NBCOT Certified Occupational Therapy Assistant (COTA) Quiz: Intervention Monitoring
20 questions · exam conditions
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Intervention MonitoringQuestion 1 of 20

A client is attending an outpatient clinic for carpal tunnel syndrome. After a session involving therapeutic putty exercises, the client calls the clinic and reports to the COTA that they experienced a significant increase in numbness and tingling in their hand that evening.

What is the COTA's BEST course of action in this situation?

Advise the client to apply ice to the hand and continue with the home exercise program as tolerated.
Document the client's report in the chart and immediately inform the supervising OTR of this adverse reaction.
Instruct the client to discontinue all home exercises until their next scheduled appointment with the OTR.
Reassure the client that this is a normal response to strengthening and to expect some soreness.
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NBCOT Certified Occupational Therapy Assistant (COTA) Quiz

NBCOT Certified Occupational Therapy Assistant (COTA) Quiz: Intervention Monitoring

Practice Intervention Monitoring in NBCOT Certified Occupational Therapy Assistant (COTA) with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

What this quiz covers

This quiz focuses on Intervention Monitoring, giving you a quick way to practice the rules, question types, and explanations that matter most for NBCOT Certified Occupational Therapy Assistant (COTA).

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

All questions

Question 1

A client is attending an outpatient clinic for carpal tunnel syndrome. After a session involving therapeutic putty exercises, the client calls the clinic and reports to the COTA that they experienced a significant increase in numbness and tingling in their hand that evening.

What is the COTA's BEST course of action in this situation?

  1. Advise the client to apply ice to the hand and continue with the home exercise program as tolerated.
  2. Document the client's report in the chart and immediately inform the supervising OTR of this adverse reaction. (correct answer)
  3. Instruct the client to discontinue all home exercises until their next scheduled appointment with the OTR.
  4. Reassure the client that this is a normal response to strengthening and to expect some soreness.
Explanation: An increase in symptoms like numbness and tingling is an adverse reaction and a potential contraindication. The COTA's responsibility is to document the event accurately and report it to the OTR immediately. The OTR must then use this information to make a clinical decision about continuing or modifying the intervention plan. A: Providing medical advice like applying ice is acceptable, but telling them to continue exercises that caused an adverse reaction is inappropriate without OTR consultation. C: While stopping exercises might be the eventual outcome, the COTA should not independently modify the home exercise program. This decision should be made by the OTR. D: Dismissing a significant increase in neurological symptoms as normal is unsafe and fails to address a potential worsening of the condition.

Question 2

A client in a work-hardening program is performing a simulated work task of lifting 20-pound boxes from the floor to a waist-high shelf. After one repetition, the client winces, stops the activity, and reports a sharp pain in their lower back.

After ensuring the client is safely seated and not in acute distress, what is the COTA's appropriate next step?

  1. Apply a cold pack to the client's lower back to manage the immediate pain and inflammation.
  2. Instruct the client to try the same lift but with a 10-pound box to see if the pain persists.
  3. Document the incident and report the client's subjective pain report and the event to the OTR. (correct answer)
  4. Advise the client to rest for the remainder of the session and to take an over-the-counter pain reliever at home.
Explanation: The client's report of sharp pain is a significant event that may indicate an injury. The COTA's primary role after ensuring immediate safety is to document what happened and communicate this information to the OTR. The OTR must be aware of the incident to assess the client, modify the plan, and determine the appropriate course of action. A: Applying a physical agent modality like a cold pack without an OTR's assessment and plan is inappropriate. B: Asking the client to repeat an activity that caused sharp pain, even with less weight, is unsafe without a full assessment by the OTR. D: Giving advice about medication, even over-the-counter, is outside the scope of OT practice.

Question 3

A client in an inpatient psychiatric facility has a goal to improve coping skills. The intervention plan, created by the OTR, lists mindfulness exercises and journaling. During a session, the client becomes distressed while journaling and states that it brings up too many traumatic memories. This response has occurred twice.

What is the COTA's most appropriate action?

  1. Insist the client continue journaling, explaining it is a necessary part of processing trauma.
  2. Independently replace journaling with a different activity, such as art therapy, for all future sessions.
  3. Document the client's response and collaborate with the OTR to discuss the suitability of this intervention. (correct answer)
  4. Suggest the client journal about positive topics only, to avoid distressing memories.
Explanation: When an intervention causes consistent distress, it is a significant finding. The COTA must monitor and report this adverse psychological response. Collaborating with the OTR is essential to determine if the activity should be modified, graded differently, or replaced. This ensures client safety and therapeutic effectiveness. A: Forcing a client to engage in a distressing activity is not therapeutic and can be harmful. B: Independently replacing a core intervention from the plan is outside the COTA's scope of practice. D: While a valid suggestion, making this modification without first consulting the OTR is an overstep. The primary action is to report the consistent adverse effect.

Question 4

In an early intervention session, a COTA is implementing a feeding plan for a toddler. The plan focuses on self-feeding with a spoon. The COTA observes that after most swallows, the toddler has a wet, gurgly vocal quality and engages in a slight cough. These behaviors were not documented in the OTR's initial evaluation.

What is the COTA's primary responsibility in this situation?

  1. Continue the feeding session but offer smaller bites to see if that resolves the issue.
  2. Reposition the toddler into a more upright posture and continue with the feeding plan.
  3. Document the observation and plan to discuss it with the OTR at their next weekly supervision meeting.
  4. Immediately stop the feeding activity and report these signs of possible aspiration to the OTR. (correct answer)
Explanation: A wet, gurgly voice and coughing during or after swallowing are cardinal signs of potential aspiration, which is a serious medical safety concern. The COTA must immediately stop the activity that is causing the risk (feeding) and report these observations to the OTR without delay. This is a safety issue that cannot wait for a scheduled meeting. A: Continuing to feed, even with smaller bites, poses an unacceptable risk of aspiration. B: While repositioning is important for safe feeding, it does not override the need to stop when clear signs of aspiration risk are present. D: Delaying the report of a significant safety concern like this is inappropriate.

Question 5

A client is recovering from a severe burn on their forearm and is wearing a compression garment to manage scarring. During a session focused on AROM, the COTA removes the garment and notices a small, open area of skin breakdown under the garment's edge that was not present before.

What is the COTA's most critical initial action?

  1. Document the finding and immediately notify the OTR and the client's nurse about the skin integrity issue. (correct answer)
  2. Apply a sterile dressing to the area and continue with the planned ROM exercises.
  3. Instruct the client to leave the compression garment off for 24 hours to allow the area to heal.
  4. Attempt to adjust the fit of the compression garment to relieve pressure on the affected area.
Explanation: Skin breakdown is a serious complication that requires immediate attention and can be a contraindication for certain interventions. The COTA's primary responsibility is client safety, which involves immediately reporting this change in skin integrity to the supervising OTR and the nursing staff. This allows for proper wound care and a re-evaluation of the compression garment's fit and wear schedule. A: Applying a dressing may be appropriate, but continuing with exercises without reporting the issue to the OTR/nurse is unsafe. C: Advising on wear schedule is a modification to the plan that should come from the OTR or physician. D: Adjusting the garment should only be done after consultation and assessment by the OTR or specialist who fitted it.

Question 6

A COTA is working with a client on a work conditioning program. The plan states to discontinue an activity if the client's self-reported pain exceeds 5/10. During a lifting task, the client states their pain is "only a 3 out of 10." However, the COTA observes the client is guarding the affected area, breathing heavily, and grimacing with each lift.

What is the COTA's most appropriate action?

  1. Stop the activity and inform the OTR about the inconsistency between the client's pain report and observed pain behaviors. (correct answer)
  2. Continue with the activity as planned, since the client's reported pain is below the threshold.
  3. Tell the client that their body language indicates a higher pain level and they should report pain more accurately.
  4. Reduce the weight by half and continue with the activity, documenting the modification in the daily note.
Explanation: When you encounter questions about pain management in work conditioning programs, you need to consider both subjective pain reports and objective behavioral observations. The principle of "do no harm" requires COTAs to prioritize client safety over protocol adherence when inconsistencies arise. In this scenario, there's a clear disconnect between what the client reports (3/10 pain) and what you observe (guarding, heavy breathing, grimacing). These behavioral signs typically indicate significant pain or distress, regardless of the numerical report. Clients may underreport pain for various reasons: fear of being removed from the program, desire to please the therapist, or misunderstanding of the pain scale. Option A is correct because it prioritizes safety and follows proper supervisory channels. When objective signs contradict subjective reports, stopping the activity prevents potential injury and consulting the OTR ensures appropriate clinical decision-making within the scope of practice. Option B is dangerous because it ignores clear pain behaviors and could lead to injury or re-injury. Option C is inappropriate because it challenges the client's self-report in a confrontational way and exceeds the COTA's scope in pain assessment interpretation. Option D makes an arbitrary modification without proper supervision and doesn't address the underlying assessment concern. Remember this key principle: When pain behaviors don't match pain reports in work conditioning, always err on the side of caution and involve your supervising OTR. Your role as a COTA includes keen observation and appropriate escalation, not independent clinical judgment about continuing potentially harmful activities.

Question 7

A COTA is implementing an intervention plan for a client with carpal tunnel syndrome. A short-term goal is to increase lateral pinch strength to 7 lbs to allow for key use. The COTA measures the client's pinch strength at the beginning of sessions on Monday, Wednesday, and Friday. The readings are 5.0 lbs, 5.5 lbs, and 5.2 lbs, respectively.

How should the COTA report these findings when collaborating with the OTR?

  1. Inform the OTR that the intervention is not working and the client has made no progress.
  2. Report the objective measurements and discuss the client's performance trend with the OTR. (correct answer)
  3. Change the intervention to using a firmer grade of therapeutic putty to increase the challenge.
  4. Conclude that the pinch gauge is providing inconsistent results and should not be used.
Explanation: The COTA's role is to gather and report objective data on client performance. Reporting the specific measurements allows the COTA and OTR to collaboratively analyze the trend (which shows some fluctuation but no clear progression). This data-driven discussion is essential for the OTR to make informed decisions about modifying the intervention plan. Making a conclusive judgment (A, D) or independently changing the intervention (C) is outside the COTA's scope.

Question 8

A COTA is working with a client in a skilled nursing facility who is recovering from a total hip replacement. The client has a goal to complete a toilet transfer with a raised toilet seat using a walker with minimal assistance. After only one week, the client is consistently performing the transfer at a supervision level.

What is the COTA's primary responsibility based on these observations?

  1. Independently write a new goal for the client that involves transfers without a raised toilet seat.
  2. Continue working on the same goal until the OTR's next scheduled weekly progress note is due.
  3. Report the client's rapid progress and consistent performance to the OTR for potential goal modification. (correct answer)
  4. Discharge this goal from the treatment plan since the client has exceeded the initial expectations.
Explanation: When a client meets or exceeds goals ahead of schedule, the COTA must communicate this progress to the OTR. This allows the OTR to re-evaluate the plan of care and, if appropriate, upgrade the goals to ensure the client continues to be challenged and therapy remains skilled and necessary. This is a core part of monitoring and collaboration. A: Writing new goals is the responsibility of the OTR. B: Continuing to work on a goal that has essentially been met may not be considered skilled intervention and does not reflect the client's progress. D: Discharging a client from a goal is part of modifying the plan of care and must be done by the OTR.

Question 9

An intervention plan for a client with a TBI specifies the use of a picture sequence board (visual cues) for a multi-step cooking task. The COTA observes that the client repeatedly ignores the board but successfully completes steps when given short, one-step verbal cues.

What is the MOST effective way for the COTA to use this observation to contribute to the intervention process?

  1. Continue to use only the visual cues as specified in the plan to promote compliance with the established method.
  2. Independently change the primary intervention strategy to rely solely on verbal cueing from now on.
  3. Conclude that the client is being non-compliant and document their lack of engagement with the visual aids.
  4. Discuss the observation with the OTR, suggesting that the client may respond better to a different cueing strategy. (correct answer)
Explanation: The COTA's role is to monitor which strategies are effective and which are not. Observing that the client responds to one type of cueing over another is valuable clinical information. The COTA should share this data with the OTR, which allows for a collaborative decision about modifying the intervention approach to be more client-centered and effective. A: Forcing an ineffective strategy is counterproductive and not client-centered. B: Independently changing the core strategy of an intervention plan is outside the COTA's scope of practice. C: Labeling the client as non-compliant is judgmental and fails to recognize that the planned approach may be a poor fit for the client's current abilities.

Question 10

A COTA is teaching a client with COPD energy conservation techniques for meal preparation. The client consistently states, "This feels unnatural and takes twice as long. I won't do this at home." The COTA has re-explained the rationale in two separate sessions, but the client's feedback remains the same.

Which action best reflects a client-centered approach to monitoring this intervention?

  1. Continue to drill the prescribed techniques, as they are evidence-based and will become more natural with practice.
  2. Document the client's feedback and collaborate with the OTR to explore alternative strategies that align with the client's preferences. (correct answer)
  3. Independently introduce new techniques for meal preparation that are not included in the original intervention plan.
  4. Document the client's statements as a sign of poor motivation and lack of insight into their condition.
Explanation: Client-centered care requires listening to and respecting the client's feedback. If an intervention is not a good fit for the client, it is unlikely to be adopted. The COTA's role is to monitor this feedback, document it as a barrier, and discuss it with the OTR. This collaboration can lead to modifying the plan to find strategies the client is more likely to use. A: Insisting on a technique the client rejects is not client-centered. C: Introducing new techniques without consulting the OTR is a modification of the plan and outside the COTA's scope. D: Labeling the client as having 'poor motivation' is subjective and fails to address the actual problem, which is a mismatch between the intervention and the client's values or preferences.

Question 11

A pediatric client's intervention plan includes a goal to "improve independence in dressing." During sessions, the COTA observes and documents that the client has successfully mastered buttoning large buttons but consistently requires moderate assistance for snapping and zippering.

What is the MOST effective way for the COTA to contribute to the ongoing intervention plan?

  1. Continue practicing only large buttons to build the client's confidence and sense of mastery.
  2. Provide the OTR with specific data on performance with different fasteners to inform goal revision. (correct answer)
  3. Independently add new, specific goals for snapping and zippering to the official plan of care.
  4. Stop all work on dressing fasteners as the client has demonstrated partial mastery of the overall goal.
Explanation: The COTA's detailed observations and data collection are vital for monitoring progress. By providing the OTR with specific information about which fasteners are mastered and which are still difficult, the COTA gives the OTR the necessary clinical information to grade the intervention and update the goals to be more specific and appropriate for the child's current skill level. A: Focusing only on a mastered skill does not promote further progress. C: Adding goals to the plan of care is the responsibility of the OTR. D: Stopping an intervention because of partial success is premature and does not address the client's remaining deficits within the goal area.

Question 12

A COTA is working with a client with low vision. The intervention plan calls for the use of a stand magnifier to read a newspaper. The COTA observes that although the client can see the words, they lose their place on the page frequently and complain of eye strain after only a few minutes.

Which action by the COTA best fulfills their role in monitoring the intervention?

  1. Tell the client to take more frequent breaks to manage the eye strain.
  2. Issue the client a bar magnifier from the clinic's supply closet to try instead.
  3. Report the observations about tracking and eye strain to the OTR for a potential re-evaluation of the device. (correct answer)
  4. Conclude that the client is not a good candidate for low vision aids and focus on other goals.
Explanation: The COTA's role is to monitor the effectiveness and potential drawbacks of the prescribed adaptive equipment. The observations of difficulty with tracking and eye strain are crucial pieces of data. Reporting this to the OTR is necessary so the OTR can reassess the client's needs and determine if a different type of magnifier, lighting, or strategy is warranted. A: While taking breaks is a good compensatory strategy, it doesn't address the root problem that the current device may not be the best fit. B: Issuing new equipment without the OTR's assessment and recommendation is outside the COTA's scope. D: Making a broad conclusion about the client's candidacy for all low vision aids is premature and should be a determination made by the OTR after further assessment.

Question 13

A COTA is delegated the task of fabricating a resting hand splint for a client with rheumatoid arthritis, using a pattern provided by the OTR. During the molding process, the COTA notices that due to recent swelling, the client's wrist cannot achieve the neutral position specified in the plan without causing significant pain.

What is the most appropriate action for the COTA to take?

  1. Stop the fabrication process and consult with the OTR about the client's pain and limited range of motion. (correct answer)
  2. Mold the splint in the client's most comfortable position, even if it deviates from the plan.
  3. Continue to gently push the wrist into the neutral position as specified by the OTR's instructions.
  4. Complete the splint and add extra padding over the areas the client reported as painful.
Explanation: When implementing a plan, the COTA must monitor for unexpected problems. If the client cannot tolerate the specified position for the orthosis due to pain or a change in their condition (increased swelling), the COTA must stop and consult the OTR. The OTR needs this information to re-evaluate the client's needs and modify the orthosis plan accordingly. Proceeding would be unsafe and result in a non-therapeutic device. A: Fabricating the splint in the wrong position could be detrimental and is a modification of the plan that requires OTR input. C: Forcing a painful position could cause injury. D: Padding a poorly fitting splint does not address the underlying issue of incorrect positioning.

Question 14

An intervention plan for a client with chronic pain focuses on activity pacing and the use of adaptive equipment for household chores. The COTA documents that for three consecutive sessions, the client has not brought their activity log and states they "forgot" to use the new long-handled dustpan.

What is the COTA's best response to this consistent pattern?

  1. Document the non-adherence and discuss the potential barriers with the OTR to problem-solve. (correct answer)
  2. Independently devise a reward system to improve the client's adherence to the home program.
  3. Discharge the client from therapy due to a documented lack of participation and progress.
  4. Re-educate the client on the importance of the activity log and equipment during each session.
Explanation: Consistent non-adherence is a critical finding that needs to be addressed. The COTA's role is to monitor and report this pattern. Discussing the issue with the OTR allows for a collaborative effort to understand the barriers (e.g., the strategies are not a good fit, the client doesn't understand, there are psychosocial factors) and modify the plan appropriately. It moves beyond simple re-education to problem-solving. A: Independently implementing a new behavioral program is a change in the intervention plan and requires OTR collaboration. C: The decision to discharge is the responsibility of the OTR. D: While re-education might be part of the solution, after three sessions of the same issue, it's clear a different approach is needed, which requires consultation with the OTR.

Question 15

A COTA is working with a client who has dementia on a familiar task of folding laundry. The intervention plan notes that the client can complete the task with verbal cues. Today, the COTA observes the client attempting to fold a pillowcase but repeatedly making the same error, a behavior known as perseveration, which has not been previously observed.

What is the MOST appropriate action for the COTA to take in response to this new observation?

  1. Document the new perseverative behavior and discuss this change in cognitive function with the OTR. (correct answer)
  2. Conclude that the client is having a bad day and redirect them to a different, preferred activity.
  3. Physically guide the client's hands through the correct folding motion to complete the task.
  4. Increase the frequency and volume of verbal cues to try and override the perseverative behavior.
Explanation: The appearance of a new cognitive symptom like perseveration is a significant change in the client's status. The COTA's role is to accurately observe, monitor, and report such changes. Documenting the specific behavior and communicating it to the OTR is crucial for the OTR to assess whether this indicates a progression of the dementia or another underlying issue, which may require a change in the intervention plan or approach. A: Physical guidance may help in the moment but doesn't address the significance of the new symptom. B: While redirecting might be a good in-the-moment strategy, the primary action is to report the change; simply dismissing it as a 'bad day' ignores important clinical data. D: Increasing verbal cues is unlikely to be effective for perseveration and may increase agitation.

Question 16

A COTA is working with a client on improving activity tolerance following a cardiac event. The OTR has set a parameter in the intervention plan to maintain a heart rate below 120 bpm during activity. While the client is ambulating, the COTA notes the client's heart rate has reached 125 bpm, but the client denies any shortness of breath or fatigue.

What is the COTA's most appropriate response?

  1. Encourage the client to slow their pace but continue walking, as they feel fine.
  2. Immediately stop the activity, have the client rest, and report the physiological response to the OTR. (correct answer)
  3. Note the heart rate in the chart but allow the client to finish the activity since they are asymptomatic.
  4. Ask the client to take deep breaths while continuing to walk to try and lower their heart rate.
Explanation: The OTR established specific physiological parameters for safety. When these parameters are exceeded, the activity must be stopped, regardless of the client's subjective report. The COTA's responsibility is to adhere to these safety precautions, ensure the client rests, and report the event to the OTR. The OTR may need to adjust the plan's intensity or duration based on this response. A: Continuing the activity, even at a slower pace, violates the established safety parameters. C: Simply documenting the event without stopping the activity ignores a critical safety guideline. D: Attempting to manage the physiological response while continuing the activity is risky; the correct action is to stop the activity that caused the response.

Question 17

In a school setting, a COTA is working with a child with autism spectrum disorder (ASD) on social participation in a small group, as per the OTR's plan. The COTA observes that during the last three group sessions, the child has consistently withdrawn, covered their ears, and retreated to a corner of the room.

Which action BEST demonstrates the COTA's role in monitoring the intervention plan?

  1. Implementing a new sensory diet protocol that the COTA believes will help the child tolerate the group.
  2. Informing the teacher that the small group setting is inappropriate and should be discontinued immediately.
  3. Continuing the intervention as planned, assuming this is a temporary behavioral response to a new setting.
  4. Documenting the specific behaviors and discussing with the OTR that the context may be a barrier to participation. (correct answer)
Explanation: The COTA's primary role is to monitor the client's response to the intervention and report findings to the OTR. Documenting the consistent pattern of withdrawal and discussing the context (the small group) as a potential barrier provides the OTR with the necessary information to re-evaluate and modify the plan. This is a collaborative process. A: Implementing a new sensory diet is a modification to the intervention plan and requires consultation with the OTR; it is outside the COTA's scope to do this independently. B: Making a unilateral decision to discontinue the intervention and directing the teacher is inappropriate and oversteps the COTA's role. C: Ignoring a consistent negative response over multiple sessions is a failure to properly monitor the client's response to the intervention.

Question 18

A COTA is leading a coping skills group on an inpatient mental health unit. The plan for the session involves a worksheet on identifying cognitive distortions. A client who has been making good progress suddenly becomes agitated, tears up the worksheet, and yells, "This is stupid!" This is a significant change from their typical behavior in the group.

After de-escalating the immediate situation, what is the COTA's most professional action?

  1. Require the client to apologize to the group before they can continue to participate.
  2. Privately discuss the outburst with other group members to get their perspective.
  3. Independently decide to exclude the client from this specific group for the next week.
  4. Document the behavior and report the specific trigger and response to the OTR and the client's treatment team. (correct answer)
Explanation: The COTA's role includes monitoring for significant behavioral changes. This outburst is a key piece of clinical information. The COTA must document the event, including the antecedent (the worksheet), and communicate this to the OTR and the broader treatment team (e.g., psychiatrist, social worker). This information is vital for understanding the client's current mental state and adjusting the overall treatment plan. A: Forcing an apology may be punitive and is not the primary therapeutic response. B: Discussing one client's behavior with other clients is a breach of confidentiality and unprofessional. D: Making decisions about a client's participation in programming should be a team decision, not made unilaterally by the COTA.

Question 19

During a home health visit, a COTA works with an 80-year-old client with moderate dementia on a grooming routine. The COTA notes a sudden and significant decline in the client's ability to sequence the task, coupled with increased confusion and lethargy not present during last week's visit.

Given this sudden change, what is the COTA's MOST important initial action?

  1. Simplify the grooming task significantly by breaking it down into one-step components for the client.
  2. Immediately report the acute change in cognitive and functional status to the supervising OTR. (correct answer)
  3. Ask the client's family caregiver if they have noticed any changes over the past week.
  4. Document the observation in the daily note and plan to re-evaluate the client's status at the next visit.
Explanation: A sudden decline in cognitive and functional status in an older adult can be a sign of an acute medical condition, such as a urinary tract infection (UTI) or dehydration. This requires prompt medical attention. The COTA's primary responsibility is to report this significant change to the OTR immediately, who can then coordinate with the client's physician or nursing staff. A: While simplifying the task is a valid treatment strategy, it does not address the potential underlying medical cause for the sudden decline. C: Asking the family is a good way to gather more information, but it should not delay reporting the change to the supervisor. D: Waiting until the next visit to re-evaluate could delay diagnosis and treatment of a serious medical issue.

Question 20

A COTA is working with a high school student with a learning disability on using a digital calendar to track assignments. The student successfully uses the calendar for two weeks, but then tells the COTA that their smartphone broke and they can no longer access the app.

How should the COTA best respond to this environmental barrier?

  1. Tell the student to get their phone fixed before the next therapy session can proceed.
  2. Report the barrier to the OTR and collaborate on identifying an alternative, low-tech system. (correct answer)
  3. Independently issue the student a paper-based planner and begin instruction on its use.
  4. Discontinue the goal for assignment tracking since the planned technology is no longer available.
Explanation: A significant change in the context (loss of the required technology) directly impacts the intervention plan. The COTA should report this barrier to the OTR. This allows the OTR and COTA to collaborate on modifying the plan, which might involve selecting and implementing an alternative system. This is a key part of monitoring the plan and its context. A: This response is not helpful or therapeutic and ignores the problem. C: While a paper planner is a logical alternative, independently changing the primary tool/strategy of the intervention plan should be done in consultation with the OTR. D: Discontinuing a goal due to a barrier is a significant plan modification that must be made by the OTR.