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Free OTR exam Practice Questions

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Sample Practice Questions

Try these 10 sample questions from the OTR exam practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

  1. 1An OTR is comparing a 12-month-old infant's grasp pattern against CDC's milestone checklist for that age before recommending finger-feeding activities. Which grasp-related skill does CDC list among the movement and physical development milestones most babies reach by 12 months?

    1. A. Picks things up between thumb and pointer finger, like small bits of food
    2. B. Stacks at least two small objects, like blocks
    3. C. Strings items together, like large beads or macaroni
    4. D. Holds crayon or pencil between fingers and thumb

    Answer: A

    Explanation: CDC's milestone checklist for 12 months lists, under movement and physical development, "Picks things up between thumb and pointer finger, like small bits of food". The other three options are also real CDC milestones, but CDC lists them at later ages: stacking at least two small objects at 15 months, stringing large beads or macaroni at 3 years, and holding a crayon or pencil between fingers and thumb at 4 years.

    Reference: Cdc Milestone Checklists — CDC Learn the Signs. Act Early. milestone checklists, Your baby at 12 months, Movement/Physical Development Milestones

  2. 2An OTR is deciding between a structured performance-based cognitive interview and a staff questionnaire for an older adult. According to CMS's assessment manual, what does direct or performance-based testing of cognitive function achieve?

    1. A. It decreases the chance of incorrect labeling and improves detection of delirium
    2. B. It decreases the time the assessment takes and improves staff agreement on scores
    3. C. It removes the influence of hearing loss and improves the score's stability over time
    4. D. It removes the need for a mood assessment and improves the care plan's specificity

    Answer: A

    Explanation: The manual states that "Direct or performance-based testing of cognitive function decreases the chance of incorrect labeling of cognitive ability and improves detection of delirium." Administration time, staff agreement, elimination of hearing effects, and substitution for mood assessment are all plausible benefits, but none of them is the benefit the manual attributes to direct testing.

    Reference: Minimum Data Set 3.0 Resident Assessment Instrument User’s Manual v1.20.1 — CMS RAI Manual, CH 3: MDS Items [C], C0200: Item Rationale, Health-related Quality of Life

  3. 3An occupational therapist is preparing intervention for an outpatient recovering from a hip replacement whose goal is independent dressing and homemaking. Which preparatory focus does Medicare outpatient therapy policy give as the compensatory technique example for this condition?

    1. A. Techniques of standing tolerance and balance
    2. B. Techniques of one-handed tool use and stabilization
    3. C. Techniques of prosthetic donning and skin inspection
    4. D. Techniques of sensory reeducation and desensitization

    Answer: A

    Explanation: The manual gives as an example of teaching compensatory technique "Teaching a patient with a hip fracture/hip replacement techniques of standing tolerance and balance to enable the patient to perform such functional activities as dressing and homemaking tasks." One-handed technique is the manual's example for a patient who has lost the use of an arm, prosthetic use is its example for an upper extremity amputee, and sensory reeducation is not among its compensatory technique examples.

    Reference: Medicare Benefit Policy Manual — Medicare Benefit Policy Manual, Chapter 15, §230 (230.2), A. General

  4. 4An OTR is appraising a federal clinical practice guideline and wants to know what determines how strongly each recommendation is graded. According to the VA and DoD stroke rehabilitation guideline, which four domains inform the strength of each recommendation?

    1. A. Confidence in evidence quality; balance of outcomes; patient values and preferences; other considerations
    2. B. Study design hierarchy; sample size adequacy; statistical significance; author consensus level
    3. C. Cost of the intervention; availability of trained staff; payer coverage; regulatory approval status
    4. D. Prevalence of the condition; severity of the condition; duration of treatment; setting of delivery

    Answer: A

    Explanation: The guideline states that the GRADE approach "uses the following four domains to inform the strength of each recommendation": "Confidence in the quality of the evidence," "Balance of desirable and undesirable outcomes," "Patient values and preferences," and "Other considerations, as appropriate (e.g., resource use, equity, acceptability, feasibility, subgroup considerations)." Study design hierarchy, cost and staffing, and disease characteristics are real appraisal inputs but are not the four domains this framework names.

    Reference: VA DoD CPG for Management of Stroke Rehabilitation — VA/DoD Stroke Rehabilitation CPG, Section A, Evidence Quality and Recommendation Strength

  5. 5An OTR preparing caregiver education on utensil use needs to name the age at which CDC's milestone checklists list eating with a spoon, rather than only trying to use one, as something most children do. At which age does CDC list eating with a spoon?

    1. A. 2 years
    2. B. 15 months
    3. C. 18 months
    4. D. 3 years

    Answer: A

    Explanation: CDC's checklist for 2 years lists "Eats with a spoon" under movement and physical development, while the 18-month checklist lists only "Tries to use a spoon". The 15-month checklist contains no spoon item at all, and by 3 years CDC has moved on to "Uses a fork".

    Reference: Cdc Milestone Checklists — CDC Learn the Signs. Act Early. milestone checklists, Your child at 2 years, Your child at 18 months, and Your child at 3 years

  6. 6An OTR wants to use repeated administrations of a standardized cognitive screen to inform care planning across a stay. According to CMS's assessment manual, what property of the screen makes that use possible?

    1. A. A resident's performance on cognitive tests can be compared over time
    2. B. A resident's performance on cognitive tests is unaffected by acute illness
    3. C. A resident's performance on cognitive tests predicts discharge destination
    4. D. A resident's performance on cognitive tests establishes a formal diagnosis

    Answer: A

    Explanation: The manual states under planning for care that "A resident's performance on cognitive tests can be compared over time." Independence from acute illness is contradicted by the manual's warning that abrupt change may signal delirium; prediction of discharge destination and establishment of a diagnosis are uses the manual does not claim for the screen.

    Reference: Minimum Data Set 3.0 Resident Assessment Instrument User’s Manual v1.20.1 — CMS RAI Manual, CH 3: MDS Items [C], C0200: Item Rationale, Planning for Care

  7. 7An occupational therapist sets up a graded woodworking activity on an inclined table for a client who lost shoulder, elbow, and wrist range of motion after burns. Under Medicare outpatient therapy policy, which category of occupational therapy service does that activity illustrate?

    1. A. Selection and teaching of task-oriented therapeutic activities to restore physical function
    2. B. Planning and implementing therapeutic tasks to restore sensory-integrative function
    3. C. Teaching compensatory technique to improve independence in activities of daily living
    4. D. Evaluation and reevaluation of function by administering diagnostic and prognostic tests

    Answer: A

    Explanation: The manual lists as one form of occupational therapy "The selection and teaching of task-oriented therapeutic activities designed to restore physical function; e.g., use of woodworking activities on an inclined table to restore shoulder, elbow, and wrist range of motion lost as a result of burns". Sensory-integrative work, compensatory technique, and evaluation are the manual's other listed categories, each with its own examples, and none covers this activity.

    Reference: Medicare Benefit Policy Manual — Medicare Benefit Policy Manual, Chapter 15, §230 (230.2), A. General

  8. 8An OTR reads a guideline statement beginning with the words we suggest and wants to know what grade that phrasing signals. According to the VA and DoD stroke rehabilitation guideline's table of corresponding text, which strength and direction does that wording indicate?

    1. A. Weak for
    2. B. Strong for
    3. C. Weak against
    4. D. Neither for nor against

    Answer: A

    Explanation: The guideline's table pairs "Strong for" with "We recommend . . .", "Weak for" with "We suggest . . .", "Neither for nor against" with "There is insufficient evidence to recommend for or against . . .", and "Weak against" with "We suggest against . . .". So the phrase in the stem signals a Weak for recommendation.

    Reference: VA DoD CPG for Management of Stroke Rehabilitation — VA/DoD Stroke Rehabilitation CPG, Table 2, Strength and Direction of Recommendations and General Corresponding Text

  9. 9An OTR is building a weekly wellness group for community-dwelling adults over 70 and must identify the activity component that the federal physical activity guidelines add for older adults beyond what they recommend for all adults. Which component do those guidelines add specifically for older adults?

    1. A. Balance training, as part of multicomponent physical activity
    2. B. Flexibility training, as part of multicomponent physical activity
    3. C. Bone-strengthening activity on at least 3 days a week
    4. D. Vigorous-intensity aerobic activity on at least 3 days a week

    Answer: A

    Explanation: The Physical Activity Guidelines for Americans state that "older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities". Bone-strengthening activity on at least 3 days a week and vigorous-intensity activity on at least 3 days a week are both real key guidelines in the same document, but they appear under children and adolescents ages 6 through 17, not older adults.

    Reference: Physical Activity Guidelines for Americans, 2nd edition — Physical Activity Guidelines for Americans, Second Edition, Key Guidelines for Older Adults and Key Guidelines for Children and Adolescents

  10. 10An OTR completes a standardized mood interview with an older adult and finds several symptoms of depressed mood present. According to CMS's assessment manual, what may the assessor conclude from that result?

    1. A. Only that specific clinical signs and symptoms of depressed mood are present
    2. B. That the resident meets criteria for a diagnosis of major depressive disorder
    3. C. That the resident should be excluded from group therapeutic activities
    4. D. That the resident's cognitive screening result is invalid and must be repeated

    Answer: A

    Explanation: The manual states that "coding the presence of clinical signs and symptoms of depressed mood does not automatically mean that the resident has a diagnosis of depression or other mood disorder. Assessors do not make or assign a diagnosis based on these findings; they simply record the presence or absence of specific clinical signs and symptoms of depressed mood." The other three conclusions overreach in different directions, and the manual in fact directs staff to "consider them when developing the resident's individualized care plan."

    Reference: Minimum Data Set 3.0 Resident Assessment Instrument User’s Manual v1.20.1 — CMS RAI Manual, CH 3: MDS Items [D], D0150: Item Rationale, Health-related Quality of Life

Topics in this practice bank

These topics describe the available practice for OTR exam. Review the examination outline and its sources for scope and allocation details.

  • Domain 1 — Evaluation and Assessment: Acquire information regarding factors that influence occupational performance on an ongoing basis throughout the occupational therapy process.
    • Task 1: Identify the influence of development and lived experience; body functions and body structures; values, beliefs, and spirituality; and identity on occupational performance.
    • Task 1 knowledge 1: Impact of typical development and aging on occupational performance, health, and wellness across the life span.
    • Task 1 knowledge 2: Expected patterns, progressions, and prognoses associated with conditions that limit occupational performance. Examples include signs and symptoms of disease; stages of disease; secondary complications.
    • Task 1 knowledge 3: Impact of body functions and body structures on occupational performance. Examples include cognitive impairments; congenital anomalies.
    • Task 1 knowledge 4: Influence of lived experiences and identity on occupational performance. Examples include history of trauma and adverse childhood events; socioeconomic status; gender, race, culture, religion.
    • Task 2: Assess a client’s functional skills, roles, prioritized needs and wants, and performance context to evaluate their occupational performance.
    • Task 2 knowledge 1: Resources and considerations for acquiring information about the client’s current condition and occupational performance. Examples include referrals; client records; developmental history; Individualized Education Program (IEP) plans; theoretical approach and frame of reference.
    • Task 2 knowledge 2: Administration, purpose, indications, advantages, and limitations of standardized and nonstandardized screening and assessment tools. Examples include criterion-referenced tests; norm-referenced tests; client and caregiver interviews; observation.
    • Task 2 knowledge 3: Internal and external factors influencing a client’s engagement in occupation. Examples include roles, habits, routines, and rituals; environmental context; family and social supports; medication side effects and interactions; mental health.
    • Task 3: Perform an activity analysis to determine the influence of task demands, current conditions, performance skills, and context on occupation.
    • Task 3 knowledge 1: Task requirements, steps to task completion, and task demands across contexts or settings.
    • Task 3 knowledge 2: Personal and environmental factors that facilitate or inhibit task completion or occupational engagement. Examples include compensation patterns; role of performance context; influence of current conditions.
  • Domain 2 — Analysis, Interpretation, and Planning: Formulate conclusions regarding client needs and priorities to develop and monitor an intervention plan throughout the occupational therapy process.
    • Task 1: Synthesize assessment results to determine eligibility for services and establish a client-centered intervention plan.
    • Task 1 knowledge 1: Interpretation and analysis of quantitative assessments. Examples include statistical terminology; scoring; limitations of scores; client reactions to testing.
    • Task 1 knowledge 2: Interpretation of qualitative findings. Examples include occupational profile; outcomes of needs assessment; results from interviews or observations.
    • Task 1 knowledge 3: Integration and application of quantitative assessment results and qualitative findings to guide critical decision-making and prioritize needs.
    • Task 2: Collaborate with the client, the client’s relevant others, occupational therapy colleagues, and other professionals using a client-centered approach and therapeutic use of self to manage occupational therapy services.
    • Task 2 knowledge 1: Roles and responsibilities among interprofessional teams when coordinating client care and providing services. Examples include referral to and consultation with other services; interprofessional communication methods; scope of practice.
    • Task 2 knowledge 2: Processes for managing interprofessional intervention plans. Examples include Individualized Education Program (IEP) plans; discharge plans; transition plans; palliative and hospice care plans.
    • Task 2 knowledge 3: Client-centered approaches and considerations for coordinating occupational therapy services. Examples include therapeutic use of self; advocacy; frequency/duration of intervention; level of service delivery.
    • Task 2 knowledge 4: Factors used to prioritize intervention goals and activities in collaboration with the client and family, teacher, caregiver, and relevant others. Examples include client-reported outcomes; level of support required; context of service delivery; progress toward goals.
    • Task 2 knowledge 5: Strategies for addressing and enhancing health literacy with the client and relevant others. Examples include caregiver training; teaching-learning models; methods for making health information accessible; informed decision-making; navigating challenges to professional expertise.
    • Task 3: Monitor and modify the intervention plan, approach, context, and goals on an ongoing basis using clinical reasoning.
    • Task 3 knowledge 1: Factors for determining and managing context and activities to meet individual and group intervention goals and objectives. Examples include client needs and priorities; response to intervention.
    • Task 3 knowledge 2: Strategies for monitoring the effectiveness of individual and group interventions. Examples include client-reported outcomes; reevaluation results; progress toward goals.
    • Task 3 knowledge 3: Clinical decision-making for assessing and adapting the intervention plan and prioritizing goals based on client response to intervention. Examples include physiological changes; behavioral reactions; emotion regulation; developmental needs.
    • Task 3 knowledge 4: Precautions or contraindications associated with a client’s condition or stage of recovery. Examples include postsurgical precautions; vital signs; laboratory values; suicidal ideation.
  • Domain 3 — Select and Manage Interventions: Select and implement interventions for managing a client-centered plan throughout the occupational therapy process.
    • Task 1: Incorporate preparatory techniques, activities, and modalities as an adjunct to interventions to promote healing and enhance engagement in occupation-based activities.
    • Task 1 knowledge 1: Considerations for selecting, preparing, and adapting the intervention technique to support optimal engagement and promote goal achievement. Examples include client condition; client safety.
    • Task 1 knowledge 2: Considerations for selecting, preparing, and adapting the intervention environment to support optimal engagement and promote goal achievement. Examples include ensuring privacy during telehealth sessions; equipment safety; line management.
    • Task 1 knowledge 3: Indications, contraindications, and precautions associated with wound management and maintaining skin integrity. Examples include stage of wound healing; prevention and management of pressure ulcers.
    • Task 1 knowledge 4: Indications, contraindications, precautions, and clinical application of superficial thermal agents. Examples include dry whirlpool; hot packs; cryotherapy.
    • Task 1 knowledge 5: Indications, contraindications, precautions, and clinical application of deep thermal, mechanical, and electrotherapeutic physical agent modalities. Examples include transcutaneous and neuromuscular electrical stimulation; biofeedback.
    • Task 2: Implement occupation-based strategies to support participation in activities of daily living (ADL), instrumental activities of daily living (IADL), health management, rest and sleep, education, work, play, leisure, and social participation across the life span.
    • Task 2 knowledge 1: Interventions for supporting leisure and play.
    • Task 2 knowledge 2: Methods for grading an activity, task, or technique based on level of development, client status, response to intervention, and client needs.
    • Task 2 knowledge 3: Considerations for facilitating individual and group participation in shared activities. Examples include group processes; group dynamics; group type and function.
    • Task 2 knowledge 4: Interventions to support cognitive, visual-motor, visual, and perceptual processing and sensory arousal. Examples include sensory modulation; proprioceptive input; vestibular strategies; low vision strategies.
    • Task 2 knowledge 5: Compensatory and remedial strategies for managing cognitive and perceptual deficits or developmental disabilities. Examples include graded cueing; chaining; metacognition; memory aids.
    • Task 2 knowledge 6: Adaptive and preventive strategies for supporting optimal engagement in occupation. Examples include use of technology/apps; joint protection; task simplification; energy conservation.
    • Task 2 knowledge 7: Intervention strategies and techniques used to facilitate oral motor skills for drinking, eating, and swallowing. Examples include hand-to-mouth patterns; mastication; adaptive utensils; positioning at mealtime.
    • Task 2 knowledge 8: Prevocational, vocational, and transitional services, options, and resources for supporting strengths, interests, employment, and lifestyle goals across the life span.
    • Task 2 knowledge 9: Strategies, techniques, and client-centered education to facilitate functional transfers.
    • Task 2 knowledge 10: Strategies for promoting wellness and mental health. Examples include relaxation; sleep hygiene; addiction management.
    • Task 3: Select and implement interventions for improving sensory, motor, neurological, and physiological status, considering client condition and current stage of recovery, to support occupational performance.
    • Task 3 knowledge 1: Methods for grading therapeutic exercise and conditioning programs consistent with indications and precautions.
    • Task 3 knowledge 2: Techniques for sensory and motor reeducation, pain management, desensitization, edema reduction, and scar management. Examples include manual edema mobilization; nerve gliding; neuromuscular reeducation; constraint-induced movement.
    • Task 3 knowledge 3: Techniques for promoting improved postural stability, dynamic balance, body mechanics, and breathing patterns during functional tasks.
    • Task 4: Select, fabricate, and modify orthotic devices, and provide training in the use of orthotic and prosthetic devices to support functional outcomes.
    • Task 4 knowledge 1: Types and functions of immobilization, mobilization, and restriction orthoses for managing specific conditions and congenital anomalies across the life span.
    • Task 4 knowledge 2: Types and functions of prosthetic devices for upper and lower extremity amputations.
    • Task 4 knowledge 3: Implications of anatomical, physiological, biomechanical, cognitive, and socioeconomic factors and healing principles for orthotic selection, design, fabrication, and modification.
    • Task 4 knowledge 4: Client-centered education and training methods for the safe and effective use of orthotic and prosthetic devices.
    • Task 5: Select assistive technology options, adaptive devices, mobility aids, and other durable medical equipment to enable participation in occupation.
    • Task 5 knowledge 1: Factors related to measuring, selecting, monitoring the fit of, and recommending modifications to seating systems, positioning devices, and mobility aids. Examples include equipment components; biomechanical considerations; usability and maintenance.
    • Task 5 knowledge 2: Types, characteristics, and features of high- and low-tech assistive technology and adaptive devices. Examples include interface options and processor parameters; equipment components.
    • Task 5 knowledge 3: Mobility options, vehicle adaptations, and alternative devices for supporting participation in community mobility. Examples include adapted driving controls; wheelchair tie downs; alternative transportation options; dynamic mobile standers; navigation apps.
    • Task 5 knowledge 4: Client factors influencing successful use and maintenance of assistive technology options, adaptive devices, mobility aids, and other durable medical equipment. Examples include developmental, physical, functional, cognitive, and mental health status; prioritized needs.
    • Task 5 knowledge 5: Client-centered education and training methods for successful use and maintenance of assistive technology options, adaptive devices, mobility aids, and other durable medical equipment.
    • Task 6: Recommend environmental modifications, while considering accessibility guidelines, standards, and legislation, to support participation in occupation consistent with client needs and status, task demands, and context.
    • Task 6 knowledge 1: Principles of ergonomics and universal design for identifying, recommending, and implementing features and reasonable accommodations in the workplace, home, and virtual and public spaces.
    • Task 6 knowledge 2: Processes and procedures for identifying, recommending, and implementing modifications in the workplace, home, and virtual and public spaces.
  • Domain 4 — Competency and Practice Management: Manage professional activities of self and relevant others as guided by evidence, regulatory compliance, and standards of practice to promote quality care.
    • Task 1: Employ evidence-based strategies and approaches to provide safe, effective, and efficient services relevant to individuals, groups, and populations.
    • Task 1 knowledge 1: Methods for locating, reviewing, interpreting, and critically appraising scholarly research to guide practice-relevant decision-making. Examples include defining a clinical question; determining the clinical bottom line.
    • Task 1 knowledge 2: Methods for applying continuous quality improvement processes and procedures to occupational therapy service delivery. Examples include program evaluation; outcome measures.
    • Task 1 knowledge 3: Evidence-based programming for advancing population health outcomes. Examples include aging in place; fall prevention; health and wellness; community support groups.
    • Task 2: Incorporate risk management techniques at the individual and practice-setting levels to protect clients, self, staff, and others from injury or harm.
    • Task 2 knowledge 1: Infection control procedures and universal precautions for reducing transmission of contaminants. Examples include PPE; isolation precautions; cleaning equipment.
    • Task 2 knowledge 2: Responses to adverse reactions, minor injuries, and emergency situations. Examples include minor burns and cuts; seizures; diabetic reactions.
    • Task 2 knowledge 3: Preventive measures for minimizing risk and promoting safety. Examples include proper body mechanics; safety data sheet (SDS); standard operating procedures; equipment maintenance; emergency preparedness; personal safety in the client’s environment.
    • Task 2 knowledge 4: Strategies and resources to prevent professional burnout. Examples include assessment of personal needs; self-advocacy regarding workload; stress management.
    • Task 3: Provide occupational therapy services in accordance with laws, regulations, state occupational therapy practice acts, and accreditation guidelines to protect consumers and meet applicable reimbursement requirements related to the service delivery setting.
    • Task 3 knowledge 1: Application of federal regulations, state practice acts, facility policies, and accreditation guidelines related to service delivery across occupational therapy practice settings. Examples include health care legislation; accreditation organizations; licensing and credentialing; supervisory role under state practice acts.
    • Task 3 knowledge 2: Influence of reimbursement policies and guidelines on occupational therapy service delivery.
    • Task 3 knowledge 3: Accountability processes and procedures for justifying, tracking, and monitoring outcomes. Examples include relevant practice terminology; documentation guidelines.
    • Task 4: Engage in professional development and competency assessment activities relevant to the job role, practice setting, scope of practice, and professional certification standards.
    • Task 4 knowledge 1: Methods for identifying, documenting, and monitoring service competency and professional development needs. Examples include competency self-assessment; mentoring.
    • Task 4 knowledge 2: Application of ethical decision-making and professional behaviors guided by the NBCOT Practice Standards and Code of Conduct.

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