CSW Masters Exam Study Prep

A 16-year-old female was referred for treatment because she has been isolating herself. Her mother fears she may be depressed. During the assessment, the social worker is gathering information about her nutrition. What question could the social worker ask to begin screening for a possible eating disorder? A. "Do you ever worry that you have lost control over how much you eat?" B. Ask her mother if she thinks her daughter has an eating disorder. C. "Has bulimia ever been a problem for you?" D. "Do you think you have an eating disorder?"

A. "Do you ever worry that you have lost control over how much you eat?" **It is important to screen for eating disorders during an assessment. Adolescent girls are at particular risk of developing an eating disorder. It's essential to ask questions, in a non-judgmental way, about eating habits and food intake. It's also important to remember that eating disorders come in many forms. You cannot tell just by looking at people whether or not they have an eating disorder.**

A social worker is meeting with a client who at times seems to be confused about answering questions. At other times, the client seems to struggle with reality. What is the best question the social worker could ask to gain information on the client's insight? A. "Do you think that you need treatment?" B. "What would you do if you found a letter on the sidewalk that had a stamp on it?" C. "Are other people concerned about you?" D. "Who were the last five presidents?"

A. "Do you think that you need treatment?" **It is important to inquire about a client's insight as part of a comprehensive assessment. To gain information about the client's insight, ask questions about whether or not the client is concerned about their symptoms, if they think their symptoms are normal, or if they think treatment is needed.**

A client describes how her husband suddenly passed away and as a result, she cannot afford to live in her home. She is grief-stricken and overwhelmed with the moving process. She states that she has no idea where she will go and feels lost without her husband. What is the best way for an empathic social worker respond? A. "It sounds like you feel overwhelmed with grief and having to relocate." B. "You are such a strong person to be going through this." C. "I'm so sorry that this has happened to you." D. "It must be very difficult for you to deal with this."

A. "It sounds like you feel overwhelmed with grief and having to relocate." **Part of developing a therapeutic relationship requires showing empathy to clients. It is important to communicate accurate understanding but not pity to clients.**

A social worker in private practice seeks consultation with another social worker. The social worker wants to sell products to clients that can enhance their treatment, such as self-help books, meditation CDs, and computer software. How should the consultant respond? A. Advise her against selling products to clients as it constitutes a dual relationship. B. Advise the social worker to do so only if she tells the clients that she is making a profit. C. Advise the social worker that it is okay to do so only if she declares herself to be a non-profit organization. D. Advise her against selling products as a client may buy the products and then discontinue treatment, which may be a disservice to the client.

A. Advise her against selling products to clients as it constitutes a dual relationship. **Exchange of money between social workers and clients (other than a payment for social work services) often constitutes a dual relationship. Social workers should not sell products to clients.**

A 19-year-old comes to his first therapy session with a social worker. He initially called to make an appointment to discuss a crisis at his home. During the appointment he acts withdrawn, will not make eye contact, and seems reluctant to discuss what is going on. What is the first step in the crisis intervention model? A. Assess the nature of the precipitating event and current problem. B. Implement an intervention strategy C. Call the family of the client to ask a representative to come immediately to the appointment D. Plan an intervention to restore the individual to a pre-crisis state

A. Assess the nature of the precipitating event and current problem. **In planning crisis intervention strategies, it is imperative to first determine the nature of the issue that brought the client to the appointment in order to assess the level of danger a person poses to himself/herself or others, as well as to assess if the client is currently in danger.**

A social worker in private practice in a small community receives a referral for a child with autism. The social worker has little experience with children and has never treated a child with autism. The social worker is interested in gaining as many clients as possible to continue to grow her practice. How should the social worker proceed? A. Collaborate with the client's mother and the referral source to discuss the social worker's lack of expertise and whether or not a more qualified clinician is available. B. Contact the referral source to refuse the referral. C. Inform the parent of the child that a general education in social work allows for treatment of children with autism spectrum disorder. D. Treat the child and learn about treatment for autism spectrum disorder.

A. Collaborate with the client's mother and the referral source to discuss the social worker's lack of expertise and whether or not a more qualified clinician is available. **Although social workers can treat a variety of mental and behavioral problems, they should not present themselves as experts in everything. If a social worker lacks knowledge in a particular treatment area, the best option is to refer the client to another expert. When this is not possible, education and supervision can be an option to support the social worker in the treatment.**

An agency social worker's caseload is supposed to be capped at 15 clients. The social worker currently has a caseload of 25 clients and is falling behind in making and documenting visits to clients. What should the social worker do first? A. Consult with the direct supervisor and ask for guidance. B. Call the state licensing agency and complain about the working conditions. C. Apologize to the clients and explain the hectic schedule to them. D. Quit the current job and find another agency to work for.

A. Consult with the direct supervisor and ask for guidance. **Clients should not be forced to bear the brunt of agency problems. Leaving or reporting the agency might be appropriate steps if the problem is not resolved, but the first action a social worker in this situation should take is consulting with the supervisor.**

A psychiatrist refers a 12-year-old girl to a social worker for anxiety treatment. After meeting with the client and her parents, the social worker concludes that the client needs increased stability in the home before she can benefit from anxiety treatment. What should the social worker do? A. Contact the psychiatrist to collaborate about the case and discuss treatment needs and options. B. Ask the family which treatment they prefer and proceed with whatever option they choose. C. Proceed with a parenting intervention to increase stability in the home. D. Proceed with anxiety treatment as the psychiatrist requested.

A. Contact the psychiatrist to collaborate about the case and discuss treatment needs and options. **It is imperative that social workers collaborate with other professionals about treatment needs and options. While other interventions may follow, the first step here is to discuss the case with the referring psychiatrist.**

A client with a long history of unstable relationships, impulsivity, and frequent outbursts of anger is referred to an inpatient unit with suicidal thoughts and self-injuring behaviors. What type of intervention is most likely to be beneficial? A. Dialectical behavior therapy B. A course of anti-anxiety medication only C. Referral to a group for survivors of child sexual abuse D. Psychodynamic psychotherapy

A. Dialectical behavior therapy **The client's symptoms meet the criteria for borderline personality disorder. Of the four choices, dialectical behavior therapy was developed specifically to address suicidal behaviors in people with borderline personality disorder. Studies have shown that it is more effective than the other choices.**

A mother brings her seven-year-old son to see a social worker at the recommendation of the child's doctor. The mother states that the doctor wants the child to lose weight but the mother does not think his weight is a problem. She states, "He's just big-boned. His father and I are both big people so what does the doctor expect?" How should the social worker intervene first? A. Discuss with the child's mother the physical, social, and emotional complications associated with being overweight. B. Begin meeting with the child to assess his coping skills to ensure he is not eating when he is experiencing negative feelings, such as boredom or sadness. C. Discharge them from services as it is clear that the mother lacks motivation to make any changes at this time. D. Recommend they talk to the doctor about a referral to a nutritionist.

A. Discuss with the child's mother the physical, social, and emotional complications associated with being overweight. **Childhood obesity can be a serious issue for children. Children who are overweight can experience physical health problems, depression, and can be targets of bullying. It is important to ensure that parents are educated about the possible complications associated with being overweight, as well as the treatment options for obesity.**

A 60-year-old divorced man is seeking services for depression. He reports that he lacks interest in activities, feels isolated, and spends a lot of time sleeping. He states that since retiring six months ago, he has not had the energy to do a lot of the projects he planned to work on after retirement. How should the social worker intervene? A. Encourage him to increase the structure to his daily routine, engage in community activities, and find new meaning to his life after retirement. B. Encourage him to begin dating in order to decrease his social isolation. C. Recommend that he return to full-time work in order to relieve his symptoms. D. Refer him to a psychiatrist for an evaluation to see if he needs medication to relieve his symptoms.

A. Encourage him to increase the structure to his daily routine, engage in community activities, and find new meaning to his life after retirement. **Depression is common for people when they retire. The lack of routine, social isolation, and loss of identity as a worker can take a toll. It is important for people to find new meaning and to have new hobbies and social activities in order to address symptoms of depression during retirement.**

A client is seeking help to manage his mood. He has been diagnosed with bipolar disorder and takes Lithium, but reports that he continues to experience depression and manic episodes. He receives disability and states that he spends much of his time alone, sometimes sleeping fifteen hours a night. At other times he stays up much of the night playing video games and then sleeps until noon. He has friends he plays video games with but lives alone and does not leave the house very often. How should the social worker intervene first? A. Encourage the client to track his symptoms in relation to his sleep pattern and activity level, in order to help him establish a regular daily routine. B. Assist the client in learning new social skills to improve his social life. C. Provide the client with psychoeducation on the importance of taking his Lithium regularly. D. Discuss opportunities to find volunteer work or other employment opportunities to get the client out of the house more often.

A. Encourage the client to track his symptoms in relation to his sleep pattern and activity level, in order to help him establish a regular daily routine. **Clients with bipolar disorder tend to benefit from having a regular schedule. Helping clients establish a daily routine and regular sleep patterns can decrease their symptoms.**

A 50-year-old male is seeking services because he reports difficulty handling stress. He comes to one of his appointments stating he wishes he could "just blow up everyone at his office," as he is angry with the way his supervisor is treating him. He states his supervisor ridiculed him publicly and his co-workers laughed. How should the social worker respond? A. Gain further information from the client about his possible intent or plan before deciding on a further course of action. B. Call the police and inform them of the client's threat. C. As part of duty to warn, call the client's employer to notify them of the client's threat. D. Ask the client to sign a contract stating he will not engage in any risky behaviors that could harm others.

A. Gain further information from the client about his possible intent or plan before deciding on a further course of action. **When clients express suicidal or homicidal ideation it is important to gain information about whether or not they are experiencing a fleeting thought, fantasy, or serious intent. It would be important to question the client further to see if he is saying this out of anger or if he really has a plan to create a device to blow up his office before proceeding with an intervention. Social workers have a duty to warn when there is an imminent risk.**

A 30-year-old female is seeking services at her doctor's recommendation. She is morbidly obese and her doctor has declined to allow her to have gastric bypass surgery. She states that she has tried everything to lose weight and does not think anything else will help but she is willing to try anything. How might a social worker intervene? A. Help the woman identify emotions that lead to eating and help her to develop new coping skills to manage her emotions. B. Help the woman advocate for herself with her doctor to reconsider gastric bypass surgery. C. Call the woman's doctor to request that the client be reconsidered for gastric bypass surgery. D. Refer the woman to a nutritionist since obesity is primarily a physical health issue.

A. Help the woman identify emotions that lead to eating and help her to develop new coping skills to manage her emotions. **Obesity is often linked to mental health issues, such as depression. When people struggle to control their emotions, sometimes they cope with food. Some people overeat while others undereat. Teaching clients new coping skills to regulate their emotions can help them develop healthier eating habits.**

A ten-year-old child has been referred for services by his pediatrician. The pediatrician hopes the child will qualify for an intensive program that will address his behavioral issues. A social worker interviews the child and his mother, and realizes the child does not meet the criteria to be diagnosed with oppositional defiant disorder, which is needed for inclusion in the program. How should the social worker proceed? A. Inform the child's mother and pediatrician that the child does not qualify for a diagnosis of oppositional defiant disorder at this time, which excludes him from the program. B. Diagnose the child with unspecified disruptive, impulse-control, and conduct disorder, but agree to continue seeing the child in hopes of seeing more symptoms that qualify for a diagnosis of oppositional defiant disorder. C. Provide the child with the diagnosis of oppositional defiant disorder so he can get the treatment he needs. D. Review the criteria for oppositional defiant disorder with the child's mother to see if she can find instances where he may exhibit some of the behaviors in order to justify the diagnosis.

A. Inform the child's mother and pediatrician that the child does not qualify for a diagnosis of oppositional defiant disorder at this time, which excludes him from the program. **A client's diagnosis needs to be made based on the criteria outlined in the DSM. Although there are programs and services with specific diagnostic requirements, it is important that social workers make their diagnosis based on an honest assessment of the client's symptoms. Providing a client with a diagnosis to qualify for a service would be unethical.**

A medical social worker has just finished helping a mother tell a five-year-old that her father has been killed in an accident. The child cries a little, asks a question or two, and then goes running off to play. How is this behavior best interpreted? A. It is normal behavior for a grieving five year old. B. It is indicative of an attachment disorder. C. It suggests that the father was abusive. D. It is a sign that the child is developmentally disabled.

A. It is normal behavior for a grieving five year old. **Young children often process grief or other powerful emotions in small "chunks." They may seem to be grieving intensely one moment and happy the next.**

A 52-year-old woman seeks help from an outpatient social worker. She states that her dentist recently told her that she grinds her teeth in her sleep and as a result she has jaw pain and struggles to chew some foods. She reports her dentist diagnosed her with TMJ and states it is likely responsible for her frequent headaches. What sort of assistance can the social worker provide that will likely be most helpful? A. Provide her with cognitive-behavioral therapy to help her learn relaxation skills and ways to manage the anxiety that may be contributing to her condition. B. Recommend she talk to her primary care physician to request a sleep study to see if she may have other underlying sleep disorders. C. Teach her how to accept her medical issues so she can live her life fully, despite her jaw pain. D. Recommend that she consult a pain specialist to obtain medication to manage her pain.

A. Provide her with cognitive-behavioral therapy to help her learn relaxation skills and ways to manage the anxiety that may be contributing to her condition. **Anxiety and stress often cause people to grind their teeth and clench their jaw. Clients who have been diagnosed with bruxism and/or temporomandibular joint (TMJ) problems can often benefit from counseling to help them learn skills to relax their muscles and deal with stress and anxiety in ways less damaging to their physical health.**

A social worker has been meeting with a woman for several sessions to address her anxiety. The woman reports that she is frustrated by her two-year-old son's inability to sit still during the hour-long church service they attend. She has avoided going to church the last few weeks because of the anxiety this causes her. How should the social worker intervene FIRST? A. Provide psychoeducation regarding childhood development and explain that it is unreasonable to expect a two-year-old to sit still for an hour. B. Encourage the woman to have her son evaluated for ADHD or other developmental problems. C. Help the woman manage her anxiety so that she can better address her son's behavioral issues. D. Provide psychoeducation regarding parenting interventions that can help the woman manage her son's restlessness.

A. Provide psychoeducation regarding childhood development and explain that it is unreasonable to expect a two-year-old to sit still for an hour. **It is important for parents to be made aware of their child's developmental needs so they can have reasonable expectations and establish age-appropriate interventions. It's unreasonable to expect a two-year-old to sit quietly for an hour--this child is not exhibiting a behavior problem.**

A mother brings her 16-year-old daughter in for treatment with a social worker. The mother says her daughter's behaviors are "out of control"--she's been disrespectful, getting into fights at school, and is failing academically. The mother further explains that her daughter's father committed suicide about six months ago, which coincides with the time her daughter's behaviors began. How should the social worker proceed FIRST? A. Provide psychoeducation to the mother and daughter on grief and normalize some of the behavioral responses the daughter is exhibiting. B. Provide supportive psychotherapy to the daughter to assist her in managing her grief depressive symptoms. C. Provide parenting education to the mother. D. Recommend CBT to help get the daughter's behaviors under control.

A. Provide psychoeducation to the mother and daughter on grief and normalize some of the behavioral responses the daughter is exhibiting. **Grief and loss can lead to a variety of emotional and behavioral responses. When clients have experienced loss it can be helpful to help them work through their feelings in a healthy way.**

A heterosexual couple in their late sixties is seeking help with their marriage. They report they are both concerned about their lack of sexual intimacy and they agree that their interest in sexual activity has declined over the last few years. How should the social worker FIRST respond? A. Provide the couple with psychoeducation on the normal sexual changes throughout the aging process. B. Work with the couple on getting to the root of the problem, as their decline in sexual activity is likely a symptom of a deeper issue. C. Recommend the husband meet with his physician to determine if medication is an option to increase his sex drive. D. Recommend the wife seeking treatment with her physician as she may be experiencing a hormonal imbalance.

A. Provide the couple with psychoeducation on the normal sexual changes throughout the aging process. **The aging process results in biological changes over time that can lead to changes in sexual desire and activity. Educating couples on these normal changes and how to respond to them can be helpful.**

A 45-year-old man was referred to a social worker by his employer. He has had difficulty concentrating at work lately and his lack of focus is impacting his job. He states that he feels exhausted much of the time and states he usually takes a nap on his lunch break. He states that he thinks he may be depressed. What is the first thing the social worker should do? A. Recommend he talk to his primary care physician about a sleep study to rule out sleep apnea or other physical health issues. B. Recommend that he take a break from work to help manage his stress and see if that helps alleviate his symptoms. C. Begin treating him for depression to see if that alleviates his symptoms. D. Refer him to a psychiatrist to see if medication can be helpful.

A. Recommend he talk to his primary care physician about a sleep study to rule out sleep apnea or other physical health issues. **Sleep disorders can lead to problems that can mimic depression. It is important to rule out physical health problems when people are chronically exhausted. Recommending he discuss a sleep study with his physician could be helpful in determining if he has a condition, such as sleep apnea, that is causing his symptoms.**

A thirty-year-old woman is seeking outpatient treatment because she has been experiencing some depressive symptoms for the past couple of years. She reports feeling very tired and lacks motivation to participate in leisure activities. When asked about her physical health she states that she is healthy. In the past, she had some thyroid problems but she states that she thinks this is resolved. She also reports that she had a miscarriage about two years ago and has had difficulty conceiving since then. What should the social worker do first? A. Recommend she talk to her doctor about having her thyroid levels checked. B. Begin talking about any links between the grief associated with her miscarriage and her depression. C. Establish treatment goals to address behavioral strategies she can use to address her depressive symptoms. D. Recommend she see a fertility specialist to discuss her difficulty conceiving as this is likely contributing to her depression.

A. Recommend she talk to her doctor about having her thyroid levels checked. **Thyroid problems have been linked to depression. Since the client reports a history of thyroid problems, it is important to recommend she have her thyroid levels tested prior to beginning mental health services as she may be experiencing a medical issue contributing to her depression.**

A social worker is facilitating an open bereavement support group. How should the first few minutes of each group be spent? A. Reminding participants of group rules such as non-judgmental listening and confidentiality. B. Leading an opening prayer. C. Introducing a specialist in bereavement who will be making a presentation. D. Going around the room so that each member of the group who wants to speak has a chance to share with others.

A. Reminding participants of group rules such as non-judgmental listening and confidentiality. **An open group means that people come and go. It is important that people attending the group for the first time be aware of the ground rules.**

An emergency room physician makes a referral to a social worker due to a 35-year-old woman's reports of how she sustained a broken bone. Her reports are inconsistent with the injury. When the social worker enters the exam room, there's a male in the room with the client. What should the social worker do? A. Request to meet with the female individually and ask her directly if she feels safe at home. B. Provide the client with the social worker's contact information and tell her she can call anytime if she has any questions or concerns. C. Ask her if there is anything she would like to discuss privately. D. Tell them about the doctor's suspicion and ask them both if there is any domestic violence in the home.

A. Request to meet with the female individually and ask her directly if she feels safe at home. **When there is suspicion of domestic violence, clients should be interviewed privately as it may not be safe for them to talk in front of an abusive partner. Also, it is acceptable to ask directly if people are feeling safe or if they have experienced any domestic violence.**

A family is meeting with a social worker to discuss a baby that they are hoping to adopt. The baby's birth mother drank heavily throughout her pregnancy. What information should the social worker provide the family about complications the baby may face? A. The baby is likely to face some cognitive deficits, motor skill problems, and behavioral issues. B. The baby may experience some initial developmental delays but is likely to be able to catch up to same age peers with appropriate early intervention. C. The baby is at risk of having a seizure disorder. D. The baby will have an increased risk of developing attention deficit hyperactivity disorder.

A. The baby is likely to face some cognitive deficits, motor skill problems, and behavioral issues. **Fetal alcohol syndrome results from mothers consuming alcohol during pregnancy. FAS can cause a variety of problems for children including mental retardation, heart problems, behavioral issues, and developmental delays.**

A 60-year-old client seeks social work services because she is feeling depressed. She states that she has lost interest in a lot of activities, has difficulty sleeping, and lacks energy. After she states that she resides with her husband and her mother, what would be the best follow up question? A. "How do your husband and your mother get along?" B. "Does anyone in the house provide caregiving of any kind to anyone else in the home?" C. "Do you like having your mother live with you?" D. "Do you get along with your husband?"

B. "Does anyone in the house provide caregiving of any kind to anyone else in the home?" **Often clients don't think to mention their role as caregivers and sometimes social workers don't ask about whether or not anyone needs assistance due to physical or mental health issues. The client's mother may have moved in to help the client and her husband financially or she may have moved in because the client is caring for her. This sort of information is important because caregivers are at a higher risk of depression, physical health deterioration, and financial problems.**

When asked about drug and alcohol use, a client states that she drinks "socially." She denies any drug use. Which is the best follow-up question to further assess her substance use? A. "Do you ever drink alone?" B. "How often would you say you drink socially?" C. "Does drinking help you to feel more social?" D. "What types of drinks do you consume?"

B. "How often would you say you drink socially?" **When assessing a person for substance use, it is important to know how often they use, how much they use, and for how long they have been using. This information may lead to further questions about how the use impacts their life and what purpose the substance serves.**

A social worker has been meeting with a client for several months to address his anxiety and depression. He arrives at a session and states he is angry with the social worker. He raises his voice, says it is the social worker's fault that he is not getting any better, and says he doesn't want to continue services. What is the social worker's best response? A. "Calm down. We can't discuss this until you are in a calmer state." B. "It sounds like you are really frustrated by the treatment you have received so far. Tell me more about what doesn't seem to be working." C. "Ending treatment is certainly your choice and you can do so at any time." D. "This is a great time to practice your skills and decrease your stress."

B. "It sounds like you are really frustrated by the treatment you have received so far. Tell me more about what doesn't seem to be working." **It is common for clients to be frustrated and angry about their treatment and lack of progress. Responding to angry clients allows social workers the opportunity to model healthy communication skills and to teach clients how to effectively ask for help and express their frustration. It is helpful to encourage clients to talk about their frustrations and to listen to them with empathy.**

A 33-year-old woman is seeking treatment from a social worker. She reports that she has been feeling depressed and tends to drink alcohol to feel better. She states that she drinks heavily several nights per week. She states that as a result of her drinking, she has missed work and received a previous legal charge for driving while intoxicated. She states that she often drinks more than she intended to but states that being drunk is the only time she feels better. What substance-related diagnosis should the client be given? A. There is not enough information to determine which diagnosis she should receive yet. It will depend on whether or not she can quit drinking. B. Alcohol Use Disorder C. Substance-Induced Depressive Disorder D. Alcohol Intoxication

B. Alcohol Use Disorder **A diagnosis of alcohol use disorder is warranted given the woman's pattern of drinking. There is no indication that the woman is currently inebriated.**

A client being treated for depression tells a social worker, "It would probably be better if I just didn't wake up some morning." What is the social worker's next step? A. Call the client's emergency contact person and discuss the situation. B. Assess for suicidal ideation, plans, and risk factors. C. Encourage the client to focus on all of the positive things in life. D. Call 911 immediately and have the client admitted to a mental health unit.

B. Assess for suicidal ideation, plans, and risk factors. **The client has not expressed any explicit suicidal ideation, only a hypothetical statement. Therefore, the best thing to do is gather more information before deciding what action, if any, should be taken.**

A social worker who works in an outpatient community mental health center is starting to expand her practice to working with children for the first time. She would like to audiotape some of her sessions so her supervisor can listen to them and then provide feedback. What should the social worker do? A. The social worker can audiotape the sessions as long as the audiotapes are made part of the client's record and are stored in a confidential manner. B. Audiotaping is only allowed if the guardian provides consent to allow them to be taped and listened to by a third party. C. Audiotaping therapy sessions is not allowed so the social worker will not be able to do so. D. The social worker can audiotape the sessions as long as the only person who listens is the supervisor who is employed at the same agency.

B. Audiotaping is only allowed if the guardian provides consent to allow them to be taped and listened to by a third party. **Part of informed consent means that clients need to be made aware of confidentiality issues. If the social workers wants to videotape or audiotape any sessions and allow them to be viewed by a third party, a client would need to give consent for this to be done. A client has a right to refuse this.**

A social worker has completed an assessment on a client and has diagnosed the client with social anxiety disorder. The client reports much difficulty going to crowded places. She states that she feels like people are staring at her wherever she goes. She dropped out of college due to the anxiety she experienced when she attended classes. What are the most appropriate initial recommendations for treatment? A. A referral to a psychiatrist to see if medication can manage her symptoms. B. Cognitive behavioral therapy and a referral to a psychiatrist to see if medication can manage her symptoms. C. Family therapy to provide psychoeducation to the family on how to support the client. D. Group therapy to expose the client to her fears.

B. Cognitive behavioral therapy and a referral to a psychiatrist to see if medication can manage her symptoms. **Social anxiety disorder can be treated with therapy and/or medication. Cognitive behavioral therapy assists people in modifying false beliefs that others are staring at them while helping them to gradually expose themselves to anxiety-provoking situations. Medication can assist in managing the symptoms of anxiety as well as any depressive symptoms the client may be experiencing.**

A 16-year-old female is seeking treatment for anxiety with a social worker. She reports that when she feels particularly anxious, she worries that she will stop breathing. She says that on several occasions, she has passed out, but she is not sure if she was feeling anxious prior to fainting. What is the FIRST step the social worker should take? A. Discuss the client's anxious thoughts and how they are contributing to her anxiety. B. Collaborate with the client's primary care physician to learn more about the fainting episodes and to ensure there are no underlying physical health issues. C. Refer the client to a psychiatrist to see if medication can help manage her anxiety. D. Begin exposure therapy to address the client's fears about breathing.

B. Collaborate with the client's primary care physician to learn more about the fainting episodes and to ensure there are no underlying physical health issues. **When someone has a medical issue that may be related to their mental health, it is important to consult with their doctor before proceeding with exposure therapy or any other mental health treatment. In this case, it is unclear if there is a link between the client's anxiety and her reports of passing out.**

A 24-year-old client is referred to the social services department after being hospitalized for an accident that occurred while he was driving drunk. The client states that his drinking "may be" a problem. He has one other DUI citation and has been fired for showing up at work intoxicated. He's not ready to make any changes yet, but asks the social worker for a list of substance abuse treatment resources "just in case." According to the Stages of Change Model, which stage best describes this client? A. Preparation B. Contemplation C. Precontemplation D. Action

B. Contemplation **When a client is aware of a problem, or the possibility of a problem, but isn't willing to do anything about it yet, they are described as being in the contemplation stage of change.**

A client is seeking treatment for depression. One of his treatment goals is to increase his social interactions. After a few sessions the social worker gets a friend request from him on Facebook. How should the social worker respond? A. Transfer the client to a different social worker since the client is not respecting boundaries. B. Decline his request and discuss boundary issues in his next session. C. Accept his request. D. Ignore the request until his next session and discuss the pros and cons of being friends on Facebook.

B. Decline his request and discuss boundary issues in his next session. **Social workers need to explain boundaries to clients. If a client is struggling with the nature of the therapeutic relationship, further explanation may be required in order to keep the relationship from spilling over into friendship, which would likely be counterproductive to treatment.**

A client with bulimia has been meeting with an outpatient social worker for several months. She continues to binge and purge up to ten times per day. Her physical health is declining and she does not appear to be benefiting from cognitive behavioral therapy. How should the social worker intervene? A. Switch to a different treatment modality. B. Discuss options for another level of care for the client, such as an intensive outpatient treatment program. C.Work with the client to help her become more motivated to make behavioral changes. D. Ask the client to allow her family to attend a session with her to discuss how they can support her progress.

B. Discuss options for another level of care for the client, such as an intensive outpatient treatment program. **When a client does not benefit from services, a different level of care may be necessary. In this case, where the client has a serious eating disorder, it is important to intervene now by discussing a different level of care with the client as she may not be able to benefit enough from outpatient services.**

A female client is seeking services for anxiety. Over the course of treatment, she reveals that her boyfriend, a convicted felon, is living in her home with her and her children. She resides in public-assistance housing and has not disclosed the boyfriend's presence to the housing authority as his status as a felon would prevent them from receiving the benefit. How should the social worker respond to her disclosure? A. Notify her of the duty to report this information to the housing authority. B. Discuss the risks of breaking the rules to ensure she is aware of potential consequences and do not report her. C. Tell her the boyfriend must move out of the home immediately or the situation will have to be reported. D.Tell her a mandated report to child protective services is required.

B. Discuss the risks of breaking the rules to ensure she is aware of potential consequences and do not report her. **Confidentiality is greatly protected in social work. There must be a serious risk of death or harm or suspicion of child abuse or neglect in order to break confidentiality. This situation does not meet any of those criteria.**

A hospital social worker is summoned to arrange for a 26-year-old client with a substance abuse problem to go into rehabilitation. During the interview, the social worker finds that the client is still very intoxicated and does not know where she is or what is happening. What should the social worker do? A. Call the patient's family and ask them to agree to put the client in rehabilitation. B. Document that the client is too intoxicated to make treatment decisions at this time and offer to re-evaluate the client for rehabilitation needs when she is sober. C. Make an intake appointment for the next day at a local outpatient treatment center. Leave the client a note specifying the date and time of her appointment. D. Arrange for placement in an inpatient rehabilitation unit and have the client transferred by ambulance.

B. Document that the client is too intoxicated to make treatment decisions at this time and offer to re-evaluate the client for rehabilitation needs when she is sober. **It is inappropriate to refer an adult client to substance abuse treatment without first obtaining informed consent. Because the client is too intoxicated to understand her options, the social worker must wait for her to regain sobriety before offering additional treatments.**

A client has been working with a social worker for several months to address his drinking. He has been diagnosed with alcohol use disorder after drinking heavily for over a decade. He entered into treatment highly motivated to stop drinking after experiencing legal problems as a result of his drinking. After three months of sobriety, he suddenly tells the social worker he thinks he is better and no longer requires any further services. How should the social worker respond? A. Discuss scheduling one further appointment where the client will invite family members to discuss the need for his family to support him after treatment ends. B. Encourage the client to continue with treatment in order to maintain his sobriety. C. Allow the client to terminate as it is likely that the client's sudden desire to stop treatment means that he has actually relapsed. D. Discuss the client's progress and discharge him.

B. Encourage the client to continue with treatment in order to maintain his sobriety. **The client has made changes, but it is likely he is still in the action stage of change and could benefit from ongoing support to assist him in maintaining his sobriety. Three months of sobriety does not mean he is cured. In all likelihood he has more work to do to maintain his progress.**

A client who has been court-ordered into therapy after being convicted of child sexual abuse seems friendly and confident. He assures the clinician that the charges against him were exaggerated and says he knows the clinician is "too smart to fall for that nonsense." The client's behavior is best described as: A. Genuine B. Manipulative C. Manic D. Psychotic

B. Manipulative **The client is clearly trying to win the social worker over, so the behavior is not genuine--manipulation. The client shows no symptoms of mania or psychosis.**

Conducting an initial assessment with a male client, what should a social worker keep in mind when framing questions about sexual abuse? A. Many men who were sexually abused also sexually abuse others. B. Men are often reluctant to acknowledge that their experiences were abusive. C. Men are only rarely sexually abused. D. Men tend to block out traumatic memories and asking the questions about sexual abuse may trigger unpleasant memories.

B. Men are often reluctant to acknowledge that their experiences were abusive. **Men can be victims of sexual abuse, just as women can. Men tend to be more reluctant to think of their experiences as abuse, but will often acknowledge unpleasant sexual experiences. When interviewing men about their abuse history it can be helpful to keep this in mind when framing questions.**

A social worker has been doing bereavement work with a client whose adult son shot himself six months ago. The client heard the gunshot and found the body. The client complains of having nightmares about blood and being unable to tolerate loud, unexpected noises. He also reports feeling isolated from the rest of his family. What is the most likely diagnosis? A. Psychosis B. Post-traumatic Stress Disorder C. Complicated Grief D. Depression

B. Post-traumatic Stress Disorder **Although the client may be experiencing depression and complicated grief, the symptoms described are more typical of post-traumatic stress disorder.**

A 35-year-old woman seeks help for increased depression and anxiety. She states that almost exactly one year ago, she and her husband were in a car accident in which her husband was killed. She states that she has done a lot of work throughout the past year to deal with the trauma of the accident and help with the grieving process. She reports that she had been doing really well until the past few weeks so she does not think that her current symptoms are related to the accident or loss of her husband. How should the social worker intervene? A.Refer her to a psychiatrist to see if medication can be helpful. B. Provide her with psychoeducation about how the anniversary of the accident contribute to an increase in symptoms. C. Encourage her to talk about her favorite memories of her husband and how she is rebuilding her life. D. Treat her for depression and anxiety, as usual.

B. Provide her with psychoeducation about how the anniversary of the accident contribute to an increase in symptoms. **People who have experienced a loss or traumatic event often experience increased symptoms of anxiety and/or depression around the anniversary of the event. Clients may benefit from learning how to anticipate this increase in symptoms and how to respond with healthy coping strategies.**

During an initial assessment a client asks how long the social worker has been working in the field and says he wants to know more about the social worker's education. How should the social worker respond? A. Explain to the client that the assessment is a discussion of the client's history, not the social worker's. B. Provide the client with the requested education and training details. C. Assure the client that the social worker is well qualified without providing specific details. D. Explore why the client is curious about these details.

B. Provide the client with the requested education and training details. **As part of informed consent, clients have a right to know about a social worker's training, expertise, and education.**

A 55-year-old client is seeing a social worker to help her with stress management. She has previously been diagnosed with depression and anxiety and she takes several medications to manage her symptoms. During the first few sessions, the social worker notices the client has difficulty at times remembering what they discussed in their last session. The client acknowledges difficulty concentrating and states that she feels "scattered." The client attributes this to the stress she has been experiencing. What should the social worker do? A. Recommend she bring someone with her to her appointments to help remind her of skills she is working on in therapy. B. Recommend she talk to her primary care physician to rule out any form of dementia or Alzheimer's. C. Continue with treating her for stress management as it may help relieve her symptoms. D. Discontinue treatment as the client cannot follow through with treatment recommendations due to her symptoms.

B. Recommend she talk to her primary care physician to rule out any form of dementia or Alzheimer's. **Sometimes clients do not think to talk to their primary care physician about problems they experience with their memory. Although this client's memory problems may be related to stress, it is important for social workers to recommend that clients talk with their primary care physician about memory issues so they can be screened for dementia.**

A social worker in private practice receives a call from a man who says he is currently receiving services through a local agency. He states that the mental health provider he is seeing is often late for appointments and does not seem to understand what he needs. He states he is interested in transferring to the social worker's private practice. How should the social worker respond? A. Tell him he will need to sign a release of information so the social worker can talk to his current service provider to see if the client's concerns are accurate. B. Recommend that he talk to his current provider first to discuss his concerns, and if he's still dissatisfied, to call back to discuss the risks and benefits of changing providers. C. Request that he sign a release of information to gain access to his records first. Then the social worker will decide whether or not to accept him as a new client. D. Agree to accept the man as a new client.

B. Recommend that he talk to his current provider first to discuss his concerns, and if he's still dissatisfied, to call back to discuss the risks and benefits of changing providers. **Clients often change service providers for various reasons. It is important that social workers consider a client's needs carefully before agreeing to accept a client. The social worker should discuss with the client whether or not it makes sense to consult with previous service providers. Clients should be informed of risks and benefits of changing services.**

A client does not remember a crucial traumatic event that occurred in childhood, but has been filled in by his family members about the details surrounding the event. Which of the following defense mechanism is the client displaying? A. Displacement B. Repression C. Rationalization D. Projection

B. Repression **When a memory is too traumatic, it is sometimes repressed--amnesia of any detail surrounding the event, as well as the event itself, is the result.**

A social worker is meeting with a 22-year-old female who has a mild intellectual disability. The client resides with her parents but is her own guardian. The social worker describes the potential risks and benefits of attending a day program for adults with developmental disabilities. The social worker is uncertain if the client really understands. What should the social worker do? A. Provide the client with written information about the risks and benefits of treatment. B. Request permission to talk to her parents and include them in making the decision about whether to attend or not. C. Meet with the client's parents and discuss the importance of their obtaining guardianship as the client may not be able to make informed, safe decisions on her own. D. Invite the client to begin attending the day treatment program and explain the risks and benefits once the client is there and is better able to understand.

B. Request permission to talk to her parents and include them in making the decision about whether to attend or not. **When a client is struggling to understand informed consent, a social worker should take reasonable efforts to discuss the potential risks and benefits with a third party who has the client's best interests in mind.**

A client tells his social worker that he is the CEO of a very important company. The social worker suspects the client may be experiencing grandiose delusions about his importance. The client is meeting with the social worker because he wants to learn how to manage his stress. What should the social worker do? A. Ask for the client's permission to conduct an internet search to reinforce his statements. B. Respect the client's privacy and address stress management techniques. C. Conduct an internet search to see if the client really is the CEO of the company. D. Consult with a supervisor.

B. Respect the client's privacy and address stress management techniques. **The NASW Code of Ethics states that, "social workers should avoid searching or gathering client information electronically unless there are compelling professional reasons, and when appropriate, with the client's informed consent." Curiosity is not a compelling reason to obtain consent. The social worker should instead help the client with his treatment goals.**

A 55-year-old client requests help for depression. She reports that her husband has made financial decisions that have caused a lot of problems for the family and have contributed to her depression. However, she does not speak up to him when she thinks he is making a poor choice. She states that her religious view is that the man is the head of the household and it is not her place to speak up. How should the social worker respond? A.Recommend that she meet with a spiritual or religious leader who may be able to help her. B. Respect the client's right to her own values and assist her in finding some changes she wants to make that can be helpful to her depression. C. Help her explore the pros and cons of holding onto her spiritual beliefs. D. Teach her assertiveness skills so she can feel comfortable expressing her concerns to her husband.

B. Respect the client's right to her own values and assist her in finding some changes she wants to make that can be helpful to her depression. **It is essential that social workers not impose their own values on clients. Clients frequently have different beliefs and values and the social worker should respond respectfully without challenging the client to change. Instead, it is important to help the client discover positive change that they can make without compromising their values.**

A social worker is asked to meet with a client who has been showing up to the free health clinic several times a month. Each time, the client reports only mild symptoms, but she believes each symptom is evidence of a life-threatening illness. What is the most likely diagnosis? A. Panic disorder B. Somatic symptom disorder C. Conversion disorder D. Malingering

B. Somatic symptom disorder **The client is not malingering, or pretending to be sick to avoid an obligation. She is clearly worried by her symptoms. Nor does she appear to be having a conversion disorder, which occurs when the mind creates a physical symptom to avoid a stressful or painful situation. Finally, although worried, she has shown no signs of panic, so the correct answer is somatic symptom disorder.**

A hospital social worker is meeting with an elderly man who was admitted for pneumonia. The client's primary care physician has recommended that he go to an inpatient rehab center to receive some physical therapy prior to returning home. The client states he plans to go straight home as he wants to sleep in his own bed and spend time with his cat, which he thinks will be much more helpful than going to a rehab clinic. What should the social worker do? A. Inform the client that the physician will not discharge him unless he can prove that he will be safe and explain that since he lives alone he should agree to going to the rehab clinic. B. Talk to the client about possible alternative strategies to help ensure that he is safe if he chooses to return home, such as having family stay with him. C. Explain to the client that he has the right to return home, but a call will need to be placed to Adult Protective Services if he is unsafe. D. Explain to the client that it is unsafe for him to return home and that he cannot make the decision to return home at this time.

B. Talk to the client about possible alternative strategies to help ensure that he is safe if he chooses to return home, such as having family stay with him. **The NASW Code of Ethics clearly states that clients have a right to refuse services. Elderly clients are no exception, so long as they are mentally competent. Clients do not have to follow through with doctor's recommendations if they do not want to. Social workers can provide them with facts and education but should allow them the right to self-determination.**

A 27-year-old man is referred to an outpatient social worker after being diagnosed with bipolar disorder by a psychiatrist. The client states that he thinks he is only depressed as he associates bipolar disorder with "being crazy." He asks the social worker what sort of prognosis he will likely have if it is true that he actually has bipolar disorder. How should the social worker respond? A. Explain that he should ask the psychiatrist this question as it is the psychiatrist who provided him with the diagnosis and can provide a more accurate prognosis. B. Tell him that bipolar disorder is treatable and many people experience recovery, but that people with bipolar do sometimes experience relapse. C. Inform him that bipolar disorder is best treated with medication and encourage him to take the medication prescribed by his psychiatrist regularly. D. Explain that bipolar disorder is difficult to manage, as people tend to be non-compliant with medications and have ongoing struggles to manage their mood swings, but that counseling can help him accept the diagnosis.

B. Tell him that bipolar disorder is treatable and many people experience recovery, but that people with bipolar do sometimes experience relapse. **Clients often worry that bipolar disorder means that they are crazy. It is important for social workers to provide them with information on how bipolar disorder can be treated and what sort of prognosis people can expect.**

A client is seeking treatment for depression. He states that he is feeling hopeless and helpless and has felt depressed for at least two years. He asks whether or not treatment is likely to help him at this point. How should the social worker respond? A. Assure him that treatment is very effective and that he can benefit from treatment. B. Tell the client that treatment is not an exact science; she cannot guarantee results, but that she will do her best to help him. C. Provide assurance by telling him about past successes she has had with other clients in similar situations. D. Tell him the outcome of treatment depends entirely on how hard he is willing to work.

B. Tell the client that treatment is not an exact science; she cannot guarantee results, but that she will do her best to help him. **Informed consent is an important part of treatment. It is essential that clients are made aware of potential risks and benefits of treatment. Mental health treatment does not offer any guarantees and is not an exact science. Clients need to be made aware of this.**

A female client seeks social work services at the recommendation of child protective services. Her children have been removed from her due to allegations of physical abuse. As part of informed consent, what information should the social worker tell the client? A. The client needs to know that child protective services will have access to all of her records since they referred her to treatment. B. That the client does not have to attend services, but there may be consequences from child protective services if she chooses not to continue. C. The client will need to talk to the child protective worker to determine what they want her to gain from services. D. Her treatment plan goals will need to be compliant with any goals that child protective services wants her to address.

B. That the client does not have to attend services, but there may be consequences from child protective services if she chooses not to continue. **When clients are referred by outside sources and told treatment is mandated, it is important to discuss this with them. In outpatient services, there are usually consequences if clients do not attend services, but they should be made aware that they are not being forced into treatment against their will. Social workers should discuss possible consequences of not attending treatment.**

Throughout an assessment with a social worker, the client talks loud and fast. The social worker has difficulty interrupting the client at times when trying to move on to the next question. At times, the client acts frenzied as he tries to get his point across and his speech is difficult to understand. When the social worker completes the mental status exam, what should the social worker say about the client? A. The client's speech is circumstantial. B. The client's speech is pressured. C. The client's speech is tangential. D. The client is manic.

B. The client's speech is pressured. **When a client's speech is frenzied, loud, and difficult to interrupt, it indicates pressured speech.**

An 18-year-old female has been in therapy for three months for depression and anxiety. In session, the client reveals to the therapist that she cuts her arms when she is upset. The cuts are shallow, and she does not want to die. She says the cutting helps her calm down. What is the therapist's next step? A. Arrange for the client to be hospitalized for self-harm. B. Work with the client to identify the emotions and situations that lead to cutting. C. Help the client examine her childhood for abuse or trauma. D. Realize that this is attention-seeking behavior and ignore it.

B. Work with the client to identify the emotions and situations that lead to cutting. **Research into self-injury shows that it is often a way to relieve negative emotions like anxiety. The most effective therapies are the ones that help clients learn to identify their feelings and express them in other ways.**

During an initial assessment, a client with depression states that she sometimes wishes she could just go to sleep and never wake up. She states that she has felt this way off and on for several months. What is the BEST way for the social worker to follow up? A. "Why do you want to die?" B. "Is your family aware that you feel this way?" C. "Have you had any close friends or family who have committed suicide?" D. "How would your family feel if you killed yourself?"

C. "Have you had any close friends or family who have committed suicide?" **Assessing for suicidal ideation is an important part of social work. So is empathy. Since no empathic question is offered here, the assessment question is the best choice. Many clients report either active or passive suicidal ideation. It is important to ask clients about any family history of suicide as this can be a risk factor. For clients with active suicidal ideation, it is important to inquire about whether or not they have ever established a plan for suicide as well--but that is not one of the responses offered here.**

A woman is referred to an outpatient social worker by the local hospital's emergency room. The woman had gone to the ER after experiencing rapid heartbeat, dizziness, trouble swallowing, chest pain, and sweating. She states that she thought she was having a heart attack but doctors ruled out any physical health problems. What was the woman most likely experiencing? A. Somatic symptom disorder. B. Social anxiety disorder. C. A panic attack. D. Generalized anxiety.

C. A panic attack. **Many people who experience panic attacks go to the hospital with symptoms very similar to a heart attack. It is important to rule out physical health conditions before treating them as a mental health issue.**

A 35-year-old woman seeks assistance after witnessing her neighbor shoot his wife in the driveway. She states that she has experienced flashbacks and nightmares and is having difficulty being home alone. She states that she is very jumpy and feels hypervigilant much of the time. What treatment recommendations should the social worker make first? A. Encourage participation in an organization that works to prevent domestic violence in conjunction with therapy and medication. B. A referral to a psychiatrist to see if medication can help. C. A referral to a psychiatrist in conjunction with beginning cognitive-behavioral therapy. D. Cognitive-behavioral therapy.

C. A referral to a psychiatrist in conjunction with beginning cognitive-behavioral therapy. **People who have experienced significant trauma and have developed PTSD can often benefit from medication and cognitive-behavioral therapy. Medication can assist them with sleep, managing anxiety, and managing depression. Therapy can help them learn new coping skills and how to work through issues related to the trauma.**

During an anger management group, a client admits to losing his temper with his 10-year-old son, shaking him and slapping him across the face "two or three times." He assures the social worker that the child is fine and that he will never do anything like that again. What should the social worker do? A. Make a home visit to see if the child has visible injuries. B. Since the social worker did not witness the abuse, the social worker is not mandated to report this incident. C. As a mandated reporter, the social worker must report the abuse to the state's child abuse hotline. D. Call the child's mother and try to convince her to take the child and move into a domestic violence shelter.

C. As a mandated reporter, the social worker must report the abuse to the state's child abuse hotline. **A social worker is mandated to report abuse when the social workers suspects or has reason to believe it has occurred.**

A social worker is referred a client by a psychiatrist who has already diagnosed the client with generalized anxiety disorder. After meeting with the client for several sessions the social worker thinks the client may have post-traumatic stress disorder. How should the social worker proceed? A. Change the diagnosis to post-traumatic stress disorder. B. Leave the diagnosis as generalized anxiety disorder but begin treating the client for post-traumatic stress disorder. C. Contact the psychiatrist to discuss the observations. D. Add a diagnosis of post-traumatic stress disorder to the generalized anxiety disorder diagnosis.

C. Contact the psychiatrist to discuss the observations. **It is common for clients to obtain different diagnoses over time. Professionals' opinions about the diagnosis may differ. It is important to collaborate with professionals in other disciplines regarding their observations when establishing or changing a treatment plan and diagnosis.**

A 24-year-old college student who has been diagnosed with schizophrenia has stopped taking his medication. He says he hears voices telling him to give away all his belongings and withdraw from school. How should his case manager respond? A. Get a court order mandating that the client take his medication. B. Call the client's parents and ask them to come take him home. C. Engage the client in conversation about why he refused his medication and offer a consultation with a psychiatrist. D. Have the client involuntarily committed.

C. Engage the client in conversation about why he refused his medication and offer a consultation with a psychiatrist. **The client has not indicated that he is a danger to others or to himself, so it is unlikely that the court system would choose to become involved, and it is unethical to contact the client's family without his consent. Therefore, the case manager's best choice is to find out why the client stopped taking medication and offer to refer him to a psychiatrist to address any medication-related concerns.**

A client tells the social worker he is angry that his doctor keeps requesting that he get lab work done. He states, "I think he must get paid more when he gets patients to do labs. I'm not going to get them done again. I just had them done a little while ago." The client has been diagnosed with bipolar disorder and is taking Lithium to stabilize his moods. How should the social worker respond? A. Discuss how Lithium can cause an increase in cholesterol so it is important to have cholesterol checks frequently. B. Explain the importance of lab work in cases of bipolar disorder as the tests can determine where the client is in the depression-mania cycle. C. Explain how lab work is necessary to test Lithium levels due to possible toxicity. D. Tell the client he has the right to refuse lab tests.

C. Explain how lab work is necessary to test Lithium levels due to possible toxicity. **People taking Lithium require frequent lab work to test their blood levels for possible toxicity. Other medications, dehydration, and other medical issues can interfere with Lithium levels so frequent checks are important. Clients need to be educated on the importance of getting their lab work done on time.**

A nine-year-old girl has been meeting with a social worker to help her deal with her parents' divorce. She states that she spent the weekend at her father's house and thinks her father slaps his girlfriend. She states she was in the other room, heard them arguing, and then heard a slapping sound, followed by her father's girlfriend saying, "Don't hit me." What should the social worker do first? A. Explain to the child's mother that a report cannot be made as the child did not physically witness the domestic violence, and encourage her to monitor the situation. B. Request the mother sign a release of information for the father's girlfriend so further information can be gained to determine if she was really hit or not. C.Make a mandated report due to the child being exposed to domestic violence if required by state law. D. Call the client's father to discuss the incident with him.

C. Make a mandated report due to the child being exposed to domestic violence if required by state law. **In some states, when children witness or hear anything that constitutes domestic violence social workers are mandated to make a report. In other states, direct witnessing of DV by a child client does not warrant a report.**

A client establishes treatment plan goals to address his anxiety. However, each week he talks about his marital problems and does not mention his anxiety. When asked about his anxiety, he tends to change the subject back to the topic of his marriage. How should the social worker proceed? A. Change his goals to reflect his desire to make change in his marriage. B. Connect the client's marriage and his anxiety and encourage him to discuss both issues. C. Point out the pattern to the client, discuss his motivation to change, and discuss whether or not he wants to establish new treatment goals to address problems in his marriage. D. Consider the behavior to be a form of avoidance and continue challenging the client to address his anxiety.

C. Point out the pattern to the client, discuss his motivation to change, and discuss whether or not he wants to establish new treatment goals to address problems in his marriage. **Clients often need help establishing treatment plan goals; their goals may change over time. It is important to point out any progress or lack of progress and to discuss these observations with the client. It can be helpful to invite the client to create new treatment goals if other issues seem to arise or if a client is choosing not to address the current goal.**

A client requests that a social worker help him with his marriage. He states that he yells at his wife and has difficulty controlling his anger. He states that he sometimes dwells on things that she says or does and this seems to fuel his angry feelings. What intervention is likely to be most helpful? A. Assist the client in uncovering the childhood roots of his anger. B. Provide the client with psychoeducation on domestic violence. C. Teach the client relaxation skills and communication skills. D. Recommend couples counseling to assist both of them in addressing the client's anger.

C. Teach the client relaxation skills and communication skills. **When people struggle to manage their anger, they often can benefit from learning new skills, such as communication skills or assertiveness skills and they can usually benefit from relaxation skills.**

A 45-year-old male was referred to a social worker by his primary care physician. He reports a debilitating back injury two years ago and says that his physician is not managing his chronic pain well. He reports that the physician plans to stop prescribing pain medication and wants him to receive services to learn how to manage his pain. The client states that nothing will work besides more medication. He asks the social worker to call his doctor and ask him to give him more narcotics. How should the social worker respond? A. Recommend that the client seek a new primary care physician who can better meet his needs. B. Assist the client in advocating for himself with his primary care doctor to obtain more pain medication. C. Provide psychoeducation on the link between mental health and physical health and discuss the potential for addiction to pain medication. D. Agree to call the doctor and recommend that the client be given more narcotics.

C. Provide psychoeducation on the link between mental health and physical health and discuss the potential for addiction to pain medication. **Chronic pain is an issue that social workers frequently address. Clients need to know the potential consequences of long-term dependence on medication, including addiction. Social workers can teach client skills to help manage their pain and improve their quality of life while living with chronic pain. Social workers can also provide education on the link between mental health and physical health.**

A 32-year-old client seeks assistance from an outpatient social worker due to his concerns that he is being discriminated at his job because he has epilepsy. He states that he gets passed up for promotions, is treated differently by his bosses, and is often not given the same chances as his co-workers. How should the social worker intervene first? A. Offer to contact his place of employment to advocate for him to receive equal rights. B. Recommend that he offer to conduct an in-service training to teach his bosses and co-workers about epilepsy so that with more education they are less likely to discriminate. C. Refer the client to organizations and resources to help him legally, such as the Epilepsy Foundation or an attorney who specializes in epilepsy discrimination. D. Teach the client coping skills to deal with the difficulties he is experiencing at work.

C. Refer the client to organizations and resources to help him legally, such as the Epilepsy Foundation or an attorney who specializes in epilepsy discrimination. **When clients experience discrimination, it can be helpful to refer them to resources that can help them receive support and legal aid. This client may benefit from finding an advocate or attorney to help him fight the discrimination at his office.**

A clinician notes that a colleague comes to work late several times a week. The clinician has also smelled alcohol on his colleague's breath during work hours. What should the clinician do first? A. Do nothing and leave intervening to the colleague's supervisor. B. Contact the state licensing agency, asking them to investigate and suspend the colleague's license if necessary. C. Speak directly to the colleague and offer to support the colleague in finding help. D. Make a report to the colleague's immediate supervisor.

C. Speak directly to the colleague and offer to support the colleague in finding help. **The NASW Code of Ethics recommends that a social worker's first step should be to consult with an impaired colleague. Additional action is warranted if the colleague cannot or will not take corrective action.**

A social worker has been working in a residential facility for clients with developmental disabilities. The social worker is changing jobs and will begin working in a local school. She is concerned about clients in the residential program missing her and wants to continue a mentoring relationship on an informal basis. What should the social worker do? A. Talk with the residential facility's management to discuss setting up a regularly scheduled time that the social worker can meet with clients to make the mentoring a formal part of the curriculum. B. Before proceeding, make sure the clients in the residential facility understand that the social worker's new role will be that of a mentor. C. The social worker should terminate with the clients and discontinue further contact. D. Provide clients with her new work number and notify them that they can call her and leave her messages but that the social worker cannot contact them back due to boundary issues.

C. The social worker should terminate with the clients and discontinue further contact. **Social workers should terminate relationships with clients successfully when services are ending. The NASW Code of Ethics provides clear information about termination and it is clear that the relationship should end when the professional relationship is over, whether because the client has chosen to discontinue services or because the social worker's job is ending. Social workers should not try to continue informal relationships with clients after services end.**

A 20-year-old college student is seeking services because he is worried about his academic performance. During the assessment he reports his grades are declining, he's having difficulty sleeping, and he can't stay focused on his work. He reports drinking to intoxication two to three nights per week but states he thinks this is average when compared to other college students. He does not want to talk about his alcohol use. He is only concerned about his declining grades and difficulty concentrating. How should the social worker proceed? A. Tell him it is impossible to help with his academic performance without also addressing his alcohol use. B. Recommended he attend a few AA meetings to see if he identifies with any of the other people in attendance. C. Work on his academic issues initially while developing a therapeutic relationship and inquire in a future session about the possible link between alcohol and his grades. D. Suggest that he undergo an evaluation to rule out attention deficit hyperactivity disorder.

C. Work on his academic issues initially while developing a therapeutic relationship and inquire in a future session about the possible link between alcohol and his grades. **Binge drinking among college students can be a serious issue. Many students do not recognize their drinking as a problem as they may be surrounded by others who drink heavily and it becomes normalized. It can be helpful to work on establishing a therapeutic relationship first before inquiring further about the possible link between his academic performance and substance use as he has made it clear that he does not wish to address his drinking now.**

A 42-year-old woman referred by her primary care physician tells a social worker that she has become disabled due to her arthritis. She says that she is feeling "more-and-more depressed." She can't do a lot of the activities she once enjoyed, such as gardening, due to her pain. She reports that she takes several medications, including pain medication prescribed by her primary care physician, but says it is only mildly helpful in managing her chronic pain. How should the social worker intervene? A. Recommend she begin attending a support group for people with chronic pain. B. Recommend she talk to her primary care doctor about providing additional pain medication. C. Discuss the need to get her pain under control before beginning outpatient mental health treatment. D. Begin cognitive-behavioral therapy to help her learn how to manage her chronic pain and relieve her depressive symptoms.

D. Begin cognitive-behavioral therapy to help her learn how to manage her chronic pain and relieve her depressive symptoms. **Chronic pain and depression are frequent co-morbid conditions. When depression increases, pain can increase and increased pain can make depression worse. Social workers can help people manage their pain better by managing their mental health symptoms. Cognitive-behavioral therapy is often helpful in teaching new skills to manage chronic pain. Other pain management strategies--not listed in the answers here--may also be useful.**

During an initial visit with a social worker in private practice, a client says that she has no insurance and cannot afford the social worker's fees. Instead, she offers to clean the social worker's office in exchange for therapy. What should the social worker do? A. End the visit immediately B. Agree to the offer C. Accept the barter, but only if the client agrees to clean the therapist's home as well D. Decline the offer and help the client explore resources for more affordable therapy

D. Decline the offer and help the client explore resources for more affordable therapy **Bartering is strongly discouraged according to the NASW Code of Ethics (1.13). In the very limited circumstances where bartering is allowed, it should be "negotiated without coercion." Declining the offer is the best response.**

A 16-year-old female has been seeing an outpatient social worker to address conflict with her parents. She reports her parents are strict and have very high expectations of her. She discloses that she is considering becoming sexually active with her boyfriend and her parents would never approve. How should the social worker respond? A. Once releases have been signed, notify her doctor so that she can be screened for pregnancy and sexually transmitted diseases. B. Disclose this information to her parents due to potential safety risks with her becoming sexually active. C. Explain to her that if she chooses to become sexually active the social worker will likely need to disclose this to her parents. D. Discuss a referral to Family Planning so she can discuss birth control and STD prevention.

D. Discuss a referral to Family Planning so she can discuss birth control and STD prevention. **Teens often discuss sexual issues with social workers. They have a right to confidentiality as long as their activity is developmentally appropriate. Social workers can provide them with education and make referrals to appropriate resources without parental consent.**

A social worker has been referred a family from a culture he is not familiar with to address some parenting concerns raised by a pediatrician's office. Prior to the first visit, the social worker should: A. Call the family to ask about their culture to ensure he does not behave in a way they may consider offensive. B. Not do anything special to prepare to help assure the family he will treat them the same as every other family. C. Prepare some material to share with them to educate them on the differences between their culture and the social worker's culture. D. Educate himself as much as possible about their culture.

D. Educate himself as much as possible about their culture. **When working with people from other cultures it is important for social workers to educate themselves as much as possible about the other culture to help facilitate effective treatment.**

A social worker has recently started working with a 15-year-old client to address his depression. After a few sessions, the client reveals he's gay and his parents do not know. He thinks this contributes to his depression. How should the social worker respond? A. Inform the client that social workers are obliged to share this type of disclosure with parents. B. Encourage the client to explore his sexuality further before labelling himself as homosexual. C. Relay the disclosure to the client's parents with the understanding that the parents won't tell the client how they learned about his homosexuality. D. Encourage him to consider the pros and cons of telling his parents.

D. Encourage him to consider the pros and cons of telling his parents. **It should be up to clients whether or not they want to reveal their sexual identity to others. Social workers can assist clients by discussing the pros and cons of disclosing this information. It is ultimately their decision.**

A proposed change in legislation would lead to loss of benefits for several of a social worker's clients. One client asks the social worker if there is anything he can do to help improve his situation as he is concerned he may lose access to many of his services and benefits. How can the social worker respond? A. Work with the client to help him accept the current state of the economy and the legislation. B. Remind him of how he can be grateful for the services he has received up until now. C. Agree to work with him even if he lacks a payor source so that he can continue to make progress. D. Encourage him to contact his local government representatives and advocate for himself.

D. Encourage him to contact his local government representatives and advocate for himself. **It is essential that social workers be aware of the impact that legislation has on social welfare services. Empowering clients to advocate for themselves can be very therapeutic. When clients lose access to services it can be helpful to teach them what they can do to try and help improve their situation.**

A client who has been court-ordered into therapy for domestic violence and substance abuse wants to know if everything he says to the therapist is confidential. How should the therapist respond? A. Ask the client what he is concerned the social worker will reveal. B. Reassure the client that what he says won't leave the office. C. Avoid the question until the social worker has built a rapport with the client. D. Explain the limits of confidentiality in court-ordered therapy.

D. Explain the limits of confidentiality in court-ordered therapy. **The social worker should be honest in all dealings with a client. Since the therapist will have to share some information with the court, the most appropriate response is to explain what is confidential and what is not.**

A social worker co-facilitates a family meeting with a colleague, who is also a social worker. The colleague rolls her eyes at times during the meeting and throughout the meeting she looks at her watch. After the meeting the colleague tells the social worker she is in a hurry to pick her son up from soccer practice as her husband has been working long hours and leaving her to do everything. What should the social worker do? A. Talk to a supervisor about her concerns regarding the colleague's behaviors. B. Consult with a third colleague to gain peer supervision about how to proceed. C. Do nothing initially and assume the colleague was having a difficult day but keep an eye out for further incidents. D. Express concern to the colleague about her behavior.

D. Express concern to the colleague about her behavior. **The NASW Code of Ethics states that social workers need to confront colleagues who may be distressed or experiencing problems that might interfere with their work. Talking to the colleague and offering help is the appropriate way to respond.**

A social worker meets with a woman who states she feels frustrated because her husband undermines her authority with her step-daughter. She states that she feels like her step-daughter has more power and control in the house than she does. The social worker responds by describing this as triangulation. What therapy approach is the social worker most likely using? A. Solution-focused therapy B. Narrative therapy C. Person-focused therapy D. Family systems therapy

D. Family systems therapy **A family systems approach looks at the relationships among family members and how these relationships impact each individual. Triangulation is a term often used in this approach to describe a three-person dynamic in which two of the people are in conflict with the third person.**

A Caucasian family adopted a ten-year-old child from Haiti several months ago. Initially, the parents report that everything was going well. However, they are seeking social work support now due to concerns about the child's behaviors. They state that at meal times, she runs around, grabs food off people's plates, refuses to use utensils, and won't sit at the table. How should the social worker intervene first? A. Recommend the family begin family therapy to assist them with the adjustment to the adoption. B. Recommend they participate in attachment therapy as she may be struggling to attach to them. C. Provide the parents with behavior management skills to help them learn how to manage her behaviors. D. Gather more information on her cultural history as she may not be used to eating meals in the same way as the family.

D. Gather more information on her cultural history as she may not be used to eating meals in the same way as the family. **It is important for social workers to evaluate cultural issues before making recommendations. Sometimes there are cultural reasons for behaviors, and social workers need to understand these reasons. The child in this example may have never experienced a sit-down meal with a family. She may be struggling to adjust to her adoptive family's culture.**

A client comes to a therapy session stating she has been feeling anxious, worried, irritable, restless, is unable to sleep well, and is having a hard time concentrating. She has been feeling this way for six months, but can not seem to figure out the cause. Which of the following is the correct diagnosis of her condition: A. Obsessive-Compulsive Disorder B. Panic Disorder C. Posttraumatic Stress Disorder D. Generalized Anxiety Disorder **Generalized anxiety disorder is diagnosed when a person is suffering from excessive worry and anxiety that occurs for more than half the days in a six-month time period. The condition will also present with restlessness, sleep disturbances, irritability, difficulty concentrating, being easily fatigued, muscle tension, and feelings of being on edge.**

D. Generalized Anxiety Disorder **Generalized anxiety disorder is diagnosed when a person is suffering from excessive worry and anxiety that occurs for more than half the days in a six-month time period. The condition will also present with restlessness, sleep disturbances, irritability, difficulty concentrating, being easily fatigued, muscle tension, and feelings of being on edge.**

A social worker has started to work with a family from Somalia after they were referred by a physician who was concerned that one of the children had suspicious-looking marks on his back. The social worker learns from the family that the marks are from "coining." As part of their traditions, Somalis rub a coin on a child's back because they believe it helps disease escape. How should the social worker proceed with treatment? A. Notify the physician that there is nothing to be concerned about as the family is not abusing the child. B. Apologize to the family for the referral because the physician's ignorance led to suspicion about abuse. C. Explain to the family that if they continue with their coining practices, a child protective report may be necessary. D. Make a mandated report regarding child abuse including disclosure of the family's ethnic heritage and their beliefs that they are helping the child.

D. Make a mandated report regarding child abuse including disclosure of the family's ethnic heritage and their beliefs that they are helping the child. **It is considered child abuse to leave marks or scars on children, even if the injury is part of a cultural tradition. A mandated report is warranted. The family's customs should be included in the report so that this may be taken into consideration.**

A client tells a social worker she has something important to reveal, but fears someone could get into trouble as a result. How should the social worker respond? A. Encourage her to continue by reminding her that she won't be judged. B. Tell her not to talk about anything that may make her feel uncomfortable. C. Remind her that keeping secrets will prevent her from making any progress. D. Offer to review the rules and limits of confidentiality and encourage her to ask any questions she may have before deciding whether or not to reveal the information.

D. Offer to review the rules and limits of confidentiality and encourage her to ask any questions she may have before deciding whether or not to reveal the information. **It is important for clients to be aware of the potential consequences of revealing information. Clients need to know the rules of confidentiality and the instances where confidentiality may need to be broken, such as when a subpoena is issued.**

A mother brings her eight-year-old daughter to see a social worker. The child's pediatrician recently diagnosed the child with oppositional defiant disorder. The child's mother states that they are very interested in doing whatever they can to address her daughter's behaviors. She states her daughter is non-compliant, argumentative, and aggressive at times. What treatment intervention is likely to be most successful? A. Group therapy to help the child learn new skills while experiencing some positive peer pressure to improve her behaviors. B. Narrative therapy to help separate the child from the behavior. C. Medication to help improve the child's mood and decrease her irritability. D. Parent training to assist the caregivers in using behavior management techniques.

D. Parent training to assist the caregivers in using behavior management techniques. **Oppositional defiant disorder can respond well to parent training. When parents change how they respond to a child's behaviors they can learn skills to reinforce more positive behaviors and discourage the negative behaviors.**

A client enters into treatment for an opiate addiction. He reports that his family is upset with him regarding his addiction but that he does not think it is a big problem for him. He states that he functions well and rationalizes his use by saying he has been prescribed opiates in the past by his doctor so he thinks his continued use is justified. How should the social worker proceed? A. Encourage the client to attend an inpatient rehabilitation program. B. Discharge the client from services as he is not interested in making any change. C. Encourage the client to enter into a 12-step program. D. Provide education on the stages of change model and conduct some motivational interviewing.

D. Provide education on the stages of change model and conduct some motivational interviewing. **People with addictions go through several stages before they are able to make a change. The Stages of Change Model (or Transtheoretical Model) provides guidelines for each of those stages that clients must pass through in order to make lasting change. It is important to use a client-centered approach and work with clients at whatever stage they are in when they enter into services. When clients are pre-contemplative, motivational interviewing can be the best intervention to help them determine if they want to make change or not.**

A woman has started meeting with a social worker after her ten-year-old daughter revealed that her soccer coach sexually abused her. The client reports feeling very guilty that the abuse happened. How should the social worker intervene? A. Explore her distorted thoughts around her guilt and help her replace them with more realistic thoughts. B. Explore how she can address the trust issues she is going to likely develop as a result of this incident. C. Tell her that it is not her fault and that sexual abuse can happen to any child. D. Provide her with information on how to recognize sexual predators and teach her strategies to keep her daughter safe.

D. Provide her with information on how to recognize sexual predators and teach her strategies to keep her daughter safe. **Parents can take steps to reduce their child's risk of sexual abuse. The social worker can help parents learn how to recognize predators and how to speak to their children about safety issues. It's important that the social worker not blame the parents but rather empower them to be actively involved in keeping their kids safe.**

A client seeks substance abuse treatment with a social worker. The client has been drinking heavily for over ten years and also uses cocaine. Due to some recent legal issues, the client reports being more motivated than ever to become clean and sober. The client asks if there is any medication available to help with remaining abstinent from alcohol. How should the social worker respond? A. Inform the client that medications such as Methadone and Suboxone do not treat alcohol addiction. B. Encourage the client to attend a Twelve Step program and to continue with individual substance abuse treatment before considering other options. C. Explain to the client the importance of addressing the underlying mental health issues that may be causing the addiction prior to beginning medication-assisted treatment. D. Provide the client with information about potentially helpful medications and offer to refer the client to a psychiatrist.

D. Provide the client with information about potentially helpful medications and offer to refer the client to a psychiatrist. **There are medications to assist clients with a variety of addictions, alcohol included. It is important to provide clients with psychoeducation on available resources and options and then refer to a psychiatrist or physician who can provide further information.**

A school social worker received a referral from a teacher regarding a second-grade student. The student's parents are immigrants from Vietnam. The student has come to school wearing the same clothes all week and teachers are concerned about him. The social worker has not been able to reach the family by phone so she goes to the home for a home visit. The student's mother is home by herself; her husband is at work. She is friendly and says that everything is just fine. She thanks the social worker for coming over. What should the social worker do? A. Leave the student's house and inform the teachers that nothing seems to be out of the ordinary. B. Try reaching the student's father via telephone to talk about any concerns he may have. C. Make a report to child protective services. D. Provide the student's mother with information on resources in the area in case she is having difficulty affording clothing or doing laundry, and then leave.

D. Provide the student's mother with information on resources in the area in case she is having difficulty affording clothing or doing laundry, and then leave. **Many families--particularly those from Vietnam--are often reluctant to talk about problems with strangers. They are also sometimes reluctant to talk when the male of the house is not at home. Sometimes immigrants lack resources and information on how to get resources. It can be most helpful to provide the family with information on how to access resources**

A client meets with a social worker to address his cocaine addiction. He states that he is ready to stop using cocaine as he recognizes the significant problems it has caused him in his life. The social worker begins helping the client identify some initial steps he can take to address his addiction. What objectives are most appropriate for the client? A. Discuss the pros and cons of continued drug use. B. Maintain stable employment. C. Acquire and maintain meaningful social relationships. D. Remain abstinent from cocaine for five days and monitor signs of withdrawal.

D. Remain abstinent from cocaine for five days and monitor signs of withdrawal. **When a client presents ready to begin behavioral changes, it is important to begin with small steps they can take to help reach their long term goals.**

As a social worker nears the end of a scheduled appointment time, her client begins to discuss a distressing incident that happened to him earlier in the week. He begins to cry. When the social worker reminds him that his time is almost over, he becomes upset and says he needs more time to talk. How should the social worker respond? A. Encourage the client to reschedule as soon as possible. B. Offer to assist him for an additional few minutes even though it will mean she will be late for her next appointment. C. Offer to cancel her next appointment so she can tend to the client's distress. D. Remind the client that she respects everyone's appointment times and he can discuss this incident first thing at his next appointment.

D. Remind the client that she respects everyone's appointment times and he can discuss this incident first thing at his next appointment. **Respecting boundary issues is an important part of social work. Although it may be important to intervene or make exceptions in a crisis, this client does not appear to be in a crisis. The social worker should make use of this opportunity to set limits, remind the client that sessions must ordinarily end on time, and encourage the client to discuss distressing incidents at the beginning of the session.**

An 18-year-old client is seeking help at the suggestion of her mother. After graduating from high school, the client continues to live at home and does not work. She has no real future plans, says she just wants to stay at home, and is content watching television and talking to friends on the phone all day. If the social worker were to apply Erikson's Psychosocial Theory, how would it explain the client's behavior? A. The client is experiencing isolation. B. The client has not yet mastered competence. C. The client is stuck in the initiative versus guilt stage. D. The client is experiencing role confusion.

D. The client is experiencing role confusion. **Erikson's Psychosocial Theory describes how people navigate the life cycle by resolving specific issues at specific stages. The goal of the adolescent stage, which Erikson labels Identity versus Role Confusion, is to gain independence and forge an identity. When adolescents attempt to delay taking on adult responsibilities, they experience Role Confusion.**