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The Occupational Therapist Registered (OTR) exam is developed and administered by the National Board for Certification in Occupational Therapy (NBCOT) as a means of certifying the character and competency of entry-level occupational therapists in order to protect the public interest and the integrity of the profession.[1] NBCOT is a non-profit agency that has certified over 214,000 occupational therapy health care professionals in the United States through its fully accredited credentialing programs.[2] NBCOT conducts periodic job task analyses to determine which tasks are more often performed by entry-level registered occupational therapists, and which tasks are most critical to their job function. The results of these analyses are then used to update the OTR exam to reflect current practice in the field. The most recent of these analyses was conducted in 2008.[3]

Function of the Test

NBCOT-OTR Study Guide

Registered occupational therapists are health care professionals that provide patient needs and abilities assessment, therapeutic planning and supervision, and evaluation of outcomes for individuals who face challenges in function in their daily roles and activities.[4] The OTR certification exam provides the public and potential employers with the assurance that those engaged in the practice of occupational therapy have achieved a widely accepted standard level of knowledge, skills, and professional behavior.[5] Certification is required for licensure and employment as an occupational therapist in all 50 states as well as in the District of Columbia.[6] According to a recent TIME, Inc. article, occupational therapy is among the fastest-growing and best-paid occupations, with an average hourly wage of $36.25.[7] Candidates must have a minimum of an entry level master’s degree in occupational therapy (OT) in order to take the OTR certification exam. Students who are candidates for graduation from an entry-level master’s or doctoral OT degree program may apply for and take the exam, but their results will not be released until they submit proof of graduation.[8] Candidates must be of sound moral and ethical character to be certified by NBCOT. Any candidate whose background includes professional or collegiate disciplinary action or suspension, or who has been convicted of a felony, must provide additional documentation to be considered for the exam.[9]

Test Administration

NBCOT-OTR Flashcards

Exams are held throughout the year at Prometric testing centers, available in multiple locations in every state.[10] Applications may be submitted online and paid for by credit card via the MyNBCOT online portal, or by completing a paper application. Academic credentials must be verified by having official transcripts (or an “Academic Credential Verification Form” for current students) sent to NBCOT from the applicant’s college or university.[11] The paper application fee is $540. Candidates whose state licensing boards require confirmation of eligibility to take the exam must pay an additional $40. If the state requires an official score report for licensing, the applicant must pay an additional $40 for this service.[12] OT students or potential students who are concerned about possible issues related to their background may apply to NBCOT for early determination of eligibility before investing in their certification career path and applying to take the exam.[13] The cost to apply for early determination is $225.[14] Special accommodations are available for individuals with documented disabilities. Candidates requiring such accommodations must request them at the time of application and submit a “Testing Accommodations Provider Recommendation Form” completed by an appropriate health care provider to NBCOT, along with supporting documentation.[15] A candidate who does not pass the exam may reapply after a 30-day waiting period.[16]

Test Format

Sections of the OTR Test
OTR Test Subject Areas  % of Exam
Acquire information regarding factors that influence occupational

performance throughout the occupational therapy process.

Formulate conclusions regarding client needs and priorities to develop

and monitor an intervention plan throughout the occupational therapy process

Select interventions for managing a client-centered plan throughout the

occupational therapy process

Manage and direct occupational therapy services to promote quality in practice 10%
Total 100%

Test Structure

The NBCOT OTR consists of four main domains of knowledge: Acquire information regarding factors that influence occupational performance throughout the occupational therapy process; formulate conclusions regarding client needs and priorities to develop and monitor an intervention plan throughout the occupational therapy process; select interventions for managing a client centered plan throughout the occupational therapy process; manage and direct occupational therapy services to promote quality in practice. The OTR contains questions in the format of multiple choice questions, scenario-based multiple choice questions, and clinical simulation test (CST) questions. [17]

Test Environment

Testing for NBCOT exams take place at Prometric Testing Centers. There, candidates are expected to arrive at least thirty minutes early, and present a government issued identification that contains a photo and signature. A secondary identification is also required, such as a debit or credit card, or voter registration card. The NBCOT OTR exam takes place on a computer format. The time allotted to complete all 170 multiple choice questions and three CST problems is four hours. There is a ten minute tutorial before the exam begins, and it will not count against the allotted four hours. [18]

Test Content

  • Sample NBCOT OTR Practice Questions
  1. An occupational therapist is working in an outpatient orthopedic clinic. During the patient's history the patient reports, "I tore 3 of my 4 Rotator cuff muscles in the past." Which of the following muscles cannot be considered as possibly being torn?
    A. Teres minor
    B. Teres major
    C. Supraspinatus
    D. Infraspinatus
  2. An occupational therapist has been instructed to provide hand wound care for a patient that has active TB and HIV. The occupational therapist should wear which of the following safety equipment?
    A. Sterile gloves, mask, and goggles
    B. Surgical cap, gloves, mask, and proper shoewear
    C. Double gloves, gown, and mask
    D. Goggles, mask, gloves, and gown
  3. A patient asks an occupational therapist the following question. Exposure to TB can be identified best with which of the following procedures?
    A. Chest x-ray
    B. Mantoux test
    C. Breath sounds examination
    D. Sputum culture for gram-negative bacteria
  4. Tricyclics (Antidepressants) sometimes have which of the following adverse affects on patients that have a diagnosis of depression?
    A. Shortness of breath
    B. Fainting
    C. Large Intestine ulcers
    D. Distal muscular weakness
  5. An occupational therapist has been assigned a patient who has recently been diagnosed with Guillain-Barre’ Syndrome. Which of the following statements is the most applicable when discussing the impairments with Guillain-Barre’ Syndrome with the patient?
    A. Guillain-Barre' Syndrome gets better after 5 years in almost all cases.
    B. Guillain-Barre' Syndrome causes limited sensation in the abdominal region.
    C. Guillain-Barre' Syndrome causes muscle weakness in the legs.
    D. Guillain-Barre' Syndrome does not effect breathing in severe cases
  6. A patient has just been prescribed Minipress to control hypertension. The occupational therapist should instruct the patient to be observant of the following:
    A. Dizziness and light headed sensations
    B. Weight gain
    C. Sensory changes in the lower extremities
    D. Fatigue
  7. An occupational therapist suspects a patient is developing Bell's Palsy. The occupational therapist wants to test the function of the cranial nerve VII. Which of the following would be the most appropriate testing procedures?
    A. Test the taste sensation over the back of the tongue and activation of the facial muscles.
    B. Test the taste sensation over the front of the tongue and activation of the facial muscles.
    C. Test the sensation of the facial muscles and sensation of the back of the tongue.
    D. Test the sensation of the facial muscles and sensation of the front of the tongue.
  8. Which of the following medications is not considered a neuromuscular blocker?
    A. Anectine
    B. Pavulon
    C. Pitressin
    D. Mivacron
  9. An occupational therapist is reviewing a patient’s medical record. The record indicates the patient has limited shoulder flexion on the left. Which plane of movement is limited?
    A. Horizontal
    B. Sagittal
    C. Frontal
    D. Vertical

More free NBCOT-OTR practice test questions.


Previous week exam scores are posted online every Thursday.[19] The OTR exam consists of two sections, each containing a different type of question. These two sections are scored differently. The first section uses a multiple-choice format in which each question has only one correct answer. Because only correct answers are counted when computing the score, there is no penalty for guessing when a candidate is not sure of the correct answer to a given question in this format. The second section contains practice-based scenario questions which may have more than one correct answer. For these questions, a candidate must choose from among as many as 12 possible answers. These types of questions are scored differently. Each correct answer is awarded points toward the candidate’s total score while each incorrect answer deducts points from the total score. Some options are neutral, or not particularly relevant to the question, and are therefore not scored. Points are not deducted for items that are not selected. For these types of questions, candidates should select only those answers in which they have a high degree of confidence.[20] To score the exam, raw scores are converted based on a scale that adjusts for differences in difficulty among multiple forms of the exam. The resulting scaled score may be between 300 and 600. A scaled score of 450 or above is required to pass the exam. This score is consistent across all versions of the exam.[21] Exams are scored on a rolling basis with results for the week posted each Thursday for candidates to view via their MyNBCOT portal page accessible through the NBCOT Web site. Within 4-6 weeks, candidates who pass the exam will receive their OTR certificate and scaled score results via postal mail. Candidates who do not pass the exam receive their scaled scores with a report showing their performance in each subject area on the exam to assist them in studying to retake the exam successfully, along with instructions for reapplying with NBCOT.[22]

Answers to Sample Questions

1;B 2;D 3;B 4;B 5;C 6;A 7;B 8;C 9;B


  1. ^ About The Exam July 13, 2015
  2. ^ About NBCOT July 13, 2015
  3. ^ Foundations of the NBCOT Certification Examinations August 1, 2015
  4. ^ About Occupational Therapy July 13, 2015
  5. ^ About The Exam July 13, 2015
  6. ^ About NBCOT July 13, 2015
  7. ^ These Are The 5 Most In-Demand Jobs Right Now
  8. ^ Certification Eligibility Requirements July 13, 2015
  9. ^ Character Review July 13, 2015
  10. ^ About The Exam July 13, 2015
  11. ^ Apply for the Exam July 13, 2015
  12. ^ cert-exam-app.pdf July 13, 2015
  13. ^ Early Determination July 13, 2015
  14. ^ Early Determination Review Payment Form July 13, 2015
  15. ^ [1] July 13, 2015
  16. ^ Repeat Candidates August 1, 2015
  17. ^ NBCOT blueprints 10 August 2015
  18. ^ NBCOT Exam Information 10 August 2015
  19. ^ [2] July 13, 2015
  20. ^ Foundations of the NBCOT Certification Examinations August 1, 2015
  21. ^ Foundations of the NBCOT Certification Examinations August 1, 2015
  22. ^ After the Exam August 1, 2015