NCBOT OTR EXAM (OCCUPATIONAL THERAPIST)
NEWEST EXAM QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES A NEW UPDATED VERSION
LATEST 2026-2027 (100% CORRECT VERIFIED ANSWERS)
ALREADY GRADED A+
1. An OTR is evaluating a client with left-sided neglect post-CVA. Which observation best indicates
the presence of this condition?
A. The client fails to recognize familiar faces.
B. The client bumps into the left doorframe when walking through it.
C. The client is unable to name common objects like a pen.
D. The client demonstrates poor short-term memory recall.
● Rationale: Left-sided neglect (unilateral neglect) is the failure to attend to stimuli on the left
side of the body or environment. Bumping into the left doorframe directly indicates inattention
to the left visual field. Face recognition issues suggest prosopagnosia; naming objects
suggests anomia; poor memory suggests memory impairment—
● None are specific to unilateral neglect.
2. A child with autism spectrum disorder (ASD) exhibits hand-flapping and rocking when the
classroom fire alarm sounds. These behaviors are BEST described as:
A. Voluntary motor control strategies.
B. Sensory-seeking regulatory behaviors.
C. Oppositional defiant responses.
D. Habitual tic disorders.
● Rationale: In ASD, repetitive behaviors like hand-flapping and rocking often serve to regulate
sensory input (self-stimulation) during overwhelming auditory stimuli. They are not
oppositional (not willful defiance), not typical tics (though tics can co-occur), and are often
involuntary in the sense of being triggered by sensory overload.
,3. An OTR is fabricating a resting hand splint for a client with rheumatoid arthritis. The splint should
position the hand in:
A. Wrist flexion, MCP extension, IP flexion.
B. Wrist neutral, MCP flexion, IP extension.
C. *Wrist 10-20° extension, MCP slight flexion, IP extension.*
D. Wrist 30° flexion, MCP full extension, IP flexion.
● Rationale: A resting hand splint aims to prevent deformity (e.g., ulnar drift, swan neck) and
reduce pain. The optimal position is wrist in slight extension (10-20°), metacarpophalangeal
(MCP) joints in slight flexion (to prevent intrinsic plus deformity), and interphalangeal (IP)
joints in near-full extension to prevent flexion contractures.
4. During a driver rehabilitation assessment, a client with left hemiparesis has difficulty maintaining
lane position. This MOST likely indicates a deficit in:
A. Visual acuity.
B. Visual scanning and attention to the left.
C. Executive function for route planning.
D. Motor strength for steering.
● Rationale: Lane position requires constant awareness of the vehicle’s position relative to road
markings. Left hemiparesis with possible left neglect or reduced left visual scanning leads to
drifting. While steering strength matters, maintaining lane position is more
perceptual/attentional than pure motor strength.
5. Which standardized assessment is MOST appropriate for evaluating fine motor coordination in a
4-year-old with developmental delay?
A. Beck Depression Inventory (BDI)
B. *Peabody Developmental Motor Scales (PDMS-3)*
C. Kohlman Evaluation of Living Skills (KELS)
D. Mini-Mental State Examination (MMSE)
● Rationale: PDMS-3 is a norm-referenced assessment of gross and fine motor skills for children
birth to 6 years. BDI is for depression, KELS is for independent living skills in adults, MMSE is
for cognitive status—none are appropriate for pediatric fine motor coordination.
,6. A client with C7 spinal cord injury (SCI) is learning to perform a pressure relief maneuver in a
manual wheelchair. The MOST effective technique is:
A. Leaning forward with arms crossed on lap.
B. Wheelie and lean sideways using the pushrims.
C. Tilt-in-space chair activated by chin control.
D. Pushing down on armrests to lift buttocks.
● Rationale: At C7 (intact triceps, wrist extensors, weak hand intrinsics), the client can perform a
“wheelie” and lean side-to-side, or lean forward with one arm hooking under the opposite thigh.
Leaning forward alone is less effective for full pressure relief; tilt-in-space is for higher-level
injuries; armrest push-ups require elbow extension and are not sustainable.
7. An OTR is treating a client with ideational apraxia after a right CVA. Which behavior would the
client MOST likely exhibit when asked to make a sandwich?
A. Unable to initiate the first step.
B. Uses a knife to spread peanut butter on the bread before opening the jar.
C. Perseverates spreading peanut butter repeatedly.
D. Cannot recognize the sandwich as a food item.
● Rationale: Ideational apraxia is the loss of the conceptual knowledge of a task sequence
(tool-object action knowledge). Using a knife before opening the jar shows loss of the overall
plan. Initiation issues suggest ideomotor apraxia or motor neglect; perseveration is more
frontal; recognition issues suggest agnosia.
8. In a hand therapy clinic, a client 6 weeks post-repair of the flexor digitorum profundus (FDP) in
zone II (Bunnell’s “no man’s land”) is following a Duran protocol. What motion should they be
performing at this stage?
A. Full passive wrist flexion with digit extension.
B. Place-and-hold flexion of the DIP joint with wrist neutral.
C. Active composite fist with wrist flexion.
D. Resisted hook grip strengthening.
● Rationale: Duran protocol (early passive motion) for zone II repairs includes protected passive
or place-and-hold flexion of the DIP joint (for FDP) within a dorsal blocking splint. Active
composite fist would risk rupture at 6 weeks; resisted strengthening is later (8-12 weeks).
, 9. An OTR is assessing a child with sensory modulation disorder who is “fearful of movement” and
avoids playground swings. Which intervention is MOST appropriate initially?
A. Provide deep pressure via weighted vest and then linear swinging.
B. Slow, linear, predictable swinging with the child in control of the stop signal.
C. Fast, rotary, unpredictable swinging to desensitize.
D. Avoid swinging and focus on tactile play.
● Rationale: For gravitational insecurity (fearful of movement), the approach is slow, linear,
predictable vestibular input with the child having control (e.g., “tell me when to stop”). Fast
rotary input would increase fear; weighted vest alone does not address vestibular fear;
avoidance does not treat the modulation issue.
10. A client with Guillain-Barré syndrome in the acute phase is bedbound. The PRIMARY OT goal at
this stage is:
A. Gait training with a walker.
B. Positioning and splinting to prevent contractures.
C. Functional electrical stimulation (FES) for muscle re-education.
D. Cognitive retraining for memory deficits.
● Rationale: Acute Guillain-Barré involves rapid progressive weakness and paralysis. The priority
is prevention of secondary complications (contractures, pressure injuries) via positioning,
splinting, and PROM. Gait training is later (recovery phase); FES is not acute; cognitive deficits
are not primary.
11. Which splint is indicated for a client with a median nerve injury (Carpal tunnel syndrome) to be
worn at night?
A. Dorsal wrist splint in neutral.
B. *Volar wrist splint in 0-10° extension with thumb CMC/MCP free.*
C. Ulnar gutter splint with ring and small fingers fixed.
D. Resting hand splint with MCP flexion.
● Rationale: Carpal tunnel syndrome involves compression of median nerve at wrist. Night
splinting keeps wrist in neutral to slight extension (reducing pressure in carpal tunnel), thumb
NEWEST EXAM QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES A NEW UPDATED VERSION
LATEST 2026-2027 (100% CORRECT VERIFIED ANSWERS)
ALREADY GRADED A+
1. An OTR is evaluating a client with left-sided neglect post-CVA. Which observation best indicates
the presence of this condition?
A. The client fails to recognize familiar faces.
B. The client bumps into the left doorframe when walking through it.
C. The client is unable to name common objects like a pen.
D. The client demonstrates poor short-term memory recall.
● Rationale: Left-sided neglect (unilateral neglect) is the failure to attend to stimuli on the left
side of the body or environment. Bumping into the left doorframe directly indicates inattention
to the left visual field. Face recognition issues suggest prosopagnosia; naming objects
suggests anomia; poor memory suggests memory impairment—
● None are specific to unilateral neglect.
2. A child with autism spectrum disorder (ASD) exhibits hand-flapping and rocking when the
classroom fire alarm sounds. These behaviors are BEST described as:
A. Voluntary motor control strategies.
B. Sensory-seeking regulatory behaviors.
C. Oppositional defiant responses.
D. Habitual tic disorders.
● Rationale: In ASD, repetitive behaviors like hand-flapping and rocking often serve to regulate
sensory input (self-stimulation) during overwhelming auditory stimuli. They are not
oppositional (not willful defiance), not typical tics (though tics can co-occur), and are often
involuntary in the sense of being triggered by sensory overload.
,3. An OTR is fabricating a resting hand splint for a client with rheumatoid arthritis. The splint should
position the hand in:
A. Wrist flexion, MCP extension, IP flexion.
B. Wrist neutral, MCP flexion, IP extension.
C. *Wrist 10-20° extension, MCP slight flexion, IP extension.*
D. Wrist 30° flexion, MCP full extension, IP flexion.
● Rationale: A resting hand splint aims to prevent deformity (e.g., ulnar drift, swan neck) and
reduce pain. The optimal position is wrist in slight extension (10-20°), metacarpophalangeal
(MCP) joints in slight flexion (to prevent intrinsic plus deformity), and interphalangeal (IP)
joints in near-full extension to prevent flexion contractures.
4. During a driver rehabilitation assessment, a client with left hemiparesis has difficulty maintaining
lane position. This MOST likely indicates a deficit in:
A. Visual acuity.
B. Visual scanning and attention to the left.
C. Executive function for route planning.
D. Motor strength for steering.
● Rationale: Lane position requires constant awareness of the vehicle’s position relative to road
markings. Left hemiparesis with possible left neglect or reduced left visual scanning leads to
drifting. While steering strength matters, maintaining lane position is more
perceptual/attentional than pure motor strength.
5. Which standardized assessment is MOST appropriate for evaluating fine motor coordination in a
4-year-old with developmental delay?
A. Beck Depression Inventory (BDI)
B. *Peabody Developmental Motor Scales (PDMS-3)*
C. Kohlman Evaluation of Living Skills (KELS)
D. Mini-Mental State Examination (MMSE)
● Rationale: PDMS-3 is a norm-referenced assessment of gross and fine motor skills for children
birth to 6 years. BDI is for depression, KELS is for independent living skills in adults, MMSE is
for cognitive status—none are appropriate for pediatric fine motor coordination.
,6. A client with C7 spinal cord injury (SCI) is learning to perform a pressure relief maneuver in a
manual wheelchair. The MOST effective technique is:
A. Leaning forward with arms crossed on lap.
B. Wheelie and lean sideways using the pushrims.
C. Tilt-in-space chair activated by chin control.
D. Pushing down on armrests to lift buttocks.
● Rationale: At C7 (intact triceps, wrist extensors, weak hand intrinsics), the client can perform a
“wheelie” and lean side-to-side, or lean forward with one arm hooking under the opposite thigh.
Leaning forward alone is less effective for full pressure relief; tilt-in-space is for higher-level
injuries; armrest push-ups require elbow extension and are not sustainable.
7. An OTR is treating a client with ideational apraxia after a right CVA. Which behavior would the
client MOST likely exhibit when asked to make a sandwich?
A. Unable to initiate the first step.
B. Uses a knife to spread peanut butter on the bread before opening the jar.
C. Perseverates spreading peanut butter repeatedly.
D. Cannot recognize the sandwich as a food item.
● Rationale: Ideational apraxia is the loss of the conceptual knowledge of a task sequence
(tool-object action knowledge). Using a knife before opening the jar shows loss of the overall
plan. Initiation issues suggest ideomotor apraxia or motor neglect; perseveration is more
frontal; recognition issues suggest agnosia.
8. In a hand therapy clinic, a client 6 weeks post-repair of the flexor digitorum profundus (FDP) in
zone II (Bunnell’s “no man’s land”) is following a Duran protocol. What motion should they be
performing at this stage?
A. Full passive wrist flexion with digit extension.
B. Place-and-hold flexion of the DIP joint with wrist neutral.
C. Active composite fist with wrist flexion.
D. Resisted hook grip strengthening.
● Rationale: Duran protocol (early passive motion) for zone II repairs includes protected passive
or place-and-hold flexion of the DIP joint (for FDP) within a dorsal blocking splint. Active
composite fist would risk rupture at 6 weeks; resisted strengthening is later (8-12 weeks).
, 9. An OTR is assessing a child with sensory modulation disorder who is “fearful of movement” and
avoids playground swings. Which intervention is MOST appropriate initially?
A. Provide deep pressure via weighted vest and then linear swinging.
B. Slow, linear, predictable swinging with the child in control of the stop signal.
C. Fast, rotary, unpredictable swinging to desensitize.
D. Avoid swinging and focus on tactile play.
● Rationale: For gravitational insecurity (fearful of movement), the approach is slow, linear,
predictable vestibular input with the child having control (e.g., “tell me when to stop”). Fast
rotary input would increase fear; weighted vest alone does not address vestibular fear;
avoidance does not treat the modulation issue.
10. A client with Guillain-Barré syndrome in the acute phase is bedbound. The PRIMARY OT goal at
this stage is:
A. Gait training with a walker.
B. Positioning and splinting to prevent contractures.
C. Functional electrical stimulation (FES) for muscle re-education.
D. Cognitive retraining for memory deficits.
● Rationale: Acute Guillain-Barré involves rapid progressive weakness and paralysis. The priority
is prevention of secondary complications (contractures, pressure injuries) via positioning,
splinting, and PROM. Gait training is later (recovery phase); FES is not acute; cognitive deficits
are not primary.
11. Which splint is indicated for a client with a median nerve injury (Carpal tunnel syndrome) to be
worn at night?
A. Dorsal wrist splint in neutral.
B. *Volar wrist splint in 0-10° extension with thumb CMC/MCP free.*
C. Ulnar gutter splint with ring and small fingers fixed.
D. Resting hand splint with MCP flexion.
● Rationale: Carpal tunnel syndrome involves compression of median nerve at wrist. Night
splinting keeps wrist in neutral to slight extension (reducing pressure in carpal tunnel), thumb
