Free NBCOT Practice Test (OTR Occupational Therapist Exam)
Occupational therapist practice questions and scenario sets written to the NBCOT OTR content outline, with an explanation for every answer.
Which approach to client education uses the stages of change model?
444 original questions · 28 scenario sets with six-option, select-three items like the real exam’s · 173 intervention questions on modalities, ADL, orthotics and equipment
NBCOT practice questions by exam domain
NBCOT’s content outline fixes each domain’s share of the exam. Each domain has a guide with free sample questions and a free ten-question drill; Domain 3, the largest, also has five topic drills, and the scenario set drill gives you two full sets in the OTR format. Every drill shows an explanation after each answer.
Domain 1: Evaluation and Assessment (23%)
About 41 of 180 items · 3 tasks
Development and conditions across the life span, body functions, lived experience and identity, the occupational profile, standardized and nonstandardized assessments, and activity analysis.
Domain 2: Analysis and Planning (23%)
About 41 of 180 items · 3 tasks
Interpreting scores and qualitative findings, eligibility and goal writing, interprofessional roles, IEP, discharge and hospice plans, health literacy, and monitoring the plan with precautions, vital signs and lab values.
Domain 3: Interventions (38%)
About 69 of 180 items · 6 tasks
Modalities and wound care, occupation-based ADL, cognition, vision, feeding and group interventions, exercise and neuro rehab, orthoses and prostheses, seating, assistive technology and environmental modifications.
Domain 4: Practice Management (16%)
About 29 of 180 items · 4 tasks
Evidence-based practice and program evaluation, infection control and emergencies, laws, payers and documentation, supervision, NBCOT renewal and ethics.
Scenario Sets
28 sets · 112 questions · all domains
Two full scenario sets in the OTR format: an opening scene about a client, then four related questions with six options each, where you select the three best.
Modalities and Wound Care
24 questions · Domain 3
Hot packs, paraffin, cryotherapy, ultrasound, TENS, NMES, biofeedback and iontophoresis with their contraindications, pressure injury stages, wound healing, line management and telehealth set-up.
ADL, Cognition and Groups
32 questions · Domain 3
One-handed dressing, joint protection and energy conservation, neglect and low vision strategies, chaining and errorless learning, feeding, transfers, group leadership, sleep, supported employment and wellness.
Exercise, Edema and Neuro Rehab
22 questions · Domain 3
Grading exercise by muscle grade, edema and scar management, desensitization and sensory reeducation, CIMT, PNF patterns, tone, balance, body mechanics and breathing techniques.
Orthotics and Prosthetics
20 questions · Domain 3
Orthoses for carpal tunnel, de Quervain, mallet finger, boutonniere, swan-neck, nerve injuries, burns and tendon repairs, fit checks and strapping, and preprosthetic and prosthetic training.
Seating, Assistive Technology and Home Modification
28 questions · Domain 3
Wheelchair measurement, tilt and seating, switch and eye-gaze access, driving and community mobility, ADA ramp, door, turning-space and grab-bar dimensions, ergonomics and universal design.
Ready for the full exam?
180 items in 4 hours, drawn in the outline’s share for each domain, with scenario sets and an explanation for every answer.
Or start with a free drillThe NBCOT OTR exam at a glance
Answer NBCOT practice questions written to the 2022 OTR Examination Content Outline, work through scenario sets in the real six-option, select-three format, read the explanation for every answer, then take a timed 180-question, 4-hour practice exam with a score for every domain.
The OTR exam is the national certification exam for occupational therapists, given by NBCOT, the National Board for Certification in Occupational Therapy. The content outline in force came from NBCOT’s 2022 practice analysis and has been used for every exam since January 2, 2024, when scenario sets also replaced the clinical simulation items. NBCOT runs a practice analysis every five years and has not announced a new OTR outline (checked November 2026).
- Exam
- The OTR certification exam of NBCOT, the National Board for Certification in Occupational Therapy. Passing it earns the Occupational Therapist Registered (OTR) credential
- Format
- 180 items: single-response multiple choice with three or four options and one correct or best answer, and six-option multi-select scenario sets. Each scenario set is an opening scene followed by four related items, each with six options of which three are correct; you select three. Sets are mixed in with the other items, and NBCOT sets no fixed share of each item type
- Time
- 4 hours. The optional tutorial does not count against the clock. You may take breaks, but the clock keeps running
- Content
- The 2022 OTR Examination Content Outline, used for every exam since January 2, 2024: Domain 1 Evaluation and Assessment 23%, Domain 2 Analysis, Interpretation, and Planning 23%, Domain 3 Select and Manage Interventions 38%, Domain 4 Competency and Practice Management 16%
- Scoring
- A scaled score from 300 to 600; 450 passes. The exam is criterion-referenced (Modified Angoff), with no domain-level passing standards. Scenario items give credit for each correct option you select, and no item deducts points for wrong choices. Scored and unscored field-test items are mixed at random; NBCOT does not publish how many are unscored
- Clinical simulations
- The clinical simulation test (CST) items were replaced by scenario sets on January 2, 2024. Scenario sets have no feedback statements, and you can change answers and flag items for review
- Where
- Computer-based at Pearson VUE test centers in the United States and internationally. You can flag items for review, change answers, highlight text and strike out options
- Fee
- $540 for the online application ($595 on paper); $430 for an online retake application ($485 on paper)
- Retakes
- Wait 30 days from your last exam before attempts 2, 3 and 4, 60 days before attempts 5, 6 and 7, and 90 days before attempt 8 and later. Each retake needs a new application
- Eligibility
- An entry-level occupational therapy degree from an ACOTE-accredited OT program (internationally educated candidates apply through NBCOT’s OTED process), agreement to the NBCOT Code of Conduct and character review approval. Your Authorization to Test letter is active for 90 days
- Candidates
- NBCOT gave 14,732 OTR exams in 2025. Of 8,511 new graduates testing for the first time, 68% passed on the first attempt; 92% of all new graduates passed within the year, counting retakes
- Renewal
- NBCOT certification renews every three years with at least 36 units of professional development or competency assessment
Where the exam fits in becoming an OTR
- Graduate with an entry-level occupational therapy degree from an ACOTE-accredited program. Internationally educated occupational therapists apply through NBCOT’s Occupational Therapist Eligibility Determination (OTED).
- Apply to NBCOT online and pay the $540 exam fee. The application is valid for 90 days, and NBCOT issues your Authorization to Test letter once your academic verification and character review are approved.
- Schedule with Pearson VUE within the 90 days of your Authorization to Test letter and take the exam.
- Check your state’s licensing requirements: state boards license occupational therapists, and NBCOT links to each state board.
- Renew your NBCOT certification every three years with at least 36 units of professional development.
Taking the occupational therapy assistant exam instead? See the COTA practice test.
How to use this NBCOT exam prep
- Take the free mixed drill to see where you stand across all four domains, including one scenario set.
- Start with Domain 3, Select and Manage Interventions: it is 38% of the exam. Take its five topic drills and repeat your weakest.
- Drill Domains 1 and 2 (23% each) for assessments, score interpretation, goal writing and precautions, then Domain 4 (16%) for safety, documentation, payers and ethics.
- Take the scenario set drill until reading the opening scene and choosing exactly three options feels routine; each correct option earns credit.
- Take the full 180-question practice exam under the 4-hour clock, then drill your lowest domain and take it again. Each new sitting draws questions you have not seen first.
Common questions
How many questions are on the NBCOT OTR exam?
180 items in 4 hours. They are a mix of single-response multiple-choice questions with three or four options and six-option multi-select scenario sets. NBCOT does not set a fixed share of each item type, and some items are unscored field-test items mixed in at random, so answer every item as if it counts.
What score do you need to pass the NBCOT exam?
A scaled score of at least 450 on NBCOT’s 300 to 600 scale. NBCOT sets the standard with the Modified Angoff method and does not publish how many questions you must answer correctly, and there are no domain-level passing standards. Our mock exam therefore shows your percentage and your score in each domain, not a pass line.
What are NBCOT scenario sets?
A scenario set starts with an opening scene about a practice situation, followed by four related items. Each item has six options, three of them correct, and you select three. You earn credit for each correct option you choose, and wrong choices lose nothing. Scenario sets replaced the clinical simulation test (CST) items on January 2, 2024.
Are there still clinical simulation (CST) questions on the OTR exam?
No. Since January 2, 2024, the OTR exam has single-response multiple-choice items and scenario sets only. NBCOT says scenario sets assess the same knowledge as CSTs in a format that works better with testing accommodations. They have no feedback statements, and you can change answers and flag them for review.
How much does the NBCOT OTR exam cost?
$540 with an online application or $595 on paper. A retake costs $430 online or $485 on paper.
What is the NBCOT OTR pass rate?
In 2025, 68% of the 8,511 new graduates who took the OTR exam for the first time passed on that attempt, and 92% of all new graduates passed within the year, counting retakes. NBCOT gave 14,732 OTR exams in 2025.
What is on the NBCOT OTR exam?
The 2022 OTR Examination Content Outline, in use since January 2, 2024, has four domains: Evaluation and Assessment (23%), Analysis, Interpretation, and Planning (23%), Select and Manage Interventions (38%) and Competency and Practice Management (16%). NBCOT runs a new practice analysis every five years; the most recent was in 2022.
Does NBCOT sell official OTR practice tests?
Yes. NBCOT sells 110-question OTR practice tests and a scenario item practice test with ten scenario sets; each is for one-time use and gives a scaled score report, not the answers you missed. The StudyPack ($85, per the exam handbook) bundles several of them. These questions are separate: original practice written to NBCOT’s content outline, with an explanation for every answer. They are not NBCOT questions, and NBCOT does not allow its exam or study-tool content to be shared.
Is this NBCOT practice exam the same format as the real exam?
Yes. The mock exam is 180 items in 4 hours, drawn in the outline’s share for each domain (41, 41, 69 and 29 items), with eight four-item scenario sets mixed in among single-answer questions. You can skip, go back, change answers and flag items for review. The result shows your percentage, your score in each domain and an explanation for every item.
Ready for test day?
180 items in 4 hours, drawn in the outline’s share for each domain, with scenario sets and an explanation for every answer.
Or start with a free drillSources
- NBCOT: Foundations of the OTR and COTA certification exams (OTR item types, 180 items, 4 hours, scoring, field-test items)
- NBCOT: 2022 OTR Examination Content Outline
- NBCOT: 2022 Practice Analysis of the OTR (domain weights for exams from 2024)
- NBCOT: 2024 exam FAQs (scenario sets replace CST items from January 2, 2024)
- NBCOT: Fees
- NBCOT: Certification Examination Handbook (eligibility, breaks, results, retakes, StudyPack)
- NBCOT: Certification activities (2025 exams given and new-graduate pass rates)
- NBCOT: Practice tests (OTR practice tests and the scenario item practice test)
- NBCOT: Renewal Handbook (36 units every three years)
Original practice questions for exam preparation, written to the NBCOT 2022 OTR Examination Content Outline; they are not NBCOT exam questions. Independent practice, not affiliated with or endorsed by NBCOT (the National Board for Certification in Occupational Therapy) or Pearson VUE. OTR and COTA are certification marks of NBCOT. Follow your state practice act and your facility’s policies in practice.