Question 1: B
Rationale: Some experts have suggested that the best possible outcome of acculturation is the ability to function well in both one's culture of origin and the dominant (mainstream) culture. In order to become "biculturally competent," immigrants need knowledge of the new culture's beliefs and values, a positive attitude toward both cultures, the belief that they can live happily and successfully in both groups without compromising their sense of cultural identity, supportive and reliable social networks in both groups, a broad range of culturally and situationally appropriate behaviors and roles, and communication competency.
Question 2: B
Rationale: If a client you are visiting at home wants family or other informal helpers to sit in on the interview, you should usually respect her preference and allow these people to attend the interview.
Question 3: D
Rationale: The key to selecting the correct answer is recognizing that the social worker must gather more information before attempting to understand the problem or what should be done to help the girl. It would be premature to formulate a diagnosis (even a "working" diagnosis) or treatment plan right now. Meeting with the parents would enable the social worker to gather information directly from them (e.g., whether something happened to trigger the girl's mood and behavioral changes, how she behaves at home) and to get their permission to consult with other professionals about their child. The meeting would also allow the social worker to involve the parents in helping their child. Based on what he or she learns at this meeting, the social worker can then determine what assessment procedures and interventions (e.g., testing, referrals, behavioral methods) would be appropriate. Answer A: The social worker needs more information before making a diagnosis. In addition, we have no evidence that the girl is anxious or is resisting going to school. She seems more depressed than anxious, though we can't know this for certain either. Answer B: This would be premature - we don't have enough information to conclude that the girl is depressed. Also, the social worker needs the parents' permission before doing this. Answer C: The social worker can't plan treatment before knowing what's wrong with the girl (e.g., perhaps a medical condition accounts for her symptoms). Also, the social worker needs to involve the parents before implementing any intervention.
Question 4: B
Rationale: This question is rather difficult unless you focus on the word "primary." You needed to think about how having this information would help the social worker understand the patient and his situation and benefit the intervention plan. In evaluating the patient and his social support network, the social worker wants to identify both strengths and needs. Among these needs may be the need for assistance in overcoming barriers to accessing and using adequate medical care including socioeconomic barriers. Patients with limited financial resources may, for example, lack adequate health insurance, have difficulty traveling to medical appointments, lack prescription coverage, etc. Additionally, because the current health-care climate emphasizes cost containment through shorter hospital stays, the patient may need services from several community agencies after his hospital stay and arranging such services can be particularly difficult when patients lack sufficient financial resources. If the patient needs help in this area, the social worker will want to provide case management services to refer and link the patient and his family to needed services and other resources.
Question 5: A
Rationale: When it comes to mindfulness, various practices can help with increasing the overall quality of life with time and consistency. Answers C and D may be secondary benefits of practicing mindfulness regularly, however, most research on mindfulness emphasizes the practice as a way of being that helps to develop capacity for awareness and thought in the here and now.
Question 6: B
Rationale: This question requires you to apply your knowledge and understanding of Erikson's "Eight Stages of Man." This client is excessively concerned about how other people are perceiving and judging her, which suggests a high level of shame and self-doubt and a low level of autonomy. According to Erikson, toddlerhood is associated with the psychosocial crisis called "autonomy vs. shame and doubt." In this stage, a sense of self (autonomy) develops out of positive interactions with one's parents or other caregivers.
Question 7: A
Rationale: Though the wrong answers might be tempting, the right answer is based on both what we know about this woman and what the research shows about depression risk among older adults. This research shows that healthy, normally functioning older adults are not at higher risk for depression, and what appears to be age-related depression is often depression about physical health problems and the associated disabilities (Sue and Sue, 2003). In other words, if the person does not have health problems, simply growing older does not increase the risk for depression.
Question 8: D
Rationale: Rick’s desire for social contact, coupled with his low intellectual ability, increases his risk of exploitation by others. He lacks a protective social network, and is therefore likely to seek out “friends” wherever he might find them. His higher degree of independence from his parents means that they are not able to intercept exploitation as much as if he had a lower degree of independence. hough Rick’s deficits in emotional recognition and intellectual ability increase his risk for exploitation by others (A), his dependence on his parents serves as a protective factor, allowing them to have more contact with his friends, and therefore, to “screen” for inappropriate or exploitive or abusive interactions. Rick’s aversion to social contact and his low independence from his parents means he has minimal contact with people who might seek to exploit him (B). Rick’s low sociability limits his contact with people who might seek to exploit him (C).
Question 9: C
Rationale: The mother's report (e.g., "chaotic" life, focus on herself rather than her child) and, in particular, the child's condition suggest a "reasonable" possibility that this child is being neglected; therefore, a child abuse report is necessary. The family's needs (including the child's medical needs) can be identified and dealt with by the CPS unit after you have made a report.
Question 10: B
Rationale: The diagnostic criteria for schizophreniform disorder are identical to those for schizophrenia except that the disturbance is present for at least one month but less than six months and impaired social or occupational functioning may occur but is not required. Schizophrenia requires six months of symptoms.
Question 11: A
Rationale: The social worker has acted unethically whether or not his friend is also a mental health professional: The social worker has discussed confidential information about a client without the client's valid consent (and, moreover, in doing so, has revealed identifying information about the client), and has talked about confidential information in a setting in which privacy can't be guaranteed.
Question 12: A
Rationale: Because two days is a short period of time to prepare such a report (especially if the supervisor needs to time review the records), it would be appropriate for the social worker to request an extension. Answer D: The supervisor will need adequate time to review the records.
Question 13: B
Rationale: Shaken baby syndrome (a.k.a. shaken infant syndrome) usually doesn't produce external signs of injury; instead, the baby usually suffers bleeding of the brain and retinal hemorrhage, which can lead to permanent neurological damage, seizure disorders, blindness, deafness, and sometimes death. As "B" says, the typical symptoms of shaken infant syndrome include lethargy, crying, vomiting, loss of appetite, and seizures.
Question 14: D
Rationale: Answer "D" is consistent with NASW's Standards the Practice of Social Work with Adolescents. This document stipulates that social workers must "maintain confidentiality in their relationship with youths and of the information obtained within that relationship." The only exceptions listed for this standard are situations requiring a child abuse report and situations in which it is necessary to reveal confidential information in order to prevent danger to the teenage minor or others.
Question 15: B
Rationale: Before deciding on the best way to proceed, you must understand the significance of religion or spirituality for this particular client. "B" includes the idea of exploring the significance of religious and spiritual events for this client. Answer A: This may turn out to be appropriate, but first you need to determine the meaning of religion or spirituality for this client. Answer C: You don't need to avoid a discussion of religion or spirituality until after these evaluations are completed. Doing so could make it seem like you're overlooking the client's cultural values. Answer D: You wouldn't place the burden of raising this topic on the client. In fact, the research has found that, for American Indians, one consequence of their history in the U.S. is that they may be distrustful of a psychotherapist's efforts to provide counseling in a "value-free" environment and prefer a therapist who actively helps them reaffirm the values of their own culture.
Question 16: A
Rationale: Wernicke-Korsakoff's syndrome is a life-threatening alcohol-related disorder resulting in persistent memory loss and caused by malnutrition and thiamine deficiency. The disease consists of two stages: Wernicke's encephalopathy develops suddenly and produces abnormal eye movements, ataxia, slowness, and confusion. Sufferers also have signs of neuropathy, such as loss of sensation, "pins and needles" sensations, and or or impaired reflexes. The level of consciousness progressively falls and, without treatment, may lead to coma and death. Korsakoff psychosis may follow Wernicke's encephalopathy if treatment is not initiated early enough. Symptoms include severe amnesia, apathy, and disorientation, with recent memory affected more than distant memory. Confabulation (invention of facts or stories) may occur in order to compensate for memory gaps. Answer B: Cirrhosis is most often the result of chronic alcohol use and is a chronic, degenerative disease of the liver. Although it can lead to death, cirrhosis progresses over a long period of time, usually years. Answer C: Hepatitis generally refers to an inflammatory condition of the liver caused by bacterial or viral infection, parasitic infestation, alcohol, drugs, toxins, or transfusion of incompatible blood. When severe, hepatitis may lead to cirrhosis and chronic liver dysfunction. A specific form of hepatitis known as "alcoholic hepatitis" is an acute toxic liver injury associated with excess alcohol consumption. Certain medications may be used to treat this condition and long-term survival is improved with abstinence or decreased alcohol consumption. Answer D: A peptic ulcer may be a medical consequence of chronic alcohol use, but it is not the most serious alcohol-related disease.
Question 17: C
Rationale: Trauma-informed care practice centers the client’s experience and ensures that clients feel physically safe in the therapeutic environment. It is possible that at some point the client was abused or otherwise experienced trauma while trapped in a room with no way to escape. Rather than adhering strictly to agency policy (A) or avoiding addressing the trauma response entirely (B and D), the best approach is to work together with the client, empowering her to identify a private space that feels safer, and to address the roots of her fear through therapy.
Question 18: B
Rationale: Of the four choices, "B" is the most likely one to provide this client with some immediate relief for her stress. Like all groups, this group has the potential to provide a number of benefits (some of which are listed in the answer) that could help fulfill some of this client's needs and, thereby, reduce her stress. Answer A: The client may be angry at her ex-husband, but she doesn't mention this in her report. Answer C: Although many clients can benefit from being exposed to cognitive restructuring techniques, this client's presenting concerns seem to be based in the reality of her current situation (rather than a product of negative self-talk) and she has presented with a number of concrete needs. "B" is a better way of addressing the situational factors currently contributing to the client's stress. (She would, however, probably benefit from receiving short-term supportive counseling from you, along with the referral to a support group.) Answer D: This intervention doesn't address any of the primary needs the client has described: She wants help with reducing her stress and probably also needs help with finding a job to support herself and her son.
Question 19: D
Rationale: In operant conditioning, extinction refers to the elimination of a behavior as a result of removing all reinforcement for it. Answer C: When using extinction, the target behavior diminishes after an initial period during which responding is more forceful and variable (i.e., an extinction burst), but eventually the behavior is eliminated altogether.
Question 20: A
Rationale: In general, when a child in play therapy cries or seems genuinely upset, the therapist must evaluate whether the crying is due to fear, sadness, anger, or physical discomfort. In this case, the child has said that she's scared. A child's fear during play therapy may be due to separation from her parent, the novelty of the situation, or some intrusion by the therapist (e.g., an intervention the therapist has attempted). You (the test-taker) don't know the cause of this girl's fear, but you can still choose "A" because it's the only answer that suggests an appropriate response to a fearful play therapy client. "A" is a good intervention when the child's crying stems from a genuine fear of the therapist's interventions. When this is the case, the therapist should proceed more slowly, openly acknowledge the child's fear, and, if there is someone with whom the child does feel safe nearby (such as a parent in the waiting room), invite that person into the session to provide the security the child needs before she can accept the therapist's interventions.
Question 21: C
Rationale: Advice giving involves offering statements that recommend what a client should do (i.e., with advice giving, the client clearly senses your preference). Whether advice giving is appropriate or not depends primarily on the purpose of your interaction with the client. Advice giving is often appropriate when the purpose of your interaction relates to referral, brokering, or advocacy, but is only rarely appropriate in psychotherapy. A notable exception is when a therapy client is in crisis: When a client is so anxious that he is unable to think clearly or make decisions, it's appropriate for you to adopt a much more active role than usual. The general principle is that, as a social worker, you should not make a decision for a client unless you conclude that the client is unable to make the decision himself.
Question 22: C
Rationale: The ecological perspective adopts a transactional view of the relationship between an organism (person) and its environment. This view suggests that a person and his environment engage in ongoing circular exchanges in which each reciprocally affects the other over time. Based on this view, proponents of the ecological model assume that a person's problems and needs result from exchanges between the person and his environment, not from either personality or environment alone.
Question 23: D
Rationale: The client appears to be having panic attacks, but before concluding this, you should have the client examined by a physician in order to rule out medical conditions that may account for these symptoms. Symptoms of hyperthyroidism include excitability, nervousness, confusion, increased appetite with weight loss, fatigue, insomnia, and higher metabolism, body temperature, and heart rate.
Question 24: B
Rationale: A frequently discussed topic in the cross-cultural counseling literature is the impact of racial or ethnic identity on the therapy process. Sue and Sue ("Counseling the Culturally Different," New York, John Wiley and Sons, 1990) note that "preference for a racially or ethnically similar counselor may really be a function of the cultural or racial identity of the minority person ... rather than of race or ethnicity per se." In other words, a preference for a therapist of the same race or ethnicity is often a manifestation of the individual's racial or ethnic identity.
Question 25: C
Rationale: Unlike therapists, therapy group members are not legally and ethically bound to maintain the confidentiality of what they hear from other members. Thus, at the outset of therapy, a group therapist should stress the importance of confidentiality. NASW's Code of Ethics says that, at the beginning of group counseling or therapy, you should seek an agreement from all of the participants to maintain one another's confidentiality. When seeking this agreement, however, you should also inform the group members that you cannot guarantee that all of the participants will abide by the agreement.