NBCC NCMHCE Exam Questions

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61.

Use the following case study to answer this question.

Which of the following would be the most congruent statement to make to this client after the second session?

  • "I'm a person just like you. What's going on with you would distress me too."

  • "We can adjust our goals if you like. I understand this is difficult."

  • "You're making great progress. Sometimes these things take time."

  • "Let's talk about what's going well for you."

Correct answer: "I'm a person just like you. What's going on with you would distress me too."

Congruence in the therapeutic environment is the attitude, demeanor, and technique of meeting a client realistically in the context of their presenting problem and their therapeutic needs. This often involves coming out from behind the professional stance and engaging with a client in more down-to-earth, personal terms. In this case, the congruent response deliberately removes the professional stance for a moment to meet the client where they are. 

The other responses do not make this attempt to connect with the client. They are encouraging, empowering, and possibly useful, but do not display congruence.

62.

Use the following case study to answer this question.

How is hypnosis useful for patients with dissociative identity disorder? 

  • For relaxation and exploring insights 

  • Hypnosis is not indicated for these clients 

  • For recall of specific trauma 

  • For reconstruction of lost time 

Correct answer: For relaxation and exploring insights 

Hypnosis can be used with patients who have dissociative identity disorder, though it is controversial. The most indicated use of such a technique for clients with dissociative identity disorder is to help relax them and explore insights into their inner conflict. 

Such a technique should be used very carefully, if at all, to recall specific trauma or to reconstruct lost time; as such recollections may not be factually accurate. 

63.

Use the following case study to answer this question.

Is Attention Deficit/Hyperactivity Disorder (ADHD) considered a neurodevelopmental disorder? 

  • Yes, ADHD is considered a neurodevelopmental disorder

  • No, ADHD is not considered a neurodevelopmental disorder

  • ADHD is considered a neurodevelopmental disorder in the minority of cases 

  • ADHD is considered a neurodevelopmental disorder in the majority of cases

Correct answer: Yes, ADHD is considered a neurodevelopmental disorder 

ADHD is considered a neurodevelopmental disorder, as it is diagnosed in childhood and sometimes persists into adulthood. It is also classified as a mental disorder, more broadly, by being classified in the DSM-5 as such.

64.

Use the following case study to answer this question.

Do the client's statements in the second session indicate a need for safety planning? 

  • No, as there is no indication of imminent danger 

  • Yes, as the client is refusing treatment 

  • No, unless the client persists in religious delusion

  • Yes, as the client could become suicidal due to guilt 

Correct answer: No, as there is no indication of imminent danger 

A safety plan is a resource for a client who may be at risk of harming themselves. It is a document or other easy way for the client to locate and use inner and outer resources during such a crisis. In the present case, there appears to be no need for a safety plan, as the client has denied suicidal ideation and there is no other evidence suggesting she might become suicidal.

Refusing treatment is to some degree a patient's right, and does not constitute a need for safety planning in the present case. The client's religious beliefs may or may not be delusions. 

65.

Use the following case study to answer this question.

At the end of the second session, the client becomes angry with you. Which is the best way to respond?

  • With conflict toleration 

  • By ending the session

  • With empathic questioning

  • By not responding 

Correct answer: With conflict toleration 

It is part of the therapeutic relationship that various interpersonal issues affect the therapeutic dyad. These could include transference, boundary violations, and anger, among others. When there is a conflict with a client, this does not mean that the therapeutic relationship or even that particular session has to end. Though the counselor may have to declare boundaries, it is best to be able to tolerate conflict so that it can be better understood.

Empathic questioning may become possible, but not without being able to deal with the client in conflict. Not responding would not properly meet the client where they are. 

66.

Use the following case study to answer this question.

If the person does not act on their urges, is it a disorder? 

  • Yes, it is in this case 

  • No, in most cases 

  • No, if the person does not act on their desires, it is not a disorder 

  • Yes, if the person is incarcerated due to their behavior 

Correct answer: Yes, it is in this case 

Frotteuristic disorder can be diagnosed even if the person has not meaningfully acted on their urges. The client must either have acted on their urges, or experience clinically significant distress (as in this case), or both. 

Incarceration is not part of the diagnostic criteria for this issue.

67.

Use the following case study to answer this question.

To what do you attribute the client's difficulty with speech in the mental status exam?

  • The tension of the situation 

  • The grief the client feels at being alone 

  • The client's past trauma 

  • The client's current intoxication 

Correct answer: The tension of the situation 

People who have social anxiety disorder can be expected to present as nervous and unsettled in novel social situations. In this case, the client is being evaluated by a stranger in addressing a problem with which they feel intensely vulnerable; the tension of the novel situation is more than enough to explain verbal stumbles.

There is no indication that the client is feeling acute grief from any cause, intoxication, or the effects of trauma. 

68.

Use the following case study to answer this question.

What important first screening item would be useful in this case?

  • A medical exam 

  • A thematic apperception test (TAT)

  • A personality inventory 

  • A substance use inventory 

Correct answer: A medical exam 

Disruptions to feeding can have many causes, some of which can be medical. It would be important for this client to receive a full medical workup in order to rule out these physical causes. 

At the current time, there is no need for a thematic apperception test, a personality inventory, or a substance use inventory. 

69.

Use the following case study to answer this question. 

After the second session, the client begins to use text messaging to contact you. In some cases, very intimate details are being revealed. What should you tell the client? 

  • That you cannot guarantee the privacy of text messaging 

  • That you can accept text messaging in lieu of a therapy session 

  • That you do not wish to receive text messages of this kind 

  • That it is a violation of the law to receive text messages of this kind 

Correct answer: That you cannot guarantee the privacy of text messaging 

Though a few problems exist with this situation, one of the most important for the client to understand is the lack of guaranteed privacy in electronic communications. The client may assume that, since you are a counselor, all of your communicative channels are secure and encrypted when they may not be.

The main concern is not how the text messages can substitute for therapy. You probably do not wish to receive messages of this kind, but for the client's sake, the main concern is their privacy. It is most likely not a violation of law, however. 

70.

Use the following case study to answer this question.

What would be the value of psychoeducation for this client? 

  • A better understanding of anxiety 

  • A better understanding of cancer 

  • A better understanding of conversion disorder 

  • A better understanding of illness anxiety disorder 

Correct answer: A better understanding of anxiety 

Psychoeducation is useful with many varieties of clients, as it gives a client the resource of knowledge about an issue of concern. In this case, rather than educate about illness anxiety disorder itself, the more useful such intervention would be to educate about anxiety. Anxiety is something the client would acknowledge she has without much persuasion, as opposed to her diagnosis of illness anxiety disorder. 

Education about cancer would likely make the client's anxiety worse. There would be no need to educate about conversion disorder.

71.

Use the following case study to answer this question.

Would this patient be appropriate for group therapy in the inpatient environment? 

  • Yes, when stabilized sufficiently 

  • No, under no circumstances 

  • Yes, upon admission 

  • No, disorders of this kind do not respond well to group process 

Correct answer: Yes, when stabilized sufficiently 

The group process has only a few rule-outs, these being clients who will excessively monopolize the time or for whom the array of benefits of group therapy will not help. In the inpatient environment, group therapy is often a frontline treatment for many clients. The benefits of group therapy do not rule out this client's diagnosis or presentation, once she has stabilized enough to participate. 

72.

Use the following case study to answer this question. 

The client offers you a small gift, a drawing they made of a character in their games. Can you accept?

  • Yes, you can accept this gift as there is no ethical issue

  • No, you cannot accept this gift as it is unethical to do so 

  • Yes, you can accept most gifts clients offer

  • No, you cannot accept gifts without legal counsel

Correct answer: Yes, you can accept this gift as there is no ethical issue

Clients will sometimes offer gifts to their counselors. The determining factor in whether or not a counselor can accept a gift tends to be the value of the item. Such a gift should not function as any kind of barter or compensation for services, and should not be of significant financial value above the compensation the counselor is already receiving for their work. In this case, the item likely has little inherent value, and refusing the offer might jeopardize the therapeutic bond.

Counselors can make most judgments about accepting gifts without legal counsel. 

73.

Use the following case study to answer this question.

Does malingering have the same features as a mood disorder?

  • Only if such features are manufactured 

  • Yes, the diagnoses have similar presentation

  • No, unless there is a manic component

  • Yes, as malingering is caused by a mood disorder

Correct answer: Only if such features are manufactured 

Malingering is the manufacture of symptoms of a mental disorder in order to avoid something such as work, or gain something such as an insurance settlement. The symptoms of a mood disorder would only be present if they are manufactured. 

Malingering is not caused by a mood disorder.

74.

Use the following case study to answer this question.

Which of the following is least characteristic of Alzheimer's Disease? 

  • Resting tremors

  • Restlessness

  • Delusions

  • Amnesia

Correct answer: Resting tremors 

Alzheimer's Disease is characterized by a variety of mental and physical symptoms, among which are restlessness, delusions, and amnesia of variable and progressive severity.

Resting tremors are less characteristic of Alzheimer's Disease.

75.

Use the following case study to answer this question.

How is illness anxiety disorder different from somatic symptom disorder? 

  • Illness anxiety disorder involves few or mild physical symptoms 

  • Somatic symptom disorder involves few or mild physical symptoms 

  • Illness anxiety disorder is based on delusional symptoms 

  • Somatic symptom disorder is based on delusional symptoms 

Correct answer: Illness anxiety disorder involves few or mild physical symptoms 

Illness anxiety disorder is characterized by a high degree of fear surrounding mild or nonexistent physical symptoms. In somatic symptom disorder, the physical symptoms can be moderate or severe. In neither case are the physical symptoms based on delusion per se. 

76.

Use the following case study to answer this question.

How does ADHD differ from a learning disability? 

  • ADHD is a learning disability

  • ADHD is a mental illness, not a learning disability

  • ADHD is of longer duration than a learning disability

  • ADHD is of shorter duration than a learning disability

Correct answer: ADHD is a learning disability 

There are many types of learning disabilities; these include ADHD, dyslexia, dysgraphia, dyscalcula, and others. ADHD is considered both a learning disability and a mental disorder and is eligible to be addressed with individualized educational plans.

77.

Use the following case study to answer this question.

If this client is diagnosed with a gambling problem, how would you treat it? 

  • Concurrently with the primary diagnosis 

  • After treatment for the primary diagnosis concludes 

  • By referring to another professional for the gambling diagnosis 

  • The gambling diagnosis would take priority

Correct answer: Concurrently with the primary diagnosis 

Though presentations and circumstances vary, in general, it is seen as helpful to treat co-occurring disorders (such as gambling in this case) with integrated treatment, so that the primary diagnosis and the co-occurring diagnosis are treated at the same time in some way. The skills and progress made in one arm of treatment can help the client with the other, and, in any event, co-occurring diagnoses are often severe enough for treatment not to be delayed. 

Referral to another professional may take place, but the treatments would still likely take place at the same time. 

78.

Use the following case study to answer this question.

Your client informs you that she has religious beliefs that will not allow her to take psychotropic medication if prescribed. How would you respond?

  • Find alternative strategies 

  • Insist on medication as best practice 

  • Consult with her religious leader

  • Slowly educate about medication

Correct answer: Find alternative strategies 

There will be times when a counselor must deal with the beliefs of a client in cases where that client's beliefs come into conflict with treatment recommendations. Though cases, methods, and urgency vary, in general, a counselor should respect the beliefs of clients and attempt to work with them in forming treatment plans. 

In this case, one should not insist, consult with the religious leader, or slowly educate about medication; these strategies do not respect the beliefs of the client. 

79.

Use the following case study to answer this question.

Is it indicated to do therapy to address mood with this patient? 

  • Yes, one should address mood-related symptoms

  • No, as the symptoms will simply recur

  • No, as the client will forget the interventions and progress 

  • Yes, this should be the primary focus of treatment 

Correct answer: Yes, one should address mood-related symptoms

Treating a person who has Alzheimer's Disease, especially in later stages, can be challenging. Overall, the focus should be on preserving function and independence as long as possible.

Though the client may be forgetful, there is no reason not to address mood-related symptoms, though the approach may be somewhat different and the expectations may not be the same as in clients without Alzheimer's Disease.

80.

Use the following case study to answer this question.

Based on the client's statements, what is the major barrier to her establishment of a support system? 

  • All-or-nothing thinking 

  • Impulsivity 

  • Body language 

  • Labile affect 

Correct answer: All-or-nothing thinking 

Clients who have borderline personality disorder tend to engage in black-and-white, "all-or-nothing" thinking. In terms of relationships, these clients often go from idolizing significant others in their life to despising them. This is evident in what this client has said, and would be a major barrier to establishing a support system of any stability.

Impulsivity, body language, and labile affect are not as significant in this respect.