NBCOT practice questions are one of the most powerful tools for exam success—but only when they’re used the right way. Simply answering questions is not enough; understanding why an answer is correct (and why the others are not) is what builds true clinical reasoning. The NBCOT exam is designed to test decision-making, safety awareness, and client-centered judgment, which means many questions can feel subjective unless you know how to break them down systematically.
Top NBCOT practice questions are written to mirror the exam’s complex, scenario-based format, including multi-select items and clinical simulations. Reviewing detailed rationales helps you identify patterns the exam consistently rewards—such as prioritizing safety, selecting the least restrictive and most ethical intervention, and matching interventions to client goals and contexts. This process also exposes common traps, like choosing an intervention too early in the OT process or overlooking contraindications.
By studying practice questions with in-depth explanations, candidates learn how to think like the exam writers. Instead of memorizing facts, you develop a structured approach to reading questions, eliminating distractors, and selecting the best possible answer. Over time, this method improves confidence, reduces second-guessing, and directly translates to stronger performance across all NBCOT domains—making practice questions with rationales an essential part of any effective NBCOT study plan.
About NBCOT practice questions:
NBCOT practice questions are intentionally designed to test clinical reasoning over memorization, requiring candidates to think through realistic client scenarios rather than recall isolated facts. Most questions reflect situations an entry-level occupational therapist would face in practice and ask for the best next step in the OT process, not just a correct definition or diagnosis. As a result, strong performance depends on understanding priorities such as safety, client-centered care, appropriate assessment selection, and promotion of independence.
Many NBCOT scenarios emphasize initial intervention choices, especially before progressing to advanced or compensatory strategies. For example, in pediatric cases involving tactile defensiveness, practice questions often reward addressing daily routines—such as dressing habits or clothing textures—before introducing sensory tools or environmental modifications. This reflects the exam’s preference for starting with functional, occupation-based solutions that are meaningful to the child and family.
In physical rehabilitation scenarios, questions frequently assess knowledge of diagnosis-driven intervention selection. A common example is a client with a C5 spinal cord injury, where the most appropriate recommendation is often a mobile arm support to maximize upper extremity function and independence rather than passive or overly restrictive equipment. These questions reinforce the importance of matching assistive devices to available muscle function.
Psychosocial content on the NBCOT consistently prioritizes safety and ethical responsibility. Practice questions involving suicidal ideation typically require selecting interventions that ensure immediate safety while remaining within the OT scope of practice, such as using cognitive behavioral therapy (CBT) strategies to address thought patterns and coping skills, rather than providing counseling outside the therapist’s role.
Neurological rehabilitation questions commonly test positioning and handling principles. For post-stroke clients, practice items often highlight positioning strategies like side-lying on the affected side to promote sensory input, prevent neglect, and reduce abnormal tone. These scenarios assess whether candidates understand the therapeutic purpose behind positioning choices.
Management and professional responsibility questions also play a significant role. Scenarios may involve OTA supervision, delegation, and legal scope of practice, requiring candidates to identify what tasks can be delegated and what must remain the responsibility of the OTR. Additionally, assessment-related questions frequently test the ability to select appropriate tools, such as recognizing Finkelstein’s test as the correct assessment for de Quervain’s tenosynovitis.
NBCOT sample questions:
1) A child avoids playground equipment that requires her feet to be off the ground. What does this behavior MOST likely indicate?
A. Difficulty modulating proprioception.
B. Somatodyspraxia
C. Gravitational insecurity
D. Bilateral integration/sequencing deficit.
2) When the OT suspects tactile defensiveness as a rationale for a child’s challenges, in what area of participation should the OT focus on FIRST?
A. Play behavior
B. Dressing habits
C. Social skills
D. Leisure interests
3) An OT is working with an individual with schizophrenia who is in the process of preparing to move from a state hospital to a group home. During a baking group, the client becomes agitated and leaves the room when another client uses the electric hand mixer to mix the cake batter, and again when two clients begin to argue loudly about which type of icing to use. How would the OT BEST describe the behavior?
A. Low registration
B. Sensory avoiding
C. Sensation seeking
D. A hearing impairment
4) During a self-care evaluation of an individual who recently sustained a brain injury, the OT instructs the individual to comb his hair immediately after he washes his face. The individual washes his face quickly, but then the therapist must give him several reminders to comb his hair. The OT is MOST likely to identify this as a deficit in what area?
A. Working memory
B. Judgment
C. Hearing
D. Abstraction
5) An OT has been working with an individual who is recovering from a TBI. A standard pivot transfer has been successfully demonstrated in the gym. The MOST appropriate way to assess generalization of this new learning would be to have the patient perform which activity?
A. Identify potential hazards in the patient’s bathrooms that could make transfers unsafe
B. Select an appropriate tub bench and nonskid mat for the patient’s bathroom at home
C. Attempt a standard pivot transfer from wheelchair to bed in the patient’s hospital room
D. Attempt a sliding board transfer from wheelchair to tub
6) A toddler with spina bifida has been referred for assessment. When collecting the initial data during interview with the child’s parent, what should the OT focus on PRIMARILY?
A. A parent’s concerns and goals for the child
B. Child’s medical management
C. Equipment needs
D. Physical layout of the home
7) When evaluating an individual with coronary artery disease for controllable risk factors, what is MOST important for the OT to include as part of the assessment?
A. Determine the individual’s age and gender
B. Assess the individual’s lifestyle and dietary habits
C. Observe the individual for obesity and cholesterol levels
D. Determine whether the individual has a family history of heart disease
8) An OT is evaluating two-point discrimination in an individual with median nerve injury. What is the BEST way to administer this test?
A. Apply the stimuli beginning at the little finger and progress toward the thumb
B. Start with the thumb area first, then progress toward the little finger
C. Present stimuli in an organized pattern to improve reliability during retesting
D. Allow the individual unlimited time to respond
9) A high school teacher diagnosed with a right-hemisphere CVA is given a paper with letters of the alphabet displayed in random order across the page and is instructed to cross out every “M.” The individual misses half of the “M”s in a random pattern. What type of deficit would cause such a response?
A. A left visual field cut
B. A right visual field cut
C. Functional illiteracy
D. Decreased attention
10) While making brownies, an individual is able to obtain all the supplies from the cabinet and check the oven temperature periodically. However, when the TV is turned on halfway through the activity, she becomes involved with the program and burns the brownies. This individual is showing signs of a deficit in which area?
A. Sustained attention
B. Detecting and reacting
C. Shifting of attention
D. Mental tracking
Conclusion:
Overall, NBCOT practice questions reward candidates who can integrate assessment findings, prioritize safety, and choose interventions that promote independence and participation. Developing the habit of reviewing rationales—especially for why incorrect options are unsafe, premature, or outside OT scope—helps transform practice questions into one of the most effective tools for NBCOT exam success.