20 free NBCOT OTR practice questions

Correct answer: B · The Canadian Occupational Performance Measure (COPM)

The COPM is a semi-structured, client-centered interview in which the client identifies occupational performance problems in self-care, productivity, and leisure, rates how important each one is, and then rates performance and satisfaction for the top concerns on 1-to-10 scales. It turns a vague concern into prioritized, measurable goals, and re-rating later shows change. A visual perception test, manual muscle testing, and a cognitive screen all measure body functions. Each may be useful later, chosen according to what he identifies, but none tells the therapist which occupations matter most to him, which client-centered planning needs first.

Look for this next time: Use the COPM to identify and rate the occupations a client prioritizes before choosing tests of specific body functions.

Correct answer: D · Hot and cold temperature discrimination

Protective sensations, such as pain (sharp and dull) and temperature, warn a person of harm. Testing hot and cold discrimination, with vision occluded, directly addresses her burns and guides strategies such as using a thermometer, long oven mitts, and visual checks of the skin. Two-point discrimination and graphesthesia measure discriminative sensation, which supports fine manipulation and object recognition rather than warning of injury. Proprioception reflects joint position sense, which matters for coordination but would not explain why she does not notice hot surfaces. Demonstrating each test first on an area with better sensation helps her understand what to report.

Look for this next time: Pain and temperature are protective sensations; test them when a client injures skin without noticing.

Correct answer: A · A standardized, norm-referenced test of motor skills

A norm-referenced test compares a child's performance with a normative sample of same-age peers and reports standard scores or percentiles, which teams use to judge how far performance falls from typical development. That comparison is what an eligibility decision needs. A criterion-referenced checklist measures whether the child has mastered specific skills against a set standard, which is useful for goal writing and progress monitoring but does not show standing relative to peers. Informal observation and an occupational profile add valuable context about participation and priorities, but neither yields a peer-referenced score. The therapist also follows the state and district eligibility criteria that apply under IDEA.

Look for this next time: Use norm-referenced tests to compare a child with same-age peers; use criterion-referenced tools to measure mastery of specific skills.

Correct answer: C · Observing her complete a medication task in a performance-based assessment

A screening score shows that impairment is likely, but not how she performs a complex daily task. A performance-based assessment, in which the therapist observes her carry out a medication-management task, such as the medication task of the Executive Function Performance Test or a simulated pillbox setup, shows which steps break down and how much cueing she needs. That is the information a safety recommendation requires. Repeating the screen in 3 months delays an answer to a current safety question. Self-rated confidence is often inaccurate when insight is reduced. A drug-interaction review is valuable but belongs to the pharmacist and prescriber, and it does not measure her ability.

Look for this next time: To judge safety in a complex IADL, observe the client perform the task; screening scores alone cannot show how she functions.

Correct answer: A · Pause, explain each step, ask permission before touch, and offer her choices

Trauma-informed care, as SAMHSA described it in its 2014 concept and guidance document, rests on principles that include safety, trustworthiness and transparency, collaboration, and empowerment through voice and choice. Pausing, explaining what will happen, asking permission before touching, and letting her choose the pace or position (for example, showing her active range first) restore a sense of control, so the evaluation can continue meaningfully. Rushing ignores her distress and can deepen it. Stopping to request a psychiatric consult treats an expected trauma response as a crisis without first trying an adjustment. Bringing in a family member without asking her assumes her preference; any support person should be her choice.

Look for this next time: When a client shows trauma responses, slow down, explain, ask consent before touch, and offer choices to restore safety and control.

Correct answer: D · About 2 standard deviations below the mean, near the 2nd percentile

Distance from the mean in standard deviations = (score − mean) ÷ SD = (70 − 100) ÷ 15 = −30 ÷ 15 = −2. In a normal distribution, about 2.3% of scores fall below −2 SD, so a score of 70 is near the 2nd percentile, a level many tests and teams treat as a significant delay. A score of 85 would be 1 SD below the mean (about the 16th percentile), and 55 would be 3 SD below (about the 0.1st percentile). On most such tests the average range lies roughly within 1 SD of the mean (85 to 115), so being within 30 points does not make a score average. The therapist interprets the number together with observation and the child's daily performance.

Look for this next time: Convert a standard score to SD units with (score − mean) ÷ SD; −2 SD is about the 2nd percentile.

Correct answer: B · In 2 weeks, client will put on a pullover shirt with setup only, using one-handed methods

A well-written goal is client-centered, occupation-based, and measurable: it names who will do which occupation, at what level of assistance, under what conditions, and by when. Option B has each part and ties directly to his priority of dressing independently before his wife leaves. "Improve dressing skills" has no measurable level of performance or time frame. A strength goal targets a client factor rather than the occupation he identified, and stronger muscles do not guarantee that he can dress himself. A goal must describe the client's performance; "the therapist will teach" states the therapist's action, which belongs in the intervention plan, not in the goal.

Look for this next time: Write goals about the client's occupational performance, with a measurable level of assistance and a time frame.

Correct answer: C · Stay with her and notify the nursing staff and treatment team immediately

A specific plan with a method and a time signals high, imminent suicide risk, and her safety comes first. The therapist keeps her under observation, staying with her or making sure staff do, and immediately notifies the nurse and the treatment team so that the unit's suicide precautions, including a search for the stored pills, can begin. Waiting until the group ends or until the next team meeting delays protective action. Confidentiality has limits when a client discloses a risk of serious harm, so the therapist should tell her that others must be informed to keep her safe. Coping strategies belong in her later plan, not in place of immediate safety action.

Look for this next time: When a client discloses a suicide plan, stay with the client and notify the team at once; confidentiality does not cover imminent risk.

Correct answer: A · Shift to compensatory aids such as phone alarms, a pillbox, and a written routine

Monitoring the plan means comparing the client's response with his goals and changing the approach when it is not working. After 6 weeks of remediation with no measurable gain, and continued failures in daily life, the plan should shift to compensatory and adaptive strategies that let him perform despite the impairment: alarms, a pillbox, external memory aids, and structured routines, practiced in his real context. Continuing or intensifying an ineffective approach postpones help with the problems he faces now. Discharge ignores his goal and the likely benefit of compensation. The occupational therapist is responsible for deciding whether to continue, modify, or discontinue services, and reevaluation supports this change.

Look for this next time: When remediation produces no gains, shift to compensatory strategies that support the client's goal in real contexts.

Correct answer: D · Put the left arm into its sleeve first, then the right arm

In one-handed dressing, the affected arm goes into its sleeve first. She threads the left arm into its sleeve and pulls the sleeve up past the elbow onto the shoulder, then brings the shirt around her back and puts in the right arm. Starting with the right arm leaves the shirt twisted and makes it very hard to work the flaccid left arm into the remaining sleeve. Both arms cannot go in together when the left arm has no active movement; even the over-the-head method starts by threading the affected arm first. Dressing while standing removes the stable seated base she needs, and an arm with no active movement cannot help her balance.

Look for this next time: In one-handed shirt dressing, put the affected arm into its sleeve first.

Correct answer: C · Sit on a shower chair and at the sink, using pursed-lip breathing

Energy conservation and breathing control are core occupational therapy strategies for COPD. Sitting for showering and grooming lowers the energy cost of each task, and pursed-lip breathing (in through the nose, then a slow exhale through pursed lips, usually during the effortful part of the movement) slows breathing and helps prevent air trapping. Pacing with planned rests also helps. Holding his breath during arm elevation increases breathlessness and strain, and unsupported arm work is especially tiring with COPD. Rushing raises oxygen demand. Hot, steamy showers often worsen breathlessness; a moderate temperature and good ventilation, such as an exhaust fan, are usually recommended.

Look for this next time: For COPD, combine sitting for self-care, pacing, and pursed-lip breathing during effort to reduce breathlessness.

Correct answer: B · Carry bags over the forearm and press water out of cloths with flat palms

Joint protection for rheumatoid arthritis means using larger, stronger joints, spreading the load over a larger surface, and avoiding positions of deformity, such as tight grip and ulnar-directed forces at the MCP joints. Carrying bags over the forearm instead of hooking them on the fingers, and pressing cloths flat instead of wringing them, apply these principles. A tight fist grip and wringing both stress the MCP joints and the soft tissues that are already allowing ulnar drift, and twisting toward the little finger adds the very ulnar force she should avoid. Complete rest leads to stiffness and deconditioning; the aim is to balance activity and rest, not to stop daily tasks.

Look for this next time: Protect RA joints by using larger joints, spreading the load, and avoiding tight grip and ulnar-directed forces at the MCP joints.

Correct answer: A · Wrist extended, MCPs flexed about 70°–90°, IPs extended, thumb abducted

Dorsal hand burns tend to pull the hand into a claw position: MCP hyperextension, IP flexion, and thumb adduction. The anti-deformity (intrinsic-plus, or safe) position counters that pull and keeps the collateral ligaments at length: the wrist in slight extension (about 20°), the MCP joints flexed about 70° to 90°, the IP joints fully extended, and the thumb abducted to preserve the first web space. The other options reproduce parts of the deformity: MCP extension with IP flexion is the claw pattern, and thumb adduction lets the web space contract. A tight fist holds the IP joints in flexion and stretches fragile dorsal tissue and the extensor mechanism. Positioning is combined with active motion as healing allows.

Look for this next time: Position dorsal hand burns in the intrinsic-plus position: wrist extended, MCPs flexed, IPs extended, thumb abducted.

Correct answer: D · Stabilizing the pelvis with the right seat depth and a pelvic belt

Seating assessment starts at the pelvis, because pelvic position drives the posture of the trunk, head, and limbs above it. Forward sliding with a posterior pelvic tilt often comes from a seat that is too deep, which keeps her from sitting back and upright. A firm seat of the right depth and a pelvic positioning belt, angled to suit her (WHO wheelchair training materials describe 45° to 90° to the seat), help hold the pelvis back and upright. Lateral supports and a chest strap treat the trunk before its base is stable. A reclined backrest opens the seat-to-back angle, which can increase the slide.

Look for this next time: In seating, position and stabilize the pelvis first; trunk and limb supports depend on a stable base.

Correct answer: B · Serve light-colored foods on a dark plate, with a contrasting placemat

Central vision loss from macular degeneration reduces acuity and contrast sensitivity, so increasing contrast is a first-line strategy. A dark plate under light foods, and a placemat that contrasts with both the plate and the table, make the food and the plate edge easier to see. Bright, even lighting without glare also helps, so dimming the room takes away light she depends on. White on white removes the contrast she needs. A handheld magnifier enlarges a small area but is impractical while eating and does not help her find the plate edge; magnifiers suit tasks such as reading labels and mail.

Look for this next time: For low vision, increase contrast and use even, glare-free lighting before relying on magnification for tasks like eating.

Correct answer: C · 24 feet

The 2010 ADA Standards (section 405.2) limit a ramp's running slope to 1:12, at most 1 inch of rise for every 12 inches of run. Run = rise × 12 = 24 in × 12 = 288 in, and 288 ÷ 12 = 24 feet. The standards also cap the rise of a single run at 30 inches (section 405.6), so this 24-inch rise can be one run, with level landings at the top and bottom. A 12-foot run would make a 1:6 slope and a 16-foot run about 1:8, both too steep. A 36-foot run gives a gentler 1:18 slope, which is acceptable but longer than the minimum. Private homes are generally not bound by the ADA, but therapists often use its standards as a guide.

Look for this next time: At the ADA maximum slope of 1:12, each inch of rise needs 12 inches of ramp: run = rise × 12.

Correct answer: A · A 68-year-old with hand osteoarthritis, morning stiffness, intact skin and sensation

Paraffin is a superficial thermal agent that increases tissue extensibility and eases stiffness before range of motion, which suits chronic arthritis with intact skin and normal sensation. An open wound is a contraindication because of the risk of infection and contamination of the wax. Impaired temperature sensation is a contraindication, or at least a serious precaution, because the client cannot report excessive heat and may be burned. Heat on acutely inflamed, hot, swollen joints can increase inflammation and edema; during an acute flare, rest or cold is preferred, and heat is kept for subacute or chronic stiffness. The therapist checks the wax temperature and inspects the skin before and after treatment.

Look for this next time: Use paraffin for chronic stiffness with intact skin and sensation; avoid it over open wounds, insensate skin, or acutely inflamed joints.

Correct answer: D · Administering a delegated standardized assessment and reporting the results

AOTA's Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services (2020) state that the occupational therapist directs the evaluation, determines the need for service, interprets the data, and develops the intervention plan. The OTA contributes by carrying out delegated assessments and reporting the results and observations to the occupational therapist, who interprets them and integrates them into decisions. The occupational therapist is also responsible for deciding whether to continue, modify, or discontinue services, with information from the OTA. State practice acts and payer rules can add requirements, such as how often supervision must occur, so the OTR checks those as well.

Look for this next time: The OTR directs the evaluation, interprets results, and sets the plan; an OTA may carry out delegated assessments and report findings.

Correct answer: C · Cushion the head, clear objects, and call 911 if it lasts over 5 minutes

CDC first aid for a seizure is to stay with the person, time it, remove anything nearby that could cause injury, put something soft and flat under the head, loosen anything around the neck, and turn the person gently onto one side to keep the airway clear. CDC advises calling 911 if the seizure lasts longer than 5 minutes, if another seizure follows soon after, if the person has trouble breathing or waking, or if the person is injured. CDC also says not to hold the person down or stop the movements, which can cause injury, and not to put anything in the mouth. Water or food should wait until the person is fully alert.

Look for this next time: During a seizure, protect the person, time it, and call 911 if it lasts over 5 minutes; never restrain or put anything in the mouth.

Correct answer: B · A systematic review with meta-analysis of randomized controlled trials

For questions about whether an intervention works, a systematic review of randomized controlled trials, with or without meta-analysis, sits at the top of common evidence hierarchies, such as the Oxford Centre for Evidence-Based Medicine 2011 levels (level 1 for treatment benefits), because it pools trials that use random allocation to limit bias. A single case report cannot separate the program's effect from chance or other changes. A cross-sectional survey of therapists' opinions measures beliefs and practice patterns, not effectiveness. Expert opinion ranks at the bottom of traditional hierarchies (level 5 in the 2009 Oxford levels), however respected the author. After finding a review, the therapist still appraises its quality and how well its participants and programs match the department's clients.

Look for this next time: For intervention effectiveness, look first for a systematic review of randomized controlled trials, then appraise its quality and fit.