AATBS EXAM 1

Question ID #4317: Freud and the object relations theorists share an emphasis on ____________ in personality development. Select one: A. the role of the superego B. the impact of biologically based drives related to sex and aggression C. the role of early childhood experiences D. the effects of separation and individuation

The correct answer is C.Object relations theory has a number of elements in common with Freudian theory but differs in its emphasis on the need for interpersonal relationships (versus needs related to sex and aggression). Object relations theorists, like Freud, believe that early childhood experiences are critical to personality development. They also posit a stage theory of development, but they view interpersonal relations as the primary contributor to personality. Answer A: This is true about Freudian theory but not about object relations theory. Answer B: This characterizes only Freudian theory. Answer D: This applies only to object relations theory.

Question ID #4369: A client whose husband died from cancer several days ago has accumulated a large quantity of her anxiolytic medication. She reports during a therapy session that she plans to take an overdose that night. What is the BEST course of action for the social worker? Select one: A. Arrange to have the client hospitalized. B. Assess the client's coping strategies and support system and write up a safety plan C. Acknowledge this as a normal grief reaction, closely monitor the client, and contact her psychiatrist D. Conduct a direct assessment of suicide and provide supportive counseling

The correct answer is A.A social worker must take reasonable steps to prevent a client's threatened suicide. The specific nature of these steps depends on the level of risk involved and the client's willingness and ability to comply with respective recommendations. The risk, in this case, is significant given the client's statements, which indicate a plan, means, and intent. The client is also struggling with an exogenous stressor: the death of her husband. The best legal approach for the social worker is to arrange for the client to be hospitalized. Voluntary commitment should be implemented if possible. However, given the details in this scenario, the social worker would be legally protected if they were to breach confidentiality and initiate the involuntary hospitalization process. Answer B: Assessing the client's coping strategies, support system, and developing a safety plan are measurements that social workers should consider when working with clients posing a suicidal risk. The actions taken vary, depending on the level of risk. However, in this scenario, this client presents with a high risk, therefore these strategies could possibly not be enough to protect the client. The reasonable steps necessary to protect this client would include hospitalization. Answer C: This should not be normalized as a normal grief reaction. Closely monitoring the client, and contacting her psychiatrist would not be considered appropriate reasonable steps given the high level of risk. Answer D: Direct assessment is used to estimate the probability that a client who has expressed suicidal thoughts or intent will actually attempt suicide in the near future. This question provides enough information for the social worker to believe that the risk of a suicide attempt is high.

Question ID #4316: A patient in psychoanalysis begins to be aware of repressed material. Which of the following is MOST likely to occur as a result? Select one: A. The patient will use defense mechanisms to manage anxiety elicited by the material. B. The patient will acquire an emotionally meaningful insight. C. The patient will work through the transference neurosis. D. The patient will regress to a safer stage of development.

The correct answer is A.According to psychoanalytic theory, becoming aware of previously unconscious material arouses anxiety, which the patient will attempt to reduce by using defense mechanisms. Answer B: Awareness of unconscious material does not automatically lead to insight. Instead, these processes occur during the stage of psychoanalysis known as working through. Answer C: Awareness of unconscious material does not necessarily lead to the resolution of transference. This occurs by helping the client understand that they are repeating unconscious responses learned in early relationships by projecting them onto current relationships. Answer D: This answer describes regression, which is a defense mechanism. The patient will use defense mechanisms, but not necessarily regression. Regression occurs when a person retreats to an earlier, safer stage of development and behaves in ways characteristic of that stage.

Question ID #4311: An 11-year-old girl was sexually abused by an uncle for several years. The girl is LEAST likely to exhibit which of the following as a consequence of this abuse? Select one: A. Frequent aggression B. Poor peer relationships C. Withdrawal into a fantasy world D. Psychosomatic illness

The correct answer is A.Aggression could be present, but aggression is more often a consequence of physical abuse. Among the typical behavioral indicators found in children who have been sexually abused are the following: appears to mistrust or fear adults; exhibits a sudden, unexplained change in behavior (e.g., depression, anxiety); exhibits fear states; has night terrors; exhibits regressive behaviors; withdraws into a fantasy world; has psychosomatic illness; engages in delinquent behavior (e.g., truancy, running away); is socially isolated or has poor peer relationships; exhibits overly sophisticated knowledge about sex; is promiscuous or overly sexualized; is unwilling to participate in physical activities; has attempted suicide; and uses alcohol or drugs. Answer B: It is not unusual for children who have been sexually abused to have poor peer relationships. Answer C: Withdrawing into a fantasy world is a defense against a painful reality. Answer D: Children who have been sexually abused are likely to have been warned not to speak of what is happening to them, which leaves psychosomatic symptoms one of the only avenues they have for expressing their pain and confusion.

Question ID #4277: According to Bowlby, what is the critical period for forming attachment? Select one: A. Two and a half years B. Five years C. One year D. 7 months

The correct answer is A.Bowlby suggests that the critical period for forming attachments is 2-1/2 years. If an attachment has not developed during this time period then it may well not happen at all. Answer B: Bowlby later suggested that the first five years of life are "sensitive" periods for forming an attachment. Answer C: Babies usually are beginning to have multiple attachments by 10 months old, including attachments to mothers, fathers, grandparents, siblings, and neighbors. However, the "critical period" for forming attachments is 2-1/2 years. Answer D: At 7 months, infants indiscriminately enjoy human company, and most babies respond equally to any caregiver.

Question ID #4390: A key component of empathy is: Select one: A. reflecting the client's feelings. B. listening to the client's feelings. C. accepting the client's feelings. D. validating and normalizing the client's feelings.

The correct answer is A.Empathy is the ability to perceive, understand, and experience the emotional state of another person (Barker, 1987). Empathic responding is used throughout the helping process to develop rapport, maintain a working relationship, and enable social workers to move toward confronting the client's problematic issues. Answer B: Being empathic involves more than hearing the client's feelings; it also involves responding to those feelings in verbal and nonverbal ways that convey to the client understanding of their inner experience.Answer C: This answer is not correct, as it does not fully answer the question regarding a key component on empathy. Answer D: Validating and normalizing the client's feelings is important to the therapeutic process, but it is not a key component of empathy.

Question ID #4299: A social worker meets with a 30-year-old client who recently divorced her husband. The couple has two children who live with the client and see their father every other weekend. The client reports feeling exhausted now that she has to care for the children by herself. In assessing this situation, the social worker should be aware that, according to research, in the initial period following divorce, a custodial mother is MOST likely to: Select one: A. use more authoritarian but less consistent punishment. B. believe she is an inadequate parent. C. be overly permissive. D. expect her ex-husband to discipline the children.

The correct answer is A.Following divorce, parents experience emotional distress and changes in functioning that often include a diminished capacity to parent (Wallerstein & Blakeslee, 1990). The mother, who usually has physical custody of the children, is frequently socially isolated and lonely and often experiences a decline in income. She tends to be uncommunicative, impatient, and less warm and loving toward her children (especially sons) and to monitor her children's activities less closely and be less consistent but more authoritarian in terms of punishment. Custodial fathers have similar problems, although they may adjust to their situation sooner than custodial mothers (Hetherington & Stanley-Hagan, 1986). Finally, noncustodial fathers are often overly permissive and indulgent with their children during visits, but after the first few months, their visits often decline in number, and many stop making child support payments (Hetherington, 1989). Answer B: This may be true, but she may also feel that she is the better parent, compared to her ex-husband, due to the tendency to blame. Answer C: The opposite is more likely to be true. Answer D: The divorced mother may or may not even want her ex-husband involved with the children.

Question ID #4268: For a DSM-5 diagnosis of panic disorder, the individual must have experienced: Select one: A. recurrent unexpected panic attacks. B. recurrent unexpected or expected panic attacks. C. at least one unexpected and one expected panic attack. D. multiple panic attacks.

The correct answer is A.For a DSM-5 diagnosis of panic disorder, the individual must have had two or more unexpected panic attacks. Answer B: The panic attacks are not "expected." They come on without warning. Answer C: The panic attacks are not "expected." They come on without warning. Answer D: This is the second-best answer, but the definition in the DSM-5 specifies "unexpected" attacks. The correct answer is: recurrent unexpected panic attacks.

Question ID #4377: In strategic family therapy and other family therapies derived from the communication model, the primary goal of the technique known as prescribing the symptom is which of the following? Select one: A. Undermining the family's resistance to change B. Changing the way a problem is perceived by changing its name C. Changing the meaning of a symptom by relabeling it D. Increasing differentiation among members of the family Feedback

The correct answer is A.Prescribing the symptom is a paradoxical strategy used to help family members change their dysfunctional rules. A paradoxical prescription is a directive given to a family or family member that overtly strengthens or promotes the system's homeostatic defenses and does not arouse resistance. It directs the clients to continue their symptomatic behavior. If followed, the directive reveals control and exposes the secondary gain of the symptomatic behavior for the family; if the clients rebel, they give up their symptoms. When prescribing the symptom, a therapist asks the family to continue or even exaggerate what they are doing in order to undermine the family's resistance to changing that behavior. Answer B: This is a description of the family therapy technique known as relabeling. Answer C: This is another way of describing relabeling. Answer D: This goal is associated with extended family systems (Bowenian) therapy, which typically does not use prescribing the symptom as a therapeutic technique.

Question ID #4340: A social worker is meeting with a client who is a lesbian. The client says that she is thinking about having a baby. What should the social worker do FIRST? Select one: A. Explore if the client has considered how other people's prejudices might affect her child B. Discuss with the client her decision about whether to have a baby C. Explore with the client the difficulties of raising a child alone D. Discuss with the client how her sexual orientation might adversely affect her child Feedback

The correct answer is B.At this point, the client is thinking about having a baby. This answer suggests that the social worker facilitate decision-making by the client and perhaps help her make appropriate plans in the event she decides to have a child. Furthermore, this is the only answer out of the four that conveys support for the client's right to make her own decisions about her life. The other answers all imply bias or judgment on the social worker's part-that she disagrees with or doubts the wisdom of the client's desire to have a baby. Answer A: The client is asking for help in a decision-making process. This option implies disagreement from the social worker. Answer C: If the client ended up becoming a parent, then the social worker or another therapist could provide assistance in this area if the client asked for it. Answer D: The suggestion that the client's sexual orientation could have a negative effect on her child is not consistent with research findings.

Question ID #4379: The clients are a family of four, including two parents and two teenage children. In the first interview, the clients report several problems, including difficulties communicating with each other and arguments about parenting. The children sometimes defy their parents and complain that their parents are too strict. The parents disagree about how to discipline the children and about what behavior should be corrected. They blame each other for this conflict. Why would the social worker use circular questioning with this family? Select one: A. To build rapport with the family B. To increase family members' flexibility in viewing the problems C. To identify environmental stimuli associated with maintenance of the problems D. To target specific problems and behavior for intervention

The correct answer is B.Circular questioning, which has been described as an indirect form of reframing, involves first asking each family member to describe specific behaviors, feelings, or relationships within the family system and then pointing out the differences in their accounts. The goal is to help family members see the similarities and differences in their perceptions, which enables family members to view their problems in a different light-i.e., it increases their flexibility in viewing their problems. Answer A: Building rapport often begins with open-ended questions and displaying empathy to the clients. This question is asking why the circular questioning is being used by the social worker. Answer C: Circular questioning is used to view problems in a different way, which is not described in this answer. Answer D: This could be a goal later in treatment, but the question is asking about a particular intervention.

Question ID #4273: The client is a 25-year-old man with severe schizophrenia who has not been responding to the traditional antipsychotic medication he has been taking. Under the circumstances, his psychiatrist is MOST likely to recommend which of the following medications? Select one: A. Haldol B. Clozaril C. Parnate D. Tegretol

The correct answer is B.Clozaril (clozapine), an atypical (second-generation) antipsychotic, is indicated for the management of severely ill individuals with schizophrenia who fail to respond adequately to standard drug treatment for schizophrenia. In fact, because of a significant risk of agranulocytosis (a blood disorder) and seizure associated with its use, Clozaril should be used only in individuals who have failed to respond adequately to intervention with appropriate courses of standard drug treatments for schizophrenia, either because of insufficient effectiveness or the inability to achieve an effective dose due to intolerable adverse side effects from those drugs. Answer A: Haldol is a traditional (first-generation) antipsychotic-this client has not responded to treatment using traditional antipsychotics. Answer C: Parnate is an MAOI antidepressant. Answer D: Carbamazepine (Tegretol) is an anticonvulsant drug that has also been found effective for mania. The correct answer is: Clozaril

Question ID #4265: A DSM-5 diagnosis of disruptive mood dysregulation disorder requires an onset of symptoms prior to ___ years of age. Select one: A. 6 B. 10 C. 16 D. 21

The correct answer is B.The diagnosis of disruptive mood dysregulation disorder cannot be assigned for the first time before the individual is 6 years of age or after they are 18 years of age, and the age of onset must be before age 10. Disruptive mood dysregulation disorder is diagnosed in the presence of severe recurrent temper outbursts manifested verbally and/or behaviorally that are grossly out of proportion in intensity or duration to the situation or provocation and a chronic, persistently irritable or angry mood between temper outbursts on most days. Symptoms must persist for at least 12 months and be exhibited in at least two of three settings (home, school, with peers). In addition, temper outbursts must be inconsistent with the individual's developmental level and occur, on average, at least three times each week. Answer A: Disruptive mood dysregulation disorder cannot be diagnosed before the age of 6 (or after 18), but the age of onset must be prior to the age of 10. Answer C: The age of onset for disruptive mood dysregulation disorder must be prior to 10 years old. Answer D: The age of onset for disruptive mood dysregulation disorder must be prior to 10 years old. It also cannot be diagnosed in someone age 18 or older.

Question ID #4323: Your new client is a recently divorced 42-year-old man who sought therapy two weeks ago for feelings of grief. While you are waiting at your dentist's office, this client enters the waiting room with a boy who appears to be his teenage son. You and the client have yet to discuss what you'll do if you happen to see each other in a setting outside of your office. How should you handle this chance encounter? Select one: A. Exit the waiting room without acknowledging the client and discuss this encounter at the beginning of your next therapy session B. Wait to see whether the client wants to acknowledge knowing you and how he does so C. Say hello to the client in a friendly way and build trust by openly acknowledging that this encounter is awkward D. If the client acknowledges knowing you, respond politely, but don't converse with him because he might be confused about therapeutic boundaries if you do

The correct answer is B.Many experts recommend that you adopt a "you first" policy that allows a client to decide if he will acknowledge you outside the practice setting. In this case, applying this policy is wise since you and the client have yet to discuss what you will do if you happen to see each other in a setting outside of your office. Answer A: Discussing this encounter and the possibility of future encounters will be helpful; however, abruptly leaving the waiting room would be unnecessary and could be misunderstood by your client. Answer C: Taking the initiative to acknowledge the client could reveal to others in the waiting room (including his son) his status as one of your clients. Without a prior discussion in which the client has given you permission to acknowledge him in a public setting, doing so would violate his confidentiality. Answer D: Refusing to converse with the client is not appropriate since he could misunderstand the behavior and end up feeling rejected, embarrassed, or offended.

Question ID #4284: Of the psychiatric disorders, genetic factors have been MOST consistently linked to: Select one: A. personality disorders. B. bipolar disorders. C. psychotic disorders. D. anxiety disorders

The correct answer is B.Of the psychiatric disorders, genetic factors have been most strongly linked to the bipolar disorders. Family studies have found that the first-degree relatives of individuals with bipolar disorder are at elevated risk for both bipolar disorder and depression. Answer A: There is no evidence of a genetic component in the risk for developing a personality disorder. Answer C: There is also strong evidence of a genetic component for schizophrenia. This evidence is provided by twin and adoption studies and studies showing that the risk for schizophrenia is substantially higher among first-degree biological relatives of people with this disorder than for people in the general population. However, bipolar disorders are more commonly linked to genetic factors.Answer D: Anxiety disorders have been linked to a number of different genes. Most researchers conclude that anxiety is genetic but can also be influenced by environmental factors.

Question ID #4365: An adult client reports having a hard time coping with stressful events. If the social worker uses stress inoculation with this client, what will she do first?

The correct answer is B.Stress inoculation is a cognitive-behavioral technique that consists of three phases: (a) education (help the client understand his behavioral and cognitive responses to stressful situations); (b) skill acquisition (help the client acquire and rehearse a variety of coping skills); and (c) application (have the client apply the coping skills to imagined, filmed, and in vivo stress-producing situations). Answer A: Identification of triggers would be important in future sessions, but not first. Answer C: A stress hierarchy is part of exposure therapy.Answer D: Mindfulness skills are taught in dialectical behavior therapy.

Question ID #4269: Symptoms of ____________ are similar to those associated with a moderate to severe case of the flu (e.g., muscle pain and cramps, diarrhea, chills, sneezing, lethargy). Select one: A. opioid intoxication B. opioid withdrawal C. cocaine intoxication D. cocaine withdrawa

The correct answer is B.Symptoms of opioid withdrawal are uncomfortable but usually not life-threatening and are similar to those associated with a bad cold or the flu. Answer A: People who are intoxicated on opioids usually are not feeling a lot of discomfort and pain- just the opposite. Answer C: Cocaine intoxication is characterized by alertness, feelings of well-being, euphoria, and energy. Answer D: Cocaine withdrawal is usually characterized by fatigue, irritability, anxiety, and depression.

Question ID #4240: The client is a middle-aged man whose wife died five months ago. The client is showing signs of major depression and reports feeling lonely and lacking support during this difficult period. The client was diagnosed with diabetes several years ago and reports that he hasn't seen his physician in almost a year, ever since his wife first became ill. Using the four-factor PIE (person-in-environment) system, how would the social worker record information about this client's situation? Select one: A. Factor I, biological; Factor II, psychological; Factor III, social; Factor IV, cultural B. Factor I, problems in social role functioning; Factor II, problems in the environment; Factor III, mental heath problems; Factor IV, physical health problems C. Factor I, mental health problems; Factor II, physical health problems; Factor III, problems in the environment; Factor IV, current level of functioning D. Factor I, problems in social role functioning; Factor II, problems in the environment; Factor III, mental and/or physical health problems; Factor IV, current level of functioning

The correct answer is B.The PIE System may be used during assessment, to plan treatment, and to evaluate interventions. Each PIE factor describes a feature of the client's problem situation. Factors I and II are usually the focus of social work practice: Factor I describes problems in the client's social role functioning (in this case, the death of the client's spouse). Factor II describes problems in the client's environment as they affect his social functioning (in this case, the client lacks emotional support as he tries to cope with his wife's death). Factor III lists any mental health problems the client has (possibly major depression in this case), and Factor IV lists physical health problems reported by the client or diagnosed by a physician (diabetes). Note that when using the PIE system to record your assessment findings, you also note information about the duration and severity of the client's Factor I and II problems, and for Factor I problems, you also indicate your clinical judgment as to the client's physical, mental, and psychological strength to cope with the problems. Answer A: While this answer roughly captures the four factors of PIE, they are in the wrong order, incomplete, and incorrectly include "cultural."Answer C: While this answer roughly captures the four factors of PIE, they are in the wrong order. Answer D: While this answer roughly captures the four factors of PIE, it incorrectly includes "current level of functioning."

Question ID #4312: High maternal anxiety during pregnancy is associated with all of the following potential consequences EXCEPT: Select one: A. premature birth. B. delivery complications. C. infants who are listless and lethargic. D. infants who have feeding and sleep problems.

The correct answer is C.Maternal anxiety is one of a number of prenatal environmental factors that influences child development. Others include maternal health, diet, and drug use. Answer A: High maternal anxiety is associated with prematurity. Answer B: High maternal anxiety is linked to a higher incidence of delivery complications. Answer D: High maternal anxiety is associated with infants who are hyperactive and irritable, as well as infants who have feeding and sleep problems after birth.

Question ID #4395: A structural family therapist who uses anecdotes about his own family to highlight similarities to the client family is ____________ the family. Select one: A. restructuring B. joining C. engaging D. realigning

The correct answer is B.The process of structural therapy involves three overlapping steps: joining, evaluating the family structure, and restructuring the family. The therapist in this question is establishing a therapeutic system by joining the family in a position of leadership. This allows the therapist to gain a greater understanding of the family's transactional patterns and encourages family members to feel secure enough to begin exploring alternative ways of interacting. There are three types of joining: Joining from a distant position involves teaching or giving directive advice. Joining from a median position (tracking) involves being an active, neutral listener and using techniques such as summarizing, observing, and commenting on processes. In tracking, the therapist may use the family values, life themes, and important life events in his communications to demonstrate that the social worker values what the clients have to say. Finally, joining from a close position (mimesis) involves imitating the style, affective range, and content of the family's communications in order to build kinship with them and reinforce the therapeutic alliance. The therapist may relate personal experiences ("I have a sister who does that") or mimic a client's behavior (e.g., sit in the same position). Answer A: Restructuring the family is the main long-term goal of structural family therapy. To restructure a family, structural therapists use several techniques, many of which are designed to deliberately unbalance (stress) the family's homeostasis in order to facilitate transformation of the family structure. Techniques include enactment, in which family members are asked to role-play their relationship patterns so that they can be identified and altered, and reframing, which involves relabeling behaviors so that they can be viewed in more positive ways.

Question ID #4367: A social worker is conducting therapy with a couple who has been fighting a lot. The clients primarily use you-statements instead of I-statements when communicating with each other. The social worker would like to help each partner get a better perspective of the other. Which intervention would the social worker utilize? Select one: A. Completing a genogram B. The empty-chair technique C. Reframing D. Using a paradoxical intervention

The correct answer is B.The purpose of the empty-chair technique (a.k.a. double-chair technique) is to help clients understand their feelings toward themselves or a significant other. It is often used to clarify the issues involved in an interpersonal conflict by helping clients view the conflict in a different light and gain insight into why they are feeling and behaving the way they are. The basic purpose of this technique is the same whether you are working with an individual or a couple. Answer A: This answer brings in elements of family systems therapy and may be helpful in the future, but it would not address the identified problem. Answer C: Reframing is an element of strategic family therapy and would be helpful in future interventions, after the couple resolves current communication deficits. Answer D: This is also an intervention related to strategic family therapy and would not be used in this situation to change I-statements. The correct answer is: The empty-chair technique

.Question ID #4272: An adult client is convinced that TV commercials are sending her personal messages, and she cannot be talked out of this belief. This is an example of which of the following? Select one: A. A delusion of being controlled B. A delusion of reference C. Magical thinking Incorrect D. An obsession

The correct answer is B.The woman is exhibiting a clearly false belief and is unwilling to consider the possibility that the belief is untrue. This is the definition of a delusion. Delusions of reference involve the belief that events, objects, or other people in one's immediate environment have a particular and unusual personal significance. Answer A: A delusion of being controlled involves the belief that one's feelings, thoughts, impulses, or actions are not one's own, but are being imposed by an external force. Answer C: Magical thinking is characterized by the belief that ones thoughts, words, or actions can cause or prevent a specific outcome in a way that defies normal laws of cause and effect. Answer D: Obsessions are recurrent, persistent, and senseless ideas, thoughts, images, or impulses that are experienced by the person as ego-dystonic

Question ID #4253: An adult client reports difficulty sleeping, a generally anxious mood, and a sense of feeling helpless and lost. The client has been married for 10 years and has two children, a 7-year-old and a 5-year-old. The client talks freely about her children but says very little about her husband, other than that he is moody. She says her symptoms are fairly long-standing, and when questioned, she says quickly that she can't really connect them to any event in her life. She remarks that her husband tells her all the time that she just has a weak character. After ruling out the possibility that the client is thinking about suicide, the social worker refers her for physical evaluations, which reveal that she doesn't have any medical condition that could account for her symptoms and doesn't use any substances at all. What should the social worker do NEXT? Select one: A. Attempt to see the entire family to assess their communication and interaction patterns and the couple's parenting styles B. Attempt to see the couple together to assess their communication and interaction patterns, including how they handle conflict C. Assist the client to identify the source of her depressed mood and anxiety symptoms D. Discuss with the client her own interpretation of her symptoms, including whether she agrees that she has a weak character

The correct answer is B.This is the best answer because the question contains many red flags for spousal abuse-the husband is moody and critical; the client is reluctant to talk about him and appears evasive when the social worker asks what she thinks might be causing her symptoms. In addition, women who are abused by an intimate partner often develop symptoms of depression and anxiety. Although many therapists interview the partners individually during assessments for spousal abuse, in this case, the social worker still needs more information to support that suspicion. Answer B offers a way of exploring whether this suspicion may be accurate. Answer A: This would be considered the second-best answer, since there is also a chance that the husband mistreats or even abuses the children. Answer C: If the woman is being abused, she may not be willing to identify her relationship with her husband as the source of her symptoms. Directly observing the couple's communication style would give the social worker more direct information to confirm or disprove the suspicion that she is being abused. Answer D: This might be something that the social worker would do later. The question is asking about what the social worker would do NEXT.

Question ID #4259: It is often difficult to distinguish between major and mild neurocognitive disorder, delirium, and major depressive disorder in older adults. However, the presence of which of the following suggests that delirium is the appropriate DSM-5 diagnosis? Select one: A. Deficits in memory B. Fatigue or loss of energy C. Impaired attention and awareness D. Flight of ideas

The correct answer is C.As described in the DSM-5, the essential feature of delirium is a disturbance in attention and awareness plus an additional disturbance in cognition (e.g., memory deficit, disorientation, language impairment, deficit in visuospatial ability, or perceptual distortion). Answer A: Memory impairment is characteristic of all three disorders and therefore is not useful for distinguishing among them. Answer B: Fatigue or a loss of energy is characteristic of major depressive disorder. Answer D: Flight of ideas is characteristic of manic and hypomanic episodes.

Question ID #4300: A social worker is assessing a 4-year-old who was in an automobile accident with his parents a week ago. No one suffered serious injury, but the parents are worried because the boy has been fussy since the accident. They wonder whether they should avoid making him ride in a car for a while. They hope that the social worker can find out what the boy remembers about the accident and whether he is afraid of being in another accident. When exploring those questions, the social worker should be aware of which of the following? Select one: A. A 4-year-old does not have the cognitive capacity to talk about an event he has experienced. B. The boy is too young to have stored information in memory about his experience. C. The boy's understanding of the concept of time, the past, and the future will be limited by his age. D. The boy will be better able to describe his memories of the accident after more time has passed.

The correct answer is C.Before age 5, children have very little understanding of the concept of time, the past, or the future. Without this understanding, they are unable to think logically about cause and effect and have difficulty imagining future events or things they haven't experienced yet. At about age 5 or 6, children begin to develop a sense of time and the ability to conceptualize cause and effect in a logical way. For example, they are able to use their past experience to imagine what future outcomes might be. Answer A: Most preschoolers can give fairly accurate answers to open-ended questions about events they've experienced and can store emotionally vivid events (ones that made them happy, sad, or afraid) accurately in memory and even describe them afterwards. Answer B: Autobiographical (episodic) memory stores information about events that have been personally experienced. While autobiographical memory is generally inaccurate until after age 3, its accuracy then increases gradually during the preschool years. Answer D: Because preschoolers' memories fade faster than those of older children and adults, a key determinant of the accuracy of preschoolers' memories is how soon after an event they are interviewed.

Question ID #4274: A woman being treated by a psychiatrist is taking medication for her mental disorder. At a party, after eating some aged cheese and drinking some wine, the woman develops an extreme headache. A friend drives her to the emergency room at a local hospital where the doctor finds that the woman has extremely elevated blood pressure. This information suggests that the woman is MOST likely taking which of the following medications? Select one: A. Klonopin B. Lithium C. An MAO inhibitor D. Chlorpromazine

The correct answer is C.Consuming foods or beverages containing tyramine (e.g., aged cheese, chicken liver, beer, wine, soy sauce) when taking an MAO inhibitor is likely to produce a hypertensive crisis, which involves the symptoms exhibited by the woman in this question. Answer A: Klonopin may cause headaches, among many other possible side effects, but not in association with consuming particular foods, as an MAO inhibiter would. Answer B: Lithium does have a number of possible side effects, including hand tremor, increased thirst and/or urination, digestive problems, weight gain, and cognitive impairment, but not in association with consuming particular foods. Answer D: Chlorpromazine (Thorazine) has numerous possible side effects, including dizziness, drowsiness, anxiety, insomnia, weight gain, and swelling, among others, but not in association with consuming particular foods, as an MAO inhibiter would.

Question ID #4292: Which of the following is associated with a higher risk of osteoporosis following menopause? Select one: A. Obesity B. African American race C. Cigarette smoking D. A late onset of menopause

The correct answer is C.Factors associated with a higher risk of osteoporosis are white race, slender build, cigarette smoking, low calcium intake, and a lack of regular exercise. Answer A: Evidence indicates that adipose tissue (fat) exerts a protective effect against bone loss. Answer B: Caucasian women are more susceptible to osteoporosis following menopause than African American women.Answer D: Women who experience menopause early (before about age 50) are at greater risk for osteoporosis (and heart disease) than are women who reach menopause later.

Question ID #4262: As described in the DSM-5, the five core symptoms of the schizophrenia spectrum disorders are: Select one: A. delusions, hallucinations, negative symptoms, impaired cognition, and disorganized speech. B. disorganized thinking, delusions, hallucinations, negative symptoms, and depersonalization or derealization. C. hallucinations, negative symptoms, grossly disorganized or abnormal motor behavior, delusions, and disorganized thinking. D. grossly disorganized or abnormal motor behavior, hallucinations, negative symptoms, affective instability, and delusions.

The correct answer is C.Hallucinations, negative symptoms (e.g., diminished emotional expression, avolition), grossly disorganized or abnormal motor behavior, delusions, and disorganized thinking are the five core symptoms of schizophrenia and other schizophrenia spectrum disorders. Answer A: Impaired cognition is an associated feature of schizophrenia, but not one of the five core symptoms of the schizophrenia spectrum disorders. Answer B: Depersonalization and derealization are associated symptoms of schizophrenia but are not the core symptoms of the schizophrenia spectrum disorders. Answer D: Affective instability is characteristic of schizoaffective disorder, which has the same symptoms as schizophrenia with the addition of a disturbance.

Question ID #4270: Which of the following is NOT a DSM-5 diagnostic criterion for bulimia nervosa? Select one: A. Binges are accompanied by a sense of a lack of control over eating. B. Binges are accompanied by inappropriate compensatory behaviors to prevent weight gain. C. People with this disorder have an intense fear of gaining weight and becoming fat. D. The self-esteem of people with this disorder is unduly affected by their body shape and weight.

The correct answer is C.Intense fear of gaining weight and becoming fat is a diagnostic criterion for anorexia nervosa but not for bulimia nervosa. Answers A, B, and D: These are all true of bulimia nervosa.

Question ID #4296: A child has just entered Kohlberg's "conventional morality" level of moral development. She is MOST likely to follow rules in order to: Select one: A. satisfy her own needs. B. avoid censure by a legitimate authority. C. avoid disapproval or dislike by others. D. avoid punishment.

The correct answer is C.Kohlberg (who was influenced by Piaget) developed a theory of moral development in which individuals move through levels and stages in an invariable sequence, with each stage arising from the previous one and each being more cognitively complex than its predecessor. Answers B and C are both characteristic of conventional morality (ages 10"13); however, the girl has just entered the conventional morality level of moral development. At the beginning of this level, a child has a good boy/good girl orientation and is motivated by a desire to avoid disapproval or dislike by others. Answer A: This is characteristic of Kohlberg's second stage (instrumental-relativist/hedonist orientation). It represents less mature moral development, during the preconventional level of morality (ages 4"10). Answer B: This is characteristic of a child later in the conventional morality level, during the law and order orientation stage. Answer D: This also represents less mature moral development, during the preconventional morality level (ages 4"10). It is characteristic of Kohlberg's first stage of moral development (punishment-obedience orientation).

Question ID #4234: A client presented for therapy complaining of anxiety and recurrent thoughts about being contaminated by touching other people. He says he can't control these thoughts and hates them because he knows they are "ridiculous and unreasonable." After completing an assessment of this client, the social worker determines that he has obsessive-compulsive disorder. As part of the treatment plan, she refers the client to a psychiatrist for a medication evaluation. Which of the following kinds of medication would be MOST useful for reducing this client's obsessions? Select one: A. Lithium B. An anxiolytic C. An antidepressant D. An antipsychotic

The correct answer is C.Pharmacotherapy combined with behavioral or cognitive-behavioral techniques is currently considered the treatment of choice for OCD. Of the drugs listed, antidepressants (i.e., a tricyclic, such as clomipramine, or an SSRI) have been most consistently found to be useful for reducing obsessions associated with OCD. Answer A: Lithium is a mood stabilizer used for clients with bipolar disorder. Answer B: Anxiolytic (or anti-anxiety) medications may be used in the short-term for treatment of anxiety, but they run the risk of dependence, so they are not usually prescribed for OCD. Answer D: Antipsychotic medications are not indicated for OCD.

Question ID #4264: A social worker is meeting with a mom, a dad, and their 16-year-old son. The parents describe being irritated with their son because he's been wanting to spend his free time with friends, "hanging out who knows where." Dad says that he and his wife have offered to host supervised parties at their house, but the boy keeps insisting that he wants to go out. Mom reports that they have had many heated arguments with their son about this and that they recently discovered that he sneaked out one evening to attend a party with friends. When asked by the social worker for his perspective, the boy says he's "pissed" because his parents are "totally unreasonable." Based on this information, what diagnosis is MOST indicated for this boy? Select one: A. Conduct disorder B. Oppositional defiant disorder C. Parent-child relational problem D. Disruptive mood dysregulation disorder

The correct answer is C.This is the best answer, in part because the boy doesn't appear to meet the diagnostic criteria for any mental disorder. Parent-child relational problem is included in the DSM-5 with other conditions that may be a focus of clinical attention, and it may include such problems as parental overprotection and feelings of anger about the other person in the relationship. The other conditions described in the DSM-5 are not mental disorders, but they may be a focus of clinical attention or may otherwise affect the diagnosis, course, prognosis, or treatment of a client's mental disorder. Coding one (or more) of these conditions is appropriate if it is a reason for the client's current visit; helps to explain the need for a test, procedure, or treatment; and/or provides useful information on circumstances that may affect the client's care, regardless of its relevance to the current visit. Answer A: In the DSM-5, the diagnosis of conduct disorder requires a persistent pattern of behavior that violates the basic rights of others and/or age-appropriate social norms or rules as evidenced by the presence of at least three characteristic symptoms during the past 12 months and at least one symptom in the past six months. The characteristic symptoms are divided into four categories: aggression to people and animals, destruction of property, deceitfulness or theft, and serious violations of rules. Answer B: In the DSM-5, the essential feature of oppositional defiant disorder is a recurrent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness that is demonstrated by four or more symptoms and is exhibited with at least one person who is not a sibling. Answer D: Disruptive mood dysregulation disorder is a new disorder in the DSM-5. It is diagnosed in the presence of (a) severe recurrent temper outbursts manifested verbally and/or behaviorally that are grossly out of proportion in intensity or duration to the situation or provocation and (b) a chronic, persistently irritable or angry mood between temper outbursts on most days. Symptoms persist for at least 12 months and are exhibited in at least two of three settings (home, school, with peers), and the temper outbursts are inconsistent with the individual's developmental level and occur, on average, at least three times each week. The diagnosis cannot be assigned for the first time before the individual is 6 years old or after he is 18 years old, and the age of onset must be before age 10.

Question ID #4260: The client is a 70-year-old man who has been experiencing cognitive symptoms. The onset of his symptoms was abrupt, and his condition has followed a stepwise, fluctuating course. It is determined that the man has vascular neurocognitive disorder. Vascular neurocognitive disorder is caused by which of the following? Select one: A. Aging B. Chronic alcoholism C. Cerebrovascular disease D. Brain damage

The correct answer is C.Vascular neurocognitive disorder is diagnosed when the criteria for major or mild neurocognitive disorder are met; the clinical features are consistent with a vascular etiology (e.g., stroke); and there is evidence of cerebrovascular disease from the individual's history, a physical examination, and/or neuroimaging that is considered sufficient to account for the symptoms. Answer A: Cognitive decline, especially with a fluctuating course, is not necessarily a consequence of aging. Answer B: The social worker already knows that the client suffers from vascular neurocognitive disorder. There is no evidence of chronic alcoholism. Answer D: Cerebrovascular disease can cause brain damage, such as a stroke.

Question ID #4327: A social worker was trained to use hypnosis by a local psychologist who has many years of experience in providing hypnosis and has appeared on television. In an effort to build her own private practice, the social worker decides to offer prospective clients a leaflet that explains hypnosis and includes testimonials from the psychologist's clients describing how hypnosis has helped them. The social worker places this leaflet on a table in her waiting room. Which of the following is true about this situation? Select one: A. This is unethical because social workers are prohibited from using client testimonials to advertise or market their services. B. This is unethical because social workers should not engage in uninvited solicitation of clients who are vulnerable to undue influence, manipulation, or coercion. C. This is unethical because it may mislead the social worker's clients or prospective clients. D. This is ethical if the social worker received prior permission from the psychologist to use the testimonials.

The correct answer is C.You are using the leaflet to build your own practice, but the client testimonials are responses to the psychologist's work, not yours. Those reading the leaflet may be misled. The Code of Ethics prohibits social workers from misleading clients, the public at large, colleagues, and employers about their background, skills, and areas of expertise. Answer A: The use of client testimonials is not always prohibited. Instead, the Code of Ethics says the following (Standard 4.07b): Social workers should not engage in solicitation of testimonial endorsements (including solicitation of consent to use a client's prior statement as a testimonial endorsement) from current clients or from other people who, because of their particular circumstances, are vulnerable to undue influence. Answer B: It is true that social workers should not engage in uninvited solicitation of potential clients who, because of their circumstances, are vulnerable to undue influence, manipulation, or coercion (Standard 4.07a), but this prohibition is not relevant in this situation. You are simply placing the leaflet on a table in your waiting room. Answer D: Getting permission from the psychologist to use the testimonials is not relevant to this situation as it could still be misleading to the social worker's clients or prospective clients.

Question ID #4318: According to Albert Ellis, founder of rational emotive behavioral therapy, emotions are: Select one: A. less important than thoughts. B. the primary controllers of behavior. C. caused by the events a person is exposed to. D. a product of thoughts and beliefs.

The correct answer is D.Ellis's REBT regards behavior as a chain of events-A, B, and C-in which A is the external event to which a person is exposed, B is the thought the person has in response to A, and C is the emotion or behavior that results from B. As a consequence of the ABC model, a major assumption of REBT is that an emotional or behavioral response to an external event is due to thoughts and beliefs about the event rather than the event itself. Therefore, the best way to modify maladaptive feelings and behaviors is to modify faulty (often irrational) cognitions. Answer A: As noted above, Ellis considers both emotions and the thoughts that provoke them to be important. Answer B: Ellis would say that our thoughts or beliefs control our behavior (and emotions). Answer C: Ellis would say that emotions are caused by a person's thoughts or beliefs about the event, not by the event itself.

Question ID #4355: A physician's office employs social workers as part of its medical home model. The social workers primarily practice complementary and alternative medicine (CAM) in conjunction with more traditional approaches. Which of the following BEST describes this model? Select one: A. Integrative methods of mental health treatment use non-traditional methods to eliminate symptoms of mental illness. B. Alternative methods of mental health treatment include traditional methods as well as non-traditional models. C. Body-based mental health treatment is within the scope of social work practice, whereas energy medicine is not. D. Complementary methods of mental health practice are given in addition to standard procedures, while alternative methods are used instead of standard treatment.

The correct answer is D.Integrative mental health methods (CAM) combine traditional and non-traditional treatments. Answer A: This only reflects half of the equation by noting the use of just non-traditional methods.Answer B: This is incorrect, as social workers must remain cautious about the scope of practice concerns when using any complementary and alternative medicine (CAM) techniques.Answer C: This is incorrect, as social workers must remain cautious about scope of practice concerns. For example, the social worker may use meditation or recommend that a client try exercise or yoga, but they could not suggest that their client take St. Johns Wort or follow a certain diet, as both are outside the social worker's scope of practice. The correct answer is: Complementary methods of mental health practice are given in addition to standard procedures, while alternative methods are used instead of standard treatment.

Question ID #4393: A social worker observes that her client's motivation for change has diminished significantly during the middle phase of treatment. Which of the following interventions would be LEAST appropriate for restoring the client's motivation? Select one: A. Expressing realistic confidence in the client's capacities B. Reminding the client of negative consequences of not changing C. Using persuasion to encourage the client to take an important step D. Conveying to the client more belief in the potential helpfulness of an intervention than she actually has

The correct answer is D.It is common for a client's motivation to diminish during the middle, or change-oriented, phase of treatment, usually because the client feels less anxious as a result of support from a social worker. Resistance emerges and clients start to believe that they are cured because the client feels better than at the outset of treatment. The social worker should make statements intended to convey the belief that therapy (or a specific intervention) can be helpful; this could be effective for restoring a client's motivation for change. A social worker should not convey anything more than he or she believes as this response indicates. Answer A: The statements a social worker makes must offer the client realistic hope. Answer B: Reminding a client of negative consequences is an effective tool to continue or maintain change. Answer C: Encouraging a client to take an important step could provide the motivation a client needs and would be appropriate in the therapeutic relationship.

.Question ID #4335: A social worker should be aware that client records: Select one: A. are protected by law and cannot be disclosed without the client's consent. Incorrect B. are the property of the social worker, without whose consent they cannot be disclosed. C. are the joint property of the social worker and client and cannot be disclosed without the consent of both. D. are not free from disclosure all of the time, regardless of the wishes of the client.

The correct answer is D.Only this statement is correct. The physical record is considered the property of the social worker, while the information in it is (for the most part) the property of the client. However, there are situations, such as court orders, that will require the social worker to disclose the information in the records, even without the client's consent. Answer A: Certain situations, such as court orders, will require the social worker to disclose the information in the records. Answer B: This is not a true statement. Answer C: As mentioned in Answer A, there are certain situations that will require the social worker to disclose the information in the records.

Question ID #4398: Which of the following is NOT characteristic of a classical bureaucracy? Select one: A. A merit-based system of compensation B. Formalized channels of communication C. A power hierarchy D. Overlapping roles and functions

The correct answer is D.Overlapping roles and functions are not found in classical bureaucracies. The Social Work Dictionary 5th Edition (Barker, 2003) defines a bureaucracy as a form of social organization whose distinctive characteristics include a task-specific division of labor [as opposed to overlapping roles and functions]; a vertical hierarchy with power centered at the top; clearly defined rules; formalized channels of communication; and selection, promotion, compensation, and retention based on technical competence (p. 54). Answer A: This is a characteristic of a classical bureaucracy. Answer B: A formalized channel of communication is a noted characteristic of a classical bureaucracy. Answer C: A power hierarchy is a characteristic of a classical bureaucracy. The correct answer is: Overlapping roles and functions

Question ID #4276: Which of the following is NOT a reason a child would be removed from their home and given an out-of-home placement? Select one: A. The caregivers suffer from substance abuse disorders and have become neglectful. B. The child has experienced emotional abuse. C. The child has a severe disability that the caregivers cannot attend to at home. D. The caregivers are extremely low-income.

The correct answer is D.Poverty, while very stressful on families, does not constitute maltreatment and is not a reason to remove a child from home. Families experiencing poverty should be provided with resources such as social welfare programs or job search and preparation support. Answer A: Out-of-home placements should be a last resort if caregivers are unable to properly care for children, but children can be removed for these reasons. Answer B: If the emotional abuse is severe, a child might be removed from home. Answer C: Some children with disabilities may also need more intensive care than family members can provide at home, in which case an out-of-home placement may be appropriate.

Question ID #4397: A social worker instructs each member of a married couple in conflict to argue for their partner's position. This is an example of: Select one: A. role-playing. B. prescribing the symptom. C. the empty chair technique. D. role reversal.

The correct answer is D.Role reversal is used to help clients understand the perceptions and feelings of significant others. It involves having one person (e.g., a spouse, a parent) take on the perspective of another person (e.g., the other spouse, the child) in an effort to better understand their position. Role reversal is particularly useful in couples and family therapy as it increases awareness of how each party feels. Answer A: Role playing is when a client rehearses behaviors that will be useful in a particular situation in order to meet a goal or fulfill an expectation. The client practices the behavior in the therapist's presence and then receives feedback. Answer B: Prescribing the symptom is a paradoxical technique that involves instructing a client to engage in or exaggerate a target dysfunctional behavior. The prescription is designed to force a client to either give up the symptom (the dysfunctional behavior) or admit that it is under voluntary control. Answer C: The empty chair technique is used to help clients understand their own feelings, including feelings about themselves or about another person. Using the technique involves placing an empty chair opposite the client, asking the client to explain to the chair (which represents the other person or the situation) their perceptions and/or feelings, and then asking the client to sit on the chair (to assume the role of the other person or the situation) and respond to what was said during the session. The therapist uses interviewing skills to explore the dialogue as it develops.

Question ID #4392: A client becomes verbally aggressive toward their social worker during a session. The social worker responds by validating the client's response and informing the client of their belief that the client has legitimate reasons for feeling so angry. What technique is the social worker using? Select one: A. Visualization B. Funneling C. Mirroring D. Fogging

The correct answer is D.The question describes fogging, a technique used to defuse attacks by angry clients who are verbally aggressive. With fogging, the social worker offers no resistance to the client, avoids responding to her with either anger or defensiveness, and calmly acknowledges that the client may have legitimate reasons for her anger, criticism, etc.-that the client's perceptions of the situation that has caused upset are valid. When the client sees that verbal attacks have no effect on the social worker, she may abandon it. Answer A: Visualization is a cognitive restructuring technique in which the social worker has a client repeatedly imagine an event the client is worried about and mentally rehearse the steps necessary to handle the event successfully. Cognitive restructuring techniques are used to help clients manage their emotional reactions and behave more effectively through modifying their distorted cognitions or errors in logic, particularly their distorted interpretations of reality. Answer B: Funneling (a.k.a. narrowing the focus) involves asking a series of questions designed to help a client describe concerns or situations with more specificity. Answer C: Mirroring generally involves speaking at a client's pace and in a way that matches their nonverbal behavior. It can be effective for bringing attention to aspects of a client's behavior and for reinforcing desired behaviors. For example, when using mirroring to reduce a client's defensiveness, a social worker would follow non-defensive communications with verbal and nonverbal behavior that mirrors (imitates) the client's.

Question ID #4258: When using the DSM-5, a social worker or other clinician would code which of the following when a client has symptoms that do not meet the diagnostic criteria for a specific disorder and the clinician does not want to specify the reason why? Select one: A. Disorder not otherwise specified B. Disorder provisional C. Other specified disorder D. Unspecified disorder

The correct answer is D.When using the DSM-5, diagnostic uncertainty about a client's diagnosis is indicated by coding one of the following: "Other specified disorder" is coded when the clinician wants to indicate the reason why the client's symptoms do not meet the criteria for a specific diagnosis (e.g., "other specified depressive disorder, recurrent brief depression"); and "unspecified disorder" is coded when the clinician does not want to indicate the reason why the client's symptoms do not meet the criteria for a specific diagnosis (e.g., "unspecified depressive disorder").Answer A: "Not otherwise specified" (NOS) is used in the DSM-IV-TR to indicate diagnostic uncertainty but has been replaced in the DSM-5 with "other specified disorder" and "unspecified disorder."Answer B: When using the DSM-5, the provisional specifier applies when "there is a strong presumption that the full criteria will ultimately be met for a disorder but not enough information is available to make a firm diagnosis" (p. 23).