March 10, 2015


The NBCOT Exam (COTA), developed by the National Board for Certification in Occupational Therapy, is a challenging and comprehensive assessment for men and women hoping to enter the rewarding field of occupational therapy. Those who pass this exam are recognized as Certified Occupational Therapy Assistants.

The content of the NBCOT Exam (COTA) is divided into three domains representing the most important tasks in occupational therapy: gathering information and formulating conclusions regarding the client’s needs and priorities to develop a client-centered intervention plan (33 percent of the exam); selecting and implementing evidence-based interventions to support participation in areas of occupation throughout the continuum of care (47 percent); and upholding professional standards and responsibilities to promote quality in practice (20 percent).

The NBCOT Exam (COTA) consists of 200 multiple-choice questions with four possible answers for each. Some of the answer choices will be partially correct, and it is the job of the candidate to select the best answer.

Scoring the exam usually takes about four weeks. Raw scores (the number of questions answered correctly) are placed on a scale of 300 to 600 according to a formula that accounts for the relative difficulty of the test version. The minimum passing score on the NBCOT exam (COTA) is 450.

NBCOT Study Guide

Start learning how to be successful on your NBCOT exam. Our NBCOT study guide is guaranteed to help you get the results you deserve on your NBCOT test. Some test takers prefer to study using flashcards and so we have created the best NBCOT flashcards that cover everything you need to know for the NBCOT exam. Note that using multiple study aids will help you maximize the benefit from your study time.

NBCOT Study Guide
NBCOT Flashcards

NBCOT Exam (COTA) Practice Test

1. A client with a visual perception disability has difficulty identifying common toiletry items (toothbrush, comb, and brush) when not in an upright position or the items are in different colors. He has been practicing identifying these objects. Which adaptive procedure is MOST appropriate to assist him in the home environment?

a. Remove all but one set of these items
b. Place items upright in open, labeled containers on the counter or a shelf
c. Arrange for a home aide to assist the client
d. Encourage him to use his sense of touch to identify items

2. A client has a splint on her wrist and forearm but has developed “window” edema between the securing straps. In addition to elevating the extremity, which of the following is the BEST initial solution?

a. Remove the splint until the edema subsides
b. Apply wider straps to better distribute the force
c. Leave straps loose until the edema subsides
d. Replace straps with bias-cut wrapping, from the distal to the proximal end

3. A client sustained a traumatic brain injury. She dressed herself, but she has put her sweater on backward, become unsteady during transfer from a wheelchair, and had difficulty ambulating when she encountered equipment or other people. Which functional assessment is MOST indicated?

a. Ask the client to sort items of different sizes and colors
b. Ask the client to identify items of clothing (sweater, blouse, pants)
c. Ask the client to place items in specific positions, using directional guides (up-down, front-back, right-left)
d. Ask the client to sort items by their shape (circle, triangle, square)

4. Which approach to exposure therapy is likely to be MOST effective in the long term for a client with severe phobias?

a. Progressive in vivo exposure
b. Flooding
c. Virtual reality exposure
d. Relaxation exercise

5. An eight-year-old child has been relearning to walk after a serious injury. Which of the following responses to “I can’t do this!” shows reflective listening?

a. “This is very simple. We’ll all help you.”
b. “You don’t need to be afraid. Your parents are right here.”
c. “New exercises can be scary because you don’t know what’s going to happen.”
d. “You’re a very brave boy, so you will do fine.”


1. B: Items should be placed in the upright position in labeled containers where the client can easily access them. Because the client has a visual perceptual disability, he may confuse items even if only one set is available. While a home aide may be necessary in some circumstances, the goal of adaptive interventions is to allow the client to be as independent as possible. The sense of touch alone may not be adequate and may be influenced by visual perceptions. Additionally, some toiletry items are similar in shape. The client should continue with remedial exercises, such as sorting and identifying, to improve perceptual skills.

2. D: To reduce window edema, the straps should be replaced with bias-cut wrapping and be applied from the distal to the proximal end until the edema subsides, because this evens out the distribution of pressure on the skin. The splint should not be removed nor the straps loosened so much that the splint is ineffective, leaving the joint unsupported. Wide straps can distribute force better than narrow ones can, but if they are too wide, they may interfere with the range of motion of unimpaired joints.

3. C: The client’s difficulty transferring, ambulating around equipment or other people, and dressing suggests a deficit in spatial relationships. The most appropriate functional test is to ask the client to place items in specific positions, using directional guidance and to record the number of errors. Standardized tests (Cross and Ayres’ Space Visualization Test) may be indicated. Therapy includes practice following directions and using senses (kinesthetic, touch) to estimate distances. An adaptive approach includes limiting environmental obstructions and placing items consistently in one place.

4 A: Progressive in vivo exposure is most effective. Exposure therapy includes:

  • Psychoeducation: Nature of phobias and the purpose of exposure therapy. Note: relaxation exercises may help clients cope, but they may impede progress in habituating clients to the fear response.
  • Analysis of fear: The therapist and client develop a fear-and-avoidance hierarchy. For example, if a client is afraid of snakes, the client may rank fears related to snakes from low (seeing a cartoon snake) to extremely high (touching a snake).
  • Progressive systematic exposure: Through imagery, virtual reality, or in vivo (actual), which is more successful? Massed exposure (“flooding”) shows short-term effectiveness, but the results are more short-lived than when the exposure is spaced.

5. C: The statement “New exercises are scary because you don’t know what’s going to happen,” reflects back the feelings the child has expressed. Reflective listening includes:

  • Listen actively: Turn toward the child, sit or kneel at his level or hold him, and look directly at him.
  • Listen for expressions of feeling: Words such as “scared,” “happy,” “excited,” “sad,” and “afraid.” Try to identify and understand feelings rather than just words or facts.
  • Reflect back: Restate the feelings the child has expressed and try to state the probable reason (“because”) behind the feelings.

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