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Quiz Session - Attempts With Random Questions

NBCC NCMHCE Exam Questions

Page 5 of 33

81.

Use the following case study to answer this question.

Are there symptoms the client is displaying that would result in a secondary diagnosis?

  • No, the current diagnosis is sufficient to describe the symptoms 

  • Yes, the client should also be diagnosed with bipolar I disorder 

  • Yes, the client should also be diagnosed with seasonal affective disorder 

  • No, there is not enough data to diagnose the patient with anything currently

Correct answer: No, the current diagnosis is sufficient to describe the symptoms 

The client has enough symptoms to qualify for the diagnosis of postpartum depression. There is not sufficient data to diagnose her with anything else at this point in terms of mental health diagnosis.

82.

Use the following case study to answer this question.

Which of the following would be the least useful intervention strategy with this client? 

  • The "empty chair" technique 

  • Systematic desensitization 

  • Trigger identification 

  • Relaxation techniques 

Correct answer: The "empty chair" technique 

The "empty chair" technique is often used in Gestalt therapy to roleplay conversations with significant others. It would not be particularly useful with this client, unless there were some family conflict to be addressed in this way.

Systematic desensitization, trigger identification, and relaxation techniques would all be indicated interventions for this client. 

83.

Use the following case study to answer this question.

In the second session, when should you take steps to defend yourself? 

  • When you feel it appropriate, using your best judgment

  • When the client makes a physical attack 

  • When the client begins using aggressive language 

  • When the client shows signs of agitation 

Correct answer: When you feel it appropriate, using your best judgment

Evaluating the interactional dynamics between yourself and clients is sometimes about evaluating your safety. Clients will sometimes become angry and aggressive, and sometimes those feelings will be turned on the counselor. The question of when to act on behalf of one's own safety is one that must be answered in the context of individual situations; in the end, a counselor must use (and will be responsible for) their best judgment.

The other choices suggest standard rules for what must be a contextual judgment. 

84.

Use the following case study to answer this question.

Your client asks you for medication. How should you respond?

  • Explain the counseling process

  • Refer to a psychiatrist

  • Terminate treatment with the patient

  • Assess for substance use issues 

Correct answer: Explain the counseling process

Many clients are naive to counseling and do not understand the process or the roles and responsibilities. In this case, it is best to let the client know what the counseling process entails, including the possible referral to a psychiatrist once the need is established.

It would not be necessary under these circumstances either to terminate treatment or assess for substance use issues. 

85.

Use the following case study to answer this question. 

Is this client a good candidate for residential care?

  • No, as her symptoms are currently manageable 

  • Yes, as she is a danger to herself 

  • Yes, as her self-care needs will need attention

  • No, as residential care is for elders 

Correct answer: No, as her symptoms are currently manageable 

In general, levels of treatment are driven by safety and utility concerns. A patient should be allowed and encouraged to make their own choices about treatment at the minimum safe level of care for that client, unless there is some compelling reason otherwise. In this case, the client may be able to manage her symptoms outside residential care.

It is not established that the client is in imminent danger, and residential care is not for elders. The client's self-care needs have not deteriorated substantially at this time. 

86.

Use the following case study to answer this question.

Which of the following would be the most genuine statement to make to the client if you are not a veteran?

  • "I don't know what you've been through, but I think I can help you."

  • "I've been well-trained to deal with your kind of trauma."

  • "We've all been through things that hurt us."

  • "Would you like to meet with someone who is a veteran?"

Correct answer: "I don't know what you've been through, but I think I can help you."

Genuineness in counseling refers to the ability of the counselor to appear as more than a professional, but as a person who is genuinely interested in helping the client work on their problems. In this case, one should not avoid the fact (if it is so) that the counselor is not a veteran, as it seems that most of the client's symptoms are related to a series of combat experiences. The counselor should make it clear that this difference in military service status is not necessarily a barrier to helping from the counselor's point of view. 

The other responses overgeneralize, depersonalize the interaction, or shift the discussion to finding a different therapist. 

87.

Use the following case study to answer this question.

Which of the following responses would be the most empathic regarding this client's possible sexual assault? 

  • "I'm sorry. I am here if you do want to talk about it."

  • "If you tell me about it, I might be able to help."

  • "I'm afraid we can't really go on without addressing it."

  • "I think if you tell me about it, you might feel better."

Correct answer: "I'm sorry. I am here if you do want to talk about it."

When clients have areas that they do not wish to discuss, it puts the counselor in a difficult position if that material could be of clinical importance. However, the client's wishes should be respected while still indicating that the counselor is available if the client wishes to address it at a future time.

The other responses insist on getting the information or, though they are sympathetic attempts to get the client to talk about it, do not respect the client's wishes. 

88.

Use the following case study to answer this question. 

What would be the response to the client in the first session most congruent with empathic attunement?

  • "We want to hear you, and there will be more time later."

  • "We only have so much time in our session today."

  • "Please be considerate of others."

  • "I'm afraid you have to stop your story now."

Correct answer: "We want to hear you, and there will be more time later."

The display of empathy in therapeutic contexts often must express itself in a declaration of boundaries or clarifications. At these times especially, it is important to demonstrate empathic attunement to reassure the client that the counselor is present with them in the therapeutic context and attempting to identify with their feelings. A good response would both provide clarity about the rules, but demonstrate full investment with the client's problem.

The other responses do not demonstrate this investment. 

89.

Use the following case study to answer this question.

How long must symptoms of generalized anxiety disorder persist in order to qualify for a diagnosis?

  • Six months 

  • Three months 

  • One year 

  • One month

Correct answer: Six months 

Symptoms of generalized anxiety disorder must be present for at least six months in order to qualify for the diagnosis. 

90.

Use the following case study to answer this question.

How is malingering different from conversion disorder?

  • Conversion disorder is not voluntary

  • Conversion disorder is voluntary

  • Malingering is not voluntary

  • Malingering involves assumption of a "sick role"

Correct answer: Conversion disorder is not voluntary 

In malingering, a person manufactures symptoms in order to avoid something or for gain. It is voluntary. In conversion disorder, a person feels real physical symptoms for which there are no physical, demonstrable causes. It is, however, not voluntary. 

In neither case is the person seeking to assume a "sick role." This is more consistent with factitious disorder.

91.

Use the following case study to answer this question. 

Which of the following would be the most empathic response to this child's concerns?

  • To accept the child's fears and carefully restate them 

  • To educate the child about their false beliefs 

  • To persuade the child that they will sleep better if they stop worrying 

  • To build rapport through play therapy 

Correct answer: To accept the child's fears and carefully restate them 

An empathic attunement to a client means that the counselor is taking on that client's concerns as their own, at least as far as the therapeutic dyad is concerned. One example in this case would be to show a desire to understand fully what the child is talking about, without judgment. This would have the added advantage of having the client express descriptive control over his fears. 

Simple psychoeducation would not show the right degree of empathy, nor would an attempt at persuasion or deflection. Joining with a client in their distress is what empathic attunement is.

92.

Use the following case study to answer this question.

If the client reported that her symptoms took place only at certain times of the year, what would be a more likely diagnosis?

  • Seasonal affective disorder 

  • Persistent depressive disorder 

  • Cyclothymic disorder 

  • Postpartum depression 

Correct answer: Seasonal affective disorder 

Seasonal affective disorder is marked by the symptoms of major depressive disorder which occur at a specific time of year.

Persistent depressive disorder, cyclothymic disorder, and postpartum depression are not diagnostically tied to a specific time of year. 

93.

Use the following case study to answer this question.

How old must a person be to be diagnosed with antisocial personality disorder? 

  • 18

  • 16

  • 15

  • 12

Correct answer: 18

In order to be diagnosed with antisocial personality disorder, a person must be 18 years old with a previous history of conduct disorder.

94.

Use the following case study to answer this question. 

What would be the best way to find out about this client's substance use? 

  • Through the client's self-report 

  • Through a review of records 

  • Through lab tests

  • Through paired observations with staff 

Correct answer: Through the client's self-report 

In this case, the nature of the client's substance use is yet to be truly determined. The best way to find out more information is to address it directly with the client and obtain their self-report about it. This will have the advantage of finding out directly from the client about their perspective of use, and provide insight into other issues that may be present around denial or ambivalence. 

A review of records may provide insight but is not as good as hearing directly from the patient. Similarly, lab tests can provide data but will not give any other insight. Paired observations with staff may add credence to a counselor's initial observations, but a client should be asked as a primary diagnostic step. 

95.

Use the following case study to answer this question.

Would you expect the different personalities to be dominant relative to specific situations?

  • Yes, the personalities in clients with dissociative identity disorder can change relative to situation

  • No, in general, personalities in clients with dissociative identity disorder do not change situationally

  • Yes, clients with dissociative identity disorder have a different personality for every situation

  • No, in general, personalities in clients with dissociative identity disorder are fixed 

Correct answer: Yes, the personalities in clients with dissociative identity disorder can change relative to situation

In clients with dissociative identity disorder, the personalities can become more or less dominant relative to situation. This ability to change relative to mood, situation, or other stimuli is reflective of what is known about the etiology of the disorder itself.

Personalities in clients who have dissociative identity disorder are not fixed, nor is there generally a personality for every situation. 

96.

Use the following case study to answer this question.

How would social skills training help this client? 

  • By helping him choose different outlets for his sexual desire

  • By distracting him from his sexual urges

  • Social skills training will not help this individual

  • Social skills training will be harmful to this individual

Correct answer: By helping him choose different outlets for his sexual desire 

In many cases of paraphilia, there is a lack of social skills that would contribute to a more normative pattern of expressed sexual desire. By helping this client learn better social skills, there would be some hope that the client would attempt to find a partner, rather than staying in his present pattern of sexual action.

The point of such training would not be distraction per se, and it would most likely not be harmful.

97.

Use the following case study to answer this question. 

Would Dialectical Behavior Therapy (DBT) be indicated for this client? 

  • DBT could be used to help this client

  • DBT is contraindicated in this case 

  • DBT offers no special benefit to this case 

  • DBT is used to treat personality disorder 

Correct answer: DBT could be used to help this client

Dialectical Behavior Therapy (DBT) began with treating high-impulsivity disorders but has since been broadened to be able to treat other problems, in this case, the bipolar disorders. DBT can be used to help these clients learn coping strategies, control their thoughts, regulate their emotions, and practice mindfulness.

98.

Use the following case study to answer this question. 

Which of the following is likely to make the client feel unsafe?

  • Being criticized 

  • Psychoeducation 

  • Relational questions 

  • Questions about others 

Correct answer: Being criticized 

It is important to remember that the overconfidence, arrogance, and selfishness of narcissistic personality disorder is in many cases based on a lack of self-esteem, making this type of client feel very vulnerable when they feel they are being criticized. They are likely to react with defensiveness and anger.

Psychoeducation, relational questions, and questions about others are unlikely to be perceived as being as risky as criticism. 

99.

Use the following case study to answer this question. 

If this client were to state they did not feel they needed treatment, what would be your response? 

  • Empathically respond with disagreement 

  • Alert the authorities 

  • Have the patient involuntarily committed 

  • Warn the patient about your mandated reporter status 

Correct answer: Empathically respond with disagreement 

Many clients who need help do not want it. However, except in certain circumstances, clients have a right not to seek out or receive treatment. If this client does not wish to be treated, the best course of action is likely to respond empathically that you believe he does.

It would not be necessary to alert the authorities, have the patient involuntarily committed, or raise the topic of your mandated reporter status, unless the client were to (in your judgment) display signs of imminent threat.

100.

Use the following case study to answer this question. 

You are doing a research study involving gathering simple demographic data from your clients. What is your responsibility to the client if you plan to gather their information? 

  • You must obtain informed consent 

  • You are not obligated to obtain informed consent 

  • Informed consent is implied in intake documents 

  • The client cannot participate due to their diagnosis 

Correct answer: You must obtain informed consent 

Even in this case, where no identifying information is collected as part of the research project, it is incumbent upon the researcher to obtain full informed consent from research participants. It is likely this responsibility is specifically dealt with in the project's design. 

Informed consent is not implied, and there is no indication the client cannot participate due to their diagnosis. 

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