NBCOT Plan

Domain 04: Competency and Practice Management: practice questions

5 original questions · 5 editor-approved · every choice explained.

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Blueprint-mapped questions with full rationales for every choice.

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Domain 04: Competency and Practice ManagementDifficulty 3/5

An OTA reports that a client has met all goals and asks whether they can discharge the client. What should the OTR do?

  1. ARefer the discharge decision to the supervising physician for approval
  2. BAuthorise the discharge based on the OTA's report of goal achievement
  3. CReassess the client and determine discharge, using the OTA's data
  4. DAsk the OTA to complete a discharge summary and co-sign the document
Show answer and rationale

Correct: C. Determining discharge is the OTR's responsibility. The OTA may gather data and contribute to the process, but the reassessment and the decision belong to the OTR.

  • B — Delegating the decision itself exceeds the OTA's scope.
  • D — Co-signing a document does not substitute for the OTR's reassessment.
  • A — Discharge from occupational therapy is an OT decision, not a physician's.
Domain 04: Competency and Practice ManagementDifficulty 2/5

Which task may be assigned to an occupational therapy aide?

  1. ACollecting range-of-motion data to monitor progress toward a goal
  2. BProviding caregiver education on a home exercise programme
  3. CImplementing a portion of the intervention plan with a stable client
  4. DSetting up equipment and transporting a client to the therapy area
Show answer and rationale

Correct: D. Aides perform non-skilled, routine tasks such as setup and transport under direct supervision. Any activity requiring clinical judgement — intervention, data collection for clinical decisions, education — is outside their scope.

  • C — Implementing intervention is an OTA activity within service competence.
  • A — Collecting clinical data requires judgement and training.
  • B — Caregiver education is a skilled intervention.
Domain 04: Competency and Practice ManagementDifficulty 3/5

Which documentation entry best demonstrates skilled occupational therapy service?

  1. AOTR graded the task by reducing cues and adapting the fastener, improving performance
  2. BClient ambulated to the therapy gym and participated in the scheduled activities
  3. CClient was pleasant and cooperative throughout the forty-five-minute session
  4. DClient completed dressing with minimal assistance and tolerated the session well
Show answer and rationale

Correct: A. Skilled documentation shows what required the therapist's expertise — analysis, grading, adaptation — and the client's response. Statements of participation, tolerance or demeanour do not demonstrate skilled need.

  • D — Assistance level alone does not show what the therapist contributed.
  • B — Attendance and participation are not skilled service.
  • C — Demeanour is irrelevant to medical necessity.
Domain 04: Competency and Practice ManagementDifficulty 2/5

State licensure law and a professional-association guideline conflict on a supervision requirement. Which governs practice?

  1. AThe professional guideline, because it reflects the profession's standards
  2. BThe state licensure law, because it has legal authority in that jurisdiction
  3. CThe employer's policy, because it accounts for local operating conditions
  4. DWhichever standard is less restrictive for the practitioner involved
Show answer and rationale

Correct: B. Licensure law is legally binding within the jurisdiction. Professional guidance and employer policy operate within it, and the stricter legal requirement must be met.

  • A — Professional guidance does not override statute.
  • C — Employer policy cannot authorise a practice the law prohibits.
  • D — Choosing the less restrictive option can violate the law.
Domain 04: Competency and Practice ManagementDifficulty 3/5

An OTR finds a single small case series supporting a new intervention. How should this evidence be used?

  1. AAdopt the intervention as standard practice for all suitable clients
  2. BWeigh it as low-level evidence alongside client values and clinical expertise
  3. CDisregard it entirely, because case series cannot inform clinical practice
  4. DAdopt it only if a colleague has used it successfully with a similar client
Show answer and rationale

Correct: B. Evidence-based practice combines the best available evidence with clinical expertise and client values. A small case series is low-level evidence: it can inform a cautious, monitored trial, not a standard of care.

  • A — A case series cannot support blanket adoption.
  • C — Low-level evidence still contributes when weighed appropriately.
  • D — A colleague's anecdote is weaker evidence than the case series.

Primary references

  1. Certification Exam Handbook (2025) — National Board for Certification in Occupational Therapy (NBCOT) · primary · retrieved 2026-09-22, verified 2026-09-22