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Quiz Session - Attempts With Random Questions

NBCC NCMHCE Exam Questions

Page 10 of 33

181.

Use the following case study to answer this question.

What is clinically valid about the goals chosen in the plan of treatment? 

  • They are goals the client can identify with 

  • The goals are not clinically valid

  • They involve a focus on empathy

  • They directly challenge the client's pathology 

Correct answer: They are goals the client can identify with 

Working with individuals who have narcissistic personality disorder is a struggle, as they may not see the need for change in themselves. Goals for these individuals are better phrased as self-improvement, such as skill building and learning. This does not indicate agreement with the client's assessment of responsibility.

The goals do not explicitly involve empathy, nor do they directly challenge the client's pathology; both of these directions early in treatment would be risky. 

182.

Use the following case study to answer this question.

You find that the client is reluctant to enact changes that you have made a focus of counseling. What should you do?

  • Help the client discover their own motivation

  • Offer to refer the client

  • End counseling with the client 

  • Provide empathy and motivation for the client

Correct answer: Help the client discover their own motivation

Ultimately, it is the client who must do the work of change. In order to accomplish change, a client may have to make themselves uncomfortable, shift their views, learn new skills, or make themselves vulnerable in any number of ways. Counselors should try to remember that change is difficult, and that clients have to have their own motivation for going through the work of change. In this case, it would be appropriate to help the client discover or remember their own reasons for seeking out counseling in the first place, and linking treatment goals to that motivation. The clarification of this motivation may indicate a new therapeutic direction.

Reluctance of this kind should be gently confronted as soon as practicable, but it is probably not necessary to immediately refer the client elsewhere or end counseling with them. Providing empathy is helpful, but the counselor cannot provide the kind of motivation that a client will need to commit to change. 

183.

Use the following case study to answer this question.

How long can the client be psychotic before the diagnosis of brief psychotic disorder is invalidated?

  • 1 month

  • 3 months 

  • 6 months 

  • 1 year 

Correct answer: 1 month

The diagnosis of brief psychotic disorder only covers clients whose symptoms persist less than one month. Beyond this time, a different diagnosis would have to be considered. 

184.

Use the following case study to answer this question.

How would a strategy of relaxation techniques help this client?

  • By alleviating the main symptom of the disorder

  • By addressing the physical symptoms the client feels

  • By educating the client about physical illness

  • By helping the client with their substance use

Correct answer: By alleviating the main symptom of the disorder 

The main symptom of illness anxiety disorder is the intense fear of illness or death due to illness for which there is no apparent physical reason. A relaxation strategy directly attacks the main and most problematic symptom of this disorder. 

Such a strategy does not educate per se, nor will it directly address substance use issues.

185.

Use the following case study to answer this question.

Which of the following will be the most important post-discharge consideration for this patient?

  • Medication adherence

  • Social supports

  • Community involvement

  • Legal support

Correct answer: Medication adherence

People with schizophrenia often struggle with medication adherence, which can have a direct effect on their functional life. Without adherence to some sort of psychopharmaceutical regimen of care, this patient is likely to be hospitalized again soon. 

Social supports, community involvement, and legal support will all be important as well, but it is likely that the determining factor of this patient's recovery will be her compliance with medication to manage her illness.

186.

Use the following case study to answer this question.

After the second session, the child invites you to be a friend on their social media account. Should you accept? 

  • No, under no circumstances 

  • Yes, if the client suggests it 

  • Yes, under most circumstances 

  • Only with parental consent 

Correct answer: No, under no circumstances 

Though the issue of social networking is a complex one in which many of the issues are far from settled, counselors should not be associates of their clients on social media for reasons of boundary crossing, confidentiality, and general ethics. Even if the client should suggest it, the risks are too great in most cases to engage with clients in this way. 

187.

Use the following case study to answer this question.

Are somatic delusions encompassed by the diagnosis of depersonalization/derealization disorder?

  • No, but somatic disturbances can be 

  • Yes, somatic delusions are encompassed by this diagnosis 

  • No, unless the client also has conversion disorder 

  • Yes, all of the client's delusions are encompassed by this diagnosis

Correct answer: No, but somatic disturbances can be 

Clients who have depersonalization/derealization disorder sometimes have feelings of unreality related to their body. However, these somatic disturbances are not delusions, as the client knows that what they are experiencing is not "real." If a client has delusions (fixed untrue beliefs), then they may have schizophrenia or other thought/psychotic disorder. 

The client would likely not be diagnosed with both depersonalization/derealization disorder and conversion disorder at the same time.

188.

Use the following case study to answer this question.

If this client stated they liked to gamble often, how would you handle it? 

  • Probe for details about the gambling 

  • Ignore it unless the client suggests it is a problem 

  • Address it by changing the treatment plan

  • Refer the client for specialized treatment

Correct answer: Probe for details about the gambling 

Gambling addiction has become more well-known as a therapeutic focus in recent years. As in other cases where there are potential addiction issues, the important thing is to find out if the habit is of diagnostic importance. It will be necessary to find out more about the level to which the client gambles, which may suggest further intervention or discussion.

Many people who have issues around addiction downplay the magnitude of their problem, so even though it is not phrased as a problem by the client initially, it should not be ignored. However, without understanding if there is a problem or how significant the problem is, there should be no adjustment to the treatment plan or referral for specialized treatment. 

189.

Use the following case study to answer this question.

Have this client's symptoms been brought about by trauma? 

  • Symptoms of panic disorder may have traumatic etiology

  • Symptoms of panic disorder do not have traumatic etiology

  • In this case, the symptoms have been brought about by stress 

  • In this case, the symptoms have been brought about by substance use 

Correct answer: Symptoms of panic disorder may have traumatic etiology

Though research is still ongoing, the etiology of panic disorder may have roots in a client's trauma. The thinking is that the anxiety underlying panic disorder may be a reaction to previously experienced traumatic or stressful events.

There is no indication that, in this case, the symptoms are only brought about by stress, or that the symptoms are brought about or exacerbated by substance use. 

190.

Use the following case study to answer this question.

Which of the following might be a good addition to the treatment plan after the second session?

  • Learning skills to manage mood 

  • Learning about suicidality 

  • Learning about the risks of substance use 

  • Learning about past causes of behavior 

Correct answer: Learning skills to manage mood 

In this case, the client seems to suffer from poor mood regulation. To some degree, this is congruent with their diagnosis, but most clients can learn how to better manage and control their mood and their responses to situations. If the treatment plan has been effective so far, the client has some understanding of triggers. The next step will be what do when triggered and how to not let the mood drive itself.

Suicidality is not present in this case, nor is substance use. Learning about the past causes of behavior is valuable, but not as valuable in this case as learning skills for mood regulation.

191.

Use the following case study to answer this question.

In general, how do persons with avoidant personality disorder approach therapy?

  • Short-term involvement focused on a single issue 

  • Long-term involvement focused on a single issue

  • Short-term involvement focused on many issues 

  • Long-term involvement focused on many issues

Correct answer: Short-term involvement focused on a single issue 

It seems that most people who suffer from avoidant personality disorder only seek out therapy when overwhelmed by an accumulation of factors. In these cases, persons with avoidant personality disorder tend to try to get a single issue resolved through short-term treatment, and then will terminate therapy when this issue is addressed to their satisfaction. 

192.

Use the following case study to answer this question.

Is a support group appropriate for individuals suffering from postpartum depression?

  • Yes, a support group is appropriate 

  • No, a support group is contraindicated 

  • Yes, but only in cases of first-time motherhood 

  • No, as group modalities generally do not help depressive symptoms 

Correct answer: Yes, a support group is appropriate 

Support groups are appropriate and can be helpful for persons suffering from postpartum depression (as well as others suffering from depressive symptoms). This indication is not relative to first-time motherhood.

193.

Use the following case study to answer this question.

What is the most suggestive element in the client's presentation that suggests malingering? 

  • There are no evident signs of malingering 

  • The client stands to gain from the amnesia

  • The client does not wish for medication 

  • The client is manufacturing her symptoms 

Correct answer: There are no evident signs of malingering 

Malingering is said to be taking place when a client presents for treatment with a false set of symptoms they have manufactured in order to avoid something, such as work. In this case, there are no evident signs of malingering and her presentation is congruent with the diagnostic symptoms of dissociative amnesia.

The client does not stand to gain from the amnesia. Many clients who are not malingering do not want medication. 

194.

Use the following case study to answer this question. 

Which of the following would be of the most use in observing interactional patterns between the mother and the child? 

  • The comfort of the child's communication with the mother 

  • The extent to which the mother speaks for the child 

  • How much the child initiates conversation with the mother 

  • The extent to which the child understands the mother 

Correct answer: The comfort of the child's communication with the mother 

In the case of a child with selective mutism, it is diagnostic to observe the comfort with which the child communicates in the environment where they are the most comfortable. This helps establish that the child does not have communication difficulties outside that diagnosis. This relationship is also worth assessing for what else it means to the child; for instance, if the child is fearful of the mother, if the child shows signs of abuse, or some other factor. 

The other choices would not be as useful in this case with this client, if the diagnosis has already been established. The specifics of the mother-child interaction are not as important as their overall character. 

195.

Use the following case study to answer this question.

Is it ethical to accept gifts from clients?

  • Yes, in certain specific circumstances

  • No, under no circumstances

  • Yes, but only after treatment is concluded

  • Not unless the client signs a waiver

Correct answer: Yes, in certain specific circumstances 

Clients will sometimes wish to show their appreciation to counselors. This is sometimes done with gifts. This is permissible, generally, as long as the gift is of no significant material value and the intent is merely friendly or appreciative. It will be up to the counselor to determine the health of the gesture and respond appropriately.

Gifts of this type can be accepted during treatment without a waiver.

196.

Use the following case study to answer this question.

Should one use genuineness with this client?

  • Yes, one should use genuineness with every client

  • No, as this client's diagnosis makes it risky

  • Yes, as this client will respond positively

  • No, as this client will respond negatively

Correct answer: Yes, one should use genuineness with every client

Genuineness is the relational style of being down to earth and human with your client, and reinforcing the basic relational bond with a form of openness and honesty. One should practice it with every client, whether or not they will respond positively, though few will respond negatively. 

This client's diagnosis does not invalidate the approach of genuineness.

197.

Use the following case study to answer this question.

What would be the first part of a cultural formation interview for this client? 

  • A cultural definition of the problem

  • Asking about Native American culture 

  • Defining the cultural issues to be addressed 

  • Addressing oppression directly 

Correct answer: A cultural definition of the problem 

Cultural formation interviews are meant to look at the presenting problem of a patient using the client's own cultural lens as a primary focus. The first component of such an interview is a cultural definition of the presenting problem. This is meant to frame the issue in the context of what it means in that client's life as a member of that culture. 

A cultural formation interview is not meant to educate the counselor. It does not seek to address cultural issues per se, but the presenting problem in a cultural context. Such a formation may or may not deal explicitly with oppression. 

198.

Use the following case study to answer this question.

After the second session, the client asks you to accompany them to a social occasion. Should you accept?

  • No, but with careful explanation 

  • Yes, it may be therapeutic for the client 

  • No, the client is deliberately crossing boundaries 

  • Yes, if it is social and not clinical in nature 

Correct answer: No, but with careful explanation 

The roles of client and counselor often need clarification. In this case, it is understandable that a vulnerable, socially isolated client that does not trust others very much might bond with a supportive counselor and want to make the relationship work in ways beyond the therapeutic. Unfortunately, this crosses an ethical and professional line between the role of counselor and the role of friend. In as supportive a manner as possible, the situation will have to be explained to the client.

There is no indication that the client is deliberately crossing boundaries. Though the attention might do the client good in some ways, it would not be therapeutic as it would go beyond what has been established in therapy as the method and direction of treatment. There might be a case where the counselor could engage with the client on a social level in a strictly therapeutic, supportive role, but this would be clinical and not social in nature. 

199.

Use the following case study to answer this question.

If the client had difficulty doing small, everyday problems of arithmetic, what would this be called? 

  • Acalculia

  • Agraphia

  • Aphasia 

  • Dementia 

Correct answer: Acalculia 

Alcalculia is the lack of ability to perform minor mathematical computations and is a common symptom of Alzheimer's Disease.

Agraphia is the loss of ability to write. Aphasia is the loss of ability to speak in some way. Dementia is a more general term for impaired cognition.

200.

Use the following case study to answer this question.

Your client suggests not having a treatment plan at all. What would be your response? 

  • Educate about the value of treatment plan compliance 

  • Suggest a modification to the existing treatment plan 

  • Stop using a treatment plan per the client's request 

  • Insist on the use of a treatment plan 

Correct answer: Educate about the value of treatment plan compliance 

Treatment planning as a concept may not be well-known to clients, particularly in sub-acute contexts. Some of these may not understand the need for such a formal approach to counseling. In these cases, some education and explanation might help; treatment planning provides a shared roadmap toward specific goals through established objectives so that there is always some measure of progress in treatment. This is in some ways what keeps counseling from being a simple conversation.

A treatment plan will most likely be necessary, though instead of simple insistence, education would be better. Modification is always possible, but it is necessary to have some way of establishing issues and measuring progress. 

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