LCAS EXAM – NORTH CAROLINA FULL 125-QUESTION
PRACTICE EXAM ANSWERS & RATIONALES | A+ GRADED
| LATEST UPDATE 2026
Domain 1: Clinical Evaluation (Questions 1–20)
1. A 28-year-old client reports drinking 15 beers daily for 10 years. Their last
drink was 8 hours ago. They are tremulous, diaphoretic, and have a heart rate of
120 bpm. What is the priority action?
A. Administer thiamine
B. Begin CBT for relapse prevention
C. Assess for CIWA-Ar protocol need
D. Refer to AA
Answer: C
Rationale: Symptoms indicate alcohol withdrawal; CIWA-Ar should be used to
guide medication. Thiamine is important but not the immediate priority before
withdrawal management.
2. Which is a valid screening tool for unhealthy alcohol use in primary care?
A. MAST
B. AUDIT
C. SASSI
D. TIP 34
,Answer: B
Rationale: AUDIT (Alcohol Use Disorders Identification Test) is WHO-developed,
validated for primary care. MAST is longer; SASSI is for substance use disorders
generally.
3. A North Carolina LCAS receives a referral for a client who only speaks Spanish.
The LCAS is not fluent. What should they do?
A. Decline the client
B. Use a bilingual family member as interpreter
C. Use a certified medical interpreter
D. Proceed with yes/no questions
Answer: C
Rationale: NC ethical codes require use of qualified interpreters. Family
members may introduce bias or confidentiality breaches.
4. A client endorses using “coke” but is vague about route. To clarify, the LCAS
should ask:
A. “How much does cocaine cost on the street?”
B. “Do you snort, smoke, or inject cocaine?”
C. “Why do you use cocaine?”
D. “Is it powder or crack?”
Answer: B
Rationale: Direct, non-judgmental closed-ended questions about route clarify
risk (e.g., injection increases infection risk).
5. The biopsychosocial assessment for LCAS in NC must include:
A. Primary care physical exam
B. SUD criteria per DSM-5
C. Polygraph results
D. Previous job performance reviews
,Answer: B
*Rationale: DSM-5 SUD criteria are required for diagnosis. Physical exam is
done by medical staff, not LCAS.*
6. Which best defines “withdrawal” diagnostically?
A. Need for increased amount to achieve intoxication
B. Characteristic syndrome when substance is stopped after heavy use
C. Craving in a specific environment
D. Failure to fulfill major role obligations
Answer: B
*Rationale: This is the DSM-5 definition. A is tolerance; C is conditioned
craving; D is a criterion but not withdrawal.*
7. A client appears intoxicated during an intake. The LCAS should:
A. Complete the full assessment
B. Send the client home
C. Reschedule when sober
D. Call police
Answer: C
Rationale: Valid assessment requires sobriety. NC rules state cannot diagnose
or consent while impaired.
8. Which labs are most useful for detecting heavy alcohol use in past 2-3 weeks?
A. LFTs (AST/ALT)
B. CDT and GGT
C. Urine drug screen
D. BUN/Creatinine
Answer: B
Rationale: CDT (carbohydrate-deficient transferrin) and GGT have moderate
sensitivity for chronic heavy alcohol use.
, 9. A client denies drug use but fentanyl is found in urine. Best response:
A. “You’re lying.”
B. “The lab must be wrong.”
C. “The test shows fentanyl. Help me understand.”
D. Discharge immediately.
Answer: C
Rationale: Non-confrontational, curious approach preserves therapeutic
alliance.
10. Which is a required component of a NC LCAS clinical evaluation?
A. Family genogram
B. Criminal background check
C. Collateral contact when possible
D. IQ test
Answer: C
Rationale: NC administrative code requires collateral info if available to
confirm self-report.
11. Which DSM-5 criterion for SUD involves spending a great deal of time
obtaining, using, or recovering from a substance?
A. Craving
B. Tolerance
C. Time spent
D. Hazardous use
Answer: C
*Rationale: “Time spent” is a distinct criterion in DSM-5 (Criterion 4).*
12. A client reports using heroin daily for 2 months, last use 12 hours ago, now
has yawning, runny nose, muscle aches. What stage of opioid withdrawal?
A. Early (Stage 1)
B. Fully developed (Stage 2)
PRACTICE EXAM ANSWERS & RATIONALES | A+ GRADED
| LATEST UPDATE 2026
Domain 1: Clinical Evaluation (Questions 1–20)
1. A 28-year-old client reports drinking 15 beers daily for 10 years. Their last
drink was 8 hours ago. They are tremulous, diaphoretic, and have a heart rate of
120 bpm. What is the priority action?
A. Administer thiamine
B. Begin CBT for relapse prevention
C. Assess for CIWA-Ar protocol need
D. Refer to AA
Answer: C
Rationale: Symptoms indicate alcohol withdrawal; CIWA-Ar should be used to
guide medication. Thiamine is important but not the immediate priority before
withdrawal management.
2. Which is a valid screening tool for unhealthy alcohol use in primary care?
A. MAST
B. AUDIT
C. SASSI
D. TIP 34
,Answer: B
Rationale: AUDIT (Alcohol Use Disorders Identification Test) is WHO-developed,
validated for primary care. MAST is longer; SASSI is for substance use disorders
generally.
3. A North Carolina LCAS receives a referral for a client who only speaks Spanish.
The LCAS is not fluent. What should they do?
A. Decline the client
B. Use a bilingual family member as interpreter
C. Use a certified medical interpreter
D. Proceed with yes/no questions
Answer: C
Rationale: NC ethical codes require use of qualified interpreters. Family
members may introduce bias or confidentiality breaches.
4. A client endorses using “coke” but is vague about route. To clarify, the LCAS
should ask:
A. “How much does cocaine cost on the street?”
B. “Do you snort, smoke, or inject cocaine?”
C. “Why do you use cocaine?”
D. “Is it powder or crack?”
Answer: B
Rationale: Direct, non-judgmental closed-ended questions about route clarify
risk (e.g., injection increases infection risk).
5. The biopsychosocial assessment for LCAS in NC must include:
A. Primary care physical exam
B. SUD criteria per DSM-5
C. Polygraph results
D. Previous job performance reviews
,Answer: B
*Rationale: DSM-5 SUD criteria are required for diagnosis. Physical exam is
done by medical staff, not LCAS.*
6. Which best defines “withdrawal” diagnostically?
A. Need for increased amount to achieve intoxication
B. Characteristic syndrome when substance is stopped after heavy use
C. Craving in a specific environment
D. Failure to fulfill major role obligations
Answer: B
*Rationale: This is the DSM-5 definition. A is tolerance; C is conditioned
craving; D is a criterion but not withdrawal.*
7. A client appears intoxicated during an intake. The LCAS should:
A. Complete the full assessment
B. Send the client home
C. Reschedule when sober
D. Call police
Answer: C
Rationale: Valid assessment requires sobriety. NC rules state cannot diagnose
or consent while impaired.
8. Which labs are most useful for detecting heavy alcohol use in past 2-3 weeks?
A. LFTs (AST/ALT)
B. CDT and GGT
C. Urine drug screen
D. BUN/Creatinine
Answer: B
Rationale: CDT (carbohydrate-deficient transferrin) and GGT have moderate
sensitivity for chronic heavy alcohol use.
, 9. A client denies drug use but fentanyl is found in urine. Best response:
A. “You’re lying.”
B. “The lab must be wrong.”
C. “The test shows fentanyl. Help me understand.”
D. Discharge immediately.
Answer: C
Rationale: Non-confrontational, curious approach preserves therapeutic
alliance.
10. Which is a required component of a NC LCAS clinical evaluation?
A. Family genogram
B. Criminal background check
C. Collateral contact when possible
D. IQ test
Answer: C
Rationale: NC administrative code requires collateral info if available to
confirm self-report.
11. Which DSM-5 criterion for SUD involves spending a great deal of time
obtaining, using, or recovering from a substance?
A. Craving
B. Tolerance
C. Time spent
D. Hazardous use
Answer: C
*Rationale: “Time spent” is a distinct criterion in DSM-5 (Criterion 4).*
12. A client reports using heroin daily for 2 months, last use 12 hours ago, now
has yawning, runny nose, muscle aches. What stage of opioid withdrawal?
A. Early (Stage 1)
B. Fully developed (Stage 2)
