NBCOT COTA Practice Questions 2026: 8 Exam-Style Items Explained

Answer: C — Resting tremor

A resting tremor appears when the limb is supported and relaxed and decreases with voluntary movement; it is a cardinal sign of Parkinson's disease (basal ganglia). Naming the tremor type correctly tells the team which tasks will be most affected and which compensations to try.

• A. An intention tremor gets worse as the hand approaches a target and points to cerebellar involvement, the opposite pattern.
• B. Rigidity is increased resistance to passive movement through the range (lead-pipe or cogwheel), not a rhythmic oscillation.
• D. Ataxia is uncoordinated voluntary movement, usually cerebellar; it shows during movement, not at rest.

Answer: B — External rotation

Adhesive capsulitis follows the glenohumeral capsular pattern: external rotation is lost most, then abduction, then internal rotation. Tasks that combine external rotation and abduction, such as combing the back of the hair, are usually the hardest.

• A. Extension is relatively spared in the capsular pattern.
• C. Abduction is limited, but it is second to external rotation in the capsular pattern.
• D. Flexion is affected, but less than external rotation and abduction.

Answer: C — Wrist, fingers and thumb in extension with the thumb abducted (palm extension)

Burned skin contracts toward the injured surface, so a palmar burn pulls the hand into flexion. The orthosis holds the wrist, fingers and thumb in extension with the thumb abducted to keep the palmar skin on stretch. A dorsal hand burn is the opposite case and uses the intrinsic-plus (safe) position.

• A. A neutral wrist splint leaves the fingers and palm free to contract into flexion.
• B. A resting position with the fingers flexed lets the palmar skin shorten, which is exactly the contracture to prevent.
• D. A cock-up splint controls only the wrist; the fingers and thumb web space can still contract.

Answer: C — Do not bend the operated hip past 90 degrees

Precautions protect the side of the hip capsule the surgeon opened. A posterior approach is protected by avoiding flexion past 90 degrees, adduction across midline and internal rotation; an anterolateral (anterior) approach is protected by avoiding hip extension and external rotation. Always follow the surgeon's actual orders, because many anterior procedures now carry few or no restrictions.

• A. External rotation is a core anterolateral precaution, so it belongs on this client's handout.
• B. Hip extension past neutral is a core anterolateral precaution, so it belongs on this client's handout.

Answer: B — Moderate-to-high intensity aerobic exercise without rest breaks

Phase 1 complete decongestive therapy reduces limb volume with manual lymph drainage, multilayer short-stretch bandaging worn nearly around the clock, skin care, and decongestive exercise done in the bandages at low to moderate intensity with rest. Strenuous continuous exercise raises the lymph load and can increase swelling during this phase.

• A. Short-stretch bandaging is the core of phase 1 and is worn most of the day.
• C. Graded exercise in the bandages uses the muscle pump to move lymph and belongs in phase 1.
• D. Manual lymph drainage is a core component of phase 1 (it requires specific training to perform).

Answer: D — Skill

Rood's sequence runs reciprocal inhibition, co-contraction, heavy work, then skill. Skill is the highest level: the proximal segment is held stable while the distal segment moves freely, which is exactly what a sustained shoulder hold with fine finger work demands.

• A. Reciprocal inhibition is the earliest phase, alternating movement of a body part without a stable base.
• B. Co-contraction is static holding of a posture with no distal task added.
• C. Heavy work is proximal movement over a fixed distal segment, such as weight shifting in quadruped, the reverse of this task.

Answer: B — Assess the COTA's competence in the school setting and set the supervision plan accordingly, within state law

The OTR is responsible for supervision, and AOTA's supervision guidelines tie its type and frequency to the COTA's demonstrated competence in that setting and population, within state practice act and payer rules. Experience elsewhere counts but must be verified: school practice brings different laws (IDEA), documentation and team roles.

• A. Restricting a qualified COTA to paperwork is not a supervision plan and withholds services the COTA is trained to give.
• C. The OTR cannot base supervision on the supervisee's self-report alone.
• D. A fixed schedule that ignores demonstrated competence is not an individualized supervision plan; frequency should follow competence and state rules.

Answer: D — Veracity

Veracity is the duty to give comprehensive, accurate and objective information, which covers documentation, billing and how practitioners represent their credentials. Falsifying a note breaks veracity even if no client is harmed.

• A. Fidelity concerns faithfulness, respect and integrity toward clients, colleagues and other professionals.
• B. Beneficence is the duty to act for the client's well-being.
• C. Justice concerns fairness, equitable access to services and following applicable law.