NBCOT Occupational Therapist OTR Exam 2026: Latest
Comprehensive Study Guide with Practice Questions,
Occupational Therapy Review, Detailed Rationales, Verified
Answers & Success Workbook
DOMAIN 1: Evaluation and Assessment of Occupational Performance
(Exam Weight: 23% | 23 Questions)
Domain 1 Tasks Covered: Gathering information about factors that influence
occupational performance • Selecting appropriate assessments • Understanding
diagnoses and conditions • Recognizing red flags and complications • Task
analysis • Identifying environmental factors • Interviewing and history-taking
Question 1. An OTR is evaluating a client who had a left CVA three weeks ago.
The client presents with right-sided hemiparesis, neglect of the right side, and
difficulty with ADLs. Which assessment is MOST appropriate to evaluate the
client's functional independence?
A) Functional Independence Measure (FIM)
B) Mini-Mental State Examination (MMSE)
C) Manual Muscle Testing (MMT)
D) Goniometry
Rationale: The FIM is a comprehensive assessment of functional independence in
ADLs that is widely used in rehabilitation settings. The MMSE (B) assesses
cognitive function. MMT (C) assesses muscle strength. Goniometry (D) measures
joint range of motion. While all these assessments provide valuable information,
the FIM directly evaluates the client's ability to perform functional activities
independently.
Question 2. A 72-year-old client with Parkinson's disease is referred to OT. The
client reports difficulty with buttoning shirts and brushing teeth. Which assessment
would BEST capture the client's fine motor performance?
A) Nine-Hole Peg Test
B) Berg Balance Scale
C) Motor-Free Visual Perception Test (MVPT)
D) Sensory Integration and Praxis Tests (SIPT)
,Rationale: The Nine-Hole Peg Test is a standardized assessment of fine motor
dexterity. The Berg Balance Scale (B) assesses balance. The MVPT (C) assesses
visual perception. The SIPT (D) assesses sensory integration and praxis, primarily
in children.
Question 3. An OTR is working with a 6-year-old child diagnosed with autism
spectrum disorder. The child's parents report difficulty with transitions and sensory
sensitivities. Which assessment would BEST capture the child's sensory processing
patterns?
A) Peabody Developmental Motor Scales
B) Sensory Profile 2
C) Bruininks-Oseretsky Test of Motor Proficiency
D) Bayley Scales of Infant Development
Rationale: The Sensory Profile 2 is specifically designed to measure sensory
processing patterns in children. The Peabody (A) and Bruininks-Oseretsky (C)
assess motor development. The Bayley (D) assesses infant development.
Question 4. A client with a C6 spinal cord injury is being evaluated for
independence in self-care. Which activity would the OTR expect the client to be
able to perform with adaptive equipment?
A) Independent bed mobility
B) Feeding with a universal cuff
C) Independent lower body dressing
D) Independent bowel management
Rationale: A client with a C6 SCI has innervation to the biceps and some wrist
extensors, allowing use of a universal cuff for feeding. Independent bed mobility
(A) and lower body dressing (C) typically require higher-level function (T1 or
below). Bowel management (D) typically requires assistance at this level.
Question 5. An OTR is evaluating a client who experienced a traumatic brain
injury. The client is confused and disoriented to time, place, and person. Which
assessment is MOST appropriate to determine the client's level of cognitive
functioning?
A) Rancho Los Amigos Levels of Cognitive Functioning
B) Mini-Mental State Examination (MMSE)
,C) Montreal Cognitive Assessment (MoCA)
D) Wechsler Adult Intelligence Scale (WAIS)
Rationale: The Rancho Los Amigos Scale is specifically designed to assess
cognitive and behavioral recovery following TBI. The MMSE (B) and MoCA (C)
are general cognitive screens. The WAIS (D) is a comprehensive intelligence test.
Question 6. A client with rheumatoid arthritis reports hand pain and stiffness,
particularly in the morning. Which assessment would BEST evaluate the client's
hand function?
A) Duruöz Hand Index
B) Jebsen-Taylor Hand Function Test
C) Purdue Pegboard Test
D) Box and Block Test
Rationale: The Duruöz Hand Index is a self-report measure of hand function in
activities of daily living specifically validated for clients with rheumatoid arthritis.
The Jebsen-Taylor (B), Purdue Pegboard (C), and Box and Block (D) are
performance-based assessments not specific to RA.
Question 7. An OTR is evaluating an older adult who has fallen twice in the past
month. Which assessment is MOST appropriate to evaluate the client's balance and
fall risk?
A) Berg Balance Scale
B) Functional Independence Measure
C) Manual Muscle Testing
D) Goniometry
Rationale: The Berg Balance Scale is a validated assessment for balance and fall
risk in older adults. The FIM (B) measures functional independence. MMT (C) and
goniometry (D) assess strength and ROM, which are components of balance but do
not directly assess fall risk.
Question 8. A 3-year-old child is referred to OT for evaluation of fine motor skills.
Which assessment is MOST appropriate?
A) Peabody Developmental Motor Scales (PDMS-2)
B) Bruininks-Oseretsky Test of Motor Proficiency (BOT-2)
C) Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI)
D) Test of Visual Perceptual Skills (TVPS)
, Rationale: The PDMS-2 is specifically designed for children from birth to 5 years
and assesses fine motor, gross motor, and visual-motor skills. The BOT-2 (B) is for
children ages 4–21. The VMI (C) assesses visual-motor integration. The TVPS (D)
assesses visual perception.
Question 9. A client with a distal radius fracture is being evaluated for OT. The
client has limited wrist extension. Which assessment is MOST appropriate to
measure the client's active range of motion?
A) Manual Muscle Testing
B) Goniometry
C) Dynamometry
D) Pinch meter
Rationale: Goniometry is the standard measurement of joint range of motion.
MMT (A) measures strength. Dynamometry (C) measures grip strength. A pinch
meter (D) measures pinch strength.
Question 10. An OTR is evaluating a client with a suspected peripheral
neuropathy. The client reports numbness and tingling in the hands. Which
assessment would BEST evaluate the client's sensation?
A) Semmes-Weinstein Monofilament Test
B) Two-point discrimination
C) Vibratory sensation with tuning fork
D) Proprioception testing
Rationale: The Semmes-Weinstein Monofilament Test is a standardized
assessment of light touch sensation and is commonly used to evaluate peripheral
neuropathy. While two-point discrimination (B), vibratory sensation (C), and
proprioception (D) assess other sensory modalities, monofilament testing is the
most appropriate for peripheral neuropathy screening.
Question 11. A client who had a total hip replacement is being evaluated. The
client reports difficulty with lower body dressing. Which precaution should the
OTR consider during evaluation?
A) No hip flexion beyond 90 degrees
B) No weight-bearing on the affected leg
C) No hip abduction
D) No hip extension
Comprehensive Study Guide with Practice Questions,
Occupational Therapy Review, Detailed Rationales, Verified
Answers & Success Workbook
DOMAIN 1: Evaluation and Assessment of Occupational Performance
(Exam Weight: 23% | 23 Questions)
Domain 1 Tasks Covered: Gathering information about factors that influence
occupational performance • Selecting appropriate assessments • Understanding
diagnoses and conditions • Recognizing red flags and complications • Task
analysis • Identifying environmental factors • Interviewing and history-taking
Question 1. An OTR is evaluating a client who had a left CVA three weeks ago.
The client presents with right-sided hemiparesis, neglect of the right side, and
difficulty with ADLs. Which assessment is MOST appropriate to evaluate the
client's functional independence?
A) Functional Independence Measure (FIM)
B) Mini-Mental State Examination (MMSE)
C) Manual Muscle Testing (MMT)
D) Goniometry
Rationale: The FIM is a comprehensive assessment of functional independence in
ADLs that is widely used in rehabilitation settings. The MMSE (B) assesses
cognitive function. MMT (C) assesses muscle strength. Goniometry (D) measures
joint range of motion. While all these assessments provide valuable information,
the FIM directly evaluates the client's ability to perform functional activities
independently.
Question 2. A 72-year-old client with Parkinson's disease is referred to OT. The
client reports difficulty with buttoning shirts and brushing teeth. Which assessment
would BEST capture the client's fine motor performance?
A) Nine-Hole Peg Test
B) Berg Balance Scale
C) Motor-Free Visual Perception Test (MVPT)
D) Sensory Integration and Praxis Tests (SIPT)
,Rationale: The Nine-Hole Peg Test is a standardized assessment of fine motor
dexterity. The Berg Balance Scale (B) assesses balance. The MVPT (C) assesses
visual perception. The SIPT (D) assesses sensory integration and praxis, primarily
in children.
Question 3. An OTR is working with a 6-year-old child diagnosed with autism
spectrum disorder. The child's parents report difficulty with transitions and sensory
sensitivities. Which assessment would BEST capture the child's sensory processing
patterns?
A) Peabody Developmental Motor Scales
B) Sensory Profile 2
C) Bruininks-Oseretsky Test of Motor Proficiency
D) Bayley Scales of Infant Development
Rationale: The Sensory Profile 2 is specifically designed to measure sensory
processing patterns in children. The Peabody (A) and Bruininks-Oseretsky (C)
assess motor development. The Bayley (D) assesses infant development.
Question 4. A client with a C6 spinal cord injury is being evaluated for
independence in self-care. Which activity would the OTR expect the client to be
able to perform with adaptive equipment?
A) Independent bed mobility
B) Feeding with a universal cuff
C) Independent lower body dressing
D) Independent bowel management
Rationale: A client with a C6 SCI has innervation to the biceps and some wrist
extensors, allowing use of a universal cuff for feeding. Independent bed mobility
(A) and lower body dressing (C) typically require higher-level function (T1 or
below). Bowel management (D) typically requires assistance at this level.
Question 5. An OTR is evaluating a client who experienced a traumatic brain
injury. The client is confused and disoriented to time, place, and person. Which
assessment is MOST appropriate to determine the client's level of cognitive
functioning?
A) Rancho Los Amigos Levels of Cognitive Functioning
B) Mini-Mental State Examination (MMSE)
,C) Montreal Cognitive Assessment (MoCA)
D) Wechsler Adult Intelligence Scale (WAIS)
Rationale: The Rancho Los Amigos Scale is specifically designed to assess
cognitive and behavioral recovery following TBI. The MMSE (B) and MoCA (C)
are general cognitive screens. The WAIS (D) is a comprehensive intelligence test.
Question 6. A client with rheumatoid arthritis reports hand pain and stiffness,
particularly in the morning. Which assessment would BEST evaluate the client's
hand function?
A) Duruöz Hand Index
B) Jebsen-Taylor Hand Function Test
C) Purdue Pegboard Test
D) Box and Block Test
Rationale: The Duruöz Hand Index is a self-report measure of hand function in
activities of daily living specifically validated for clients with rheumatoid arthritis.
The Jebsen-Taylor (B), Purdue Pegboard (C), and Box and Block (D) are
performance-based assessments not specific to RA.
Question 7. An OTR is evaluating an older adult who has fallen twice in the past
month. Which assessment is MOST appropriate to evaluate the client's balance and
fall risk?
A) Berg Balance Scale
B) Functional Independence Measure
C) Manual Muscle Testing
D) Goniometry
Rationale: The Berg Balance Scale is a validated assessment for balance and fall
risk in older adults. The FIM (B) measures functional independence. MMT (C) and
goniometry (D) assess strength and ROM, which are components of balance but do
not directly assess fall risk.
Question 8. A 3-year-old child is referred to OT for evaluation of fine motor skills.
Which assessment is MOST appropriate?
A) Peabody Developmental Motor Scales (PDMS-2)
B) Bruininks-Oseretsky Test of Motor Proficiency (BOT-2)
C) Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI)
D) Test of Visual Perceptual Skills (TVPS)
, Rationale: The PDMS-2 is specifically designed for children from birth to 5 years
and assesses fine motor, gross motor, and visual-motor skills. The BOT-2 (B) is for
children ages 4–21. The VMI (C) assesses visual-motor integration. The TVPS (D)
assesses visual perception.
Question 9. A client with a distal radius fracture is being evaluated for OT. The
client has limited wrist extension. Which assessment is MOST appropriate to
measure the client's active range of motion?
A) Manual Muscle Testing
B) Goniometry
C) Dynamometry
D) Pinch meter
Rationale: Goniometry is the standard measurement of joint range of motion.
MMT (A) measures strength. Dynamometry (C) measures grip strength. A pinch
meter (D) measures pinch strength.
Question 10. An OTR is evaluating a client with a suspected peripheral
neuropathy. The client reports numbness and tingling in the hands. Which
assessment would BEST evaluate the client's sensation?
A) Semmes-Weinstein Monofilament Test
B) Two-point discrimination
C) Vibratory sensation with tuning fork
D) Proprioception testing
Rationale: The Semmes-Weinstein Monofilament Test is a standardized
assessment of light touch sensation and is commonly used to evaluate peripheral
neuropathy. While two-point discrimination (B), vibratory sensation (C), and
proprioception (D) assess other sensory modalities, monofilament testing is the
most appropriate for peripheral neuropathy screening.
Question 11. A client who had a total hip replacement is being evaluated. The
client reports difficulty with lower body dressing. Which precaution should the
OTR consider during evaluation?
A) No hip flexion beyond 90 degrees
B) No weight-bearing on the affected leg
C) No hip abduction
D) No hip extension
