NCMHCE practice test

Question 1 · Assessment and Diagnosis

A 34-year-old man reports three weeks of low mood, insomnia, and loss of interest following a layoff. He denies prior episodes and has no suicidal ideation. What is the most appropriate next step?

• Diagnose major depressive disorder and begin cognitive restructuring
• Complete a structured diagnostic interview including duration, functional impairment, and substance use before assigning a diagnosis
• Refer immediately for psychiatric medication evaluation
• Assign adjustment disorder with depressed mood and monitor

Question 2 · Assessment and Diagnosis

A client with a documented alcohol use disorder presents with new panic attacks. Which assessment question most directly clarifies the differential?

• How long have the panic attacks lasted?
• Do the attacks occur only during withdrawal or intoxication periods?
• Does anyone in your family have anxiety?
• What coping skills have you tried?

Question 3 · Risk Assessment

A client discloses passive suicidal ideation with no plan, no means, and strong protective factors. What is the counselor's first action?

• Initiate involuntary hospitalization
• Complete a full risk assessment covering intent, plan, means, history, and protective factors, then collaboratively develop a safety plan
• Contact the client's family immediately
• Continue the session agenda and revisit next week

Question 4 · Risk Assessment

Mid-session, a client's partner calls the office demanding information about the client's treatment. What do you do?

• Confirm the client is in treatment but share nothing else
• Neither confirm nor deny the client's status without a signed release
• Share only the diagnosis
• Ask the client in session whether it is okay while the partner waits on the line

Question 5 · Treatment Planning

A client meets criteria for PTSD and moderate alcohol use disorder. Which treatment sequencing decision is best supported?

• Complete trauma processing before addressing the drinking
• Stabilize safety and substance use while building coping resources, then move into trauma processing
• Treat only the alcohol use disorder and re-evaluate in a year
• Refer out because co-occurring disorders exceed counseling scope

Question 6 · Treatment Planning

Which of these is written as a measurable treatment plan objective?

• Client will feel less anxious
• Client will improve self-esteem
• Client will reduce GAD-7 score from 16 to 9 or below within 12 weeks
• Client will process childhood experiences

Question 7 · Counseling and Psychotherapy

A client in the contemplation stage of change says, 'I know I should cut back, but drinking is the only thing that relaxes me.' The most effective response is:

• Provide education on the health risks of alcohol
• Reflect the ambivalence and elicit the client's own change talk
• Set a quit date together
• Confront the rationalization directly

Question 8 · Counseling and Psychotherapy

A client with panic disorder avoids grocery stores. Which intervention has the strongest evidence base?

• Free association about the origin of the fear
• Graduated in-vivo exposure paired with interoceptive exposure and cognitive restructuring
• Relaxation training alone
• Supportive counseling until anxiety naturally remits

Question 9 · Counseling and Psychotherapy

A 15-year-old client asks that her parents not be told she is sexually active. Legally and ethically, the counselor should:

• Promise complete confidentiality to preserve rapport
• Tell the parents immediately
• Clarify the limits of confidentiality for minors under state law, explore the client's concerns, and encourage family communication where safe
• End treatment until parental consent is renegotiated

Question 10 · Core Counseling Attributes

A client from a collectivist cultural background defers all treatment decisions to her father. The culturally responsive response is to:

• Insist on individual autonomy as an ethical requirement
• Explore the client's own preferences and the family's role, and incorporate family involvement in a way she endorses
• Refer to a counselor of the same cultural background
• Document noncompliance with treatment planning

Question 11 · Core Counseling Attributes

You notice strong irritation toward a client who reminds you of a family member. The appropriate first step is:

• Terminate the counseling relationship
• Disclose the reaction to the client in session
• Recognize the countertransference and bring it to clinical supervision
• Ignore it because reactions do not affect treatment

Question 12 · Assessment and Diagnosis

A client scores in the clinical range on a screening instrument the counselor has never used with this population. What should the counselor do?

• Report the score as diagnostic
• Check the instrument's normative sample and validity for this population before interpreting the score
• Discard the result
• Re-administer the instrument the following week