2
Q
Choose the correct answer:
A new client presents with vague anxiety, poor sleep, and recent job loss. Before planning treatment, the social worker should:
- A. Begin supportive counseling immediately
- B. Refer for medication management
- C. Complete a biopsychosocial-spiritual assessment
A
C. Complete a biopsychosocial-spiritual assessment
Assessment precedes intervention; understanding biological, psychological, and social contributors guides accurate planning.
3
Q
Choose the correct answer:
A client reports frequent nightmares after a recent accident. The first task is to:
- A. Teach relaxation immediately
- B. Conduct a safety assessment and rule out acute stress disorder
- C. Explore trauma narrative in detail
A
B. Conduct a safety assessment and rule out acute stress disorder
Safety and diagnostic clarity precede exposure or insight-oriented work.
4
Q
Choose the correct answer:
When working with a non–English-speaking client, the social worker’s most appropriate step is to:
- A. Simplify questions and proceed in English
- B. Ask a bilingual relative to translate
- C. Use a professional interpreter
A
C. Use a professional interpreter
Professional interpreters preserve confidentiality and accuracy; family translators risk bias and role conflict.
5
Q
Choose the correct answer:
A client presents with flat affect and poverty of speech but denies depression. The next best step is to:
- A. Assume trauma numbing
- B. Provide immediate CBT for depression
- C. Conduct a differential assessment for psychotic spectrum disorder
A
C. Conduct a differential assessment for psychotic spectrum disorder
Negative symptoms require ruling out psychosis before initiating mood-focused interventions.
6
Q
Choose the correct answer:
A school social worker notices a child’s drawings consistently show violence and fear. The next appropriate step is to:
- A. Explore safety and screen for abuse
- B. Encourage artistic expression
- C. Refer for gifted assessment
A
A. Explore safety and screen for abuse
Behavioral and artistic cues may reveal trauma; mandatory screening ensures child safety.
7
Q
Choose the correct answer:
During a session, a client with borderline traits alternates between praising and criticizing the therapist. The best therapeutic stance is:
- A. Withdraw emotional engagement
- B. Maintain consistency and model boundaries
- C. Confront the client’s behavior
A
B. Maintain consistency and model boundaries
Maintaining stability counteracts splitting and builds trust.
8
Q
Choose the correct answer:
In a group setting, one member dominates discussion and interrupts others. The leader should:
- A. Ignore the behavior to avoid embarrassment
- B. Intervene respectfully to restore group balance
- C. Remove the member from the group
A
B. Intervene respectfully to restore group balance
Immediate but respectful redirection maintains group norms and safety.
9
Q
Choose the correct answer:
A client with MDD repeatedly cancels appointments, citing hopelessness. The social worker’s next step is:
- A. Conduct suicide risk assessment
- B. Confront avoidance behavior
- C. Terminate for noncompliance
A
A. Conduct suicide risk assessment
10
Q
Choose the correct answer:
A client insists, “Everyone at work is against me; they all talk about me behind my back.”
- A. “Let’s look for the evidence that supports and contradicts that thought.”
- B. “That sounds painful—tell me more about your coworkers.”
- C. “You’re overreacting to ordinary office politics.”
A
A. “Let’s look for the evidence that supports and contradicts that thought.”
A CBT-consistent response challenges distorted cognitions through collaborative evidence testing, promoting cognitive restructuring rather than reassurance or dismissal.
11
Q
Choose the correct answer:
A couple reports escalating conflict and verbal hostility in sessions.
- A. Interpret the conflict as transference.
- B. Establish clear ground rules and assess for safety.
- C. Explore each partner’s childhood attachment history.
A
B. Establish clear ground rules and assess for safety.
The initial task in couples work is containment—creating safety and structure before exploring deeper dynamics.
12
Q
Choose the correct answer:
A depressed client spends most days in bed and avoids activities once enjoyed.
- A. Use behavioral activation to re-engage daily routines.
- B. Assign journaling for insight.
- C. Focus on dream analysis.
A
A. Use behavioral activation to re-engage daily routines.
Behavioral activation targets withdrawal by scheduling reinforcing, mastery-building activities.
13
Q
Choose the correct answer:
A substance-use client relapses after three months of sobriety and expresses shame.
- A. Normalize lapse as learning opportunity.
- B. Terminate treatment for relapse.
- C. Increase confrontation.
A
A. Normalize lapse as learning opportunity.
A harm-reduction stance reframes relapse as data for adjustment, supporting motivation and self-efficacy.
14
Q
Choose the correct answer:
A client feels paralyzed by intrusive thoughts and fears losing control.
- A. Challenge thoughts directly.
- B. Teach systematic desensitization immediately.
- C. Introduce mindfulness and acceptance strategies.
A
C. Introduce mindfulness and acceptance strategies.
Acceptance-based and mindfulness interventions (ACT/DBT) cultivate tolerance of internal experience and reduce avoidance
15
Q
Choose the correct answer:
In family therapy, parents criticize a withdrawn adolescent.
- A. Join with the adolescent to equalize power.
- B. Give homework without addressing dynamic.
- C. Side with parents to strengthen hierarchy.
A
A. Join with the adolescent to equalize power.
Structural therapy begins with joining to balance subsystems and establish rapport with underpowered members.
16
Q
Choose the correct answer:
A social worker notes frustration toward a demanding client.
- A. Disclose irritation to client.
- B. Ignore feelings and stay neutral.
- C. Seek supervision to examine countertransference.
A
C. Seek supervision to examine countertransference.
Supervision offers a reflective space to manage countertransference and prevent enactment.
17
Q
Choose the correct answer:
An agency repeatedly ignores requests for culturally appropriate materials.
- A. Purchase materials personally.
- B. Do nothing to maintain harmony.
- C. Document concern and advocate for systemic change.
A
C. Document concern and advocate for systemic change.
Macro-level intervention and advocacy uphold cultural competence standards.
18
Q
Choose the correct answer:
A client requests the therapist’s personal opinion on a moral dilemma.
- A. Offer a personal belief if it may help.
- B. Redirect conversation.
- C. Explore the meaning of the request.
A
C. Explore the meaning of the request.
Exploring the request maintains boundaries and uncovers the client’s underlying need for validation or guidance.
19
Q
Choose the correct answer:
A client reports “constant worry,” muscle tension, and insomnia for more than six months.
- A. Generalized Anxiety Disorder
- B. Major Depressive Disorder
- C. Obsessive–Compulsive Disorder
A
A. Generalized Anxiety Disorder
Persistent, diffuse anxiety lasting at least 6 months with physical tension and impaired concentration defines GAD. Other disorders involve discrete episodes or compulsions.
20
Q
Choose the correct answer:
An elderly man becomes disoriented, agitated, and hallucinating two days after hip surgery.
- A. Delirium
- B. Dementia (Neurocognitive Disorder)
- C. Psychotic Depression
A
A. Delirium
Delirium presents acutely with fluctuating consciousness and is often medically induced; dementia is gradual. Immediate medical evaluation is required.
21
Q
Choose the correct answer:
A client reports hearing voices for three months, decreased hygiene, and social withdrawal.
- A. Brief Psychotic Disorder
- B. Schizophrenia
- C. Schizophreniform Disorder
A
C. Schizophreniform Disorder
Duration under 6 months meets criteria for Schizophreniform Disorder; beyond that, schizophrenia is diagnosed.
22
Q
Choose the correct answer:
A client presents with elevated mood, decreased sleep, racing thoughts, and risky behavior for 5 days without severe impairment.
- A. Bipolar I Disorder
- B. Cyclothymic Disorder
- C. Bipolar II Disorder (Hypomanic Episode)
A
C. Bipolar II Disorder (Hypomanic Episode)
Hypomania lasts ≥ 4 days without major impairment; Bipolar I requires mania ≥ 1 week or hospitalization.
23
Q
Choose the correct answer:
A woman experiencing intrusive flashbacks after a sexual assault three weeks ago meets criteria for:
- A. Post-Traumatic Stress Disorder
- B. Acute Stress Disorder
- C. Adjustment Disorder
A
B. Acute Stress Disorder
Symptoms within 1–30 days of trauma fit ASD; beyond 1 month = PTSD. Early intervention can reduce progression risk.
24
Q
Choose the correct answer:
A client reports persistent fear of social scrutiny and avoids eating in public.
- A. Avoidant Personality Disorder
- B. Agoraphobia
- C. Social Anxiety Disorder
A
C. Social Anxiety Disorder
Excessive fear of humiliation in social or performance situations defines social anxiety; agoraphobia involves fear of escape difficulty.
25
Q
Choose the correct answer:
A man presents with repeated health complaints and medical visits despite reassurance. No significant findings are ever found.
- A. Somatic Symptom Disorder
- B. Factitious Disorder
- C. Illness Anxiety Disorder
A
A. Somatic Symptom Disorder
Preoccupation with multiple bodily symptoms plus distress characterizes SSD; illness anxiety centers on fear of disease, not ongoing symptoms.
26
# Choose the correct answer:
A social worker meeting a client for intake notices slurred speech and the smell of alcohol.
* A. Ask confrontationally about intoxication.
* B. Proceed with assessment and note observations.
* C. Terminate the session immediately.
B. Proceed with assessment and note observations.
## Footnote
The worker should document objective observations, assess capacity, and ensure safety. Immediate termination may risk the client’s wellbeing; careful evaluation and possible referral follow agency policy.
27
# Choose the correct answer:
A client reports loss of interest in activities, difficulty sleeping, and feelings of worthlessness for the past two weeks.
* A. Major Depressive Disorder
* B. Adjustment Disorder
* C. Dysthymia (Persistent Depressive Disorder)
A. Major Depressive Disorder
## Footnote
MDD requires ≥ 2 weeks of depressed mood or anhedonia with functional impairment and additional symptoms such as guilt, concentration problems, or appetite/sleep changes.
28
# Choose the correct answer:
A client with generalized anxiety disorder begins therapy. What should the social worker do first?
* A. Establish measurable treatment goals collaboratively.
* B. Teach relaxation skills in the first session.
* C. Identify triggers and develop a safety plan.
A. Establish measurable treatment goals collaboratively.
## Footnote
Assessment and goal setting precede technique application. Collaboration increases commitment and treatment alignment.
29
# Choose the correct answer:
A teenager caught shoplifting insists she only did it “for fun.” Which assessment tool is most relevant?
* A. Suicidality scale
* B. Autism screening
* C. Conduct Disorder diagnostic criteria
C. Conduct Disorder diagnostic criteria
## Footnote
Repeated rule-breaking or disregard for others’ rights suggests Conduct Disorder rather than situational stress. Early identification guides intervention.
30
# Choose the correct answer:
A social worker completing a mental status exam (MSE) documents that the client’s thought process is tangential. This means:
* A. The client’s thoughts never return to the main point.
* B. The client provides logical but overly detailed responses.
* C. The client experiences delusions.
A. The client’s thoughts never return to the main point.
## Footnote
Tangential thinking diverges from the topic and fails to return, distinguishing it from circumstantial speech where the main point is eventually reached.
31
# Choose the correct answer:
A social worker observes an adolescent displaying sadness, irritability, and poor grades. Before diagnosing depression, the worker should:
* A. Begin antidepressant medication.
* B. Ask about family’s psychiatric history only.
* C. Rule out normal adolescent mood swings.
C. Rule out normal adolescent mood swings.
## Footnote
Differential assessment distinguishes normative developmental variability from clinical disorder; premature labeling can stigmatize youth.
32
# Choose the correct answer:
A client scores 105 on an IQ test with a Standard Error of Measurement (SEM) of 5. What range best represents her true score 68 % of the time?
* A. 95–115
* B. 90–120
* C. 100–110
C. 100–110
## Footnote
One SEM in either direction (± 5) covers approximately 68 % of the distribution, representing the confidence interval for the true score.
33
# Choose the correct answer:
A social worker receives a referral for a client with possible cognitive decline. What is the most appropriate initial step?
* A. Refer for medication management only.
* B. Complete a thorough biopsychosocial and medical history.
* C. Administer an intelligence test immediately.
B. Complete a thorough biopsychosocial and medical history.
## Footnote
Assessment of biological and psychosocial factors (e.g., depression, substance use, nutrition) ensures accurate differential diagnosis before intervention.
34
# Choose the correct answer:
A client reports panic attacks when driving after a car accident. The most appropriate diagnosis is:
* A. Specific Phobia – Situational Type
* B. Generalized Anxiety Disorder
* C. Panic Disorder without Agoraphobia
A. Specific Phobia – Situational Type
## Footnote
Fear confined to one situation (driving) indicates a situational phobia rather than pervasive anxiety.
35
# Choose the correct answer:
A counselor sets a goal for a client to “reduce depressive symptoms by 30 % within six weeks, as measured by the PHQ-9.”
* A. This goal is vague and immeasurable.
* B. The goal violates client autonomy.
* C. This goal follows SMART criteria.
C. This goal follows SMART criteria.
## Footnote
Specific, Measurable, Achievable, Relevant, and Time-limited objectives support accountability and evidence-based evaluation.
36
# Choose the correct answer:
A client who lost his job presents with anger and insomnia but denies suicidal thoughts. The social worker’s priority is to:
* A. Explore career options immediately.
* B. Begin anger-management training.
* C. Conduct a full risk assessment to confirm safety.
C. Conduct a full risk assessment to confirm safety.
## Footnote
Even when suicidality is denied, acute loss and dysregulation warrant structured risk evaluation. Safety assessment precedes all interventions.
37
# Choose the correct answer:
A 45-year-old client reports sudden memory gaps and describes feeling detached from her body after trauma.
* A. PTSD
* B. Depersonalization/ Derealization Disorder
* C. Borderline Personality Disorder
B. Depersonalization/ Derealization Disorder
## Footnote
Primary symptoms are persistent detachment from self or surroundings while reality testing remains intact. In PTSD, dissociation appears only within a broader constellation of re-experiencing and avoidance symptoms.
38
# Choose the correct answer:
During intake, a client states, “I drink to calm my nerves every night, but I can stop anytime.” What should the social worker assess next?
* A. Tolerance and withdrawal symptoms.
* B. Spiritual beliefs.
* C. Level of social support.
A. Tolerance and withdrawal symptoms.
## Footnote
Assessing physiological dependence helps distinguish risky use from Substance Use Disorder and guides appropriate level of care.
39
# Choose the correct answer:
A young adult reports frequent checking of locks and handwashing rituals that take hours daily.
* A. Obsessive-Compulsive Personality Disorder
* B. Generalized Anxiety Disorder
* C. Obsessive-Compulsive Disorder
C. Obsessive-Compulsive Disorder
## Footnote
OCD involves ego-dystonic intrusive thoughts (obsessions) and repetitive acts (compulsions) that relieve anxiety. OCPD reflects rigid personality traits without distress over the behavior.
40
# Choose the correct answer:
A college student complains of heart palpitations, dizziness, and fear of dying. ER tests are normal.
* A. Illness Anxiety Disorder
* B. Generalized Anxiety Disorder
* C. Panic Disorder
C. Panic Disorder
## Footnote
Sudden, intense physical fear episodes with worry about recurrence define Panic Disorder; GAD involves chronic worry, not discrete attacks.
41
# Choose the correct answer:
A client complains of low energy, guilt, and hopelessness. He denies suicidal thoughts but reports trouble functioning at work. Which assessment is most appropriate?
* A. Beck Depression Inventory-II (BDI-II)
* B. Minnesota Multiphasic Personality Inventory (MMPI-2)
* C. Myers-Briggs Type Indicator
A. Beck Depression Inventory-II (BDI-II)
## Footnote
The BDI-II measures severity of depressive symptoms and guides treatment planning. MMPI evaluates broader psychopathology; MBTI and WAIS serve other purposes.
42
# Choose the correct answer:
A client reports recurrent nightmares and exaggerated startle response six months after combat exposure.
* A. Post-Traumatic Stress Disorder
* B. Acute Stress Disorder
* C. Adjustment Disorder
A. Post-Traumatic Stress Disorder
## Footnote
PTSD requires symptoms persisting longer than one month following trauma, including re-experiencing, avoidance, arousal, and negative mood changes.
43
# Choose the correct answer:
When determining treatment priorities for a new client, the social worker should address which concern first?
* A. Depressed mood
* B. Suicidal ideation with plan
* C. Housing instability
B. Suicidal ideation with plan
## Footnote
Safety supersedes all other goals. Immediate risk to self or others must be stabilized before psychosocial issues are addressed.
44
# Choose the correct answer:
A client diagnosed with Schizophrenia expresses concern about medication side effects. The social worker should:
* A. Encourage open discussion and coordinate with the prescriber.
* B. Avoid discussing medication because it is medical.
* C. Tell the client to continue medication regardless.
A. Encourage open discussion and coordinate with the prescriber.
## Footnote
Social workers collaborate with medical professionals while supporting client autonomy and adherence through education and advocacy.
45
# Choose the correct answer:
A newly divorced client experiences sleep disturbance, low concentration, and sadness for three months but continues working effectively.
* A. Major Depressive Disorder
* B. Dysthymia
* C. Adjustment Disorder with Depressed Mood
C. Adjustment Disorder with Depressed Mood
## Footnote
Symptoms appear within 3 months of a stressor and do not meet full MDD criteria. Functioning remains relatively intact.
46
# Choose the correct answer:
A 60-year-old client reports tremors, restlessness, and confusion after starting a new antidepressant.
* A. Psychotic episode – hospitalize involuntarily.
* B. Serotonin Syndrome – refer for emergency medical evaluation.
* C. Anxiety side effect – monitor only.
B. Serotonin Syndrome – refer for emergency medical evaluation.
## Footnote
Serotonin Syndrome is a medical emergency characterized by agitation, hyperreflexia, tremor, and autonomic instability. Immediate coordination with medical staff is essential.
47
# Choose the correct answer:
During a mental status exam, the social worker observes that the client’s mood is sad but affect is bright and smiling. This indicates:
* A. Incongruent affect
* B. Labile affect
* C. Restricted affect
A. Incongruent affect
## Footnote
Affect that does not match the client’s stated mood is incongruent and may signal defensive presentation or mood disorder.
48
# Choose the correct answer:
A client presents with pressured speech, flight of ideas, and minimal need for sleep. The most likely diagnosis is:
* A. Bipolar I Disorder, manic episode
* B. Cyclothymic Disorder
* C. Schizoaffective Disorder
A. Bipolar I Disorder, manic episode
## Footnote
Mania includes abnormally elevated mood, decreased sleep, grandiosity, and rapid thought—lasting at least one week or requiring hospitalization.
49
# Choose the correct answer:
A client reports confusion and auditory hallucinations developing within hours of alcohol withdrawal.
* A. Alcohol withdrawal delirium
* B. Schizophrenia
* C. PTSD with flashbacks
A. Alcohol withdrawal delirium
## Footnote
Delirium tremens occurs after cessation in dependent drinkers, marked by disorientation, agitation, and hallucinations—medical emergency.
50
# Choose the correct answer:
Which is the most accurate description of a biopsychosocial assessment?
* A. Diagnostic checklist using DSM criteria.
* B. Interview limited to client’s medical history.
* C. Holistic evaluation of biological, psychological, and social influences.
C. Holistic evaluation of biological, psychological, and social influences.
## Footnote
This model views the person-in-environment comprehensively, addressing interrelated systems influencing behavior and functioning.
51
# Choose the correct answer:
A social worker assesses an adolescent referred for truancy. The first step should be to:
* A. Confront the adolescent about responsibility.
* B. Explore contextual factors such as family stress, peers, and school climate.
* C. Develop a behavioral contract immediately.
B. Explore contextual factors such as family stress, peers, and school climate.
## Footnote
Assessment precedes intervention. Understanding environmental contributors avoids pathologizing normal adolescent struggles.
52
# Choose the correct answer:
A client reports low mood after the death of a spouse six months ago. Functioning is improving, and she finds comfort in memories.
* A. Normal bereavement
* B. Persistent Complex Bereavement Disorder
* C. Adjustment Disorder with Depressed Mood
A. Normal bereavement
## Footnote
Healthy grief allows gradual return of interest and joy. Pathological grief involves persistent yearning and impairment beyond cultural norms.
53
# Choose the correct answer:
Which SMART treatment goal is most appropriate for a client with social anxiety?
* A. “Stop feeling anxious.”
* B. “Attend two social events and practice relaxation techniques weekly for four weeks.”
* C. “Increase comfort in social situations.”
B. “Attend two social events and practice relaxation techniques weekly for four weeks.”
## Footnote
SMART goals are Specific, Measurable, Achievable, Relevant, and Time-limited, focusing on observable behaviors.
54
# Choose the correct answer:
A client with panic disorder reports fear of having a heart attack during episodes. The social worker should:
* A. Encourage avoidance of triggering situations.
* B. Provide psychoeducation about panic physiology.
* C. Focus on unconscious anger.
B. Provide psychoeducation about panic physiology.
## Footnote
Normalizing physical sensations reduces catastrophic interpretation and empowers cognitive reappraisal.
55
# Choose the correct answer:
A client’s assessment reveals poor insight, paranoia, and disorganized thinking. The social worker should next:
* A. Conduct a risk assessment for harm and coordinate with medical professionals.
* B. Begin cognitive-behavioral therapy immediately.
* C. Encourage journaling of paranoid thoughts.
A. Conduct a risk assessment for harm and coordinate with medical professionals.
## Footnote
Psychotic symptoms require safety evaluation and potential medication coordination—safety always supersedes treatment planning.
56
# Choose the correct answer:
A client reports feeling “empty” and fears abandonment. Relationships are intense and unstable.
* A. Histrionic Personality Disorder
* B. Narcissistic Personality Disorder
* C. Borderline Personality Disorder
C. Borderline Personality Disorder
## Footnote
BPD features emotional instability, identity diffusion, fear of abandonment, and dichotomous (“all or nothing”) relationships.
57
# Choose the correct answer:
A client expresses suicidal thoughts but denies having a plan or means. The social worker’s first action should be to:
* A. Initiate involuntary hospitalization.
* B. Notify family immediately.
* C. Conduct a detailed suicide risk assessment.
C. Conduct a detailed suicide risk assessment.
## Footnote
A structured risk assessment determines intent, means, and protective factors before choosing a level of intervention. Safety assessment always precedes action.
58
# Choose the correct answer:
A client with schizophrenia reports command hallucinations to harm others.
* A. Assess risk and warn potential victims per duty to protect laws.
* B. Provide reassurance and wait for symptoms to subside.
* C. Explore childhood trauma.
A. Assess risk and warn potential victims per duty to protect laws.
## Footnote
The Tarasoff ruling mandates protective action when specific threats are communicated. Ethical duty includes assessment, supervision, and documentation.
59
# Choose the correct answer:
A client reports extreme anxiety, dizziness, and chest tightness after a recent divorce. Medical workup is negative.
* A. Panic Disorder
* B. Generalized Anxiety Disorder
* C. Adjustment Disorder with Anxiety
C. Adjustment Disorder with Anxiety
## Footnote
When emotional or behavioral symptoms follow a stressor within 3 months and do not meet criteria for another disorder, Adjustment Disorder is most accurate.
60
# Choose the correct answer:
A social worker suspects child neglect but lacks concrete evidence.
* A. Wait for confirmation from another professional.
* B. Interview the child without parental consent.
* C. File a report based on reasonable suspicion.
C. File a report based on reasonable suspicion.
## Footnote
Mandated reporters act on reasonable suspicion—not proof. Failing to report risks client safety and legal liability.
61
# Choose the correct answer:
A client with depression expresses passive death wishes but no active intent.
* A. Develop a safety plan and increase monitoring.
* B. Initiate involuntary hospitalization.
* C. Terminate services.
A. Develop a safety plan and increase monitoring.
62
# Choose the correct answer:
A client expresses fear that coworkers are conspiring against him but denies hallucinations. Functioning remains intact.
* A. Schizophrenia
* B. Delusional Disorder, Persecutory Type
* C. Paranoid Personality Disorder
B. Delusional Disorder, Persecutory Type
## Footnote
Delusional Disorder features fixed, non-bizarre beliefs without significant thought disorganization or impairment. Schizophrenia requires broader functional decline and hallucinations.
63
# Choose the correct answer:
A 10-year-old exhibits distractibility, impulsivity, and hyperactivity in both home and school.
* A. Conduct Disorder
* B. ADHD – Combined Presentation
* C. Oppositional Defiant Disorder
B. ADHD – Combined Presentation
## Footnote
Symptoms across settings confirm ADHD. ODD involves defiance toward authority; Conduct Disorder includes rule-breaking or aggression.
64
# Choose the correct answer:
A client reports extreme anxiety about being judged while speaking in public.
* A. Agoraphobia
* B. Panic Disorder
* C. Social Anxiety Disorder
C. Social Anxiety Disorder
## Footnote
Social Anxiety involves fear of humiliation in evaluative settings. The concern centers on social performance, not general panic or avoidance of all crowds.
65
# Choose the correct answer:
During suicide risk assessment, which finding indicates highest immediate danger?
* A. Past suicidal ideation only
* B. Protective family network
* C. Hopelessness and a specific plan with access to means
C. Hopelessness and a specific plan with access to means
## Footnote
The combination of hopelessness, specificity, and available means predicts imminent lethality and requires urgent safety intervention.
66
# Choose the correct answer:
A client presents with financial strain, unemployment, and marital stress. The social worker explores social supports, economic stressors, and coping strengths.
* A. Ecological approach
* B. Person-in-environment perspective
* C. Systems theory
A. Ecological approach
## Footnote
The ecological model assesses interaction between individual and environment, emphasizing adaptation and reciprocal influence—central to social work practice.
67
# Choose the correct answer:
A social worker evaluates a teen with escalating school fights and irritability following concussion. The next step is to:
* A. Refer for neurological and psychiatric evaluation.
* B. Begin anger management sessions.
* C. Assign journaling exercises.
A. Refer for neurological and psychiatric evaluation.
## Footnote
Medical issues must be ruled out before psychosocial intervention. Post-concussion symptoms can mimic behavioral disorders.
68
# Choose the correct answer:
A social worker notices a client frequently misses sessions due to transportation issues.
* A. Terminate due to noncompliance.
* B. Ignore attendance until progress stops.
* C. Address barriers and modify the treatment plan collaboratively.
C. Address barriers and modify the treatment plan collaboratively.
## Footnote
Intervention planning must reflect realistic client access and systemic obstacles; engagement strategies sustain treatment adherence.
69
# Choose the correct answer:
A client with generalized anxiety shows minimal progress after four months of CBT. The social worker should:
* A. Reassess diagnosis, goals, and treatment fit.
* B. Shift immediately to psychodynamic therapy.
* C. Continue identical plan longer.
A. Reassess diagnosis, goals, and treatment fit.
## Footnote
Ongoing assessment ensures interventions remain evidence-based and individualized. Nonresponse requires re-evaluation, not abandonment.
70
# Choose the correct answer:
A client denies suicidal ideation but has given away possessions and withdrawn from friends.
* A. Accept denial and proceed normally.
* B. Treat as high risk and complete safety planning.
* C. Wait for explicit ideation before acting.
B. Treat as high risk and complete safety planning.
## Footnote
Behavioral cues outweigh verbal denial. Ethical duty requires proactive safety assessment and intervention whenever warning signs are present.
71
# Choose the correct answer:
A 35-year-old recently released from prison exhibits paranoia and hypervigilance in public settings. The social worker should:
* A. Refer for anger management.
* B. Diagnose psychotic disorder immediately.
* C. Explore environmental triggers and assess for trauma-related responses.
C. Explore environmental triggers and assess for trauma-related responses.
## Footnote
Reentry often involves trauma, institutionalization effects, and mistrust. Differential assessment distinguishes PTSD-related hyperarousal from psychosis.
72
# Choose the correct answer:
A client with severe anxiety begins to hyperventilate during session. The social worker should FIRST:
* A. Ask the client to describe the fear in detail.
* B. Guide the client in diaphragmatic breathing.
* C. Explore the origins of the anxiety.
B. Guide the client in diaphragmatic breathing.
## Footnote
Crisis stabilization precedes exploration. Grounding or breathing techniques regulate physiology before insight-based processing.
73
# Choose the correct answer:
A client reports daily alcohol use and expresses concern but refuses inpatient treatment. The social worker should:
* A. Explore ambivalence using motivational interviewing.
* B. Warn about withdrawal seizures.
* C. Confront denial directly.
A. Explore ambivalence using motivational interviewing.
## Footnote
Motivational interviewing enhances intrinsic motivation by resolving ambivalence—client-centered, nonjudgmental, and evidence-based for substance use.
74
# Choose the correct answer:
A client presents with chronic physical pain without medical explanation. The social worker suspects somatic symptom disorder. What should be done first?
* A. Initiate relaxation training immediately.
* B. Collaborate with medical professionals to rule out organic causes.
* C. Diagnose based solely on symptom report.
B. Collaborate with medical professionals to rule out organic causes.
## Footnote
Ethically, biological conditions must be excluded before assuming psychological origins. Collaboration ensures comprehensive assessment.
75
# Choose the correct answer:
When writing measurable objectives, which statement best reflects correct practice?
* A. “Client will identify three triggers for anxiety by next session.”
* B. “Client will discuss goals as desired.”
* C. “Client will feel better about self.”
* D. “Client will report improved mood soon.”
A. “Client will identify three triggers for anxiety by next session.”
## Footnote
Specific, behavioral, and time-bound goals are observable and measurable—consistent with evidence-based treatment planning.
76
# Choose the correct answer:
A client in couples counseling reports verbal abuse by the partner. The social worker should FIRST:
* A. Assess safety and risk for escalation.
* B. Encourage mutual discussion of issues.
A. Assess safety and risk for escalation.
## Footnote
Safety is paramount. Conjoint sessions may increase risk in abusive relationships; screening for danger comes before relational work.
77
# Choose the correct answer:
A client with PTSD refuses to discuss trauma memories but continues therapy for coping skills. The social worker should:
* A. Respect readiness and focus on stabilization
* B. Confront the client about avoidance
* C. Terminate treatment for noncompliance
A. Respect readiness and focus on stabilization
## Footnote
Trauma-informed care prioritizes safety and pacing. Forcing disclosure risks retraumatization; readiness dictates timing of deeper work.
78
# Choose the correct answer:
A social worker treating a couple learns one partner is secretly in another relationship. The worker should:
* A. Inform the other partner immediately
* B. Clarify confidentiality limits in conjoint therapy and encourage disclosure
* C. Keep the information private to preserve trust
B. Clarify confidentiality limits in conjoint therapy and encourage disclosure
## Footnote
Dual confidentiality must be handled transparently. The social worker cannot keep secrets that impact the integrity of joint treatment.
79
# Choose the correct answer:
A supervisor pressures a clinician to shorten assessment sessions to increase billing volume.
* A. Refuse and document ethical concerns in writing
* B. Comply to retain employment
* C. Discuss casually without documentation
A. Refuse and document ethical concerns in writing
## Footnote
Ethical standards require prioritizing client welfare and accurate billing practices. Written documentation protects the clinician and clients.
80
# Choose the correct answer:
A client holds a fixed belief that neighbors are intentionally poisoning their food. The belief persists despite repeated medical reassurance and lack of corroborating evidence.
This belief is BEST conceptualized as:
* A. An obsession
* B. An overvalued idea
* C. A delusion
C. A delusion
## Footnote
Domain Rationale:
This item tests diagnostic assessment and differentiation of thought content, a core Assessment & Planning function.
81
# Choose the correct answer:
A basketball player averages 27 points per game and is ranked sixth among forwards in a regional league.
The level of measurement MOST clearly represented is:
* A. Interval
* B. Ordinal
* C. Ratio
B. Ordinal
## Footnote
Domain Rationale:
The emphasis is on interpreting data meaningfully during assessment, specifically understanding ranking versus raw score properties.
82
# Choose the correct answer:
The Education for All Handicapped Children Act (PL 94-142) requires ALL of the following EXCEPT:
* A. Education in the least restrictive environment
* B. Provision of a free and appropriate public education
* C. Mandatory placement in specialized schools
C. Mandatory placement in specialized schools
## Footnote
Domain Rationale:
Knowledge of policy-informed assessment and planning mandates is essential for accurate service coordination.
83
# Choose the correct answer:
A client presents to the emergency department multiple times with sudden chest pain, shortness of breath, and fear of imminent death. Medical evaluations consistently reveal no physiological cause.
These symptoms are MOST consistent with:
* A. Panic disorder
* B. Illness anxiety disorder
* C. Somatic symptom disorder
A. Panic disorder
## Footnote
Domain Rationale:
This item evaluates clinical symptom pattern recognition, not treatment selection.
84
# Choose the correct answer:
Which belief is NOT characteristic of a delusional process?
* A. The belief is experienced as intrusive and unwanted.
* B. The belief significantly impairs functioning.
* C. The belief is fixed and resistant to counterevidence.
A. The belief is experienced as intrusive and unwanted.
## Footnote
“Distressing” ≠ “intrusive.” Intrusiveness points toward obsessions, not delusions.
85
# Choose the correct answer:
When evaluating repeated ER visits with unexplained cardiopulmonary complaints, the clinician should do ALL of the following EXCEPT:
* A. Assess for panic symptoms and avoidance patterns.
* B. Assume malingering due to repeated presentations.
* C. Explore catastrophic misinterpretations of bodily sensations.
B. Assume malingering due to repeated presentations.
86
# Choose the correct answer:
A client insists that coworkers are deliberately sabotaging her work and poisoning her lunch. The belief has remained unchanged for months and is not shared by others in her cultural or religious community.
Which feature is NOT most consistent with a delusional belief?
* A. Significant impact on occupational functioning
* B. Resistance to contradictory evidence
* C. Recognition that the belief may be irrational
C. Recognition that the belief may be irrational
## Footnote
Delusions are ego-syntonic and fixed, not questioned. Insight ≠ delusion.
87
# Choose the correct answer:
A clinician reviews data showing that individuals with more years of education tend to earn higher incomes.
All of the following statements are accurate EXCEPT:
* A. The variables move in the same general direction
* B. The relationship is statistically positive
* C. Education can be assumed to cause higher income
C. Education can be assumed to cause higher income
## Footnote
Correlation ≠ causation, even when it feels obvious.
88
# Choose the correct answer:
A professional athlete averages 27 points per game and is ranked sixth among forwards in the league.
Which level of measurement is LEAST defensible?
* A. Interval
* B. Ratio
* C. Ordinal
A. Interval
## Footnote
Scores may be ratio, but the question emphasizes ranking, which demotes the scale to ordinal. Interval sneaks in as the trap.
89
# Choose the correct answer:
Which statement is NOT required under the Individuals with Disabilities Education Act (IDEA)?
* A. Education in the least restrictive environment
* B. Mandatory placement in specialized disability schools
* C. A free and appropriate public education
B. Mandatory placement in specialized disability schools
## Footnote
Policy questions now test what is explicitly prohibited, not memorized lists.
90
# Choose the correct answer:
A client presents repeatedly to the ER with chest pain, dizziness, and fear of dying. Medical evaluations are normal.
Which diagnosis is MOST UNLIKELY?
* A. Post-traumatic stress disorder
* B. Panic disorder
* C. Illness anxiety disorder
A. Post-traumatic stress disorder
## Footnote
PTSD has panic features—but requires trauma anchoring, not health anxiety alone.
91
# Choose the correct answer:
Adlerian family therapy emphasizes all of the following EXCEPT:
* A. Exploring the goals of behavior
* B. Encouraging social interest
* C. Identifying irrational beliefs
C. Identifying irrational beliefs
## Footnote
“Irrational beliefs” = CBT contamination trap
92
# Choose the correct answer:
Which feature is NOT characteristic of panic disorder?
* A. Persistent concern about additional attacks
* B. Sudden onset of intense fear
* C. Delusional conviction of imminent death
C. Delusional conviction of imminent death
## Footnote
Fear ≠ psychosis, even when dramatic
93
# Choose the correct answer:
Which belief is MOST UNLIKELY to be classified as an overvalued idea?
* A. A strongly held belief shared by a subculture
* B. A belief held with some doubt
* C. A fixed belief resistant to all counterevidence
C. A fixed belief resistant to all counterevidence
## Footnote
Fixed + impermeable = delusion, not overvalued idea
94
# Choose the correct answer:
Which statement does NOT accurately describe somatic symptom–related disorders?
* A. Medical reassurance does not relieve anxiety
* B. Symptoms are intentionally produced
* C. Distress is disproportionate to findings
B. Symptoms are intentionally produced
95
# Choose the correct answer:
A child is labeled “defiant” for not following instructions.
What should be assessed FIRST?
* A. Peer modeling
* B. Parenting style
* C. Language processing
C. Language processing
## Footnote
Competency: Differential assessment
96
# Choose the correct answer:
A client reports panic only in grocery stores.
What assessment question is MOST relevant?
* A. “What happens physiologically in that setting?”
* B. “When did this begin?”
* C. “Do you avoid crowds?”
A. “What happens physiologically in that setting?”
## Footnote
Competency: Symptom clarification
97
# Choose the correct answer:
A client reports sadness, insomnia, and appetite loss for 2 weeks after job loss.
NEXT step?
* A. Refer for medication
* B. Assess severity and functional impairment
* C. Diagnose MDD
B. Assess severity and functional impairment
## Footnote
Competency: Diagnostic assessment
98
# Choose the correct answer:
A client’s coping skills appear immature for age.
What should be considered FIRST?
* A. Developmental history
* B. Treatment resistance
* C. Cognitive decline
A. Developmental history
## Footnote
Competency: Developmental formulation
99
# Choose the correct answer:
A client reports housing instability and depression.
What planning priority comes FIRST?
* A. Safety and basic needs
* B. CBT goals
* C. Insight goals
A. Safety and basic needs
## Footnote
Competency: Treatment planning hierarchy
100
# Choose the correct answer:
A social worker suspects substance use disorder.
What assessment data is MOST critical?
* A. Pattern and impact of use
* B. Motivation level
* C. Legal history
A. Pattern and impact of use
## Footnote
Competency: Diagnostic criteria assessment
101
# Choose the correct answer:
A client reports chronic worry for several years.
NEXT assessment focus?
* A. Duration and pervasiveness
* B. Family history
* C. Coping strategies
A. Duration and pervasiveness
## Footnote
Competency: Differential diagnosis
102
# Choose the correct answer:
A client’s symptoms worsen every winter.
What should be assessed FIRST?
* A. Seasonal pattern
* B. Support system
* C. Cognitive distortions
A. Seasonal pattern
## Footnote
Competency: Pattern recognition
103
# Choose the correct answer:
A client presents with inconsistent symptoms across settings.
What should the social worker explore FIRST?
* A. Malingering
* B. Environmental triggers
* C. Medication adherence
B. Environmental triggers
## Footnote
Competency: Contextual assessment
104
# Choose the correct answer:
A client denies suicidal intent but reports feeling “empty and done.”
NEXT assessment step?
* A. Conduct suicide risk assessment
* B. Dismiss concern
* C. Focus on strengths
A. Conduct suicide risk assessment
## Footnote
Competency: Risk assessment
105
# Choose the correct answer:
A family seeks therapy for a “problem child.”
What should be assessed FIRST?
* A. Family interaction patterns
* B. Child behavior
* C. School performance
A. Family interaction patterns
## Footnote
Competency: Systems-based assessment
106
# Choose the correct answer:
A client minimizes trauma exposure.
What planning consideration is MOST important?
* A. Immediate exposure work
* B. Challenging distortions
* C. Establishing safety and pacing
C. Establishing safety and pacing
## Footnote
Competency: Trauma-informed planning
107
# Choose the correct answer:
A client presents with somatic complaints and anxiety.
What should be assessed FIRST?
* A. Medical rule-outs
* B. Coping skills
* C. Insight
A. Medical rule-outs
## Footnote
Competency: Biopsychosocial assessment
108
# Choose the correct answer:
A client requests therapy but cannot articulate goals.
What should the social worker do FIRST?
* A. Collaboratively define goals
* B. Assign homework
* C. Provide psychoeducation
A. Collaboratively define goals
## Footnote
Competency: Goal-setting
109
# Choose the correct answer:
A client reports discrimination-related distress.
What should be assessed NEXT?
* A. Personal resilience only
* B. Environmental and systemic stressors
* C. Cognitive distortions
B. Environmental and systemic stressors
## Footnote
Competency: Person-in-environment assessment
