This week, you will be assessed on the use of diagnosis, assessment,

This week, you will be assessed on the use of diagnosis,
assessment, and intervention in a multiple-choice final exam.
This exam is modeled in the National Clinical Mental Health
Counseling Exam (NCMHCE) format that is used in many states
as their licensure exam and for the Certified Clinical Mental
Health Counselor (CCMHC) national certification. As opposed
to other exams where you are asked to recall specific facts, this
exam is based on case scenarios where you will apply your
clinical problem-solving ability to assess, diagnose, and treat
crisis and trauma situations. You will focus on identifying “the
best answer”—as opposed to the “correct” answer. This means
that each question contains more than one correct answer, but
only one answer is the best. As “best answer” exams require a
great deal of discernment, be sure to read each question
carefully, look for the correct answers, and then discern the
“best” answer. Taking a comprehensive exam in this format will
pay off in the end when you sit for the NCMHCE in the future. I
need this completed by 11/02/18 at 7pm. .
QUESTION 1
1.
Case #1 – Jenna
Jenna is a six-year-old Caucasian female who currently resides
with her foster parents, her older biological sister, and two
foster brothers. Jenna and her siblings were taken from her
biological parents because of suspected sexual abuse and
neglect. It is reported that Jenna lived in a home without food,
water, and utilities. Jenna’s foster parents report that her
biological mother “may have some disabilities and has never
had the financial means to take care of her children.” Jenna’s
biological brother is in a separate foster home. He is suspected
of sexually abusing both Jenna and her older sister. It has been

reported that he sexually abused Jenna, while her sister was
helplessly told to watch. Jenna has expressed this trauma with
agitated behavior. The traumatic event is re-experienced by
repetitive play where she stimulates herself on furniture. Jenna
avoids the stimuli associated with the trauma by avoiding
conversations associated with sexual abuse. Jenna avoids
activities, places, and people associated with the trauma except
for her sister who was also a victim. Jenna also has a sense of a
foreshortened future. She frequently brings up death with her
foster parents. Jenna has persistent symptoms of increased
arousal that were not present before the trauma as indicated by
irritability and outbursts of anger nearly every day with her
biological sister and her foster father. Jenna is also hyper
vigilant and does not want her foster father around. The
disturbances have lasted for over a month and have caused
clinically significant social impairment to the point she is
unable to attend a full day of school due to emotional
breakdowns.
1) What intake information should be obtained and assessed to
formulate a provisional DSM-5 diagnosis?
Select AS MANY
as you consider essential.
a.
History of learning disabilities.
b.

Length of time problematic behaviors have persisted.
c.
Changes in sleeping patterns.
d.
Substance use.
e.
Attention problems.
f.
Details of sexual trauma.

g.
Hypervigilance or increased arousal.
2 points
QUESTION 2
1. What assessment tools might offer meaningful information on
this client?
Select the ONE
most appropriate option. (Refer to Case #1)
a.
Beck Anxiety Inventory
b.
Attachment Questionnaire for Children (AQC)

c.
Clinician Administered PTSD Scale for Children and
Adolescents (CAPS-CA)
d.
Child and Adolescent Needs and Strengths (CANS)
2 points
QUESTION 3
1. Based on the available information, what would appear to be
the most appropriate provisional DSM-5 diagnosis?
Select the ONE
most appropriate primary diagnosis. (Refer to Case #1)
a.
Disruptive Mood Dysregulation Disorder (296.99)
b.

Postttraumatic Stress Disorder (309.81)
c.
Acute Stress Disorder (308.3)
d.
Adjustment Disorder with Mixed Disturbance of Emotions and
Conduct (309.4)
2 points
QUESTION 4
1. Based on the provisional diagnosis, what interventions might
work best as you begin to work with this client?
Select AS MANY
as you consider indicated. (Refer to Case #1)
a.
Group Therapy

b.
Behavioral Rehearsal
c.
Grounding Techniques
d.
Play Therapy
e.
Flooding Techniques

f.
Medical Referral for Anxiety Medication
g.
Assertiveness Training
2 points
QUESTION 5
1. In developing a collaborative treatment plan with the client,
identify immediate goals to be addressed.
Select AS MANY
as you consider correct and necessary. (Refer to Case #1)
a.
Reunification with Biological Family
b.

Addressing Sexualized Behaviors
c.
Increasing Emotional Regulation
d.
Preventing Revictimization
e.
Reenactment of Traumatic Events
2 points
QUESTION 6
1.
Case #2 – Morgan
Morgan is staying at a local shelter after she experienced a
natural disaster that destroyed her home three days ago. She is a

25-year-old lesbian female who was living with her partner. She
has a flat affect and makes no eye contact as she talks about
having to vacate her home in the middle of the night as the
waters were filling her condo. Her partner did not make it out
and drowned in the storm. She has not made contact with any of
her other relatives who she says she has been distant from for
“many years.” She mentions that before the storm she was
taking “some meds to help with my moods” but is not sure of
the medication name. Since she arrived at the shelter, she has
laid in her cot, not taken any showers, eaten very little food,
and avoided any contact with shelter workers or other families.
She has a significant startle response when approached and has
difficulty remembering basic information. She cries herself to
sleep and has moments where she screams out at night after
having “nightmares about drowning.”
What intake information should be obtained and assessed to
formulate a provisional DSM-5 diagnosis? Select AS MANY as
you consider important.
a.
Substance abuse history
b.
Medical history

c.
Educational history
d.
Military history
e.
Quality of family relationships
f.
Psychiatric history
g.

Employment history
h.
Threat to self or others
2 points
QUESTION 7
1. What assessment tools might offer meaningful information on
this client?
Select the ONE
most appropriate option for your work while she is at the
shelter. (Refer to Case #2)
a.
Beck Depression Inventory
b.

Inventory of Complicated Grief
c.
Triage Assessment Form
d.
The Behavioral Assessment Rating Scales
2 points
QUESTION 8
1. Based on the available information, what is the most
appropriate provisional DSM-5 diagnosis?
Select the ONE
most appropriate primary diagnosis. (Refer to Case #2)
a.
Major Depressive Disorder, Single episode, Mild (296.21)

b.
Posttraumatic Stress Disorder (309.81)
c.
Generalized Anxiety Disorder (300.02)
d.
e.
Adjustment Disorder with Depressed Mood (309.3)
2 points
QUESTION 9
1. Based on the intake data, identify immediate potential issues

to be addressed as a crisis counselor while the client is in the
shelter.
Select AS MANY
as are correct and necessary. (Refer to Case #2)
a.
Hygiene
b.
Impulse Control
c.
Family Relationships
d.
Housing

e.
Suicidality
f.
Medication compliance
g.
Employment issues
h.
Stress management
2 points
QUESTION 10

1. Based on the provisional diagnosis, what theories or models
will likely work best for the client?
Select AS MANY
as you consider correct and appropriate in working with the
client while she is at the shelter. (Refer to Case #2)
a.
Group Therapy
b.
Psychological First Aid
c.
Existential Therapy
d.

Grief Therapy
e.
Maslow’s Hierarchy of Needs
2 points
QUESTION 11
1.
Case #3 - Bob
Bob is a 45 year old African American man. He was recently
medically discharged from the US Navy due to extensive
injuries he sustained during his last time in combat. He is
separated from his wife and has two teenage children. He has a
prescription for an opioid pain medication and discloses that he
has been engaging in daily marijuana use and drinks about 5-6
beers a day “to cope.” He has an extensive history of childhood
physical and emotional trauma. His mother was alcoholic and
his father was physically abusive to him and his siblings. He
says that he is struggling over the past few months with "what
could have been" if he was not so "damaged." He sounds very
agitated, stating that the pain is unbearable and he “can’t stand
it anymore.” He mentions that he might be better off dead.
Based on the available information, what would appear to be the
most appropriate provisional DSM-5 diagnosis?
Select the ONE

most appropriate.
a.
Adjustment Disorder with Mixed Disturbance of Emotions and
Conduct (309.4)
b.
Substance-Induced Anxiety Disorder (292.89)
c.
Posttraumatic Stress Disorder (309.81)
d.

e.
Generalized Anxiety Disorder (300.02)
2 points
QUESTION 12
1. To better determine the client’s current level of functioning
and behavioral problems, what additional data may be helpful?
Select AS MANY
as are necessary. (Refer to Case #3)
a.
Collateral contact with the medical provider.
b.
Collateral contact with his spouse and children.
c.

Military record review.
d.
Substance abuse screening.
e.
Legal history review.
2 points
QUESTION 13
1. Which of the following risk factors are present in the case
description?
Select AS MANY
a.
History of previous attempts.

b.
Specific plan.
c.
History of drug and/or alcohol use.
d.
Cut off from others.
e.
Lack of belongingness.

f.
Feelings of helplessness.
g.
Financial loss.
h.
Access to firearms.
i.
Radical shifts in behaviors and mood.
2 points
QUESTION 14
1. Indicate the responses that would be most appropriate for
addressing potential suicidal ideation.
Select AS MANY

as you consider correct. (Refer to Case#3)
a.
You say you are suicidal, but what’s really bothering you?
b.
You can tell me. I’m a professional and have been trained to
be objective about these things.
c.
It seems like you’ve been suffering so much that hurting
yourself seems like the only way you can make the pain go
away.
d.
You have so much to live for, think about your wife and

children.
e.
Tell me more about your suicidal feelings.
f.
You seem to be somewhat upset.
2 points
QUESTION 15
1. Based on the provisional diagnosis, what interventions and
referrals might work best for the client?
Select AS MANY
a.
Suicide Safety Plan

b.
Create a No Harm Contract
c.
Family Counseling
d.
Medication Review
e.
Cognitive Reframing
f.

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