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Quiz Session - Attempts With Random Questions

NBCC NCMHCE Exam Questions

Page 2 of 33

21.

Use the following case study to answer this question. 

During this client's intake, he mentions that his mother "maintains his affairs to some degree." What should you do with this information?

  • Verify the client's legal status

  • Ignore the comment due to his diagnosis 

  • Engage with the comment later in the session

  • Contact the client's mother

Correct answer: Verify the client's legal status

Though many with autism spectrum disorder live functional lives without supervision, it is possible that this client has a guardian. When the client makes this statement, he might be saying this, or he might be talking about something else. If the client has a guardian, this guardian will need to be contacted in order to treat this client.

Persons with ASD can be difficult to understand and can communicate in ways that are not clear. It is best to find a way to clarify the client's remark as soon as possible without contacting the client's mother, as it has yet to be established that a guardianship exists. 

22.

Use the following case study to answer this question.

If the client had indicated a concrete, present desire to hurt herself, what would be done?

  • Contact with authorities to ensure safety 

  • Contract for safety 

  • A promise to deal with the issue next session

  • Treatment planning directed at suicidality 

Correct answer: Contact with authorities to ensure safety 

There are times when patients are not safe, presenting a concrete and believable danger to themselves or others. In these cases, though specific jurisdictional elements vary, the proper thing to do is to prevent the harm from happening; for instance, contacting authorities to ensure safety or engaging in civil commitment. 

A contract for safety will likely not be possible in a case where a client is actively suicidal in the moment. The issue should not be pended until another session, or left to treatment planning. 

23.

Use the following case study to answer this question.

What is likely to impact this client's grasp of your education about transference? 

  • The client's insecurity 

  • The client's acuity

  • The client's crisis 

  • The client's impulsivity 

Correct answer: The client's insecurity 

Persons with narcissistic personality disorder are essentially insecure, accounting for their desire to be admired and their exaggerated sense of self-importance. An attempt to teach this client about transference will be risky and difficult due to the client's insecurity.

The client's acuity seems manageable, and he does not appear to be in crisis. His impulsivity does not appear to be a major concern at the moment, if present. 

24.

Use the following case study to answer the question.

Does the client's wish not to receive psychotropic medication pose a problem for treatment?

  • Not in this case, as medication is not a frontline treatment for this disorder 

  • Yes, as medication is generally indicated to handle symptoms of this disorder 

  • Not until medication is recommended for the dissociative symptoms 

  • Yes, as medication generally cures amnesia within a few weeks 

Correct answer: Not in this case, as medication is not a frontline treatment for this disorder 

Dissociative amnesia cannot be cured by medication at this time, nor is medication generally indicated for dissociative symptoms. Medication may be useful to deal with the stress, anxiety, and other ancillary issues surrounding the main diagnosis. 

25.

Use the following case study to answer this question.

Which of the following would not be considered a client strength in this case?

  • The client's hypomanic energy 

  • The client's support system 

  • The client's wealth and resources 

  • The client's willingness to be treated 

Correct answer: The client's hypomanic energy 

Client strengths are those items in terms of internal or external qualities or assets the client possesses that will help them during the course of their treatment. In this case, the client has a good support system, is wealthy, and is willing to seek help; all of which are substantial aids to treatment.

The client's hypomanic energy (when present) is a symptom. Though it does give her energy, it comes with costs that form part of the reason she is seeking help. 

26.

Use the following case study to answer this question.

How would you go about finding out if the client's diversity issues were impacting her treatment? 

  • Through direct, compassionate questioning

  • By letting the client bring up diversity issues first 

  • Through a standardized questionnaire 

  • There are no presenting diversity issues in this case

Correct answer: Through direct, compassionate questioning

One should not assume that, simply because a client belongs to categories considered diverse, that they are necessarily impacted by those issues in a way that affects treatment. In this case, the expert is the client. Asking about such issues through direct but compassionate questioning is probably the best way forward, as it is less formal than a standardized questionnaire and is more open-ended as a form of inquiry.

One should not wait for the client to bring up the diversity issues first. We do not know, without more information from the client, how diversity issues affect her issues. 

27.

Use the following case study to answer this question.

Applying an empathic understanding of the client, what is their problem from their point of view? 

  • They are misunderstood by others 

  • They are disliked by others 

  • They are ignored by others 

  • They are not paid attention to enough by others 

Correct answer: They are misunderstood by others 

Empathic responding means understanding what the client's problem is from that client's point of view. Though it is only one part of a total formulation of what can be done in terms of treatment planning to help a client, their understanding of their own problem is key. In this case, the issue from the client's point of view does not seem to be as much about attention, being disliked or ignored; it is that their own way of doing things and their personality is not well-understood by everyone else. 

28.

Use the following case study to answer this question.

Would you expect the therapeutic relationship to change with this client after the second session?

  • Yes, as trust and progress have been established 

  • No, due to the child's diagnosis 

  • Yes, as the mother has accepted you

  • No, sufficient progress has not been gained 

Correct answer: Yes, as trust and progress have been established 

The status of the therapeutic relationship must always be kept in view and addressed as needed. In this case, there are solid signs of progress with this client, which indicates a growing trust with you. One would expect the therapeutic relationship to improve in subsequent visits as progress continues and trust is deepened and used to make therapeutic gains.

The child's diagnosis does not rule out a change in the therapeutic relationship. The mother's acceptance is significant, but more significant are the signs on the part of the child that they are wiling to engage with you in treatment. 

29.

Use the following case study to answer this question.

If this patient were to begin drinking again, would the OCD diagnosis be dropped?

  • No, there would be two diagnoses

  • Yes, as substance use rules out OCD 

  • No, unless the substance use problem is severe

  • Yes, as the two conditions cannot be treated at the same time 

Correct answer: No, there would be two diagnoses

It is not uncommon for a person in treatment to have other issues pertinent to their primary diagnosis. In the case of co-occurring disorders, a client has two or more diagnoses reflecting a substance use component. In these cases, all diagnoses are generally preserved and an attempt is made at integrated, concurrent treatment. 

The substance use problem's severity would not preclude the patient having multiple diagnoses. 

30.

Use the following case study to answer this question.

You plan to refer this client to a hypnotist. Are you obligated to secure informed consent?

  • Yes, you should secure informed consent 

  • No, you are not obligated to secure informed consent for hypnosis 

  • No, as a general informed consent at intake is sufficient 

  • Yes, as hypnosis is considered a risky treatment 

Correct answer: Yes, you should secure informed consent 

Whenever a client is exposed to the possibility of a new treatment modality, such as hypnosis in this case, all of the potential risks, benefits, and other important aspects of the potential intervention should be explained to the client until the counselor is sure that the client understands everything they are agreeing to. Hypnosis is no exception, and the general consent for services clients deal with at intake will not be sufficient. 

31.

Use the following case study to answer this question.

Which of the following is the most significant strength of the client in a treatment context? 

  • Supportive family 

  • Adequate resources 

  • Veteran status 

  • Community resources for PTSD

Correct answer: Supportive family 

Strengths are assets that a client has that support their therapeutic progress. In this case, the client has a supportive family who it may be expected will help him as he proceeds through treatment. This is more significant than his having adequate resources, as his family will likely actively support his treatment and having enough resources means the client doesn't have to worry about meeting basic needs. 

Community resources are not an asset the client possesses per se. The client's veteran status is a strength in some ways, but it is not as significant a strength for the therapeutic context as is his supportive family.

32.

Use the following case study to answer this question.

Should the therapist use a plan of treatment with this client?

  • Yes, one should begin formulating a plan of treatment as soon as practical

  • No, one does not need a plan of treatment in cases of adjustment disorder 

  • Yes, many sessions from now when symptoms have eased 

  • No, until the patient states they are ready for a treatment plan 

Correct answer: Yes, one should begin formulating a plan of treatment as soon as practical

Treatment planning is formally required in many settings, and is sometimes related to reimbursement. Though in private practice formal treatment planning may or may not be required based on circumstances, it is a process that adds structure to the therapeutic context. A good plan of treatment is like the roadmap of therapy, and is also a form of contract between therapist and client. Not only does a plan of treatment outline what progress looks like and detail the steps within that process, it is a tangible shared reference point for client and therapist. 

Treatment plans are appropriate for those with adjustment disorder. Treatment plans should be begun as soon as possible, and not wait for symptoms to fully ease. Treatment planning should not wait for the client to initiate, as they may not know what a treatment plan is or what it is for. 

33.

Use the following case study to answer this question.

What would be the main advantage of psychoeducation for this client? 

  • To help her gain knowledge about the disorder 

  • To help her cope with the symptoms of the disorder 

  • To help her accept responsibility for the accident

  • To help her relate her religious beliefs to her symptoms 

Correct answer: To help her gain knowledge about the disorder 

Psychoeducation is a therapeutic technique that involves the passing of information along to the client. In this case, the client would benefit from knowing concrete information about dissociative amnesia, which might help her deal with her other beliefs about what happened.

Eventually, the hope is that psychoeducation does help a client cope in some way, but the main purpose is to provide factual information. In this case, psychoeducation is not about helping her accept responsibility or to relate religious beliefs to symptoms. 

34.

Use the following case study to answer this question. 

When would the conflict between you as group leader and this client need to be addressed?

  • As soon as is reasonable

  • The next time it happens

  • When treatment planning is evaluated 

  • Immediately, with the group present

Correct answer: As soon as is reasonable

There will sometimes be dynamics between group leaders and group members that influence the functioning of the group. In most cases, the best course of action is to address the matter with the client one on one as soon as it is reasonable to do so. 

Addressing the issue should not wait until the next time it happens or when treatment planning is evaluated. Addressing the dynamics with the entire group present is likely not necessary if the issue is between individuals. 

35.

Use the following case study to answer this question. 

The client says they use cannabis, but does not want you to "report it." How would you best respond?

  • By explaining the limits of confidentiality 

  • By discouraging the client from disclosing further 

  • By recommending drug treatment in some form 

  • By agreeing not to disclose 

Correct answer: By explaining the limits of confidentiality 

As a general rule, a client's use of illicit drugs would fall under the umbrella of confidentiality unless that use of drugs imminently endangered themselves or someone else. It would be best at this point to stop the client, explain the limits of confidentiality, and let the client make the choice as to how to proceed. Jurisdictions vary widely, however, and whatever the local or jurisdictional stance might be, it will be the counselor's responsibility to help the client understand it. 

Simply discouraging the client from disclosing would not help the client, and simply agreeing not to disclose might be a commitment the counselor cannot keep. Drug treatment may or may not be called for, but at this point it would be premature to recommend it. 

36.

Use the following case study to answer this question.

The client is required to attend groups as a condition of her discharge plan, yet, after the second session, she clearly seems not to wish to engage further. She says "no" whenever group members are being gathered, and leaves when she is escorted to the group room. 

What should you do in your role as a clinician?

  • Deal with the treatment requirement 

  • Enforce group membership 

  • Waive group membership altogether

  • Use incentives to encourage compliance 

Correct answer: Deal with the treatment requirement 

Even in inpatient environments, to the extent possible, every client has the right to refuse treatment. If group participation has been made a requirement of this patient's discharge plan, and it is clear the patient does not wish to engage with groups, the requirement should be carefully evaluated. There is ample evidence of this patient's progress and improvement; they should not be punished with continued inpatient stay only because they don't wish to attend groups any longer. 

It is not advisable to try to force the patient to attend groups; it will be unethical and ineffective, as will bribes. The clinician in an inpatient setting is unlikely to be able to waive a treatment plan requirement unilaterally and should consult with the treatment team before making such a large adjustment to the patient's treatment plan.

37.

Use the following case study to answer this question. 

Which of the following is the biggest barrier to therapeutic alliance with this patient? 

  • Not being able to share in the client's delusions

  • The physical danger the client represents 

  • The client's pervasive psychosis 

  • The absence of medication to assist with symptom control 

Correct answer: Not being able to share in the client's delusions

The treatment of clients who experience significant, stable delusions is problematic, mainly due to the fact that therapeutic alliance is at risk due to the inability of the counselor to responsibly share in the client's delusions, which will no doubt be the client's main area of concern. 

The client does not appear to pose a physical danger at the current time, and the psychosis is limited (as is usual in delusional disorder) to the focus area of delusional concern. Medication may or may not be necessary.

38.

Use the following case study to answer this question.

Which of the following is the most likely to make this client terminate treatment? 

  • Confrontation about the client's exaggerations

  • Supportively addressing underlying issues 

  • Engaging with the client's symptoms as real 

  • Referring to a psychiatrist

Correct answer: Confrontation about the client's exaggerations

Clients who have factitious disorder are not looking for a truthful, thorough examination of their real status in terms of physical health. This client is likely to abandon treatment if that treatment directly confronts him about the likely exaggeration of his symptoms.

None of the other options is as likely to cause the client to terminate treatment. 

39.

Use the following case study to answer this question.

Is this client currently exhibiting transference issues toward you? 

  • No, there is no visible evidence of transference

  • Yes, as the client is sexually inappropriate with you 

  • No, as the client is avoiding the topic of sexuality 

  • Yes, as the client is internally comparing you with loved ones 

Correct answer: No, there is no visible evidence of transference 

Transference refers to the way clients bring "extra" feelings into the therapeutic relationship. Often these are romantic feelings, but can be other things such as anger. In this case, the client has shown no such signs of inappropriate feelings toward you.

The client has not been sexually inappropriate, nor have they avoided the topic of sexuality. There is no way to tell if the client is internally comparing you with loved ones. 

40.

Use the following case study to answer this question.

Would psychodynamic therapy be indicated for a patient with schizoid personality disorder? 

  • Yes, to seek a positive sense of self 

  • No, given the nature of the disorder 

  • Yes, to build a new life plan 

  • No, due to the nature of psychodynamic therapy 

Correct answer: Yes, to seek a positive sense of self 

Though treating patients who have schizoid personality disorder is always problematic, there are some treatment recommendations using psychodynamic modality. Psychodynamic therapy can be used with schizoid patients (who are willing) to explore a more positive sense of self, as well as exploring the nature of dysfunctional relationships to find closure.

Building a new life plan would not be a focus of psychodynamic therapy, which is concerned with inner conflict. 

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