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Free COTA Certification Exam Practice Questions

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Sample Practice Questions

Try these 10 sample questions from the COTA Certification Exam practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

  1. 1During a home session, an occupational therapy assistant observes that a client with Parkinson's disease takes steps that become faster and faster while walking to the kitchen and has trouble slowing down or stopping. Which term describes this gait feature?

    1. A. Festination
    2. B. Start hesitation
    3. C. Bradykinesia
    4. D. Postural instability

    Answer: A

    Explanation: NINDS describes this pattern directly: "When walking, each step may get faster and faster and a person may have a hard time stopping or slowing down. This is called festination." Start hesitation is trouble initiating steps (freezing in place), bradykinesia is generalized slowness of movement, and postural instability refers to balance and posture problems, so none of them names the accelerating, hard-to-stop steps seen here.

    Reference: Parkinson's Disease (NINDS Health Information) — Symptoms of PD, parkinsonian gait paragraph

  2. 2On day 3 after a minor cut on the hand, a client's wound is slightly swollen, pink, and tender, with a small amount of clear fluid. How should the occupational therapy assistant interpret these findings?

    1. A. They are signs of dead tissue at the wound edges that require contacting the provider right away
    2. B. They are signs of infection that require contacting the provider right away before activity continues
    3. C. They are expected during the stage in which the immune system protects the wound from infection
    4. D. They are signs that granulation tissue has finished forming and the scar has begun to strengthen

    Answer: C

    Explanation: MedlinePlus explains that once the scab forms, the immune system protects the wound and "The wound becomes slightly swollen, red or pink, and tender", with some clear fluid that helps clean the area; "This stage takes about 2 to 5 days." Signs of infection are redness with increased pain or yellow or green pus, black edges signal dead tissue, and tissue rebuilding and scar formation occur later.

    Reference: How wounds heal (MedlinePlus Medical Encyclopedia) — Stages of Wound Healing

  3. 3An occupational therapy assistant is scheduled to see a hospitalized client who is suspected of having tuberculosis of the lungs and is in a negative pressure room. What protection must the assistant put on before entering the room?

    1. A. A surgical mask put on before coming within 6 feet of the client
    2. B. A well-fitted respirator mask put on before entering the room
    3. C. A gown and gloves put on before touching the client or bed rails
    4. D. Gloves put on only if contact with body fluids is expected

    Answer: B

    Explanation: MedlinePlus lists tuberculosis infecting the lungs among germs that warrant airborne precautions, managed in a negative pressure room, and states: "Anyone who goes into the room should put on a well-fitted respirator mask before they enter." A surgical mask is the droplet precaution, a gown and gloves are the contact precaution, and gloves for anticipated fluid contact are part of standard precautions; none protects against airborne TB.

    Reference: Isolation precautions (MedlinePlus Medical Encyclopedia) — Transmission-based Precautions, airborne precautions

  4. 4A client who has had Parkinson's disease for many years tells the occupational therapy assistant that stiffness and slowness return early in the morning before the first dose of carbidopa-levodopa and again between doses, sometimes without warning. Which disease-related pattern is the client describing?

    1. A. Dyskinesia
    2. B. Off periods
    3. C. Orthostatic hypotension
    4. D. REM sleep behavior disorder

    Answer: B

    Explanation: NINDS explains that with longer disease duration "symptoms may start happening in the morning before their first dose of carbidopa-levodopa and in between doses", and that people may have sudden, unpredictable off periods when the medicine does not seem to work. Dyskinesia is unwanted twisting or writhing movement, orthostatic hypotension is a blood pressure drop on standing, and REM sleep behavior disorder is acting out dreams; none describes the return of symptoms before doses.

    Reference: Parkinson's Disease (NINDS Health Information) — How is PD treated, Carbidopa-levodopa

  5. 5A client with paraplegia sits in a wheelchair during the day and sleeps in a bed at night. To prevent pressure injuries, how often does MedlinePlus advise relieving pressure in each position?

    1. A. In both the wheelchair and the bed, change position every 1 to 2 hours
    2. B. In the wheelchair, shift weight every 1 to 2 hours; in bed, change position every 15 to 20 minutes
    3. C. In both the wheelchair and the bed, change position every 15 to 20 minutes
    4. D. In the wheelchair, shift weight every 15 to 20 minutes; in bed, change position every 1 to 2 hours

    Answer: D

    Explanation: MedlinePlus gives different intervals for the two surfaces. In the wheelchair: "You or your caregiver should shift your weight (lean forward, left and right) in your wheelchair every 15 to 20 minutes." In bed: "Change your position every 1 to 2 hours to keep the pressure off any one spot." Swapping the intervals or using one interval for both positions misapplies this guidance. Sitting puts more pressure on a small area, so the wheelchair interval is the shorter one.

    Reference: Preventing pressure injuries (MedlinePlus Medical Encyclopedia) — If You Use a Wheelchair

  6. 6A client with a C difficile infection needs ADL training in the hospital room. The isolation sign indicates that anyone who may touch the client or objects in the room must wear a gown and gloves. Which category of transmission-based precautions is in place?

    1. A. Airborne precautions
    2. B. Droplet precautions
    3. C. Contact precautions
    4. D. Standard precautions

    Answer: C

    Explanation: MedlinePlus explains that contact precautions are for germs spread by touching, names C difficile among them, and states: "Anyone entering the room who may touch the person or objects in the room should wear a gown and gloves." Droplet precautions require a surgical mask, airborne precautions require a respirator and negative pressure room, and standard precautions apply to all patients rather than being a transmission-based category.

    Reference: Isolation precautions (MedlinePlus Medical Encyclopedia) — Transmission-based Precautions, contact precautions

  7. 7A 32-year-old client with multiple sclerosis reports several past episodes of leg weakness and blurred vision. Each episode improved fully or partially, and months passed between episodes without new symptoms. Which course of multiple sclerosis does this history describe?

    1. A. Primary-progressive MS
    2. B. Secondary-progressive MS
    3. C. Relapsing-remitting MS
    4. D. Clinically isolated syndrome

    Answer: C

    Explanation: NINDS defines relapsing-remitting MS this way: "Symptoms come in the form of recurrent attacks with total or partial recovery." The client's repeated attacks with recovery and symptom-free periods fit this course. Secondary-progressive MS involves a gradual steady decline as attacks become less common, primary-progressive MS worsens from the beginning without noticeable attacks, and clinically isolated syndrome is a single attack, not several.

    Reference: Multiple Sclerosis (NINDS Health Information) — Types of MS, Relapsing-remitting MS

  8. 8A bedbound client at risk for pressure injuries likes to sit up in bed to watch television. To limit sliding that can harm the skin, what is the maximum angle to which the head of the bed should be raised?

    1. A. 30 degrees
    2. B. 45 degrees
    3. C. 60 degrees
    4. D. 90 degrees

    Answer: A

    Explanation: MedlinePlus advises: "Do not raise the head of your bed to more than a 30 degree angle. Being flatter keeps your body from sliding down. Sliding may harm your skin." Higher angles increase sliding down the mattress.

    Reference: Preventing pressure injuries (MedlinePlus Medical Encyclopedia) — When You Are in Bed, other tips

  9. 9A client with influenza on Droplet Precautions must leave the room for a medically necessary test, and the occupational therapy assistant will push the wheelchair. Which transport arrangement does the CDC isolation guidance describe?

    1. A. The client stays unmasked, with any infected areas of the body contained and covered
    2. B. The client stays unmasked, and the assistant transporting the client wears a surgical mask
    3. C. The client wears a mask, and the assistant transporting the client also wears a well-fitted respirator
    4. D. The client wears a mask and follows cough etiquette, and the assistant transporting the client does not need a mask

    Answer: D

    Explanation: For Droplet Precautions, the CDC summary says: "If transport or movement in any healthcare setting is necessary, instruct patient to wear a mask" and "No mask is required for persons transporting patients on Droplet Precautions." A surgical mask is what staff wear when entering the room of a client on Droplet Precautions, not what the transporter needs. A well-fitted respirator is the room-entry requirement for Airborne Precautions. Containing and covering infected body areas is the transport step for Contact Precautions.

    Reference: Isolation Precautions: Summary of Recommendations (CDC) — V.C.4.b, Droplet Precautions, Patient transport

  10. 10The OTR asks the occupational therapy assistant to help a client who was recently diagnosed with amyotrophic lateral sclerosis (ALS), and the client's family, understand what to plan for. Which statement reflects the expected course of ALS?

    1. A. Motor impairment remains permanent but stays stable rather than worsening over the coming years
    2. B. Weakness peaks within the first few weeks after onset and is then usually followed by substantial recovery
    3. C. Symptoms appear as discrete attacks that are each followed by long periods of partial or complete recovery
    4. D. Muscle weakness spreads to other body parts over time, while reasoning and memory usually remain intact

    Answer: D

    Explanation: NINDS states that "As the disorder progresses, muscle weakness and atrophy spread to other parts of the body" and that people with ALS "usually remain able to reason, remember, and understand." Early peak weakness followed by recovery describes Guillain-Barre syndrome, attacks with recovery describe relapsing-remitting MS, and permanent but nonprogressive impairment describes cerebral palsy, so those options do not fit ALS.

    Reference: Amyotrophic Lateral Sclerosis (ALS) (NINDS Health Information) — What is ALS, progression and cognition paragraphs

Topics in this practice bank

These topics describe the available practice for COTA Certification Exam. Review the examination outline and its sources for scope and allocation details.

  • Domain 1 — Collaborate and Gather Information: Under the supervision of the OTR, acquire information on an ongoing basis regarding factors that influence occupational performance.
    • Task 1: Recognize the influence of development and lived experience; body functions and body structures; values, beliefs, and spirituality; and identity on occupational performance.
    • Task 1 knowledge 1: Impact of typical development and aging on occupational performance, health, and wellness across the life span.
    • Task 1 knowledge 2: Expected patterns, progressions, and prognoses associated with conditions that limit occupational performance. Examples include signs and symptoms of disease; stages of disease; secondary complications.
    • Task 1 knowledge 3: Impact of body functions and body structures on occupational performance. Examples include cognitive impairments; congenital anomalies.
    • Task 1 knowledge 4: Influence of lived experiences and identity on occupational performance. Examples include history of trauma and adverse childhood events; socioeconomic status; gender, race, culture, religion.
    • Task 2: Acquire information about a client’s functional skills, roles, prioritized needs and wants, and performance context to inform the development of and updates to an occupational profile.
    • Task 2 knowledge 1: Resources for acquiring information about the client’s current condition and occupational performance. Examples include referrals; client records; developmental history; Individualized Education Program (IEP) plans.
    • Task 2 knowledge 2: Purpose, advantages, limitations, and service competency needs related to the administration of standardized and nonstandardized assessments and screening methods. Examples include criterion-referenced tests; norm-referenced tests; client and caregiver interviews; observation.
    • Task 2 knowledge 3: Internal and external factors influencing a client’s engagement in occupation. Examples include roles, habits, routines, and rituals; environmental context; family and social supports; medication side effects and interactions; mental health.
    • Task 3: Perform an activity analysis to determine the influence of task demands, current conditions, performance skills, and context on occupation.
    • Task 3 knowledge 1: Task requirements, steps to task completion, and task demands across contexts or settings.
    • Task 3 knowledge 2: Personal and environmental factors that facilitate or inhibit task completion or occupational engagement. Examples include compensation patterns; role of performance context; influence of current conditions.
    • Task 4: Collaborate with the client, the client’s relevant others, occupational therapy colleagues, and other professionals using a client-centered approach and therapeutic use of self to provide quality occupational therapy services.
    • Task 4 knowledge 1: Roles and responsibilities among interprofessional teams when coordinating client care and providing services. Examples include referral to and consultation with other services; interprofessional communication methods; scope of practice.
    • Task 4 knowledge 2: Processes for supporting interprofessional intervention plans. Examples include Individualized Education Program (IEP) plans; discharge plans; transition plans; palliative and hospice care plans.
    • Task 4 knowledge 3: Client-centered approaches and considerations for coordinating occupational therapy services. Examples include therapeutic use of self; advocacy; frequency/duration of intervention; level of service delivery.
    • Task 4 knowledge 4: Factors used to prioritize intervention goals and activities in collaboration with the client and family, teacher, caregiver, and relevant others. Examples include client-reported outcomes; level of support required; context of service delivery; progress toward goals.
    • Task 4 knowledge 5: Strategies for addressing and enhancing health literacy with the client and relevant others. Examples include caregiver training; teaching-learning models; methods for making health information accessible; informed decision-making; navigating challenges to professional expertise.
    • Task 5: Monitor the intervention plan, approach, context, and goals on an ongoing basis, in collaboration with the OTR, using clinical reasoning.
    • Task 5 knowledge 1: Factors for determining and managing context and activities to meet individual and group intervention goals and objectives. Examples include client needs and priorities; response to intervention.
    • Task 5 knowledge 2: Strategies for monitoring the effectiveness of individual and group intervention. Examples include client-reported outcomes; reevaluation results; progress toward goals.
    • Task 5 knowledge 3: Clinical decision-making for prioritizing goals and implementing modifications to the intervention plan based on client responses, under the supervision of the OTR. Examples include physiological changes; behavioral reactions; emotion regulation; developmental needs.
    • Task 5 knowledge 4: Precautions or contraindications associated with a client condition or stage of recovery. Examples include postsurgical precautions; vital signs; laboratory values; suicidal ideation.
  • Domain 2 — Select and Implement Interventions: Implement interventions, under the supervision of the OTR, in accordance with the intervention plan and level of service competence to support client participation in areas of occupation throughout the occupational therapy process.
    • Task 1: Incorporate preparatory techniques, activities, and modalities as an adjunct to interventions to promote healing and enhance engagement in occupation-based activities.
    • Task 1 knowledge 1: Considerations for selecting, preparing, and adapting the intervention technique to support optimal engagement and promote goal achievement. Examples include client condition; client safety; theoretical approach and frame of reference.
    • Task 1 knowledge 2: Considerations for selecting, preparing, and adapting the intervention environment to support optimal engagement and promote goal achievement. Examples include ensuring privacy during telehealth sessions; equipment safety; line management.
    • Task 1 knowledge 3: Indications, contraindications, and precautions associated with wounds and maintaining skin integrity. Examples include stage of wound healing; prevention and management of pressure ulcers.
    • Task 1 knowledge 4: Indications, contraindications, precautions, and clinical application of superficial thermal agents. Examples include dry whirlpool; hot packs; cryotherapy.
    • Task 1 knowledge 5: Indications, contraindications, precautions, and clinical application of deep thermal, mechanical, and electrotherapeutic physical agent modalities. Examples include transcutaneous and neuromuscular electrical stimulation; biofeedback.
    • Task 2: Implement occupation-based strategies to support participation in activities of daily living (ADL), instrumental activities of daily living (IADL), health management, rest and sleep, education, work, play, leisure, and social participation across the life span.
    • Task 2 knowledge 1: Interventions for supporting leisure and play.
    • Task 2 knowledge 2: Methods for grading an activity, task, or technique based on level of development, client status, response to intervention, and client needs.
    • Task 2 knowledge 3: Considerations for facilitating individual and group participation in shared activities. Examples include group processes; group dynamics; group type and function.
    • Task 2 knowledge 4: Interventions to support cognitive, visual-motor, visual, and perceptual processing and sensory arousal. Examples include sensory modulation; proprioceptive input; vestibular strategies; low vision strategies.
    • Task 2 knowledge 5: Compensatory and remedial strategies for managing cognitive and perceptual deficits or developmental disabilities. Examples include graded cueing; chaining; metacognition; memory aids.
    • Task 2 knowledge 6: Adaptive and preventive strategies for supporting optimal engagement in occupation. Examples include use of technology/apps; joint protection; task simplification; energy conservation.
    • Task 2 knowledge 7: Intervention strategies and techniques used to facilitate oral motor skills for drinking, eating, and swallowing. Examples include hand-to-mouth patterns; mastication; adaptive utensils; positioning at mealtime.
    • Task 2 knowledge 8: Prevocational, vocational, and transitional services, options, and resources for supporting strengths, interests, employment, and lifestyle goals across the life span.
    • Task 2 knowledge 9: Strategies, techniques, and client-centered education to facilitate functional transfers.
    • Task 2 knowledge 10: Strategies for promoting wellness and mental health. Examples include relaxation; sleep hygiene; addiction management.
    • Task 3: Implement interventions for improving sensory, motor, neurological, and physiological status, considering client condition and current stage of recovery, to support occupational performance.
    • Task 3 knowledge 1: Methods for grading therapeutic exercise and conditioning programs consistent with indications and precautions.
    • Task 3 knowledge 2: Techniques for sensory and motor reeducation, pain management, desensitization, edema reduction, and scar management. Examples include manual edema mobilization; nerve gliding; neuromuscular reeducation; constraint-induced movement.
    • Task 3 knowledge 3: Techniques for promoting improved postural stability, dynamic balance, body mechanics, and breathing patterns during functional tasks.
    • Task 4: Select, fabricate, and modify orthotic devices, and provide training in the use of orthotic and prosthetic devices in order to support functional outcomes.
    • Task 4 knowledge 1: Types and functions of immobilization, mobilization, and restriction orthoses for managing specific conditions and congenital anomalies across the life span.
    • Task 4 knowledge 2: Types and functions of prosthetic devices for upper and lower extremity amputations.
    • Task 4 knowledge 3: Implications of anatomical, physiological, biomechanical, cognitive, and socioeconomic factors and healing principles for orthotic selection, design, fabrication, and modification.
    • Task 4 knowledge 4: Client-centered education and training methods for the safe and effective use of orthotic and prosthetic devices.
    • Task 5: Integrate assistive technology options, adaptive devices, mobility aids, and other durable medical equipment into the intervention to enable participation in occupation.
    • Task 5 knowledge 1: Factors related to measuring, selecting, monitoring the fit of, and recommending modifications to seating systems, positioning devices, and mobility aids. Examples include equipment components; biomechanical considerations; usability and maintenance.
    • Task 5 knowledge 2: Types, characteristics, and features of high- and low-tech assistive technology and adaptive devices. Examples include interface options and processor parameters; equipment components.
    • Task 5 knowledge 3: Mobility options, vehicle adaptations, and alternative devices for supporting participation in community mobility. Examples include adapted driving controls; wheelchair tie downs; alternative transportation options; dynamic mobile standers; navigation apps.
    • Task 5 knowledge 4: Client factors influencing successful use and maintenance of assistive technology options, adaptive devices, mobility aids, and other durable medical equipment. Examples include developmental, physical, functional, cognitive, and mental health status; prioritized needs.
    • Task 5 knowledge 5: Client-centered education and training methods for successful use and maintenance of assistive technology options, adaptive devices, mobility aids, and other durable medical equipment.
    • Task 6: Implement environmental modifications, while considering accessibility guidelines, standards, and legislation, to support participation in occupation consistent with client needs and status, task demands, and context.
    • Task 6 knowledge 1: Principles of ergonomics and universal design for identifying, recommending, and implementing features and reasonable accommodations in the workplace, home, and virtual and public spaces.
    • Task 6 knowledge 2: Processes and procedures for identifying, recommending, and implementing modifications in the workplace, home, and virtual and public spaces.
  • Domain 3 — Uphold Professional Standards and Responsibilities: Uphold professional standards and responsibilities by achieving service competence and applying evidence-based interventions to promote quality in practice.
    • Task 1: Employ evidence-based strategies and approaches to provide safe, effective, and efficient services relevant to individuals, groups, and populations.
    • Task 1 knowledge 1: Methods for locating, reviewing, and interpreting scholarly research to guide practice-relevant decision-making. Examples include applying the Patient, Intervention, Comparison, Outcome (PICO) model; identifying best evidence.
    • Task 1 knowledge 2: Methods for contributing to continuous quality improvement processes and procedures related to occupational therapy service delivery. Examples include program evaluation; acquiring information to measure outcomes.
    • Task 1 knowledge 3: Types of evidence-based programming for advancing population health outcomes. Examples include aging in place; fall prevention; health and wellness; community support groups.
    • Task 2: Incorporate risk management techniques at the individual and practice-setting levels to protect clients, self, staff, and others from injury or harm.
    • Task 2 knowledge 1: Infection control procedures and universal precautions for reducing transmission of contaminants. Examples include PPE; isolation precautions; cleaning equipment.
    • Task 2 knowledge 2: Responses to adverse reactions, minor injuries, and emergency situations. Examples include minor burns and cuts; seizures; diabetic reactions.
    • Task 2 knowledge 3: Preventive measures for minimizing risk and promoting safety. Examples include proper body mechanics; safety data sheet (SDS); standard operating procedures; equipment maintenance; emergency preparedness; personal safety in the client’s environment.
    • Task 2 knowledge 4: Strategies and resources to prevent professional burnout. Examples include assessment of personal needs; self-advocacy regarding workload; stress management.
    • Task 3: Provide occupational therapy services in accordance with laws, regulations, state occupational therapy practice acts, and accreditation guidelines to protect consumers and meet applicable reimbursement requirements related to the service delivery setting.
    • Task 3 knowledge 1: Application of federal regulations, state practice acts, facility policies, and accreditation guidelines related to service delivery across occupational therapy practice settings. Examples include health care legislation; accreditation organizations; licensing and credentialing.
    • Task 3 knowledge 2: Influence of reimbursement policies and guidelines on occupational therapy service delivery.
    • Task 3 knowledge 3: Accountability processes and procedures for justifying, tracking, and monitoring outcomes. Examples include relevant practice terminology; documentation guidelines.
    • Task 4: Engage in professional development and competency assessment activities relevant to the job role, practice setting, scope of practice, and professional certification standards.
    • Task 4 knowledge 1: Methods for identifying, documenting, and monitoring service competency and professional development needs. Examples include competency self-assessment; mentoring.
    • Task 4 knowledge 2: Application of ethical decision-making and professional behaviors guided by the NBCOT Practice Standards and Code of Conduct.

How to use these free practice questions

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These are independent study questions, not actual examination items. For examination requirements and official information, view COTA Certification Exam details.