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Maryland Occupational Therapist (OT) Licensing Exam
2026/2027 | Complete NBCOT-Style Q&A with Well-
Elaborated Answers & Rationales | 100% Verified
Solutions | Instant PDF Download
Domain 1: Evaluation and Assessment
1. A 5-year-old child with mild developmental delay is learning to self-dress. The child can put on a
T-shirt but struggles with buttoning. What is the most appropriate initial action for the OTR?
• A) Refer the child for a fine motor evaluation.
• B) Teach the child to use a button hook.
• C) Modify the T-shirt to use Velcro closures.
• D) Observe the child’s fine motor skills during a structured play activity.
Correct Answer : D) Observe the child’s fine motor skills during a structured play activity.
Rationale: Before intervening, the OTR must conduct a thorough assessment to identify specific deficits.
Observing fine motor skills in a natural context provides essential information about the child’s abilities,
which guides intervention planning.
2. An OTR is evaluating a client with a traumatic brain injury. The client’s family reports that the client
is frequently agitated and has difficulty with memory. What is the most appropriate assessment tool?
• A) Mini-Mental State Examination (MMSE)
• B) Canadian Occupational Performance Measure (COPM)
• C) Kohlman Evaluation of Living Skills (KELS)
• D) Rancho Los Amigos Scale
Correct Answer : D) Rancho Los Amigos Scale
Rationale: The Rancho Los Amigos Scale is a widely used tool to assess cognitive functioning in clients
with traumatic brain injury, focusing on levels of awareness, orientation, and behavior.
3. A client with rheumatoid arthritis reports difficulty preparing meals due to hand pain and
weakness. What is the most appropriate initial step?
• A) Prescribe adaptive equipment such as a jar opener.
,2
• B) Conduct a kitchen safety assessment.
• C) Observe the client performing meal preparation tasks.
• D) Recommend a home health aide.
Correct Answer : C) Observe the client performing meal preparation tasks.
Rationale: Direct observation in the client’s natural environment allows the OTR to identify specific
barriers and develop a client-centered intervention plan.
4. An OTR is assessing a 7-year-old with autism spectrum disorder. The child avoids eye contact and
becomes distressed with transitions. Which assessment tool is most appropriate?
• A) Sensory Profile
• B) Peabody Developmental Motor Scales
• C) Bayley Scales of Infant Development
• D) Wechsler Intelligence Scale for Children
Correct Answer : A) Sensory Profile
Rationale: The Sensory Profile assesses sensory processing patterns, which are often atypical in children
with autism spectrum disorder.
5. A client with a spinal cord injury at C6 is being evaluated for wheelchair mobility. Which assessment
is most critical?
• A) Manual muscle testing of the upper extremities.
• B) Range of motion of the lower extremities.
• C) Cognitive screening.
• D) Visual acuity testing.
Correct Answer : A) Manual muscle testing of the upper extremities.
Rationale: For a C6 injury, function of the upper extremities (e.g., elbow flexion, wrist extension)
determines wheelchair propulsion and independence.
6. An OTR is evaluating a client with dementia who resides in a long-term care facility. The client is
unable to report his own functional abilities. What is the best source of information?
• A) The client’s family.
• B) The client’s primary physician.
• C) A standardized cognitive assessment.
,3
• D) Direct observation and caregiver report.
Correct Answer : D) Direct observation and caregiver report.
Rationale: When a client cannot self-report, the OTR must rely on direct observation of performance
and information from caregivers who know the client’s typical abilities.
7. A client with a stroke presents with left-sided neglect. What assessment would best quantify this
deficit?
• A) Line bisection test.
• B) Mini-Mental State Examination.
• C) Beck Depression Inventory.
• D) Functional Independence Measure.
Correct Answer : A) Line bisection test.
Rationale: The line bisection test is a simple, validated assessment for unilateral neglect; the client is
asked to mark the center of a horizontal line, and deviation to one side indicates neglect.
8. An OTR is evaluating a child with developmental coordination disorder. The child has difficulty with
balance and handwriting. Which assessment is most appropriate?
• A) Bruininks-Oseretsky Test of Motor Proficiency (BOT-2).
• B) Sensory Integration and Praxis Tests (SIPT).
• C) Vineland Adaptive Behavior Scales.
• D) Pediatric Evaluation of Disability Inventory (PEDI).
Correct Answer : A) Bruininks-Oseretsky Test of Motor Proficiency (BOT-2).
Rationale: The BOT-2 assesses fine and gross motor skills, including balance and manual dexterity,
making it ideal for children with motor coordination difficulties.
9. A client with carpal tunnel syndrome reports night pain and difficulty gripping objects. What is
the most appropriate assessment to identify the underlying cause?
• A) Nerve conduction study.
• B) Grip strength dynamometry.
• C) Phalen’s test.
• D) Tinel’s sign.
, 4
Correct Answer : A) Nerve conduction study.
Rationale: A nerve conduction study confirms the diagnosis of carpal tunnel syndrome by measuring the
speed of nerve impulses across the wrist.
10. An OTR is evaluating a client with depression who reports low motivation for daily activities. What
is the most important factor to assess?
• A) The client’s past work history.
• B) The client’s current living environment.
• C) The client’s level of interest in activities.
• D) The client’s medication regimen.
Correct Answer : C) The client’s level of interest in activities.
Rationale: Anhedonia (loss of interest in previously enjoyed activities) is a core symptom of depression.
Assessing the client’s motivation helps guide meaningful engagement.
11. A client with a hand burn is referred for an evaluation. What is the priority assessment?
• A) Active and passive range of motion of the hand.
• B) Scar management needs.
• C) Pain level.
• D) Activities of daily living performance.
Correct Answer : A) Active and passive range of motion of the hand.
Rationale: Following a burn, preventing contractures is critical. Assessing ROM early allows the OTR to
initiate splinting and positioning to maintain function.
12. An OTR is assessing a 10-year-old with a learning disability. The child has difficulty with
handwriting and copying from the board. What is the most appropriate assessment?
• A) Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI).
• B) Peabody Developmental Motor Scales.
• C) Sensory Profile.
• D) Bruininks-Oseretsky Test of Motor Proficiency.
Correct Answer : A) Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI).
Rationale: The VMI specifically assesses the integration of visual perception and motor skills, which is
essential for handwriting and copying tasks.
Maryland Occupational Therapist (OT) Licensing Exam
2026/2027 | Complete NBCOT-Style Q&A with Well-
Elaborated Answers & Rationales | 100% Verified
Solutions | Instant PDF Download
Domain 1: Evaluation and Assessment
1. A 5-year-old child with mild developmental delay is learning to self-dress. The child can put on a
T-shirt but struggles with buttoning. What is the most appropriate initial action for the OTR?
• A) Refer the child for a fine motor evaluation.
• B) Teach the child to use a button hook.
• C) Modify the T-shirt to use Velcro closures.
• D) Observe the child’s fine motor skills during a structured play activity.
Correct Answer : D) Observe the child’s fine motor skills during a structured play activity.
Rationale: Before intervening, the OTR must conduct a thorough assessment to identify specific deficits.
Observing fine motor skills in a natural context provides essential information about the child’s abilities,
which guides intervention planning.
2. An OTR is evaluating a client with a traumatic brain injury. The client’s family reports that the client
is frequently agitated and has difficulty with memory. What is the most appropriate assessment tool?
• A) Mini-Mental State Examination (MMSE)
• B) Canadian Occupational Performance Measure (COPM)
• C) Kohlman Evaluation of Living Skills (KELS)
• D) Rancho Los Amigos Scale
Correct Answer : D) Rancho Los Amigos Scale
Rationale: The Rancho Los Amigos Scale is a widely used tool to assess cognitive functioning in clients
with traumatic brain injury, focusing on levels of awareness, orientation, and behavior.
3. A client with rheumatoid arthritis reports difficulty preparing meals due to hand pain and
weakness. What is the most appropriate initial step?
• A) Prescribe adaptive equipment such as a jar opener.
,2
• B) Conduct a kitchen safety assessment.
• C) Observe the client performing meal preparation tasks.
• D) Recommend a home health aide.
Correct Answer : C) Observe the client performing meal preparation tasks.
Rationale: Direct observation in the client’s natural environment allows the OTR to identify specific
barriers and develop a client-centered intervention plan.
4. An OTR is assessing a 7-year-old with autism spectrum disorder. The child avoids eye contact and
becomes distressed with transitions. Which assessment tool is most appropriate?
• A) Sensory Profile
• B) Peabody Developmental Motor Scales
• C) Bayley Scales of Infant Development
• D) Wechsler Intelligence Scale for Children
Correct Answer : A) Sensory Profile
Rationale: The Sensory Profile assesses sensory processing patterns, which are often atypical in children
with autism spectrum disorder.
5. A client with a spinal cord injury at C6 is being evaluated for wheelchair mobility. Which assessment
is most critical?
• A) Manual muscle testing of the upper extremities.
• B) Range of motion of the lower extremities.
• C) Cognitive screening.
• D) Visual acuity testing.
Correct Answer : A) Manual muscle testing of the upper extremities.
Rationale: For a C6 injury, function of the upper extremities (e.g., elbow flexion, wrist extension)
determines wheelchair propulsion and independence.
6. An OTR is evaluating a client with dementia who resides in a long-term care facility. The client is
unable to report his own functional abilities. What is the best source of information?
• A) The client’s family.
• B) The client’s primary physician.
• C) A standardized cognitive assessment.
,3
• D) Direct observation and caregiver report.
Correct Answer : D) Direct observation and caregiver report.
Rationale: When a client cannot self-report, the OTR must rely on direct observation of performance
and information from caregivers who know the client’s typical abilities.
7. A client with a stroke presents with left-sided neglect. What assessment would best quantify this
deficit?
• A) Line bisection test.
• B) Mini-Mental State Examination.
• C) Beck Depression Inventory.
• D) Functional Independence Measure.
Correct Answer : A) Line bisection test.
Rationale: The line bisection test is a simple, validated assessment for unilateral neglect; the client is
asked to mark the center of a horizontal line, and deviation to one side indicates neglect.
8. An OTR is evaluating a child with developmental coordination disorder. The child has difficulty with
balance and handwriting. Which assessment is most appropriate?
• A) Bruininks-Oseretsky Test of Motor Proficiency (BOT-2).
• B) Sensory Integration and Praxis Tests (SIPT).
• C) Vineland Adaptive Behavior Scales.
• D) Pediatric Evaluation of Disability Inventory (PEDI).
Correct Answer : A) Bruininks-Oseretsky Test of Motor Proficiency (BOT-2).
Rationale: The BOT-2 assesses fine and gross motor skills, including balance and manual dexterity,
making it ideal for children with motor coordination difficulties.
9. A client with carpal tunnel syndrome reports night pain and difficulty gripping objects. What is
the most appropriate assessment to identify the underlying cause?
• A) Nerve conduction study.
• B) Grip strength dynamometry.
• C) Phalen’s test.
• D) Tinel’s sign.
, 4
Correct Answer : A) Nerve conduction study.
Rationale: A nerve conduction study confirms the diagnosis of carpal tunnel syndrome by measuring the
speed of nerve impulses across the wrist.
10. An OTR is evaluating a client with depression who reports low motivation for daily activities. What
is the most important factor to assess?
• A) The client’s past work history.
• B) The client’s current living environment.
• C) The client’s level of interest in activities.
• D) The client’s medication regimen.
Correct Answer : C) The client’s level of interest in activities.
Rationale: Anhedonia (loss of interest in previously enjoyed activities) is a core symptom of depression.
Assessing the client’s motivation helps guide meaningful engagement.
11. A client with a hand burn is referred for an evaluation. What is the priority assessment?
• A) Active and passive range of motion of the hand.
• B) Scar management needs.
• C) Pain level.
• D) Activities of daily living performance.
Correct Answer : A) Active and passive range of motion of the hand.
Rationale: Following a burn, preventing contractures is critical. Assessing ROM early allows the OTR to
initiate splinting and positioning to maintain function.
12. An OTR is assessing a 10-year-old with a learning disability. The child has difficulty with
handwriting and copying from the board. What is the most appropriate assessment?
• A) Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI).
• B) Peabody Developmental Motor Scales.
• C) Sensory Profile.
• D) Bruininks-Oseretsky Test of Motor Proficiency.
Correct Answer : A) Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI).
Rationale: The VMI specifically assesses the integration of visual perception and motor skills, which is
essential for handwriting and copying tasks.
