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Reading an NBCOT® Exam Question

1st January, 2008

All material Copyright © 2009
By: Alison Bodor, M.S. OTR/L
The NBCOT® Certification Exam for the OTR® candidate is a combination of multiple choice, scenario, and clinical simulation exam questions. The scenario question is given in the form of a multiple choice question. Therefore, the method and strategy you incorporate for a standard multiple choice question can be utilized with the scenario format as well. The clinical simulation portion of the exam is a new section for the 2009 OTR® certification exam. Your reasoning skills are tested in a different format than the multiple choice exam questions.
The NBCOT® Certification Exam for the COTA® candidate is a multiple choice format. Therefore, one can employ a test strategy that will satisfy tackling a multiple choice question.
Both exams are criterion-referenced. This essentially means NBCOT® has determined a minimum passing score to determine one’s ability, skill, and knowledge to perform as an entry-level practitioner.
How can one pass? Probably one of the best methods to employ is repetition, repetition, repetition. And this is best done by taking practice tests. One needs to become comfortable with reading an exam question, identifying the stem of a question, and synthesizing the information to determine the best answer. Each exam question has a principle area that delivers information to the exam candidate to reduce the answer choices down to the best one.
Take a look at a sample test question:
An OTR or COTA is educating a client with chronic obstructive pulmonary disease how to incorporate
pursed lip breathing with self care tasks. The MOST EFFECTIVE breathing technique to incorporate
during a dressing task to decrease symptoms of dyspnea is:

  1. Promote the client to breathe in when lifting legs into pants
  2. Encourage the client to breathe out when pulling a shirt overhead
  3. Reinforce a daily self care routine be performed in sitting
  4. Emphasize the use of a pulse oximeter during lower body dressing


  1. First, determine the areas of the stem of the exam question. The stem of the question is how the
    problem is presented to the exam candidate. Therefore, there are many key words that comprise the
    stem and it is not localized in one area.
    An OTR or COTA is educating a client with chronic obstructive pulmonary disease how to incorporate
    pursed lip breathing with self care tasks. The MOST EFFECTIVE breathing technique to incorporate
    during a dressing task to decrease symptoms of dyspnea is:
  2. Next, think about or visualize this example and the possible answer or technique you would employ
    in practice. Do you see it in the answer choices?
  3. Then, eliminate the incorrect answer choices. Sometimes the incorrect choices may seem obvious to
    rule out, as they have distinctive qualities that do not apply to or contradict the stem of the question.1. Promote the client to breathe in when lifting legs into pants
    2. Encourage the client to breathe out when pulling a shirt overhead
    3. Reinforce daily self care routine be performed in sitting; this is considered an energy
    conservation technique.
    4. Emphasize the use of a pulse oximeter during lower body dressing; this is not considered a breathing technique.
    However, emphasizing the use of a pulse ox can be done in addition to pursed lip or diaphragmatic breathing.
  4. If or when you are left with two remaining answer choices, apply those answer choices to the stem of
    the question. Synthesizing this information requires you to comprehend the exam question. Decreasing
    symptoms of shortness of breath would require the client to breathe in or out during exertion?
  5. Choose the best answer by reducing the information presented to you in the question and the
    remaining answer choices.

Correct Answer:
Answer 2: Breathing out during exertion can decrease SOB and does not cause an increased strain on
the lungs or cardiovascular system.
In summation, taking practice exam questions is a great way for one to become familiar and comfortable
with the format of the NBCOT® Certification Exam, as well as help one identify areas they need to
become more familiar with to aid their success in passing
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