TDC Mock Exam/Clinical Level Final Mock Exam I

TDC Mock Exam/Clinical Level Final Mock Exam IPublished on Therapist Development Center () Home Printer-friendly Clinical Level Final Mock Exam I Clinical Level Final Mock Exam I Printer Friendly Version You got 119 of 170 possible points. Your score: 70% Quiz Time: 3 hours 39 minutes 8 seconds Question 1 A 10-year-old boy is placed with a foster family that has different religious beliefs than the child. The foster parents want the foster child to follow their religious practices. What is the social worker’s BEST course of action in this situation? Score: 1 of 1 A. Tell the family to follow the child’s religion. B. Instruct the child to follow the family’s religion. C. Tell the child not to practice any religion to avoid conflict. D. Identify alternate placement for the child. Rationale: The best option here is D. All the other options go against honoring the diversity of the people. Some people may not pick this because they think that another option would not be available, but if it is an option on the exam then it is available. Question 2 A family comes in with high expectations of their 10-year-old child. The child excels in school and the teacher states that he has never had an infraction although he appears to be unhappy and has a hard time socially. The parents are likely using what kind of parenting style? Score: 1 of 1 A. Authoritarian Rationale: The clues in the stem are that the child excels, hasn’t had an infraction but seem unhappy and has a hard time socially. This is the description of a child raised in an Authoritarian home. Children raised Authoritative parenting styles are the best adjusted. Both Permissive and Univolved children display behavioral problems and generally have lower school performance. B. Authoritative C. Permissive D. Uninvolved Question 3 A woman has been going to therapy for the past two months. Whenever the therapist brings up emotional material the woman dismisses it and says she isn't interested in talking about those subjects. She talks a lot about her day to day life and says she thinks she is ready to terminate. What should the therapist do next: Score: 1 of 1 A. The client seems like she is doing fine and feels she is ready to terminate so the therapist should start the termination process. B. The therapist should address the client's resistance in discussing the emotional material. Rationale: A client expressing disinterest in discussing emotional material is likely a sign of resistance. C. The therapist should give the client two more sessions to see if she still feels ready for termination. D. The therapist should inform the client that she needs to talk about this material or else the therapy sessions will be over. Question 4 An unlicensed social worker is meeting with an older woman for their first therapy session. The older woman reminds the social worker a lot of her mother who she does not have a good relationship with. The social worker finds herself becoming easily frustrated with the older woman and is having a hard time remaining calm. What should the social worker do first: Score: 1 of 1 A. She should bring up the situation with the client and explain why she is becoming agitated. B. Since it is only the first session, she should transfer her to another therapist. C. She should talk to a supervisor about her countertransference issues. Rationale: The experience the social worker is having is a countertransference reaction. When you put the answers in order, the first thing to do would be to talk to a supervisor this could lead to her doing D or B. Answer A would not be appropriate in the initial phase of treatment as it makes the social workers issues the focus. D. She should journal about her feelings after the sessions. Question 5 A clinical social worker is evaluating a friendly, 5-year-old child who has difficulty making friends in school. He is very verbal, but has a hard time answering questions about his feelings. He is eager to talk about all the different types of reptiles and knows all about them. What should be the social worker’s next step: Score: 0 of 1 A. Diagnose him with Autism Spectrum Disorder. B. Use play therapy to try to connect with him on different topics. C. Refer him to a social skills group. Rationale: The best option is C. While there are signs of Austism Spectrum Disorder, there is not enough to make a formal diagnosis. Answer B suggests the social worker direct the play which you wouldn’t do in the initial phase of treatment. The main issue is his inability to make friends and talk about his feelings so a social skills group is clearly indicated. There is no reason to have him transfer to another school. D. Suggest that he is transferred to a different school. Question 6 A social worker is conducting a study on the effectiveness of group therapy in decreasing depression in teenagers recently diagnosed with diabetes. Which of the follow refers to the extent to which the results of a study can be generalized to other situations and people? Score: 1 of 1 A. External Validity Rationale: This is a factual recall question; B, C, and D would all be described differently. B. Internal Validity C. Reliability D. Statistical Significance Question 7 A social worker in a community clinic meets with a 8-year-old. He is argumentative, quick to anger and shows signs of being vindictive. What would be the best approach to take in trying to gain his trust: Score: 1 of 1 A. Give him warnings and follow through with consequences. B. Diagnose him with Oppositional Defiant Disorder. C. Refer him for medication evaluation. D. Use active listening to understand his situation. Rationale: The best answer is D. Giving him warnings is not going to build his trust. Neither B nor C build trust. Question 8 A social worker is part of an evaluation team assessing the effectiveness of a neighborhood outreach program targeting families with children ages 0-5. The social worker is in charge of collecting qualitative data. Which of the following is the BEST example of a qualitative measure? Score: 1 of 1 A. Looking at the way variables such as age and income level impact the utilization of client services. B. Tracking the number of clients served in a year through a specific program C. Comparing the number of clients using a new service compared to an old service D. Interviewing clients about their level of satisfaction with the changes in program delivery Rationale: D is the best answer because it involves gathering information directly from program participants. A, B, and C are all examples of quantitative data. Question 9 A social worker in a community agency receives a referral for her friend’s preschool-age son. The social worker should: Score: 1 of 1 A. Involve the friend in a comprehensive assessment and treatment plan B. Conduct an initial assessment and make treatment recommendations C. Refer the son to a different therapist Rationale: Social workers should avoid dual relationships with clients. In this case, the son would be at risk of not receiving the best treatment, as the social worker may have preconceived notions about the son or may treat him differently due to the social worker’s relationship with the mother. Avoiding dual relationships ensures the client’s safety and ability to receive appropriate treatment. D. Treat the son after getting consultation regarding confidentiality and boundaries Question 10 A 55 year-old Native American woman seeks treatment following the death of her son. When working with Native American clients, in order to be culturally sensitive and develop a good therapeutic relationship it is important to observe all of the following in order to be culturally sensitive and develop a good therapeutic relationship, EXCEPT: Score: 1 of 1 A. Be directive Rationale: Answers B, C, and D are all advised approaches with Native Americans. This leaves answer A as the only one that should be avoided. B. Use active listening and reflective responses. C. Avoid interrupting D. Allow for periods of silence Question 11 A client with a history of severe depression reports hypersomnolence and decreased appetite. The client reports having discontinued his prescribed medication because he didn’t think he needed it anymore. The social worker should FIRST: Score: 0 of 1 A. Question the client as to the other reasons for discontinuing the medication B. Instruct the client to resume the medication C. Encourage to the client to speak to his psychiatrist Rationale: Because the increase in symptoms is likely to be directly related to the discontinuation of medication, the client should be encouraged to go back to his psychiatrist. It would be outside of the social worker’s scope of practice to instruct the client to resume medication. While questioning the client about the reasons for discontinuing medication and discussing alternative treatment options may be appropriate interventions at some point, the social worker should FIRST encourage the client to speak to his doctor regarding his increase in neurovegetative symptoms. D. Discuss alternative treatment options Question 12 A gay couple who say they are both in long-term recovery for cocaine addictions request couples’ therapy. The couple reports frequent arguments and an increased sense of distance in their relationship. The social worker should FIRST: Score: 0 of 1 A. Teach the couple communication skills. B. Assess for a drug relapse in either partner. Rationale: B is the best answer because a decrease in intimacy and an increase in arguments may be signs that one partner has relapsed, putting stress on the relationship. This needs to be assessed first. A, C, and D can be done later. C. Assign the couple intimacy exercises as homework. D. Teach the couple anger management skills. Question 13 A married couple meet with a social worker in private practice for an initial session. Afterwards, the wife calls the social worker and states, “I have something I want to talk to you about, but my husband can’t find out.” The social worker’s MOST appropriate response would be to: Score: 0 of 1 A. Reassure the wife that what she says will be kept confidential. B. Recommend that both husband and wife meet individually before the next couple’s session. C. Advise the wife of the therapist’s “no secrets” policy and suggest disclosure at a future couple’s session. Rationale: Redirecting the wife to reserve the disclosure for the marital session is the best answer because it will preserve the therapist’s ability to treat the couple effectively. A would potentially jeopardize the couple’s treatment by creating a situation in which the social worker and wife are keeping secrets from the husband. B does not make sense since couple’s treatment has already been initiated. Recommending that the couple see individual therapists may be missing the point, as the couple has presented for marital therapy, not individual therapy, and keeping secrets may be part of the couple’s problem. D. Refer the husband and wife to separate individual therapists. Question 14 A social worker receives a referral from parents regarding their 9 year-old daughter. A social history reveals symptoms consistent with a diagnosis of Major Depressive Disorder. What should the social worker do FIRST? Score: 1 of 1 A. Determine if the child has had a recent physical examination to rule out possible physical causes for her symptoms Rationale: While B, C and D may all be appropriate at some time in the near future, option A is the best choice as medical conditions should always be ruled out before giving a diagnosis. B. Under the diagnosis of Major Depressive Disorder, refer the child to a psychiatrist for medication. C. Have the parents fill out a questionnaire to confirm the diagnosis of Major Depressive Disorder. D. Begin cognitive behavioral therapy with the child to decrease symptoms. Question 15 A couple starts seeing a social worker after the death of their two children in a car accident. The social worker’s supervisor notices that the social worker is spending many hours on the phone with the couple and is seeing them more often than her other clients. The supervisor should: Score: 1 of 1 A. Work with the social worker to assess if the level of intervention is necessary. Rationale: The best place to start would be A. This is an example of the supervisor recognizing that the social worker’s boundaries may be compromised so the best response would be to discuss it with the social worker. B. Advise the social worker that her behavior is unethical. C. Transfer the clients immediately to a different social worker. D. Have the social worker tell the clients that they can’t contact her after hours. Question 16 A social worker in a community clinic meets with a woman who presents with issues related to her job. She discusses a recent incident in which she was gone from work for several days without notifying her boss or coworkers, although she has no memory of this. The client has found a pamphlet and tickets from a Broadway show in her home, although she states that she’s never been to New York. The client is describing which of the following conditions? Score: 1 of 1 A. Depersonalization B. Derealization C. Delirium D. Dissociation Rationale: D is the best answer because engaging in activities with no consciousness or memory of the activities is a form of dissociation; A, B and C describe different phenomena. Question 17 A 12-year-old African-American boy has been meeting with a social worker for 2 months for feelings of depression. He recently discovered that one of his ancestors was a slave who led a rebellion during the Civil War. He previously felt ashamed of his background, but in sessions, starts speaking about his ancestor as being a “brave leader.” In terms of racial identity development, the client’s experience could be best described as: Score: 0 of 1 A. Conformity B. Dissonance Rationale: B is the correct answer because according to a minority identity development model, the stage of dissonance includes a period in which the individual moves from feeling shame about their identity to feelings of pride. In the stage associated with answer A, the individual prefers the dominant culture and devalues their own background; in the stage associated with answer C, the individual rejects the dominant culture and has a sense of appreciation for their own culture; in the stage associated with answer D, the individual moves toward feeling that the dominant culture is not all bad and that there are individual differences. C. Resistance D. Introversion Question 18 A newly licensed social worker is providing outreach to a community that recently experienced a major hurricane. The social worker goes door-to-door, asking families if they need mental health services and outlining opportunities to receive these services. At the end of her first week, the social worker realizes that no families have expressed interest in receiving mental health services. The social worker should next: Score: 1 of 1 A. Attend upcoming community events to join with the community and understand their needs. Rationale: A is the best answer. The social worker should recognize that a community that has recently experienced a stressful or traumatic event may not be open to new people or offerings. Joining with the community and understanding their needs will assist the social worker in meeting those needs effectively. B might help, but does not do as much to create a relationship between the social worker and the community. The social worker will not know unless s/he gets to know the community better. C is premature, and D continues with an intervention that is not working at this time. B. Provide informational flyers in community centers to reach people in a less threatening way. C. Terminate the intervention since no one is interested. D. Continue the intervention as planned. Question 19 A 50-year-old woman in the commercial real-estate business is referred to her EAP due to interpersonal conflicts with female co-workers. During the assessment, the social worker learns that the woman frequently minimizes her colleagues concerns regarding sexism and sexual harassment in the workplace and during work functions. The woman says, “They need to get over it. This is just part of the business. They’re being too sensitive.” The social worker should view this response as: Score: 1 of 1 A. Expected, given the employment setting and cultural standards. B. An internalization of the sexism the client has experienced during her career. Rationale: B is the best answer because the client’s behavior indicates she has internalized the sexism she has experienced over time. A is not a good answer because, while it may be true, it does not identify the process through which this has occurred as well as B does. C is not indicated by the client’s statements or behavior. D may be true, but is not clear from the information provided in the question stem. C. Evidence of a personality disorder. D. An indication that long-term therapy is needed. Question 20 A 45-year-old man meets with a social worker for an initial appointment. He reports that his wife is an alcoholic and becomes verbally abusive when she is intoxicated. He indicates that his wife refuses to go to treatment, insisting that they can resolve this problem on their own. The therapist should FIRST: Score: 0 of 1 A. Provide the man with psychoeducation around substance abuse and the stages of change. B. Explore the man’s issues and work collaboratively to develop treatment goals. Rationale: The best answer is B. A, C, and D could be options later in treatment after a treatment plan focusing on the man has been established. C. Explore the man’s commitment to the relationship. D. Help the man identify the reasons behind his wife’s behavior. Question 21 A new client comes to treatment after losing his job of 15 years. He reports that “nothing in his life is going right,” and goes on to note that his marriage is failing, recent investments are not paying off, and that he has “no real friends.” In addition to a risk assessment, the social worker should focus on: Score: 1 of 1 A. The client’s strengths and resources Rationale: A is the best answer because it focuses on the client’s strengths. B is not indicated by the client’s symptoms or presenting problem. C and D may be helpful, but the social worker should identify the client’s strengths and resources so that interventions and treatment decisions can be made appropriately. B. A possible medical issue C. Referring the client for employment assistance D. A referral for couples therapy Question 22 A social worker at a local community mental health agency started a group for adults who grew up in the Foster care system. Each week fewer group members show up. In order to keep the group strong and ensure reasonable attendance, the social worker should: Score: 1 of 1 A. Talk to the group members to assess why attendance is dwindling and have them assist with the group structure and future topics. Rationale: You would start by asking group members why they haven’t been attending the group. B, C, and D are possible responses once you ask the members about their experiences. B. Cancel the group since it is not needed. C. Change the day and time of the group to hopefully make it more convenient. D. Have a different social worker take over the group. Question 23 A social worker is attending a neighborhood block party. While speaking with her neighbor, the neighbor discloses that she was so frustrated with her child the other day that she hit her with a belt. While the neighbor is not a client of the social worker, she should first: Score: 1 of 1 A. Make a suspected child abuse report B. Report the incident according to state law. Rationale: In some states, social workers are mandated reporters 24/7, while in others they are only mandated reporters while in their professional capacity. Answer A would not be correct, since the law may not require this. B is the best answer because it allows the social worker to do whatever is legally required. She could do C if the neighbor asked for assistance. Answer D would violate the neighbors trust. C. Refer the neighbor to a different social worker so there is no dual relationship. D. Contact the school to discuss the child. Question 24 A social worker at a day treatment facility for teens with mood disorders is asked to provide crisis intervention following the suicide of a program participant. The social worker should FIRST: Score: 1 of 1 A. Refrain from sharing information due to confidentiality. B. Contact the residents’ parents to inform them of the situation. C. Facilitate a group session to discuss the incident with the other participants. Rationale: You would want to host a group meeting to ensure that all members hear the same information at the same time so C is the best thing to do first. You could then do B and D. While you would want to be sensitive to issues of confidentiality, you would not have to refrain from sharing any information as it affects the whole community. D. Have individual meetings with each participant to discuss the incident. Question 25 A social worker in a community mental health agency meets with a 14-year-old boy and his parents after 3 months of treatment. The family first presented for treatment because the boy was experiencing feelings of anxiety and had several panic attacks. The goal of the session is to review the client’s progress and reevaluate the treatment plan. All of the following are examples of objective data EXCEPT: Score: 1 of 1 A. The number of panic attacks the client reports in the past 2 weeks B. The client’s score on the Beck Anxiety Inventory C. The client’s ability to express feelings to the social worker Rationale: C is the best answer because it represents subjective data (information from the client’s point of view gathered through an interview). A, B, and D are all examples of objective data: observable and measurable data. D. The parents’ report on how often the child avoids anxiety-provoking situations Question 26 A 41-year-old woman has been in therapy for two years for anxiety attacks and depression. She is no longer taking medication and is currently symptom free. During recent therapy sessions she frequently laughs and enjoys herself. Which of the following actions should the social worker take? Score: 1 of 1 A. Interpret the client's behavior as a flight into good health. B. Confront the client regarding avoidance of underlying issues. C. Develop a termination plan with the client to maintain progress made. Rationale: C is the best answer because the client’s presenting problems have been resolved and the client is doing well without the aid of medication, both of which indicate a readiness for termination. A does not make sense because the client has been in treatment for 2 years; a flight into good health is typically seen at the initiation of treatment. B and D are not supported by the information in the stem. D. Identify precipitating events leading to the new symptom development. Question 27 A 30-year-old man meets with a social worker for the first time and describes himself as a failure. He recently lost his job and his girlfriend of two years broke up with him. He feels hopeless about his life and is beginning to believe his family’s criticism and rejection of him are justified. As the interview progresses, his discouragement and feelings of worthlessness become more apparent. The social worker should FIRST: Score: 1 of 1 A. Refer the client to a psychiatrist for a medication evaluation. B. Help the client identify why his relationship with his girlfriend ended. C. Schedule a family session. D. Ask the client if he’s had any thoughts about hurting himself. Rationale: Hopelessness and feeling like a failure are both risk signs for suicide. D would be the place to start. Once that was ruled out, A, B, and C could be considered. Question 28 A 55-year-old female client is in therapy with a male social worker for help with her relationships with her grown sons. The social worker perceives that a good working relationship has been established, but in the eighth session, the client announces that she wants a new social worker. She states that the social worker is too young and inexperienced to help with her particular problem. The social worker should FIRST: Score: 1 of 1 A. Encourage the client to discuss her feelings about their relationship. Rationale: A is the best answer because the social worker should be discussing the client’s feelings about the relationship. This would be the place to begin, so A is the best answer. B, C, and D could be done once the issue had been explored more. B. Review his professional experience to reassure the client. C. Help the client to differentiate the social worker from her grown sons. D. Offer a list of older social workers and facilitate a referral. Question 29 A 53-year-old man comes to a social work agency for help regarding a loss of interest in sexual relations with his wife of 20 years. In the intake interview, the client further describes decreased energy, achiness all over his body and depressed mood. The social worker should FIRST: Score: 1 of 1 A. Evaluate the client for sexual dysfunction. B. Assess the client for depression. C. Refer for a psychiatric evaluation. D. Refer for a physical evaluation. Rationale: D is the best answer because the client is describing physical symptoms and depressed mood; the social worker needs to rule out a medical cause for the client’s problems before moving forward. A, B, and C could be done after a medical issue was ruled out. Question 30 A client is being treated by a social worker. She has a history of relationship problems and suicidal gestures. In the first session, the client tells the social worker how great she thinks the social worker is. What is the MOST important element of a treatment plan for this client? Score: 1 of 1 A. Establishment of clear therapeutic boundaries with the client. Rationale: A is the best answer because the client is presenting with several symptoms indicative of Borderline Personality Disorder (relationship problems, suicidal gestures, idealization of the social worker) and boundaries are a key component to engaging in effective treatment with a client with this profile. B, C, and D are not specifically related to treatment with clients with Borderline Personality Disorder. B. Short-term cognitive therapy to work with distorted self-image. C. Long-term psychoanalytic therapy to process painful memories of the past. D. Adjunctive group treatment to address relationship problems. Question 31 A client who is gay tells his social worker that he wants to have a baby. He reports that his plan is to contact an adoption agency to begin the process. What should the social worker do FIRST: Score: 1 of 1 A. Assess the client’s ability to manage the potential negative response from family members. B. Refer the client to a parenting class for single fathers. C. Assess the client’s understanding of the steps needed to adopt a child. D. Explore the client’s desire to become a parent. Rationale: D is the best answer because it starts where the client is and takes a nonjudgmental stance. A does not make sense, since the stem does not indicate that his family is involved or that they would be unsupportive. B might be helpful later, but not before D. C is somewhat judgmental and assumes that the client has not thought through or researched the decision. Question 32 A social worker is hired by a non-profit foundation to complete a process evaluation on three agencies that received grants from the foundation. Each of the following is an example of a process evaluation question EXCEPT: Score: 0 of 1 A. Was the program more successful with certain groups of people than with others? Rationale: A is the best answer because it is not a question associated with process evaluation; it is associated with program evaluation. B. Was the program well managed? C. Was there adequate agency support for the program? D. What specific interventions were put into place by the program? Question 33 A client with a history of interpersonal problems with co-workers has recently been fired for getting into repeated arguments with colleagues and supervisors. The client arrives at the next session late and becomes very angry when the social worker inquires about the client being late. The client yells, “Why are you monitoring my every move? Can’t you just trust me and leave me alone?” The social worker should interpret the client’s behavior as: Score: 1 of 1 A. Resulting from a feeling of judgment by the social worker. B. Displaying problems that occur in workplace relationships. Rationale: B is the best answer because it is MOST likely that the client is exhibiting behavior that is typical in another area of the client’s life; since the question references problems in the workplace, this is probable. A, C, and D are not supported by information in the stem. C. Indicating a need for medication to stabilize the behavior. D. Signaling a desire to terminate treatment. Question 34 A patient admitted into ER has his partner listed as the emergency contact. The social worker learns that the nursing staff contacted his family instead of the partner. The social worker should NEXT: Score: 0 of 1 A. Call the partner. B. Tell the patient that his family was notified. Rationale: B is the best answer because the client should know and be able to emotionally prepare for his family’s response or arrival at the hospital. A might be a good step, but not until after the client is informed of the mistake. C would violate the client’s confidentiality and takes away his self-determination. D does not make sense since the doctor is not mentioned in the stem and has not been a part of this particular situation. C. Wait until the family arrives and find out what they think is best. D. Discuss the situation with the doctor. Question 35 A school social worker is meeting with a 17-year-old Latino student as part of her post-graduation assessment/planning. During the conversation, the student expresses a desire to go to college and then begins weeping and explains that as an undocumented student, most colleges will be out of reach. The social worker should FIRST: Score: 0 of 1 A. Assist the student in identifying colleges that will accept undocumented students Rationale: A is the best answer because it meets the student where she is and will help empower her and help her be hopeful about her future. B is in opposition with social work values. C may be needed at some point, but is not indicated at this time. D would be a longer term goal, but would not be what the social worker does FIRST, particularly in a school setting. B. Explain that the social worker cannot help since the student is technically breaking the law C. Refer the student to an immigration attorney D. Help the student process her feelings about being undocumented Question 36 An adult with Down Syndrome and diabetes is in an emergency room for treatment due to noncompliance with insulin shots. Before releasing her, the physician asks the social worker to interview the client and her parents, with whom she lives, about the situation. The social worker learns that the noncompliance with insulin has been an issue at home and at the client’s place of employment. What should the social worker do FIRST? Score: 1 of 1 A. Provide the parents with information about how to apply for conservatorship. B. Explore the client’s understanding of her illness and the significance of medical treatment. Rationale: B is the best answer because the social worker first needs to understand what is behind the client’s noncompliance before moving forward. A is too extreme and likely unnecessary. C is a good intervention, but not before B; D is not supported by the information in the stem. C. Discuss the effects and benefits of medication with the whole family. D. Reframe the client’s noncompliance as an example of her seeking independence. Question 37 The 66-year-old wife of a man with a Mild Neurocognitive Disorder seeks counseling from a social worker due to increasingly stressful caregiving responsibilities. The wife is well-integrated into the mental health and medical care delivery systems since her husband has been receiving a range of treatments since age 55. In order to reduce the wife’s sense of burden, the social worker should FIRST help her: Score: 1 of 1 A. Provide her with psychoeducation regarding the illness and available treatments. B. Utilize a life review to help her identify her husband’s positive contributions. C. Improve her response accuracy to decrease crises. D. Re-evaluate her system of caregiving resources outside the family. Rationale: D is the best answer because it most directly addresses the client’s feelings of stress related to caregiving duties. A is probably not necessary since the client has been integrated into delivery systems for over 10 years. B will not address her stress level; C may not be possible given the nature of her husband’s illness. Question 38 A social worker and client have been working together for 2 months. The client, a 27-year-old woman, initially presented due to concerns about her alcohol use and its effect on her relationships and ability to perform her job duties. After the initial session, the client began minimizing her alcohol use and typically comes to session with another topic she wants to discuss. The social worker has attempted to confront the client about her avoidance of the topic, but the client is adamant that her drinking is not a problem at this time. The social worker should: Score: 1 of 1 A. Continue to confront the client about her alcohol use B. Consult with a colleague about the client’s resistance to change C. Convey acceptance and monitor the client’s readiness for change Rationale: C is the best answer because it meets the client where she is and also monitors when she might be ready to address her substance use. A is not the best answer because the social worker has already attempted to confront the client and it was not effective. Continuing to confront the client may damage the therapeutic relationship. B might be appropriate, but is not as good as C in terms of meeting the client where she is. D is not indicated: the client keeps coming to treatment and may be benefitting from it in many ways. D. Discuss termination due to lack of client engagement Question 39 A client who has recently immigrated to the United States seeks therapy to adjust to the client’s culturally different spouse. To assess the client’s level of acculturation, which of the following factors should the social worker take into consideration FIRST? Score: 1 of 1 A. Newly immigrated individuals are often hesitant to challenge cultural traditions in their marital relationships. B. Newly immigrated individuals are resistant to learning the rules of a new country. C. Gender differences cause more discomfort than acculturation issues. D. The pace of acculturation may vary from group to group. Rationale: D is the best answer because it does not make assumptions and encourages the social worker to understand more about this individual’s experience. A and B both make negative assumptions. C is not true. Question 40 A social worker meets with a veteran who has been diagnosed with PTSD. During a session, the client’s eyes glaze over while he is talking about an experience in which several members of his platoon were killed. He sits forward in the chair, staring over the social worker’s shoulder, and talks in a calm, monotonous voice. The social worker should: Score: 1 of 1 A. Employ a grounding technique to reconnect the client with the present moment Rationale: A is the best answer because the client is experiencing a flashback and the social worker should try to help him distinguish between what is happening now versus what happened in the past to decrease his distress. B is not a good answer because therapeutically it is not helpful to allow flashbacks to continue. C is not indicated in this moment. D does not make sense since the client in the question is not expressing these feelings. B. Allow the flashback to continue so the client can express his feelings C. Assess the client for suicidal ideation D. Empathize with the client’s feelings of fear and loss of control Question 41 A 45-year-old social worker on an adult inpatient unit has developed a pattern of increasing tardiness and incomplete paperwork over the past 6 months. In addition, in team meetings and in group supervision, the social worker makes statements such as, “this place is like a revolving door...no one ever gets better. How can we be expected to keep helping people who clearly aren’t helping themselves?” The supervisor should FIRST: Score: 1 of 1 A. Discuss with the social worker how these behaviors interfere with job performance. Rationale: All the answers are possible things to do in this situation. If you put these answers in the order you would do them, they would go A, B, C, D; so A is the best answer. B. Advise the social worker of the necessity to change this attitude. C. Reflect the social worker’s job performance in an annual performance review. D. Suggest that the social worker consider a career change. Question 42 A 38-year-old woman with Borderline Personality Disorder continually engages in scapegoating during a weekly treatment group. After consultation, the social worker facilitating the group decides to dismiss the client from the group due to the destructive nature of her in-group behaviors. What should the social worker to FIRST in order to facilitate termination? Score: 1 of 1 A. Inform the client during a group session that she will be leaving the group in 2 weeks. B. Ask the group whether the client should be dismissed from the group. C. Schedule an individual appointment with the client to discuss the decision. Rationale: C is the best answer because this is a matter that should be handled privately and confidentially. A and B are inappropriate and would clearly shame the client in front of other group members. D could be done as part of the individual appointment, but would not be done FIRST. D. Refer the client for individual treatment before termination is discussed. Question 43 A social worker in a community mental health agency begins working with parents and their 12-year-old son. The family has been referred because the son’s grades are deteriorating and he’s been getting into fights at school. During the first few sessions, the social worker notices that the parents repeatedly express anger toward their son for lying, but when the son tells the truth, they yell at him for his “poor choices.” The social worker should NEXT: Score: 1 of 1 A. Separate the child and the parents to help them each express frustration in a safe space B. Point out this double bind to the parents Rationale: B is the best answer because it names the dynamic that is occurring in the room and may help the parents understand why the boy is not likely to be honest with them. A is not indicated in this situation and will not help address the dynamic that is occurring. C may be helpful, but not before the social worker helps raise the parents awareness of the dynamic. D is not supportive and will also not help address the dynamic at hand. C. Ask the son to respond to the parents’ anger D. Point out how unproductive being dishonest it Question 44 In establishing a therapeutic alliance with a client from a different racial or ethnic background, the FIRST issue for the social worker to address is: Score: 1 of 1 A. The racial or ethnic difference and how it may impact treatment. Rationale: The best answer option is A because it deals directly with the client-therapist relationship and brings the topic up for exploration. B might be done later in treatment, but not FIRST. C would be addressed in consultation or supervision if the therapist felt it was interfering with treatment, but would not be done FIRST. D would not do anything to help establish a therapeutic alliance between the client and social worker. B. Transference issues with the therapist. C. The therapist’s countertransference. D. The client’s history of encounters with people of different racial or ethnic backgrounds. Question 45 A white social worker at a hospital is asked to evaluate a black woman who was recently brought in by the paramedics. When the social worker approaches the client, she refuses to tell the social worker what happened and states repeatedly that she fears anything she says to the social worker will be used against her. The woman requests to instead speak with the Latina nurse who has been caring for her since arrival. What is the MOST likely explanation for the woman’s behavior? Score: 1 of 1 A. Cultural paranoia, which represents a healthy reaction to racism. Rationale: Answer A is the best answer because it takes into account the cultural issues presented in the case. B and C both pathologize the client’s behavior; D makes a negative judgment about the client’s behavior, when it may in fact be protective. B. An episode of acting out of Borderline Personality dynamics. C. Pathological paranoia regarding all social workers. D. Resistance to assessment and treatment. Question 46 A 16-year-old is brought to treatment for an eating disorder. How would a social worker using Feminist Theory Therapy view this issue? Score: 1 of 1 A. Unresolved issues of early childhood can manifest as eating disorders. B. Her automatic thoughts cause unhealthy body-image. C. Cultural expectations of women negatively affect their sense of self. Rationale: C is the best answer because it directly relates to Feminist Theory and how mental health is affected by a patriarchal culture. A would be more of a psychodynamic view. B would be a Cognitive Behavioral view. D is not as specific but is more psychodynamic in nature. D. Denial of food is a defense mechanism to manage anxiety. Question 47 A social worker receives a referral for family therapy. The family consists of mother, father, a 14-year-old girl, and an 8-year-old boy. The parents report they want the family to spend “quality time” together, but whenever they try, everyone ends of up fighting. The daughter rolls her eyes and reports that her parents try to talk to her “like they are my friends.” The 8-year-old says he wants to play with kids in the neighborhood and go to sleepovers, but the parents refuse, saying he can have “all of that fun right here at home.” The social worker should focus treatment on: Score: 0 of 1 A. Helping the family establish appropriate roles and boundaries Rationale: A is the best answer because the question stem indicates that the parents are trying to interact with their children like peers instead of parents. Helping the parents establish more appropriate roles with the children may decrease the tension and allow for more positive family interactions. B and D may be helpful, but would not be the focus of treatment in this case. C will not be as helpful until the parents develop more appropriate boundaries and roles for themselves. B. Assisting the family in healthy communication strategies C. Facilitating activity-based family interactions to build on relational strengths D. Creating connection through conflict resolution Question 48 An 8-year old child with developmental delays is currently in a regular classroom setting. He is struggling to keep up with the work and he is noticing he is not being assigned the same work material as his classmates. The social worker should first: Score: 1 of 1 A. Advocate for him to receive an aid in the classroom. Rationale: The best answer is A as you would do this before having him transferred to a special education class. There is no reason to do a mental status exam at this point. Answer D would be breaking the child’s confidentiality. B. Transfer him to a special education classroom. C. Assess him using the mental status exam. D. Speak to his classmates about his situation. Question 49 The mother of an eight-year-old boy calls the school social worker and says that her son has been refusing to come to school because he is teased about being overweight. The mother demands that the school punish the students who have been teasing her son. What should the social worker do FIRST? Score: 1 of 1 A. Encourage the mother not to overreact to the child’s report. B. Get a list of the names of the bullies from the mom. C. Meet with the child to assess and develop problem-solving strategies. Rationale: C is the best place to start. You want to connect with your client (the child) and find out what is going on from them directly before you proceed with any other action. A dismisses the mother and the child’s feelings; B disempowers the client. D might be helpful at some point, but not before C. D. Refer the mom to a parenting support group. Question 50 A social worker is approached by a mother regarding her 2 ½ year-old daughter. The mother is distressed by the fact that her daughter frequently says “NO” when asked to clean up after herself, has occasional temper tantrums and wants to do “everything” independently. The social worker’s BEST response would be to: Score: 1 of 1 A. Educate the mother about child development. Rationale: The child is exhibiting normal, healthy behavior for a 2 year-old. Answer A would be the best place to start. B. Schedule a biopsychosocial evaluation of the child. C. Review possible behavior modification techniques. D. Engage the mother and daughter in family therapy. Question 51 A 72-year-old woman has been in treatment with a social worker for 6 months for depression and anxiety. One day, she arrives thirty minutes late for a regularly scheduled appointment. She reports that she got confused on the bus and couldn’t remember which stop to get off at. The social worker should FIRST: Score: 0 of 1 A. Call the client’s family and inform them of the incident. B. Call the client a taxi for the ride home. C. Encourage the client to get a physical examination. Rationale: The best answer is C because it addresses the concern without taking away the client’s selfdetermination. D. Recommend immediate hospitalization for further evaluation. Question 52 A social worker in a small community is contacted by a prospective client regarding therapy for conflicts she is experiencing at her job. The social worker knows that the client works at the agency where the social worker was previously a supervisor, although the social worker did not supervise the client. The prospective client insists that the social worker’s knowledge of the agency environment and culture will benefit treatment because of increased understanding. What is the social worker’s MOST appropriate response? Score: 1 of 1 A. Decline to provide therapy due to knowledge of the previous business relationship. Rationale: Answer A and D are your best options for this questions. A is a little stronger because in this case it would be better to refer her to someone not connected to the previous working environment. Providing a safe space for clients is an essential part of therapy. A client like this may assume that you will agree with her view of the situation but your previous knowledge of the environment could actually be a hindrance to your work together. B. Assure the client of confidentiality before beginning treatment. C. Provide treatment while maintaining self-awareness regarding boundary issues. D. Explore the meaning of dual relationships before beginning treatment. Question 53 An emergency room social worker is asked to evaluate an 18 year-old pregnant female who was admitted after an accident at her job. The woman reports to the social worker that she hasn’t seen a doctor “in a year or so,” gets most of her meals at the fast-food restaurant where she works, gets very little sleep and enjoys “partying” with her friends on the weekends. The social worker should FIRST: Score: 0 of 1 A. Assess the client’s knowledge of the effects of her behavior on the fetus. Rationale: Answer D is out because you do not report child abuse on an unborn child. If you put the other options in order, A is the best answer. It would be important to assess her understanding of her behavior before intervening. B. Refer the client to support services for teen mothers. C. Provide psychoeducation about the effects of alcohol on fetal development. D. Immediately report the client for suspected abuse of her unborn child. Question 54 A social worker is working with a family with three children, the oldest of whom, age 14, is in a wheelchair because of cerebral palsy. The parents describe the child’s lack of interest in family activities and believe that he is depressed. The child remarks that his mother hovers over him, and they never let him go anywhere alone. He expresses an interest in going to special needs summer camp, but his parents shake their heads. What should the social worker do FIRST? Score: 1 of 1 A. Support the parents’ understandable need to be protective. B. Refer the 14-year-old for a medication evaluation. C. Provide psychoeducation about normal adolescent development. Rationale: The parents are concerned about the 14-year-old’s behavior, but his behavior sounds healthy for his age. Of the answers given, C would be the best place to start. D. Encourage parents to support their son’s independence. Question 55 An 85-year-old World War II veteran is referred by his primary care physician due to somatic complaints for which no physiological basis could be found. The man is in relatively good health except for age-related hearing and vision loss. The client complains of insomnia, fatigue, and stomach aches. When asked about recent activities, the client discusses having attended the funeral of one of his fellow soldiers and the fact that he had to have a neighbor drive him there due to recently losing his driver’s license because of his deteriorating vision. The client states that this was his last friend from the war and states, “I guess I’ll probably go soon, too.” When setting treatment goals, the social worker should FIRST assess the: Score: 1 of 1 A. Client’s need for a referral to the Veteran’s Administration. B. Likelihood that medication will help relieve his symptoms. C. Availability of support groups for older veterans. D. Possibility that the client is depressed due to multiple losses. Rationale: The best answer is D as the immediate assessment should be of his mental health status. The client has had multiple losses so that should factor in as well. Question 56 A 23-year-old woman seeks treatment from a social worker through her university following a dramatic breakup with her girlfriend. During the assessment, the social worker notes that the client seems to have abandonment issues that stem from a long history of fragmented relationships. If the social worker operates from a client-centered therapy model, all of the following interventions apply EXCEPT: Score: 0 of 1 A. Empathizing with the client’s experience B. Exploring the client’s cultural background and expectations in relationships Rationale: A, C, and D are all interventions that are associated with client-centered therapy. B is not specifically associated with this model. C. Matching the tone and pacing of the client’s verbal communication D. Maintaining a positive stance toward the client Question 57 A group of non-profit agencies are concerned about recent violence in the neighborhoods they serve. During a conference call, one of the program managers suggests forming a coalition. Which of the following statements is MOST true about coalitions?: Score: 1 of 1 A. They draw together representatives of a number of groups who have common interests or concerns regarding a particular issue Rationale: A is the correct answer because it addresses the purpose of coalitions. B, C, and D are not accurate. B. They are made up of individuals in disagreement about a particular policy C. The effectiveness of a coalition is determined by the number of individuals in that coalition D. Members of coalitions come from similar backgrounds, allowing them to be in agreement on all issues surrounding a particular policy issue. Question 58 A 42-year-old woman meets with a social worker after being laid off from her job of 15 years. The woman reports that in addition to being let go from her job, she recently discovered that her husband has been cheating on her. The woman reports that she hasn’t been able to eat or sleep and that “images of him keep running through my mind.” She reports being unable to get out of bed most days and states, “why should I get up? I don’t have anything going for me anymore anyway.” The social worker should: Score: 1 of 1 A. Refer the client to a divorce support group B. Refer the client for a medication evaluation C. Help the client focus on her strengths D. Ask the client if she’s been having thoughts of suicide Rationale: The client is reporting significant losses, symptoms of depression, and a sense of hopelessness, all of which should trigger a risk assessment by the social worker. A, B, and C are all good interventions, but would be done AFTER the social worker ensures the client’s safety. Question 59 A social worker for the police department is assigned to a new supervisor, who is a lead detective. The detective asks the social worker to try and coerce a victim to participate in the identification of her assailant, even though the victim has already stated that she does not want to do this. What should the social worker do? Score: 1 of 1 A. Follow the detective’s orders and attempt to convince the victim to comply. B. Rely on police department policy regarding victims and witnesses. C. Ask to be reassigned to another supervisor. D. Base professional action on social work ethical standards. Rationale: Regardless of the environment or supervision, social workers are responsible for adhering to the Code of Ethics. Question 60 A social worker is meeting with a client involved in a bitter custody dispute with her ex-boyfriend. The client shares that her six-year-old daughter doesn’t like her dad’s new girlfriend. The client adds, “If I ever hear that his girlfriend does something to my daughter, I’ll make sure she pays.” What should be the social worker’s immediate concern? Score: 1 of 1 A. Warn the former girlfriend of the threat. B. Acknowledge the client's feelings about this situation. C. Clarify what the client means by “I’ll make sure she pays.” Rationale: When a client makes a threat of harm (to self or others), the social worker must FIRST clarify the intent and meaning of the threat. A goes too far, as the information provided is not sufficient to warrant a Tarasoff situation, B and C do not address the potential safety issue. D. Focus on the six-year-old daughter’s need for peaceful parenting. Question 61 A 29 year old is in treatment for Schizophrenia. She complains to her social worker about experiencing involuntary facial tics and twitches in her arms and legs. What should the social worker do? Score: 1 of 1 A. Explain to her that she could be experiencing side effects from her antipsychotic medication and refer her to speak to her Doctor. Rationale: The symptoms she is experiencing are common side effects of antipsychotics. Answer A is the best because it refers her to talk with her Doctor about it as this would be out of the scope of practice of a social worker. B. Assess her to see if she is using illegal drugs. C. Explain that this can be a symptom of Schizophrenia. D. Talk to her Doctor about increasing her medication since she is experiencing greater symptoms. Question 62 A 69-year-old diabetic client is referred by her doctor. She recently had her leg amputated because she hasn’t been following her insulin and diet plan. The client cries in session and tells you “I just can’t manage all this and I don’t see it getting better.” What should the social worker do FIRST? Score: 1 of 1 A. Strengthen the client’s social support network. B. Get a release to consult with the doctor about her treatment. C. Develop a plan for medical compliance. D. Assess client for potential suicide. Rationale: The client’s stated feelings of hopelessness make D the best place to start. A, B, and C would all be done after ensuring the client’s safety. Question 63 After eight sessions with a teenage girl who suffers from anxiety and depression, her mother calls and informs the social worker that they won’t be bringing the daughter for therapy because they don’t think it’s helping. The social worker believes that the daughter is benefiting from therapy. The social worker should NEXT: Score: 1 of 1 A. Explore the mother’s views that therapy isn’t working. Rationale: A is the best place to start because the therapist can’t appropriately move forward with any other action before having some understanding of the mother’s perspective. B, C, and D might all be appropriate, but not until the social worker understands why the mother doesn’t think the treatment is working. B. Provide referral to another social worker. C. Encourage the mother to allow the daughter to come for a termination session. D. Discuss the ways the social worker believes the client has improved. Question 64 A company hires a social work consultant after experiencing a noticeable shift in employee morale that the administration believes is impacting productivity. The consultant should FIRST: Score: 1 of 1 A. Provide training to administration on ways to improve employee morale B. Identify other reasons for decreased productivity C. Encourage the company to lay off individuals who are having a negative impact on work culture D. Provide space for employees to express their concerns and experiences Rationale: D is the first step in addressing morale issues; employees should have the opportunity to express themselves so that targeted solutions can be developed. A and C would be done later; B would hopefully be identified as a result of D. Question 65 Which of the following factors should a social worker routinely consider when assessing for the risk of child abuse? Score: 1 of 1 A. Caretaker characteristics, socioeconomic background, and disciplinary style. B. Caretaker characteristics, behavioral signs, and parenting style. C. Physical symptoms, behavioral signs, and disciplinary style. Rationale: C is the best answer because it includes three factors that would help the social worker assess for risk of child abuse. Caretaker characteristics, socioeconomic background, and parenting style may be correlated with a risk of abuse, but will not provide the social worker with information needed to actually assess for risk of abuse. D. Physical symptoms, socioeconomic background, and parenting style. Question 66 A school social worker has been assigned to work with an 8-year-old girl referred by her teacher for profanity with peers. What should the social worker to FIRST? Score: 1 of 1 A. Schedule a family conference. B. Request a medical evaluation. C. Report child abuse. D. Confer with the teacher about the behavior. Rationale: When school social workers receive referrals, the FIRST step is to obtain information from the referral source (usually the teacher); A and B may be appropriate steps later in the process. C does not make sense, since there is no indication of child abuse in the stem. Question 67 A social worker has been facilitating a support group for mothers with postpartum depression for nearly a year when she receives a training opportunity that will require her to be gone for several months. The social worker should NEXT: Score: 0 of 1 A. Notify the group of her training opportunity and explain why she will be gone B. Meet with each group member individually to process what her absence will mean for them C. Arrange for another social worker to take over the group to ensure the client’s needs are met Rationale: The social worker’s primary responsibility is to ensure that the client’s receive ongoing care and support, making C the best answer. A is not the best answer because it may go into more detail than is appropriate regarding her absence and does not ensure group members are receiving continued support. B is not the best answer since the social worker should inform the group of her absence as a unit. D does not make sense because it does not address the need for continuity of care. D. Consult with a supervisor about how to terminate with group members Question 68 A white social worker receives a referral from a school counselor for a 5 year-old black male. The counselor reports that the child refuses to stay in his seat, is disruptive to his peers and is oppositional with the teacher. When the social worker meets with the boy’s parents, they offer one-word answers to questions and the father sits with his arms folded across his chest. He states, “You people are always targeting us. I bet you don’t see any white kids getting referred!” What should the social worker do FIRST? Score: 1 of 1 A. Refer the parents to a black social worker. B. Suggest behavioral modification techniques to address the behaviors. C. Clarify the parents’ understanding of the reasons for the referral. Rationale: When clients are referred by a 3rd party and appear hostile or resistant in the initial session, it is important to make sure they know WHY they have been referred. A is premature; B and D may both be appropriate, but not before a relationship is established. D. Explore the parents’ perceptions of their child’s behavior. Question 69 A social worker in community agency has been working with a client with Borderline Personality Disorder for 2 years; the social worker has begun to feel that the client needs involvement in a Dialectical Behavioral Treatment (DBT) program in order to improve. The client is hospitalized for a suicide attempt before the social worker can discuss this treatment option. The social worker should: Score: 0 of 1 A. Suggest that the hospital refer the client to a local DBT program. B. Contact the DBT program and refer the client upon discharge. C. Call the client in the hospital to discuss termination and referral. D. Resume work with the client after discharge. Rationale: It would be inappropriate for the social worker to attempt to terminate and refer the client when the client is in the midst of a crisis, making A, B and C all poor choices. In order to avoid client abandonment, the therapist should resume work with the client after discharge to assure that the client is stable and would then begin discussing termination and referral. Question 70 A social worker has been working with a 24-year-old client who has recently lost his job and is depressed; the client has had to move back in with his parents as a result of lost income. One day, the client’s mother calls the social worker and expresses concern about her son’s inability to find a new job. The mother presses the social worker to learn whether or not her son has discussed plans to contact a staffing agency for an interview. The social worker should FIRST: Score: 1 of 1 A. Validate the mother’s concern about her son. B. Explain that information cannot be disclosed without a client’s consent. Rationale: The social worker MUST ensure the client's confidentiality; A and D would both violate the client's confidentiality; C may be appropriate at the next session, but would not come before the therapist declined to disclose information to the mother. C. Discuss the mother’s concerns with the client at the next session. D. Set up a family session with the mother and son to discuss their issues. Question 71 A social worker at a non-profit organization is preparing a proposal for a com