NBCOT OTR Practice Questions 2026: 8 Exam-Style Items Explained

Answer: B — Perseveration

Perseveration is the continued repetition of a movement, word or task after it is no longer appropriate, and it is common after frontal-lobe damage. The sock is already on, so the repeated pulling reflects an inability to stop or shift the motor plan, not a perception problem. Intervention targets shifting set, such as cueing the next step or changing the task.

• A. Asomatognosia is a lack of awareness of body structure and how body parts relate; she knows where her foot is and is acting on it.
• C. Unilateral body neglect means ignoring one side of the body; she is attending to the foot, just for too long.
• D. Visual agnosia is failure to recognize objects by sight; she has recognized the sock and is using it.

Answer: C — Minimal assistance

On the revised 10-level Rancho scale, Level VII (Automatic-Appropriate) is defined as needing minimal assistance for routine daily living skills: the client does familiar routines almost automatically but still has impaired judgment, safety awareness and problem solving. Each level of the revised scale carries its own assistance level, which is why the number matters in a planning item.

• A. Maximal assistance matches Levels IV and V (Confused-Agitated and Confused-Inappropriate, Non-Agitated).
• B. Moderate assistance matches Level VI (Confused-Appropriate), where the client follows simple directions but still needs moderate help.
• D. Stand-by assistance matches Level VIII (Purposeful-Appropriate); a Level VII client still needs minimal hands-on or cueing help.

Answer: B — Walking very briskly on level ground (about 4.5 mph)

In the Compendium of Physical Activities, walking on level ground at about 4.5 mph costs roughly 7 METs, above the ordered ceiling. Bed making (about 3 METs), general gardening (about 4 METs) and water aerobics (about 5.5 METs) all fall under 6, so they can be graded into the plan while the therapist monitors symptoms, heart rate and perceived exertion.

• A. General gardening is about 4 METs, within the 6-MET limit.
• C. Making a bed is about 3 METs, a typical light IADL that fits the order.
• D. Water aerobics is about 5.5 METs, close to but under the ceiling, so it is acceptable with monitoring.

Answer: C — Intensive therapy for her sexual concerns

PLISSIT has four tiers: Permission, Limited Information, Specific Suggestions and Intensive Therapy. Entry-level practitioners work in the first three tiers; Intensive Therapy requires advanced training, so the correct action at that tier is referral to a qualified specialist. Sexual activity is an ADL in the OTPF-4, so the first three tiers are within OT scope.

• A. STI prevention education is Limited Information, the second tier, and within entry-level scope.
• B. Assertiveness training is a Specific Suggestion tied to her safety and social participation, the third tier, and within entry-level scope.
• D. Basic information about the menstrual cycle is Limited Information and supports health management.

Answer: B — Fluidotherapy

Fluidotherapy circulates heated air through a bed of fine cellulose particles; the moving medium transfers heat by convection, and the client can exercise the hand inside the unit. PAM items are often separated by heat-transfer mode: conduction, convection, conversion or radiation. State practice acts may also require documented competency before an OT uses PAMs.

• A. Paraffin heats by conduction through direct contact with the wax, and the hand is held still inside the wax glove.
• C. Ultrasound is a deep heating agent that works by conversion of acoustic energy, not a superficial convection agent.
• D. Iontophoresis uses direct current to drive ionized medication through the skin; it is not a heating modality.

Answer: B — Storing clean cups in the cupboard to the left of the dishwasher

A remedial approach makes the client work at the deficit: placing frequently used items in left space forces him to scan and reach into the neglected side during a daily task. His awareness and motivation make him a good candidate for this approach. The other choices keep things in intact space, which is compensation.

• A. Placing items on the right keeps them in intact space; this compensates for the neglect instead of retraining attention.
• C. Midline placement avoids the neglected field, so it does not challenge left-sided scanning.
• D. Having people approach from the right is a classic compensatory change, suited to clients with poor awareness, not to restoring attention.

Answer: C — Stop the session and call emergency medical services

Flushed dry skin, extreme thirst and deep, rapid (Kussmaul) breathing point to hyperglycemia progressing to diabetic ketoacidosis, which needs emergency treatment with fluids and insulin. The therapist stops the activity and activates EMS. Fast-acting sugar is the response to hypoglycemia (shaky, sweaty, pale, hungry), which this client does not show.

• A. Fluids by mouth cannot reverse ketoacidosis, and continuing exercise with these signs is unsafe.
• B. Sugar treats hypoglycemia; this picture is hyperglycemic, and giving sugar delays the care he needs.
• D. Waiting while he has Kussmaul breathing delays treatment of a life-threatening emergency.

Answer: B — Going with his daughter for a haircut about once a month

Under the Medicare Benefit Policy Manual (Chapter 7, section 30.1.1), a homebound client may still leave home for health care, religious services and adult day care, and may make infrequent, short non-medical trips; CMS gives an occasional trip to the barber as an example. What matters is that leaving home normally takes a considerable and taxing effort and requires a device, special transportation or another person's help.

• A. Driving himself to shop several times a week shows he can leave home without a considerable and taxing effort.
• C. A daily recreational outing is frequent, not an infrequent, short absence.
• D. Regular part-time work outside the home is inconsistent with a normal inability to leave home.