• 60 questions

NBCOT Practice Test

Unofficial NBCOT practice questions for the OTR exam, in the four domains of the board's content outline.

Which block-stacking result fits the motor skill markers for a 2-year-old?

Pick an answer, then press Check answer. Then you see Correct or Not quite, with the reason. Keys: A to D pick, Enter checks.

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Exam mode: 45 questions, 60 minutes.

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Unofficial practice questions, not affiliated with the National Board for Certification in Occupational Therapy. Bank checked October 7, 2026.

The real exam, as the board describes it

Questions
180
Time limit
240 minutes
Passing score
At least 450, on a scale of 300 to 600.
Scoring
Credit for each right option chosen. No points are taken off for a wrong one.
Appointment
About four hours and 45 minutes, with check-in, tutorials and surveys around the four hours of exam time.

Checked October 7, 2026 against Certification Exam Handbook, 2022 OTR Examination Content Outline and Foundations of the NBCOT Exam page, NBCOT. Rules change, so confirm with the agency itself before your test.

The board's own exam outline page

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All 60 questions

Evaluation and assessment 14

  • A 68-year-old client holds a medication label at arm's length to read it. Which age-related change is the most common vision problem of this kind? MedlinePlus, Aging changes in the senses; outline Domain 1, task 1
  • A client has painful, swollen wrists and finger joints on both hands, with morning stiffness that lasts more than an hour. Which condition does this pattern fit? MedlinePlus, Rheumatoid arthritis; outline Domain 1, task 1
  • A client who rests the elbows on a desk for hours each day has tingling in the ring and little fingers. Which nerve travels to those fingers and lies near the surface at the elbow? MedlinePlus, Ulnar nerve dysfunction; outline Domain 1, task 1
  • A client with carpal tunnel syndrome is tested for sensation. Where does the median nerve typically provide feeling? MedlinePlus, Carpal tunnel syndrome; outline Domain 1, task 1
  • A parent reports that her 12-month-old turns the pages of a board book several pages at once. What does this suggest? MedlinePlus, Developmental milestones record - 12 months and 2 years; outline Domain 1, task 1
Show all 60 questions (55 more)

Evaluation and assessment, continued

  • A preschool teacher asks when a child typically can cut out a picture with scissors and hop on one foot without losing balance. Which age fits both? MedlinePlus, Developmental milestones record - 4 years; outline Domain 1, task 1
  • A referral lists an injury of the spinal cord at its middle (thoracic) level. What should the therapist expect before the first evaluation? MedlinePlus, Spinal cord trauma; outline Domain 1, task 1
  • A relaxed infant lying face up has the head turned to the right. The right arm reaches away from the body and the left arm flexes with a clenched fist. Which reflex is this? MedlinePlus, Infant reflexes; outline Domain 1, task 1
  • After a broken upper arm bone, a client cannot bend the hand back at the wrist. Which nerve is most likely involved? MedlinePlus, Radial nerve dysfunction; outline Domain 1, task 1
  • An infant's arms fling out and then draw back when the head is allowed to drop slightly. Until about what age is this Moro reflex normally seen? MedlinePlus, Moro reflex; outline Domain 1, task 1
  • An older client who was oriented yesterday is suddenly and severely confused this morning, on the second day after surgery. Which term fits a sudden change of this kind? MedlinePlus, Delirium; outline Domain 1, task 1
  • During a developmental screening, a 9-month-old picks up a cereal piece between the tip of the thumb and the index finger. How should the therapist read this? MedlinePlus, Developmental milestones record - 9 months; outline Domain 1, task 1
  • During a skin check, a wheelchair user has a blister over the tailbone, on skin that had been red for several days. Which stage of pressure sore is this? MedlinePlus, How to care for pressure sores; outline Domain 1, task 2
  • Which block-stacking result fits the motor skill markers for a 2-year-old? MedlinePlus, Developmental milestones record - 2 years; outline Domain 1, task 1

Analysis, interpretation and planning 14

  • A child scores 70 on a test with a mean of 100 and a standard deviation of 15. What is the z-score? National Library of Medicine, Finding and Using Health Statistics: z-score; outline Domain 2, task 1
  • A client in an outpatient session says, "I have a plan to end my life tonight." Which response matches MedlinePlus guidance? MedlinePlus, Suicide and suicidal behavior; outline Domain 2, task 3
  • A client is three days out from a hip replacement with precautions in place. Which movement must the dressing plan avoid? MedlinePlus, Taking care of your new hip joint; outline Domain 2, task 3
  • A client with diabetes checks blood sugar before a kitchen activity and reads 62 mg/dL. How does MedlinePlus class this value? MedlinePlus, Low blood sugar; outline Domain 2, task 3
  • A norm-referenced test has a mean of 100 and a standard deviation of 15, and its scores are normally distributed. About what share of the norm group scores between 85 and 115? National Library of Medicine, Finding and Using Health Statistics: Standard Deviation; outline Domain 2, task 1
  • A parent signs consent for an initial special education evaluation on September 1. The State has set no timeframe of its own. Under IDEA, the evaluation must be conducted within how long? 34 CFR 300.301(c)(1); outline Domain 2, task 1
  • A student receives occupational therapy as a related service. How often must the IEP Team review the IEP, at a minimum? 34 CFR 300.324(b)(1); outline Domain 2, task 2
  • A student with a disability is 15. By when must the IEP include transition services and measurable postsecondary goals? 34 CFR 300.320(b); outline Domain 2, task 2
  • A therapist chooses between two assessment tools and asks which one measures what it is supposed to measure. Which property is that? National Library of Medicine, Finding and Using Health Statistics: Validity; outline Domain 2, task 1
  • A toddler receives early intervention under Part C of IDEA. How often must the Individualized Family Service Plan be reviewed, at a minimum? 34 CFR 303.342(b)(1); outline Domain 2, task 2
  • After teaching a caregiver a home program, the therapist wants to confirm the explanation was understood. Which method does MedlinePlus describe for this? MedlinePlus, Communicating with patients; outline Domain 2, task 2
  • An IEP Team weighs pulling a student out of class for all services. Which IDEA principle must guide the plan? 34 CFR 300.114(a)(2); outline Domain 2, task 2
  • Before an activity, a seated adult client has a pulse of 88 beats per minute and takes 28 breaths per minute. How do these compare with MedlinePlus normal resting ranges? MedlinePlus, Vital signs; outline Domain 2, task 3
  • During a session, a client with a spinal cord injury develops a throbbing headache, heavy sweating and flushed skin above the level of injury. What should happen first? MedlinePlus, Autonomic dysreflexia; outline Domain 2, task 3

Select and manage interventions 23

  • A ball strikes a client's straightened fingertip, which now droops toward the palm. What is the most common treatment? MedlinePlus, Mallet finger - aftercare; outline Domain 3, task 4
  • A caregiver is taught to reposition a client who stays in bed. How often should the position be changed to keep pressure off any one spot? MedlinePlus, Preventing pressure injuries; outline Domain 3, task 1
  • A client has ulnar nerve compression at the elbow. Which self-care measures does MedlinePlus list? MedlinePlus, Ulnar nerve dysfunction; outline Domain 3, task 4
  • A client is fitted with a single-tip cane after surgery on the right knee. In which hand should the cane be held? MedlinePlus, Using a cane; outline Domain 3, task 5
  • A client who uses a wheelchair all day is learning skin protection. How often should weight be shifted by leaning forward and to each side? MedlinePlus, Preventing pressure injuries; outline Domain 3, task 5
  • A client with a weak right leg practices going up a curb with a cane. Which leg steps up first? MedlinePlus, Using a cane; outline Domain 3, task 5
  • A client with arm lymphedema is prescribed a compression sleeve. What wearing schedule does MedlinePlus give? MedlinePlus, Lymphedema - self-care; outline Domain 3, task 3
  • A client with carpal tunnel syndrome is given a wrist splint. When does MedlinePlus say to start wearing it? MedlinePlus, Carpal tunnel syndrome; outline Domain 3, task 4
  • A client with hip precautions is learning lower-body dressing. Which sequence does MedlinePlus give for putting on pants? MedlinePlus, Taking care of your new hip joint; outline Domain 3, task 2
  • A client with one weak arm after a stroke wants to dress without help. Which clothing changes does MedlinePlus suggest? MedlinePlus, Stroke - discharge; outline Domain 3, task 2
  • A client with rheumatoid arthritis has pain when opening jars and turning keys. Which group of therapies does MedlinePlus list to ease joint pain? MedlinePlus, Rheumatoid arthritis; outline Domain 3, task 2
  • A client with swallowing problems is set up for lunch. Which pair of mealtime tips does MedlinePlus give? MedlinePlus, Swallowing problems; outline Domain 3, task 2
  • A clinic doorway is being checked for wheelchair access. What is the minimum clear width of a door opening under the 2010 ADA Standards? 2010 ADA Standards for Accessible Design, section 404.2.3; outline Domain 3, task 6
  • A clinic mounts a brochure rack that wheelchair users will reach forward to, with nothing in the way. What is the highest it may be under the 2010 ADA Standards? 2010 ADA Standards for Accessible Design, section 308.2.1; outline Domain 3, task 6
  • A daughter asks how to help her mother with dementia get through the day at home. Which strategy does MedlinePlus list? MedlinePlus, Dementia - home care; outline Domain 3, task 2
  • A home visit finds an older adult stepping over a wet tub edge to shower standing up. Which changes does MedlinePlus list for the bath or shower? MedlinePlus, Bathroom safety for adults; outline Domain 3, task 6
  • A horizontal grab bar is planned beside a toilet in a public restroom. How high above the finish floor do the 2010 ADA Standards place it? 2010 ADA Standards for Accessible Design, section 609.4; outline Domain 3, task 6
  • A therapist checks the fit of a client's walker. Which finding shows that it is adjusted correctly? MedlinePlus, Using a walker; outline Domain 3, task 5
  • A therapist reviews plans for an accessible restroom. What is the minimum diameter of a circular wheelchair turning space under the 2010 ADA Standards? 2010 ADA Standards for Accessible Design, section 304.3.1; outline Domain 3, task 6
  • A therapist teaches a family to talk with a client who has aphasia after a stroke. Which tip does MedlinePlus give? MedlinePlus, Communicating with someone with aphasia; outline Domain 3, task 2
  • A therapist trains a spouse in a bed-to-wheelchair pivot transfer. How should the wheelchair be set up first? MedlinePlus, Moving a patient from bed to a wheelchair; outline Domain 3, task 2
  • During a pivot transfer the client reaches up to hold on. Where should the client NOT hold? MedlinePlus, Moving a patient from bed to a wheelchair; outline Domain 3, task 2
  • The entrance of a community center is 24 inches above the walk. Under the 2010 ADA Standards, how long must a new ramp run be at the steepest slope allowed? 2010 ADA Standards for Accessible Design, section 405.2; outline Domain 3, task 6

Competency and practice management 9

  • A certified therapist receives a disciplinary action from a state licensing board. Under the NBCOT Code of Conduct, by when must it be disclosed to NBCOT? NBCOT Certification Exam Handbook, Candidate/Certificant Code of Conduct, Principle 1; outline Domain 4, task 4
  • A client has a seizure during a session and is lowered to the floor. Which action does MedlinePlus say NOT to take? MedlinePlus, Epilepsy or seizures - discharge; outline Domain 4, task 2
  • A client is on airborne precautions in a negative pressure room. What must the therapist do before entering? MedlinePlus, Isolation precautions; outline Domain 4, task 2
  • A client is on contact precautions. The therapist will handle the bed rails and help the client transfer. What should be worn on entering? MedlinePlus, Isolation precautions; outline Domain 4, task 2
  • A client makes a written request for a copy of her therapy records. Under the HIPAA Privacy Rule, by when must the covered entity act on the request? 45 CFR 164.524(b)(2); outline Domain 4, task 3
  • A therapist must lift a box of weights from the floor. Which technique does MedlinePlus give for lifting? MedlinePlus, Lifting and bending the right way; outline Domain 4, task 2
  • A therapist wants to post a photo of a client using a new adaptive device on social media. What does the NBCOT Code of Conduct require first? NBCOT Certification Exam Handbook, Candidate/Certificant Code of Conduct, Principle 8; outline Domain 4, task 4
  • The clinic stocks a new disinfectant. Under OSHA's Hazard Communication standard, where must its safety data sheet be? 29 CFR 1910.1200(g)(8); outline Domain 4, task 2
  • While appraising a study of a splinting program, a therapist asks whether the results can be attributed to the splint and not to another cause. Which property of the study is being judged? National Library of Medicine, Finding and Using Health Statistics: Validity; outline Domain 4, task 1

How this list was compiled: Our own questions, written to the four domains of the 2022 OTR Examination Content Outline of the National Board for Certification in Occupational Therapy (https://www.nbcot.org/-/media/PDFs/2022_OTR_Content_Outline.pdf, read 2026-10-07; listed on https://www.nbcot.org/exam-info/exam-outline): Evaluation and Assessment 23%; Analysis, Interpretation, and Planning 23%; Select and Manage Interventions 38%; Competency and Practice Management 16%. The bank holds 14, 14, 23 and 9. Every fact was read on 2026-10-07 in MedlinePlus (medlineplus.gov), the 2010 ADA Standards for Accessible Design (ada.gov), the Code of Federal Regulations at ecfr.gov (34 CFR parts 300 and 303, 45 CFR 164.524, 29 CFR 1910.1200), the National Library of Medicine course Finding and Using Health Statistics, or the Code of Conduct printed in the NBCOT Certification Exam Handbook, each named under its question. Licence: Questions, choices and explanations are original work of this site.

How it works

This free NBCOT practice test has 60 OTR exam questions of our own, in the four domains of the board's outline. It is unofficial, not affiliated with, endorsed by or sponsored by the National Board for Certification in Occupational Therapy.

Read the full guide

What the exam covers

The 2022 OTR Examination Content Outline, the exam's blueprint since January 2024, weights evaluation and assessment 23%; analysis, interpretation and planning 23%; selecting and managing interventions 38%; competency and practice management 16%. Read October 7, 2026. These NBCOT exam practice questions number 14, 14, 23 and 9.

Timing

For timed NBCOT exam prep, Exam mode asks 45 questions in 60 minutes, a quarter of the real exam at the same pace.

Where the answers come from

Each answer names a public page: MedlinePlus, the 2010 ADA Standards, the federal special education rules in 34 CFR part 300, or the code of conduct in the board's handbook.

  • The real exam also has three-option items and scenario sets that ask for three of six options. Here every question has four choices.

Questions and answers

Are these sample NBCOT exam questions from the real test?

No. All 60 are our own, written from the published outline and public sources. The board sells its own NBCOT practice exam and study pack; these NBCOT practice tests are a separate bank of occupational therapy exam questions, and none rewords a board item.

What is the occupational therapy exam?

For therapists, the OT certification exam is the OTR exam of the National Board for Certification in Occupational Therapy. Assistants take the separate COTA exam, which has its own outline.

What is a passing score on the NBCOT exam?

A scaled score of at least 450, on a scale of 300 to 600, by the board's Foundations of the NBCOT Exam page. This page reports the number right and does not convert it.

Is there a PDF of NBCOT exam questions?

Real exam content may not be shared under the board's code of conduct. Print, on the score card, makes a paper test from this bank (tick With answer key for the key), and your browser's print window can save it as a PDF.

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