Question 1: B
Rationale: Beck's cognitive therapy (CT) assumes that depressive symptoms can be removed by altering the cognitions that underlie them, and the majority of communications by the therapist take the form of questions designed to help the client examine relevant information. Questioning often takes the form of Socratic dialogue, or questions designed to help the client reach logical conclusions about a problem and its consequences.
Question 2: B
Rationale: The client is experiencing at least one symptom of psychosis plus a negative symptom associated with schizophrenia (flat affect). He may have a psychotic disorder or other serious psychiatric condition that requires immediate attention. Therefore, "B" is the best answer: The first step should be to stabilize the client's severe psychiatric symptoms because it's unlikely that any other intervention would be effective as long as he is actively psychotic. Generally, for clients with both a substance use disorder and a severe co-occurring psychiatric disorder, you should treat the latter disorder first - i.e., you should stabilize the client before beginning addiction treatment. Answer A: While this client may eventually benefit from participating in a group (e.g., an HIV support group, 12-step group), this would not be your first intervention given the client's psychotic symptom and flat affect. Answer C: This would be important to do soon, but you probably won't have much success in addressing this client's alcohol use as long as he is experiencing severe psychiatric symptoms. Answer D: Many people with HIV disease suffer social losses (such as being estranged from family members), which complicates their coping efforts. However, dealing with social losses is not your priority right now with this client.
Question 3: D
Rationale: egetative symptoms include persistent problems with appetite, weight loss or weight gain, sleep difficulties, reduced energy levels, and changes in sexual desire or function.
Question 4: C
Rationale: According the Erikson, the psychosocial issues of early adulthood center on intimacy and solidarity versus isolation. The main task at this stage ("intimacy vs. isolation") is the establishment of intimate bonds of love and friendship.
Question 5: A
Rationale: This is a difficult question because all of these behaviors may be seen in children who have been sexually abused. "A" is the best answer, however. This child "frequently" masturbates at school - inappropriate masturbation that has a compulsive or driven quality is an indicator of sexual abuse. Answer B: This might indicate sexual abuse, but these indicators are more commonly found in children who have been physically abused. Answer C: This is the second best answer. Unusual sexual play and an unusual level of knowledge about sexual activity are indicators of sexual abuse. In this case, however, it's not clear which child initiated this activity. In addition, sexually abused children who engage in aggressive or forced sexual activity with other children usually do so with younger children. Answer D: This may be an indicator of sexual abuse (to protect one's body). However, children who have been physically abused may also use clothing to hide their bodies, in particular, their injuries.
Question 6: B
Rationale: This question is difficult because two of the incorrect answers can be viewed as "truisms." A crisis involves a sequence of events that takes a person from equilibrium to disequilibrium and back to equilibrium. This sequence generally occurs over a period of six to eight weeks. Answer A: Eliminate this because it suggests that the needs of the agency are more important than the needs of the client. Answer C: While it's true that the processes and methods of crisis intervention are tailored so that they will be effective for resolving crises, this answer doesn't explain why six to eight weeks in particular is the best time-frame for crisis intervention (e.g., three or four weeks or nine or 10 weeks of therapy also would be considered short-term therapy). Answer D: While this statement is true, like "C" it doesn't explain why six to eight weeks in particular is the best time-frame for crisis intervention.
Question 7: A
Rationale: It's difficult to choose an answer without knowing more about this client, in particular her level of acculturation and religious background. However, the question implies several things that could help you identify the best answer. First, the client immigrated quite recently, suggesting that she may still adhere to the values of native culture. Second, the client was sent to you by her doctor, suggesting that a medical condition that could account for her symptoms has been ruled out. Third, the client may be somaticizing emotional stress, since, among traditional Asian individuals, physical illnesses are more acceptable than psychic ones. There's a good chance the client is experiencing a psychosocial problem that she's unwilling to disclose to you. Fourth, the client's behavior with you suggests that, consistent with traditional Asian values, the client believes that she should solve her problems within her family or community, rather than disclose personal information to an outsider such as a social worker. All of this suggests that "A" is the best answer offered. Korean individuals in the U.S. have high church attendance and their churches are often the focal institutions of their community. The client may feel more comfortable addressing her problem with a pastor and, perhaps, framing it as a spiritual issue.
Question 8: A
Rationale: This client appears to have a strong faith in religion, which has been challenged by his recent experience. It would be useful for the client to know that religious support is available to him. There are churches, such as the Fellowship United Methodist Church, that are accepting of a gay congregation. In general, when working with gay, lesbian, bisexual, or transgender (GLBT) clients, social workers should be aware of and use community resources to increase their clients' support network and sense of community. Answer B: This doesn't really address the presenting problem since the client has already come out to his pastor. It also implies that it was a mistake for the client to come out to his pastor; although this could be true, rather than emphasizing this at this time (which might make the client feel at fault for what has happened), the social worker should first provide the client with an alternative means of attaining religious support, to replace the one he has lost. If the client still needs to come out to others in his life, then it would be useful to help him consider this decision carefully and weigh the pros and cons. Answer C: This could be appropriate since the client is questioning his faith. However, you (and the social worker) already know that the client has a strong faith in religion (he's attended his church for five years) and why his faith has been challenged. "A" is a more direct and immediate way of addressing the client's presenting problem. Answer D: Providing the referral in "A" is better because it recommends a specific place for the client to go for support.
Question 9: C
Rationale: Tourette's disorder is usually treated using medication, behavior modification, and biofeedback. In addition to this, muscle relaxation training and other stress reduction techniques can also be effective interventions for some patients because the tics associated with Tourette's can be worsened by stress and sometimes controlled through "will power" - i.e., muscle relaxation, stress reduction ("The American Medical Association Encyclopedia of Medicine," edited by C. B. Clayman, Random House, New York, p. 988, 1989). Answer A: Tardive dyskinesia is a condition caused by the long-term use of antipsychotic medication. Treatments for TD include taking the patient off of the drug and, in some cases, giving the patient a GABA agonist. Answer B: Impotence may be caused by physiological conditions, which must be ruled out first. When impotence is not caused solely by a medical condition or substance use, treatments include psychoeducation, sensate focus, cognitive restructuring, and, when indicated, the resolution of unconscious conflicts interfering with erectile capacity. Answer D: Muscle relaxation is unlikely to be recommended for a spinal cord injury because this kind of injury frequently results in the loss of muscle function and or or sensation. Spinal cord injuries typically require occupational and physical therapy and, sometimes, mental health counseling to facilitate psychological adjustment.
Question 10: D
Rationale: The MMPI-2 is one of the most widely used self-report inventories for the assessment of personality. Its clinical and validity scales provide information about an examinee's characteristic traits and behaviors, including symptoms, major needs, perceptions of the environment, reactions to stress, self-concept, sexual identification, emotional control, interpersonal relationships, and psychological resources.
Question 11: C
Rationale: Emotional abuse or neglect involves a failure to provide for the appropriate emotional development of the child, resulting in psychological damage to the child. Emotional maltreatment is often more difficult to identify than other forms of child abuse or neglect because its consequences tend to be subtle and its symptoms frequently resemble those of emotional disturbances unrelated to abuse or neglect. Answer A: Signs of physical neglect, in which the child has been deprived of adequate food, shelter, clothing, medical care, or supervision, may be observed by people coming into contact with the child (e.g., there may be signs of malnutrition, constant fatigue, poor hygiene, frequent absences from school). Answer B: Signs of physical abuse, such as bruises, welts, lacerations, loss of hair, acting out behaviors, and hypervigilance, may be observed by those who come into contact with the child. Answer D: Signs of sexual abuse, such as inappropriate touching of a playmate's body parts, becoming withdrawn, regressive behaviors, fear states, and eating disturbances, may be observed by others. A physical exam may also reveal signs of sexual abuse.
Question 12: D
Rationale: According to Piaget, just as living organisms adapt to their environment biologically, people adapt to their environment cognitively. Such adaptation involves two complementary processes: Assimilation refers to the incorporation of new knowledge into existing cognitive schemas (structures), and accommodation refers to the modification of existing schemas (structures) to incorporate new knowledge. For instance, when playing with a toy for the first time, the child will treat it as she would any other new object (e.g., hit it, throw it, taste it). At this point, the child is trying to understand the toy by assimilating it into her existing cognitive schemas. Over time, as the child begins to identify the toy's unique properties, she will accommodate by modifying her schemas, thereby developing new ways of interacting with the toy.
Question 13: C
Rationale: The research has generally found individual psychotherapy alone (especially cognitive or cognitive-behavioral therapy or interpersonal psychotherapy) to be most effective for mild depressions; and psychotherapy plus antidepressant medication to be best for moderate to severe and psychotic depressions (e.g., American Psychiatric Association, 2000). Answer B: This would be a good choice if the client were suicidal or otherwise in need of medical or mental health intervention in a safe place, 24 hours a day. Though the potential for suicidality should continue to be monitored, the client does not seem to pose a danger to himself at this time. Answer D: This client doesn't appear to be a good candidate for a support group at this time. Group approaches are usually contraindicated for people who are very depressed and withdrawn.
Question 14: B
Rationale: This is a good example of the "best" answer questions you might see on the exam. The case suggests that you've been drawn in by the client's manipulations; therefore, the best action at this time is to seek consultation so that you can examine your actions and feelings with someone more objective.
Question 15: C
Rationale: Make sure you noticed the qualifier "least." In their research, Masters and Johnson (1966) found that growing older causes only relatively minor changes in female sexuality and that sexual desire and the ability to achieve orgasm do not decrease in females as they age. And the DSM-IV-TR notes that female orgasmic capacity actually increases with age and that, therefore, female orgasmic disorder may be more common in relatively younger women. Answers A and B: The reduced levels of estrogen and progesterone associated with menopause lessen lubrication and have other adverse effects on vaginal tissues and, consequently, can cause discomfort during intercourse. In terms of sexual drive and interest, however, the change in balance between estrogen, progesterone, and testosterone can actually result in an increase in desire since testosterone is the hormone responsible for sex drive. Answer D: The DSM-IV-TR indicates that sexual stimulation that is inadequate in focus, intensity, and or or duration may be a cause of female sexual problems. This applies to women of any age.
Question 16: D
Rationale: Of the various precipitants of relapse, negative emotional states have been found to be the most frequent cause. Marlatt and Gordon report that, for alcoholics, 38 percent of incidents of relapse are related to negative emotional states; 18 percent to interpersonal conflicts; and 18 percent to social pressure. Together, these three account for nearly three-fourths of relapse incidents.
Question 17: A
Rationale: You know a little bit about the client's symptoms and you know that they have been present for "a few weeks." In addition, the question suggests that her symptoms were triggered by a traumatic event involving the loss of life. In acute stress disorder, characteristic symptoms (see below) develop in response to the same type of trauma associated with PTSD; the symptoms start within four weeks of the trauma and last for at least two days but no longer than one month. If the symptoms persist for more than four weeks, the diagnosis is changed to PTSD. The symptoms of acute stress disorder include the following: (1) While or after experiencing the trauma, the client has at least three dissociative symptoms (e.g., derealization, dissociative amnesia, sense of emotional detachment). (2) The client has at least one symptom from each symptom group associated with PTSD - i.e., persistent re-experiencing of the trauma (e.g., nightmares); avoidance of stimuli that cause recollection of the trauma or generalized numbing of responsiveness (e.g., significantly diminished interest in normal activities); and marked anxiety or increased arousal. Though the question doesn't describe dissociative symptoms or symptoms of marked anxiety or increased arousal, "A" is still the best answer based on the symptoms you do know about, their duration, and the event that seems to have triggered the symptoms. Answer C: In adjustment disorder, the precipitating trauma and or or the patient's response to the trauma do not meet the criteria for PTSD or acute stress disorder. Because the trauma in this case involved the death of another person, it fits the criteria for a stressor that might trigger acute stress disorder or PTSD. In addition, the client's symptoms appear to be in excess of those associated with an adjustment disorder - the predominant manifestations of adjustment disorder with anxiety are symptoms such as nervousness, worry, or jitteriness. Answer D: A loss of interest in usual activities and appetite loss are symptoms of major depression. However, this is a "made-up" diagnosis - "with anxiety" is not one of the various specifiers that may be used with major depression.
Question 18: C
Rationale: "Separation anxiety" refers to distress displayed by babies when they are separated from their primary or customary caregivers. It usually begins at about 6 to 8 months of age, peaks at about age 14 to 18 months, and then gradually declines. Unlike separation anxiety disorder, separation anxiety, when it occurs during this developmental period, is considered normal. It reflects a child's increasing cognitive skills and growing emotional and social bonds with his or her primary caregiver.
Question 19: C
Rationale: Bronfenbrenner's ecological systems theory emphasizes that, when studying a child's development, it is necessary to look not only at the child and her immediate environment, but also at the interaction of the larger environment. Thus, this theory looks at a child's development within the context of the system of relationships that form her environment. It defines "layers" (nested contexts) of the environment, with each having an effect on a child's development. The "microsystem" is the layer closest to the child and contains the structures with which the child has direct contact; it encompasses the relationships and interactions a child has with her immediate surroundings. The "mesosystem" provides the connection between the structures of the child's microsystem; an example includes the connection between a child's teacher and her parents. The "exosystem" defines the larger social system in which the child does not function directly. The structures in this layer affect a child's development by interacting with structures in her microsystem. Examples include parent workplace schedules and community-based family resources. The "macrosystem" is the outermost layer in the child's environment. It is comprised of cultural values, customs, and laws, which influence all of the other layers. For example, if a culture believes that parents should be solely responsible for raising their children, the culture is less likely to provide resources to help parents. This, in turn, affects the structures in which the child's parents function (e.g., their ability to carry out their responsibilities toward their child in the context of the child's microsystem). Note that Bronfenbrenner's theory recently has been renamed "bioecological systems theory" to emphasize that a child's biology is also a primary environment affecting her development.
Question 20: C
Rationale: The question indicates that the social worker is meeting for the first time with the family. The family is confronting a serious psychosocial stressor and would benefit from receiving support and guidance from the social worker. "Reframing" is often effective for reassuring clients, especially at the beginning of treatment. Reassurance, in turn, is a sustainment technique that can be very effective for reducing anxiety and offering clients a feeling of hope about their situation. Lessened anxiety and greater hope, in turn, often help to free up clients' emotional and mental energies so that they can begin to engage in problem-solving activities.
Question 21: D
Rationale: This question is worded in a confusing way (you may see a few "confusing" questions on the exam, too). When you see a confusing question, try to reword it so that it makes more sense to you. Translated, this question is asking, "According to research, which of the following contains a FALSE statement about factors that affect people's health and or or health-care utilization?" With this "translation" in mind, you can then look at each answer and ask yourself, "Is this statement true or false?" The only clearly false statement is the one in "D." Women are more likely than men to seek and use health care. Women are also more effective in using coping mechanisms and social support before, during, and after an illness. Men often don't prioritize their health or health care unless they are very ill and are more likely to use alcohol, drugs, and tobacco in response to stress. Answer A: This answer may have tempted you because you don't know whether this client has health benefits or not. On other hand, you probably do know that people with lower SES often lack health insurance, usually because they can't afford to pay the premiums or because their jobs don't offer health benefits. Remember, the question says "according to research": Therefore, you should base your evaluation of each answer on what the research shows. On that basis, this answer accurately states that, given her low SES, there's a good chance that this client doesn't have health insurance. Answers B and C: These are true statements according to research.
Question 22: A
Rationale: "A" demonstrates that you consider the client to be the expert on his own experience of his culture and that you're interested in how his cultural background has shaped him. Also, asking the client about his culture would open up an important channel of communication between you and the client. Answer B: This may be tempting because a key purpose of this meeting is to elicit information about the presenting problem. However, you've just acknowledged the cultural difference between you and the client and told him that you don't know much about his culture. You wouldn't then drop that issue and move on to something else, as this could make the client feel as though you don't care about his cultural values, etc. Answer C: You may discover that you need to refer the client to a therapist who shares his cultural background, especially if the client requests a referral, but this isn't the best answer for several reasons. First, referral may not be necessary. Second, if you can't see this client because you lack sufficient knowledge about his culture, you could refer him to a therapist who has this knowledge - i.e., your referral need not be to a therapist who shares the client's background, unless this is the client's preference.
Question 23: C
Rationale: The characteristics of traditional masculinity include assertiveness, ambition, and self-confidence, and being in control in emotional situations and at work, yet this man is described as being passive, lacking ambition, and worrying a lot. People, like this man, who experience a discrepancy between how they believe they should think, feel, or behave based on gender role expectations and how they actually think, feel, or behave experience "gender role conflict." Both unresolved gender role conflict and adhering to extreme standards of masculinity (for males) or femininity (for females) can have a negative impact on mental health.
Question 24: C
Rationale: Social workers should collaborate with other mental health professionals when doing so is indicated and serves the best interests of their clients. The social worker should first discuss this issue with both of her clients, however, so that everyone is in agreement.
Question 25: C
Rationale: This social worker should not publicize his own work in the media. NASW's Code of Ethics urges social workers to provide appropriate professional services in public emergencies to the greatest extent possible and to place service to others above their own self-interests. Answer A: According to the Code of Ethics, "social workers should not engage in solicitation of testimonial endorsements, including solicitation of consent to use a client's prior statement as a testimonial endorsement, from current clients or from other people who, because of their particular circumstances, are vulnerable to undue influence" (Standard 4.07b).Answer B: Offering guarantees of help or improvement to prospective clients is a violation of the Code of Ethics, as well as prohibited by law in most states. For example, brochures and other advertisements shouldn't contain statements or claims that are intended or likely to create false or unjustified expectations of favorable results. The issue in this question, however, is that the social worker should not actively publicize in the media the professional services he provided his community during this public emergency.