select and Implement Interventions · COTA-028

An office worker with rheumatoid arthritis has severe morning stiffness and asks her employer for help. Which is an example of reasonable accommodation in EEOC guidance?

  • A. A modified schedule with a later start time
  • B. Removing an essential function of her job permanently
  • C. Lowering the production standard that applies to everyone in her role
Show answer and explanation

Answer: A.

EEOC guidance lists part-time or modified work schedules, including adjusted arrival times, among reasonable accommodations. The employer may choose among effective accommodations.

  • B EEOC says an employer doesn't have to eliminate an essential function.
  • C Nor does it have to lower production standards applied to everyone, though it may have to help her meet them.

Source: EEOC, Enforcement Guidance on Reasonable Accommodation (General Principles; Modified Schedule).
Read the source: EEOC, Enforcement Guidance on Reasonable Accommodation and Undue Hardship under the ADA

Question 26 of 50

Domain 1 · Collaborate and Gather Information · COTA-005

During an outpatient session, a client recovering from a work injury quietly tells the COTA, "My family would be better off without me." What should the COTA do first?

  • A. Reassure him the feeling will pass, and continue the planned activity
  • B. Ask him directly whether he is thinking about suicide
  • C. Promise to keep the comment between the two of them so he keeps talking
  • D. End the session early so he can go home and rest
Show answer and explanation

Answer: B.

The NIMH action steps start with Ask: ask directly whether the person is thinking about suicide. Asking doesn't plant the idea; it opens the door to help. From there the steps are to be there, help keep him safe, help him connect with support such as the 988 Suicide & Crisis Lifeline, and follow up. In a clinic that means following the facility's safety procedure and telling the supervising OTR right away.

  • A Reassurance skips the most important question and leaves risk unassessed.
  • C A promise of secrecy can't be kept when safety is at stake.
  • D Sending him home alone ends contact at the moment he needs connection.

Source: NIMH, 5 Action Steps (Ask; Be There; Help Keep Them Safe; Help Them Connect; Follow Up), revised 2024; 988 Lifeline, Help Someone Else (Do's and Don'ts).
Read the source: NIMH, 5 Action Steps to Help Someone Having Thoughts of Suicide · 988 Lifeline, Help Someone Else

Question 27 of 50

Domain 2 · Select and Implement Interventions · COTA-039

A client with visual processing difficulty is relearning simple meal preparation. Which three kitchen changes fit the UCSF home-safety tips? Select the three best answers.

  • A. Serve mashed potatoes on a white plate
  • B. Use a cutting board with contrasting sides, cutting light foods on the dark side
  • C. Use a patterned tablecloth to brighten the table
  • D. Add task lighting over the work area
  • E. Keep cupboard doors open so items stay visible
  • F. Put light-colored foods on dark plates
Show answer and explanation

Answers: B, D, F.

UCSF recommends contrast (a two-sided black and white cutting board; light foods on dark plates, dark foods on light plates) and task lighting over the work area.

  • A White potatoes on a white plate remove the contrast.
  • C UCSF advises avoiding patterned tablecloths.
  • E UCSF advises keeping cupboard doors and drawers closed when not in use.

Source: UCSF Memory and Aging Center, Home Safety Tips (Kitchen; Eating).
Read the source: UCSF Memory and Aging Center, Home Safety Tips for People with Visual Dysfunction

Question 28 of 50

Domain 2 · Select and Implement Interventions · COTA-034

During a home visit with an older client who needs support getting up from the toilet, which bathroom change matches CDC's Check for Safety checklist?

  • A. Use the towel bar for support
  • B. Have grab bars put in next to the toilet and next to and inside the tub
  • C. Add a soft throw rug in front of the toilet
  • D. Turn off the hallway light at night to save energy
Show answer and explanation

Answer: B.

CDC's Check for Safety checklist recommends grab bars next to and inside the tub and next to the toilet for anyone who needs support getting in and out of the tub or up from the toilet.

  • A A towel bar isn't built to hold body weight.
  • C The checklist says to remove throw rugs or secure them so they can't slip.
  • D The checklist recommends a nightlight on the path to the bathroom.

Source: CDC STEADI, Check for Safety (2017), Bathrooms and Bedrooms; MedlinePlus, Bathroom Safety for Adults (Safety Bars for the Bath and Toilet).
Read the source: CDC STEADI, Check for Safety · MedlinePlus, Bathroom Safety for Adults

Question 29 of 50

Domain 3 · Uphold Professional Standards and Responsibilities · COTA-011

The OTR asks a newly certified COTA to fabricate a custom thermoplastic hand orthosis tomorrow. The COTA has never made one and has no documented competence with the technique. What should the COTA do?

  • A. Make it using an online video for guidance
  • B. Tell the OTR about the competence gap, and ask for training and supervision before doing it
  • C. Ask a rehab aide who has watched orthoses being made to fabricate it
  • D. Make it and have the OTR check the fit afterward
Show answer and explanation

Answer: B.

AOTA's supervision guidelines say the COTA must demonstrate service competence and must not accept delegated responsibilities beyond their demonstrated skill and competence. Speaking up is part of the COTA's own responsibility to seek appropriate supervision.

  • A A video doesn't establish service competence.
  • C Aides don't provide skilled OT services; fabricating an orthosis is skilled work.
  • D Checking the fit afterward doesn't fix accepting a task the COTA isn't competent to do.

Source: AOTA Supervision Guidelines (2020), Roles and Responsibilities item 2; General Principles item 1.
Read the source: AOTA, Guidelines for Supervision, Roles, and Responsibilities (2020)

Question 30 of 50

Domain 3 · Uphold Professional Standards and Responsibilities · COTA-049

A COTA is entering and leaving the room of a client on contact precautions. Which three steps follow CDC's PPE sequence? Select the three best answers.

  • A. Put on gloves first, then the gown
  • B. Put the gown on first and the gloves last
  • C. Wear the same gown into the next client's room
  • D. Take off the gloves out in the hallway
  • E. Remove the gown and gloves before leaving the room
  • F. Perform hand hygiene immediately after removing all PPE
Show answer and explanation

Answers: B, E, F.

CDC's sequence puts the gown on first and gloves last, has PPE removed before leaving the room (except a respirator, removed after leaving), and ends with hand hygiene immediately after removing all PPE.

  • A reverses the donning order.
  • C Reusing a gown between clients spreads contamination.
  • D Removing gloves in the hallway carries contamination out of the room.

Source: CDC, Sequence for Putting On and Safely Removing PPE (CS250672-E, pp. 1–3; CDC catalog publication date Oct 16, 2014).
Read the source: CDC, Sequence for Putting On and Safely Removing PPE

Question 31 of 50

Domain 2 · Select and Implement Interventions · COTA-017

The OTR asks the COTA to screen clients for a constraint-induced movement therapy group modeled on the EXCITE trial. Which client meets the wrist-and-finger range-of-motion thresholds used for EXCITE's higher-functioning group?

  • A. 10° of active wrist extension and no finger extension
  • B. Full shoulder flexion, with no active wrist movement
  • C. Can grip a cup but can't release it
  • D. 20° of active wrist extension and 10° of extension at the MCP and IP joints of every digit
Show answer and explanation

Answer: D.

EXCITE's higher-functioning group required at least 20° of active wrist extension and 10° of extension at the finger (MCP and IP) joints of every digit on the affected side. MCP joints are the knuckles where the fingers meet the hand; IP joints are the joints between the finger bones. EXCITE also included a lower-functioning group with different movement thresholds, and full enrollment required other criteria.

  • A Wrist extension is below 20°, and there's no finger extension.
  • B Shoulder motion doesn't meet the wrist and finger criteria.
  • C Grasp without release does not demonstrate the required active extension.

Source: Wolf et al., Lancet Neurol 2008 (EXCITE), Methods: Study participants and procedures, higher- and lower-functioning criteria.
Read the source: Wolf et al., The EXCITE Trial: Retention of Improved Upper Extremity Function Among Stroke Survivors Receiving CI Movement Therapy

Question 32 of 50

Domain 1 · Collaborate and Gather Information · COTA-003

The COTA has just shown a client's husband how to help her pull on pants while she follows posterior hip precautions. Which check best confirms he understood?

  • A. Ask, "Do you have any questions?"
  • B. Give him a handout and have him sign that he received it
  • C. Ask him to name the three hip precautions
  • D. Ask him to show and explain, in his own words, how he'll help her dress tomorrow morning
Show answer and explanation

Answer: D.

This is teach-back: asking the learner to explain or show, in their own words, what they'll do. AHRQ describes it as a check on how well you explained, not a test of the learner. Watching him demonstrate also shows whether he can apply the precautions during the real task.

  • A A yes/no question invites a polite "no questions" and does not demonstrate understanding.
  • B A signature shows he received paper, not that he understood it.
  • C Naming precautions checks recall, not whether he can keep her safe while dressing.

Source: AHRQ Health Literacy Universal Precautions Toolkit, Tool 5.
Read the source: AHRQ, Use the Teach-Back Method: Tool 5

Question 33 of 50

Domain 2 · Select and Implement Interventions · COTA-029

A client's wrist is sore after orthosis training, and she asks for an ice pack. She has Raynaud's disease. What should the COTA do?

  • A. Apply ice for 10 minutes with a towel between the pack and her skin
  • B. Apply ice directly to the skin for a short time
  • C. Apply ice, but check her skin after 20 minutes
  • D. Not apply cold, because Raynaud's is a contraindication, and tell the OTR
Show answer and explanation

Answer: D.

The SESLHD heat and cold guideline lists vasospasm (Raynaud's disease) among the contraindications to cold therapy. Technique doesn't fix a contraindication. The OTR can choose another approach.

  • A and C Protective layers and monitoring don't remove the contraindication.
  • B Putting an ice pack directly on skin adds a risk of skin injury.

Source: SESLHD Guideline 073 (Oct 2024), §2.1.6.
Read the source: SESLHD, Application of Heat or Cold Therapy

Source access note: when we rechecked sources on November 4, 2026, this link to the cited SESLHD guideline PDF returned a page-not-found error, so this specific document could not be rechecked. The original citation is retained as used.

Question 34 of 50

Domain 3 · Uphold Professional Standards and Responsibilities · COTA-046

At a HIPAA-covered facility, a billing coworker asks the COTA for a client's full history from the ordinary treatment record so she can process a claim for a bath chair. What does the HIPAA minimum necessary standard require?

  • A. Share the full record, because the coworker works for the same facility
  • B. Refuse to share anything, because HIPAA bars sharing with billing
  • C. Share only the information needed to process the claim
Show answer and explanation

Answer: C.

HHS explains that the minimum necessary standard applies to uses and disclosures for payment and operations, including within the organization: share only what's needed for the task. (Disclosures to other providers for treatment are an exception.)

  • A Working at the same facility doesn't remove the minimum necessary rule.
  • B HIPAA permits payment uses with applicable safeguards; it does not ban all sharing with billing.

Source: HHS, Minimum Necessary Requirement; Uses and Disclosures for Treatment, Payment, and Health Care Operations.
Read the source: HHS, Minimum Necessary Requirement · HHS, Uses and Disclosures for Treatment, Payment, and Health Care Operations

Question 35 of 50

Domain 2 · Select and Implement Interventions · COTA-026

The SLP's swallow evaluation recommends that a client use a chin-down posture with thin liquids. At breakfast she drinks coffee with her head tipped back and coughs. She is alert and breathing without difficulty. What should the COTA do?

  • A. Switch her to thickened liquids on the COTA's own judgment
  • B. Let her finish the coffee and then document the coughing
  • C. Teach her to tip her head farther back so the liquid goes down faster
  • D. Pause drinking, cue the chin-down posture the SLP recommended, and report the coughing to the SLP and OTR
Show answer and explanation

Answer: D.

Pause drinking while she coughs. ASHA describes postural techniques such as chin-down, which may narrow the entrance to the airway, and notes that strategies are chosen from the swallow evaluation. The COTA's job at mealtime is to carry out the recommended strategy and report a change like coughing.

  • A Changing liquid consistency is decided through the swallow evaluation, not by the COTA alone.
  • B Letting her keep drinking while coughing delays action.
  • C Tipping the head back is the opposite of the recommended posture.

Source: ASHA Practice Portal, Adult Dysphagia (Assessment; Postural/Position Techniques); Blackpool Teaching Hospitals, Safe Swallowing Strategies for Dysphagia; AOTA Supervision Guidelines (2020), Intervention Implementation and Intervention Review.
Read the source: ASHA Practice Portal, Adult Dysphagia · Blackpool Teaching Hospitals, Safe Swallowing Strategies for Dysphagia · AOTA, Guidelines for Supervision, Roles, and Responsibilities (2020)

Question 36 of 50

Domain 1 · Collaborate and Gather Information · COTA-014

A client with a C6 spinal cord injury is in a seated session. Which three findings should make the COTA suspect autonomic dysreflexia? Select the three best answers.

  • A. Light-headedness that started right after sitting up and eases when he reclines
  • B. A sudden, pounding headache
  • C. Unchanged hand weakness that has been present since the injury
  • D. Flushing and sweating of his face and neck
  • E. Blood pressure well above his usual baseline
  • F. Blood pressure well below his usual baseline
Show answer and explanation

Answers: B, D, E.

Autonomic dysreflexia occurs with injuries at or above T6. The Consortium for Spinal Cord Medicine guideline describes a sudden headache, flushing and sweating—often of the face and neck—and a sharp rise in blood pressure over the person's baseline. These clients often have a low baseline, so compare with his usual reading.

  • A and F suggest low blood pressure, rather than the rise that defines autonomic dysreflexia.
  • C Unchanged weakness is a baseline motor deficit, not evidence of a new autonomic episode.

Source: Consortium for Spinal Cord Medicine, Evaluation and Management of Autonomic Dysreflexia and Other Autonomic Dysfunctions (2021), recommendations 1.1 and 2.1.
Read the source: Consortium for Spinal Cord Medicine, Evaluation and Management of Autonomic Dysreflexia and Other Autonomic Dysfunctions (2021)

Question 37 of 50

Domain 2 · Select and Implement Interventions · COTA-040

A COTA is helping plan access to a newly built public clinic's adult toilet room under the 2010 ADA Standards. Doorway openings are no more than 24 inches deep. Which three dimensions meet the relevant requirements? Select the three best answers.

  • A. A doorway with 28 inches of clear width
  • B. A doorway with at least 32 inches of clear width
  • C. Horizontal toilet grab bars with the top of the gripping surface 40 inches above the finished floor
  • D. Horizontal toilet grab bars with the top of the gripping surface 33 to 36 inches above the finished floor
  • E. A 60-inch-diameter clear turning space
  • F. A ramp with a 1:8 running slope
Show answer and explanation

Answers: B, D, E.

For this new construction, the 2010 Standards call for a 32-inch minimum clear width at these doors, horizontal toilet grab bars with the top of the gripping surface 33 to 36 inches above the finished floor, and a 60-inch-diameter turning space as one option for wheelchair turning.

  • A 28 inches is below the 32-inch minimum.
  • C 40 inches is above the allowed mounting height.
  • F The maximum running slope for this ramp is 1:12; 1:8 is too steep. The limited exception for certain existing sites does not apply to this new construction.

Source: 2010 ADA Standards §404.2.3, §609.4, §304.3.1 and §405.2, including the existing-site exception.
Read the source: 2010 ADA Standards for Accessible Design

Question 38 of 50

Domain 2 · Select and Implement Interventions · COTA-022

Over the heel of a client who spends most of the day in bed, the COTA sees intact skin with a persistent, non-blanchable deep maroon discoloration. Which NPIAP category fits?

  • A. Stage 1 pressure injury
  • B. Deep tissue pressure injury
  • C. Unstageable pressure injury
Show answer and explanation

Answer: B.

NPIAP defines a deep tissue pressure injury as intact or non-intact skin with persistent, non-blanchable deep red, maroon or purple discoloration. It signals damage beneath the surface and needs prompt reporting.

  • A Stage 1 is non-blanchable redness of intact skin. NPIAP notes that purple or maroon color points to deep tissue injury instead.
  • C Unstageable means full-thickness skin and tissue loss whose extent is hidden by slough or eschar.

Source: NPIAP Pressure Injury Stages (2016).
Read the source: NPIAP, Pressure Injury Stages

Question 39 of 50

Domain 1 · Collaborate and Gather Information · COTA-007

A school-based COTA is preparing information for a student's IEP meeting. Under the Individuals with Disabilities Education Act (IDEA) regulations, which of these must the IEP include?

  • A. The student's medical diagnosis code
  • B. A physician's prescription for occupational therapy
  • C. Raw scores from every test given during the evaluation
  • D. A statement of measurable annual goals, including academic and functional goals
Show answer and explanation

Answer: D.

Under 34 CFR 300.320(a)(2), the IEP must include a statement of measurable annual goals, including academic and functional goals. The IEP also states the related services the child will receive, which can include occupational therapy.

  • A A diagnosis code isn't among the IEP contents listed in 300.320.
  • B A prescription isn't an IEP content requirement under IDEA.
  • C The IEP describes present levels of performance; it doesn't require every raw score.

Source: 34 CFR 300.320(a)(1), (a)(2) and (a)(4); 34 CFR 300.34(a).
Read the source: 34 CFR 300.320, Definition of individualized education program · 34 CFR 300.34, Related services

Question 40 of 50

Domain 3 · Uphold Professional Standards and Responsibilities · COTA-044

A client with a T3 spinal cord injury and an indwelling urinary catheter reports a sudden pounding headache, and his blood pressure is far above his usual baseline. What should happen first?

  • A. Lay him flat and raise his legs
  • B. Sit him upright with his legs down, get nursing or medical help, loosen anything tight, and check his catheter tubing for kinks
  • C. Finish the session and recheck his blood pressure afterward
Show answer and explanation

Answer: B.

This is suspected autonomic dysreflexia. The Consortium for Spinal Cord Medicine guideline's first steps: sit the person upright with legs lowered, remove or loosen tight clothing and devices, monitor blood pressure and pulse every 1–2 minutes until stable, and look for the trigger, starting with the urinary system. A kinked or blocked catheter can be a trigger. It's an emergency, so medical help is needed.

  • A Lying flat with legs up raises blood pressure further.
  • C Delay risks stroke and other serious complications.

Source: Consortium for Spinal Cord Medicine, Evaluation and Management of Autonomic Dysreflexia and Other Autonomic Dysfunctions (2021), recommendations 2.6–2.10 and 2.17.
Read the source: Consortium for Spinal Cord Medicine, Evaluation and Management of Autonomic Dysreflexia and Other Autonomic Dysfunctions (2021)

Question 41 of 50

Domain 2 · Select and Implement Interventions · COTA-018

A COTA is teaching a 6-year-old to put on a T-shirt using backward chaining. How does the first session go?

  • A. The COTA does every step except pulling the shirt down over the belly, which the child does
  • B. The child does the first step, finding the bottom of the shirt, and the COTA finishes
  • C. The child tries the whole task each time with verbal cues
Show answer and explanation

Answer: A.

In backward chaining the adult completes all the steps except the last one, which the child does. The child finishes with success, and the adult hands over earlier steps one at a time as the child masters each.

  • B describes forward chaining.
  • C is whole-task practice, not chaining.

Source: Gateshead Health NHS Foundation Trust, Backward Chaining (updated June 11, 2025), Backward Chaining Technique and T-shirt example.
Read the source: Gateshead Health NHS Foundation Trust, Backward Chaining

Question 42 of 50

Domain 2 · Select and Implement Interventions · COTA-030

A client with no contraindications to cold will use an ice pack after therapy. The facility uses the linked SESLHD cold-therapy protocol. Which application matches that protocol?

  • A. Place the pack directly on the skin for maximum effect
  • B. Leave the pack on continuously for 45 minutes
  • C. Continue the application even if discomfort and redness persist
  • D. Put a damp towel between the pack and the skin, limit it to 20 minutes, and check the skin regularly
Show answer and explanation

Answer: D.

Under this protocol, the guideline calls for an insulating layer such as a damp towel between the ice and the skin, no more than 20 minutes of cold within any one hour, and regular visual skin checks. It also says the client should be warned about ice burns.

  • A Direct contact risks skin and nerve damage.
  • B 45 minutes exceeds the 20-minute limit.
  • C The guideline says to stop cold therapy if discomfort and redness persist.

Source: SESLHD Guideline 073, version 2.1 (October 3, 2024), §2 Principles and §2.1.4–2.1.5.
Read the source: SESLHD, Application of Heat or Cold Therapy

Source access note: when we rechecked sources on November 4, 2026, this link to the cited SESLHD guideline PDF returned a page-not-found error, so this specific document could not be rechecked. The original citation is retained as used.

Question 43 of 50

Domain 1 · Collaborate and Gather Information · COTA-010

A COTA is reading the manual for a pediatric assessment. The test uses a fixed administration and scoring procedure and compares a child's score with scores from a large sample of children the same age. What kind of test is it?

  • A. Criterion-referenced
  • B. Norm-referenced
  • C. Nonstandardized
  • D. Self-report
Show answer and explanation

Answer: B.

NBCOT's own Foundations page defines the difference: a norm-referenced test compares a test taker with a reference group, while a criterion-referenced test compares performance with a predefined standard. Comparing a child with same-age peers is norm-referenced. (NBCOT's own exams are criterion-referenced.)

  • A Criterion-referenced tests compare a score with a set standard, not with peers.
  • C A test with age norms and a fixed procedure is standardized.
  • D Nothing in the description says the child or caregiver rates themselves.

Source: NBCOT Foundations (What is a criterion-referenced test?); 2022 COTA outline, Domain 1 Task 2.
Read the source: NBCOT, Foundations of the Certification Examinations · NBCOT, 2022 COTA Examination Content Outline

Question 44 of 50

Domain 2 · Select and Implement Interventions · COTA-041

A client says she sleeps poorly and asks for changes to her evening routine. Which three suggestions match CDC's list of better sleep habits? Select the three best answers.

  • A. Go to bed and get up at the same time every day
  • B. Eat a large meal right before bed so hunger doesn't wake her
  • C. Turn off phones and other devices at least 30 minutes before bed
  • D. Keep the bedroom warm
  • E. Avoid caffeine in the afternoon and evening
  • F. Have a glass of wine at bedtime to relax
Show answer and explanation

Answers: A, C, E.

CDC's sleep habits include a consistent bed and wake time every day, turning off electronic devices at least 30 minutes before bedtime, and avoiding caffeine in the afternoon or evening.

  • B CDC says to avoid large meals before bedtime.
  • D CDC recommends a cool bedroom.
  • F CDC says to avoid alcohol before bedtime.

Source: CDC, About Sleep (What to do).
Read the source: CDC, About Sleep

Question 45 of 50

Domain 2 · Select and Implement Interventions · COTA-035

A client with carpal tunnel symptoms types for hours with her wrists bent sharply upward. Which workstation advice is consistent with AAOS guidance?

  • A. Raise the back of the keyboard so her wrists stay extended
  • B. Lower the keyboard so her wrists bend down while typing
  • C. Set up the workstation so her wrists stay straight, and change position often instead of holding a bent wrist for long periods
Show answer and explanation

Answer: C.

AAOS notes that holding the wrist in extreme flexion or extension for long periods raises pressure on the median nerve, and that changing activities or the workstation can slow the condition. A setup that keeps the wrist straight reduces that source of pressure.

  • A Sustained extension is one of the positions that raises pressure.
  • B Sustained flexion does too.

Source: AAOS OrthoInfo, Carpal Tunnel Syndrome (Cause; Activity changes).
Read the source: AAOS OrthoInfo, Carpal Tunnel Syndrome

Question 46 of 50

Domain 1 · Collaborate and Gather Information · COTA-008

A preschool teacher asks the COTA what to expect from a 4-year-old's crayon use. Which skill appears on CDC's list of things most children do by 4 years?

  • A. Holds a crayon or pencil between fingers and thumb, not in a fist
  • B. Writes their first and last name
  • C. Ties their own shoelaces
Show answer and explanation

Answer: A.

CDC's 4-year checklist lists holding a crayon or pencil between fingers and thumb (not a fist) under movement milestones. It also lists drawing a person with three or more body parts. CDC defines milestones as things 75% or more of children can do by that age, and notes the checklists don't replace standardized developmental screening.

  • B and C aren't on CDC's 4-year list. Their absence alone does not establish a developmental delay.

Source: CDC Learn the Signs. Act Early., Milestones by 4 Years (updated May 2026).
Read the source: CDC, Milestones by 4 Years

Question 47 of 50

Domain 2 · Select and Implement Interventions · COTA-025

A client is following posterior hip precautions, which bar bending her hip past 90°. Which device lets her put on socks without breaking that precaution?

  • A. Button hook
  • B. Sock aid
  • C. Rocker knife
Show answer and explanation

Answer: B.

A sock aid lets her slide each foot into a sock while sitting upright, so she doesn't bend forward past 90° to reach her feet.

  • A A button hook helps with fasteners when finger dexterity is limited.
  • C A rocker knife is for one-handed cutting.

Source: Cambridge University Hospitals, Total hip replacement—for those following hip precautions (Hip precautions; Dressing); Royal Berkshire NHS, Household gadgets and adaptations (Dressing); St. Ambrose University Assistive Technology House, Rocker Knife.
Read the source: Cambridge University Hospitals, Total hip replacement—for those following hip precautions · Royal Berkshire NHS, Household gadgets and adaptations · St. Ambrose University Assistive Technology House, Rocker Knife

Question 48 of 50

Domain 3 · Uphold Professional Standards and Responsibilities · COTA-050

A COTA supervises an OT aide in an outpatient clinic. Under AOTA's guidelines, which three conditions must be present before the COTA delegates a client-related task to the aide? Select the three best answers.

  • A. The outcome of the task is predictable
  • B. The aide can decide how to adapt the task if the client tires
  • C. The client's condition and the environment are stable
  • D. The aide can perform services the client's payer bills as skilled therapy
  • E. The client has already shown the ability to perform the task
  • F. The task requires the aide to interpret the client's response
Show answer and explanation

Answers: A, C, E.

AOTA's guidelines let a COTA directly supervise an aide, subject to applicable state, workplace and payer requirements. Before a client-related task is delegated, the outcome must be predictable, the client's condition and environment stable (needing no judgment, interpretation or adaptation by the aide), the client must have shown the ability to do the task, and the routine must be clearly established.

  • B and F require judgment or interpretation, which aides don't provide.
  • D Aides do not provide skilled occupational therapy services; they also must not perform billable functions the payer prohibits.

Source: AOTA Supervision Guidelines (2020), General Supervision and Supervision of Occupational Therapy Aides, pp. 1 and 4–5.
Read the source: AOTA, Guidelines for Supervision, Roles, and Responsibilities (2020)

Question 49 of 50

Domain 2 · Select and Implement Interventions · COTA-036

A client with a dementia-related visual processing problem says afternoon sun on the kitchen floor makes it hard to see where she's walking. Which change fits the UCSF home-safety tips?

  • A. Polish the floor to a high shine so it reflects more light
  • B. Replace lampshades with bare bulbs for more light
  • C. Hang sheer curtains or blinds to cut glare from direct sun
Show answer and explanation

Answer: C.

UCSF's tips recommend reducing glare from direct sunlight with blinds, shades or sheer curtains, and avoiding exposed bulbs without shades.

  • A A shiny floor adds glare.
  • B UCSF specifically advises against exposed bulbs.

Source: UCSF Memory and Aging Center, Home Safety Tips for People with Visual Dysfunction (General environment).
Read the source: UCSF Memory and Aging Center, Home Safety Tips for People with Visual Dysfunction

Question 50 of 50

Domain 2 · Select and Implement Interventions · COTA-032

A client has hand swelling after a wrist fracture, and the OTR has started edema management. Her treatment plan permits gentle finger movement. Which home program fits the hand-oedema guidance?

  • A. Let the hand hang at her side so fluid can drain
  • B. Keep the hand elevated above heart level and make gentle fists and finger movements often
  • C. Massage firmly from the elbow down toward the fingertips
  • D. Keep the fingers still so the swelling can settle
Show answer and explanation

Answer: B.

The NHS hand-oedema leaflet pairs elevation above the heart with regular movement of the fingers, which pumps fluid out of the hand. The leaflet's retrograde massage uses light strokes from the fingertips toward the forearm.

  • A A dependent hand fills with more fluid.
  • C The described massage moves toward the body, from fingers toward the forearm, not the reverse.
  • D Keeping fingers still loses the pumping action and invites stiffness.

Source: Imperial College Healthcare NHS Trust, Swelling (oedema) management (January 2024), How can I reduce the swelling?—Elevation, Retrograde massage and Movement.
Read the source: Imperial College Healthcare NHS Trust, Swelling (oedema) management

Source access note: when we rechecked sources on November 4, 2026, this link to the cited Imperial College Healthcare leaflet returned a page-not-found error, so this specific document could not be rechecked. The original citation is retained as used.

Check your score

Keep two tallies as you go. Select exactly three options before checking a select-three item, and track unanswered items separately:

  • Correct choices: 1 point for each single-answer question you get right, plus 1 point for each correct option you pick on a select-three item (up to 3 per item). That's 70 points in all. NBCOT also gives credit for each correct option on multi-select items and takes nothing off for wrong picks; this practice tally applies that principle without reproducing NBCOT's scoring system.
  • Fully correct items: count an item only when you got it completely right. On a select-three item, that means all three correct options. There are 50 items in all.
Points and items by NBCOT COTA domain
Domain (2022 COTA outline) Question numbers Items Points possible Share of the real exam
1 · Collaborate and Gather Information 2, 5, 7, 12, 16, 18, 22, 26, 32, 36, 39, 43, 46 13 19 27%
2 · Select and Implement Interventions 1, 3, 6, 8, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 28, 31, 33, 35, 37, 38, 41, 42, 44, 45, 47, 49, 50 27 37 55%
3 · Uphold Professional Standards and Responsibilities 4, 10, 14, 20, 24, 29, 30, 34, 40, 48 10 14 18%
Total 50 70

What your score means. Both numbers describe these 50 items only. They don't convert to an NBCOT score, and they don't predict whether you'll pass. NBCOT reports a scaled score from 300 to 600; you need at least 450 to pass, and the decision rests on the whole exam, with no passing standard for individual domains. With 10 to 27 items per domain here, a weak domain is a pointer for what to review, not a measurement of your ability. (NBCOT, Foundations)

Answer key

Answer key for all 50 questions
# Item ID Domain Type Answer
1 COTA-015 D2 Single B
2 COTA-004 D1 Single A
3 COTA-019 D2 Single D
4 COTA-042 D3 Single C
5 COTA-012 D1 Select 3 A, C, F
6 COTA-023 D2 Single C
7 COTA-001 D1 Single C
8 COTA-027 D2 Single C
9 COTA-037 D2 Select 3 A, C, F
10 COTA-045 D3 Single A
11 COTA-020 D2 Single A
12 COTA-006 D1 Single C
13 COTA-031 D2 Single A
14 COTA-047 D3 Single B
15 COTA-024 D2 Single C
16 COTA-013 D1 Select 3 B, D, F
17 COTA-033 D2 Single C
18 COTA-002 D1 Single A
19 COTA-038 D2 Select 3 B, D, F
20 COTA-043 D3 Single D
21 COTA-016 D2 Single B
22 COTA-009 D1 Single B
23 COTA-021 D2 Single C
24 COTA-048 D3 Single C
25 COTA-028 D2 Single A
26 COTA-005 D1 Single B
27 COTA-039 D2 Select 3 B, D, F
28 COTA-034 D2 Single B
29 COTA-011 D3 Single B
30 COTA-049 D3 Select 3 B, E, F
31 COTA-017 D2 Single D
32 COTA-003 D1 Single D
33 COTA-029 D2 Single D
34 COTA-046 D3 Single C
35 COTA-026 D2 Single D
36 COTA-014 D1 Select 3 B, D, E
37 COTA-040 D2 Select 3 B, D, E
38 COTA-022 D2 Single B
39 COTA-007 D1 Single D
40 COTA-044 D3 Single B
41 COTA-018 D2 Single A
42 COTA-030 D2 Single D
43 COTA-010 D1 Single B
44 COTA-041 D2 Select 3 A, C, E
45 COTA-035 D2 Single C
46 COTA-008 D1 Single A
47 COTA-025 D2 Single B
48 COTA-050 D3 Select 3 A, C, E
49 COTA-036 D2 Single C
50 COTA-032 D2 Single B

Turn missed questions into a review plan

Pick up to three items you missed or guessed. For each one, fill in a row like this:

Review log for missed questions with a filled example
Item ID Detail I missed Why my choice didn't fit What I'll review or try next
COTA-001 Discharge is a discontinue decision, and that belongs to the OTR. I treated "most goals met" as permission for the COTA to end services. Reread AOTA's split of OTR and COTA roles, then sort ten everyday decisions into "OTR decides" and "COTA contributes."

If the principle still isn't clear, open the linked source. Then test yourself on a changed detail rather than the same answer letter: for example, what changes if the client asks the OTR directly, or if the stalled goal is the one she cares about most? Getting a familiar item right a second time isn't new evidence you're ready. Applying the same idea to a new case is.

How this practice test compares with the real COTA exam

How this practice test compares with the real NBCOT COTA exam
Real NBCOT COTA exam This practice test
Length and time 190 items in 4 hours (about 76 seconds per item on average) 50 items; about 63 minutes at the same average pace, excluding explanation review
Item types Single-answer items with three or four options, plus six-option multi-select items where you choose three The same two types
Multi-select format Standalone items: a stem and six options, three correct Ten standalone select-three items, mixed in with the others
Scenario sets None. Scenario sets are on the OTR exam only None
Item-type mix No fixed COTA item-type percentages stated in the checked NBCOT publications Our own mix: 17 three-option, 23 four-option and 10 select-three items
Content basis 2022 COTA Examination Content Outline (27 / 55 / 18%) Same outline; items spread 13 / 27 / 10 across the three domains (26 / 54 / 20%)
Scoring Credit for each correct option, no deductions; scaled 300–600, 450 to pass Raw tallies only; never converted to a scaled score
Feedback Candidates who don't pass get a report with a domain-level performance chart An explanation for every option, with a source

Sources: NBCOT Certification Exam Handbook, pp. 22–24 and 28–29; NBCOT Foundations; NBCOT 2024 Exam FAQs; 2022 COTA Examination Content Outline.

COTA, not OTR. The COTA and OTR exams are different. The OTR exam has 180 items and uses scenario sets built around an opening scene; the COTA exam has 190 items with standalone multi-select questions. NBCOT says the COTA item types didn't change in 2024, when the OTR exam dropped its old clinical simulation (CST) items. (NBCOT, 2024 Exam FAQs)

Some field-test items don't count. Each NBCOT exam includes a preselected number of unscored field-test items mixed in randomly, and you can't tell which ones they are. Treat every question as if it counts. (NBCOT, Foundations)

This is a shorter practice set, not a full-length exam; it does not cover every knowledge statement in the outline.

Official NBCOT practice resources

  • Free: NBCOT's multi-select item sample shows two six-option items in the official layout. The exam tutorial walks through the testing screen and tools. NBCOT notes that the samples don't recreate the exam-day experience.

Sources

NBCOT exam information (checked November 4, 2026)

Teaching references used in the explanations

Last verified: November 4, 2026. We checked NBCOT's COTA exam format, scoring rules and posted content outline, and the source behind each practice item.

By: Castleport Test Prep Editorial Team · How we write and check practice questions

Spot a problem with a question? Report it here and include the item ID (for example, COTA-024) so we can check it against its source.

Castleport Test Prep is an independent publisher. We are not affiliated with, endorsed by, or approved by the National Board for Certification in Occupational Therapy (NBCOT). Exam and credential names identify their subjects; trademarks belong to their respective owners. These practice questions are original and unofficial. They are not actual, recalled or adapted NBCOT exam items, and using them doesn't guarantee a passing score, certification or licensure.

Free NBCOT COTA Practice Test: 50 Questions + Explanations