A 52-year-old office manager with rheumatoid arthritis is referred to outpatient OT after a flare. She says she is "falling behind at everything" but cannot say where to start. Which assessment BEST identifies the occupational problems she considers most important and how satisfied she is with her performance?

Canadian Occupational Performance Measure

Functional Independence Measure ratings

Health Assessment Questionnaire disability index

Jebsen-Taylor Hand Function Test subtests

A 7-year-old is referred for slow, poorly formed handwriting. On the Beery VMI he earns a standard score of 78 (mean 100, standard deviation 15). His teacher asks what the score means for planning. Which interpretation is MOST accurate?

His score is about 1.5 standard deviations below the mean, lower than most peers

His visual-motor integration is within the average range, because the score is still above 70

His visual-motor skills are equal to those of a typical child aged 78 months on this test

He answered about 78 percent of the test items correctly, which is slightly below grade level

A 52-year-old woman with rheumatoid arthritis attends outpatient therapy during an acute flare. Her MCP and wrist joints are warm, red and swollen, and she reports pain of 7/10 with any motion. She wants to resume making breakfast. Which preparatory method is MOST appropriate before activity practice?

Cold packs to the inflamed joints, then gentle pain-free active motion

Moist hot packs to the wrists, then sustained passive stretching of the joints

Paraffin wax dips to both hands, then light resistive putty exercise

Continuous ultrasound over the MCP joints, then grip strengthening

A 35-year-old man in a burn unit has full-thickness burns to the anterior neck and both axillae. The OT is establishing a positioning program to prevent contractures. Which position BEST meets this goal?

Neck slightly extended without a pillow and shoulders abducted near 90 degrees

Neck in neutral on one pillow with the shoulders adducted across the chest

Neck rotated to one side with both shoulders internally rotated on pillows

Neck flexed on two pillows with both arms resting at the sides for comfort

The team has referred a first grader who struggles with scissors and clothing fasteners for an initial special education evaluation. The teacher asks the school-based OT to give a standardized fine motor test this week. What must happen before the OT tests the student?

The district obtains the parents' informed written consent for the evaluation

The teacher documents classroom concerns for at least one full semester

The principal signs an approval for the testing on behalf of the family

The OT completes the testing and then informs the parents at the IEP meeting

After a BOT-2 evaluation, a parent reads that her 8-year-old son's fine motor composite is at the 25th percentile. She asks, 'So he only got a quarter of the items right?' Which explanation is MOST accurate?

He scored as well as or better than about 25 percent of same-age children in the norm group

He performed like a child whose age is about 25 percent younger than his actual age

He answered about 25 percent of the test items correctly, which is well below his age level

He scored lower than about 25 percent of same-age children, in the bottom quarter only

A 44-year-old with relapsing-remitting multiple sclerosis attends outpatient therapy for hand stiffness and reduced dexterity that interfere with buttoning work shirts. She reports that her symptoms worsen after hot showers and on warm afternoons. Which preparatory method is MOST appropriate before fine motor practice?

Gentle active hand range of motion in a cool room

Warm whirlpool immersion of both hands and wrists

A moist hot pack applied to both forearms and hands

Fluidotherapy to both hands at a comfortably warm setting

A 34-year-old in a residential substance use program reports that weekends, when he used to drink with coworkers, feel empty and are when cravings are strongest. Which group intervention BEST supports relapse prevention?

Planning substance-free weekend leisure and naming risky situations

Discussing in detail the events that led up to his most recent relapse

Practicing relaxation alone so he can rest through the weekend

Reviewing how alcohol damages the liver and the nervous system

A school-based OT realizes that a progress note she signed in the district's electronic record yesterday lists the wrong number of sessions attended by a fourth grader. The note has already been shared with the IEP team. What should the OT do?

Add a dated correction that identifies the error and keeps the original visible

Delete the original note and replace it with a corrected version dated yesterday

Ask the district clerk to overwrite the number so the record looks consistent

Leave the note unchanged, since signed notes cannot be corrected afterward

NBCOT OTR Occupational Therapist Registered Exam

Free NBCOT OTR Occupational Practice Questions

10 sample questions for the NBCOT OTR Occupational Therapist Registered Exam, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Evaluation and Assessment, Analysis, Interpretation, and Planning, Select and Manage Interventions.

Question 1 · Evaluation and Assessment
A 52-year-old office manager with rheumatoid arthritis is referred to outpatient OT after a flare. She says she is "falling behind at everything" but cannot say where to start. Which assessment BEST identifies the occupational problems she considers most important and how satisfied she is with her performance?
- A.Functional Independence Measure ratings
- B.Health Assessment Questionnaire disability index
- C.Jebsen-Taylor Hand Function Test subtests
- D.Canadian Occupational Performance Measure
Show answer and explanation
Answer: D. Canadian Occupational Performance Measure
The COPM is a client-centered, semistructured interview in which the client identifies her own occupational performance problems and rates their importance, her performance and her satisfaction. The Health Assessment Questionnaire is tempting because it is used in arthritis, but it rates difficulty with a fixed list of activities rather than the client's own priorities and satisfaction.
Question 2 · Analysis, Interpretation, and Planning
A 7-year-old is referred for slow, poorly formed handwriting. On the Beery VMI he earns a standard score of 78 (mean 100, standard deviation 15). His teacher asks what the score means for planning. Which interpretation is MOST accurate?
- A.His visual-motor integration is within the average range, because the score is still above 70
- B.His visual-motor skills are equal to those of a typical child aged 78 months on this test
- C.He answered about 78 percent of the test items correctly, which is slightly below grade level
- D.His score is about 1.5 standard deviations below the mean, lower than most peers
Show answer and explanation
Answer: D. His score is about 1.5 standard deviations below the mean, lower than most peers
A standard score of 78 is 22 points, or roughly 1.5 standard deviations, below the mean of 100, placing him below most same-age children in the norm group. Standard scores are not percent-correct values and are not age equivalents. The average range is usually described as within one standard deviation of the mean (85 to 115), so 78 is not average.
Question 3 · Select and Manage Interventions
A 52-year-old woman with rheumatoid arthritis attends outpatient therapy during an acute flare. Her MCP and wrist joints are warm, red and swollen, and she reports pain of 7/10 with any motion. She wants to resume making breakfast. Which preparatory method is MOST appropriate before activity practice?
- A.Moist hot packs to the wrists, then sustained passive stretching of the joints
- B.Paraffin wax dips to both hands, then light resistive putty exercise
- C.Continuous ultrasound over the MCP joints, then grip strengthening
- D.Cold packs to the inflamed joints, then gentle pain-free active motion
Show answer and explanation
Answer: D. Cold packs to the inflamed joints, then gentle pain-free active motion
During an acute inflammatory flare, superficial cold reduces pain and inflammation, and exercise is limited to gentle, pain-free active motion to protect the joints. Paraffin and other superficial heat suit chronic stiffness but can increase inflammation in hot, swollen joints, and resistive or stretching exercise stresses inflamed joint capsules.
Question 4 · Select and Manage Interventions
A 35-year-old man in a burn unit has full-thickness burns to the anterior neck and both axillae. The OT is establishing a positioning program to prevent contractures. Which position BEST meets this goal?
- A.Neck in neutral on one pillow with the shoulders adducted across the chest
- B.Neck rotated to one side with both shoulders internally rotated on pillows
- C.Neck slightly extended without a pillow and shoulders abducted near 90 degrees
- D.Neck flexed on two pillows with both arms resting at the sides for comfort
Show answer and explanation
Answer: C. Neck slightly extended without a pillow and shoulders abducted near 90 degrees
Burned tissue contracts toward the position of comfort, which for the neck is flexion and for the axilla is adduction, so positioning opposes these patterns with neck extension and shoulder abduction. A pillow under the head encourages a neck flexion contracture even though it feels more comfortable.
Question 5 · Select and Manage Interventions
The team has referred a first grader who struggles with scissors and clothing fasteners for an initial special education evaluation. The teacher asks the school-based OT to give a standardized fine motor test this week. What must happen before the OT tests the student?
- A.The teacher documents classroom concerns for at least one full semester
- B.The district obtains the parents' informed written consent for the evaluation
- C.The principal signs an approval for the testing on behalf of the family
- D.The OT completes the testing and then informs the parents at the IEP meeting
Show answer and explanation
Answer: B. The district obtains the parents' informed written consent for the evaluation
Under IDEA, the school must obtain informed parental consent before conducting an initial individual evaluation for special education and related services. Testing first and informing the parents later is tempting when the team wants quick results, but it violates the family's procedural rights, and school staff cannot consent for the parents.
Question 6 · Evaluation and Assessment
A 47-year-old man attends a partial hospitalization program for major depression after losing his job. He says he no longer knows "what I am supposed to be doing with my life." Which assessment BEST identifies his past, present and anticipated roles and how much he values each one?
- A.Allen Cognitive Level Screen
- B.Role Checklist
- C.Mini-Mental State Exam
- D.Interest Checklist
Show answer and explanation
Answer: B. Role Checklist
The Role Checklist, based on the Model of Human Occupation, asks clients to indicate the roles they held in the past, hold now and expect to hold in the future and to rate the value of each. The Interest Checklist is tempting because it comes from the same model, but it surveys leisure interests rather than occupational roles.
Question 7 · Analysis, Interpretation, and Planning
After a BOT-2 evaluation, a parent reads that her 8-year-old son's fine motor composite is at the 25th percentile. She asks, 'So he only got a quarter of the items right?' Which explanation is MOST accurate?
- A.He performed like a child whose age is about 25 percent younger than his actual age
- B.He answered about 25 percent of the test items correctly, which is well below his age level
- C.He scored lower than about 25 percent of same-age children, in the bottom quarter only
- D.He scored as well as or better than about 25 percent of same-age children in the norm group
Show answer and explanation
Answer: D. He scored as well as or better than about 25 percent of same-age children in the norm group
A percentile rank shows the percentage of the norm group who scored at or below the child, not the percentage of items answered correctly. At the 25th percentile he scored lower than about 75 percent of peers, not lower than 25 percent. Percentiles are not age equivalents, so the age-based reading is also wrong.
Question 8 · Select and Manage Interventions
A 44-year-old with relapsing-remitting multiple sclerosis attends outpatient therapy for hand stiffness and reduced dexterity that interfere with buttoning work shirts. She reports that her symptoms worsen after hot showers and on warm afternoons. Which preparatory method is MOST appropriate before fine motor practice?
- A.Warm whirlpool immersion of both hands and wrists
- B.A moist hot pack applied to both forearms and hands
- C.Gentle active hand range of motion in a cool room
- D.Fluidotherapy to both hands at a comfortably warm setting
Show answer and explanation
Answer: C. Gentle active hand range of motion in a cool room
Many people with MS are heat sensitive: raising body or tissue temperature can temporarily worsen conduction in demyelinated nerves (Uhthoff phenomenon), so a cool environment and active movement are the safest preparation. Fluidotherapy sounds gentle and is used for stiffness, but it is still a superficial heating agent and carries the same risk of increasing fatigue and weakness.
Question 9 · Select and Manage Interventions
A 34-year-old in a residential substance use program reports that weekends, when he used to drink with coworkers, feel empty and are when cravings are strongest. Which group intervention BEST supports relapse prevention?
- A.Discussing in detail the events that led up to his most recent relapse
- B.Practicing relaxation alone so he can rest through the weekend
- C.Planning substance-free weekend leisure and naming risky situations
- D.Reviewing how alcohol damages the liver and the nervous system
Show answer and explanation
Answer: C. Planning substance-free weekend leisure and naming risky situations
Relapse prevention in OT focuses on filling unstructured time with satisfying, substance-free occupations and planning for high-risk situations. Health education about alcohol's effects is commonly included in programs but does not change the routine and leisure patterns that drive his cravings.
Question 10 · Select and Manage Interventions
A school-based OT realizes that a progress note she signed in the district's electronic record yesterday lists the wrong number of sessions attended by a fourth grader. The note has already been shared with the IEP team. What should the OT do?
- A.Add a dated correction that identifies the error and keeps the original visible
- B.Delete the original note and replace it with a corrected version dated yesterday
- C.Ask the district clerk to overwrite the number so the record looks consistent
- D.Leave the note unchanged, since signed notes cannot be corrected afterward
Show answer and explanation
Answer: A. Add a dated correction that identifies the error and keeps the original visible
Documentation is a legal record, so errors are corrected with a dated, signed addendum or correction that identifies the change while the original entry remains visible. Deleting and backdating a replacement note is tempting because the record looks clean, but it alters the legal record and misrepresents when the entry was made.

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