NCMHCE - National Clinical Mental Health Counseling Examination Intake, Assessment, and Diagnosis 3 — Questions and Answers
Question 1: A client presents with persistent sadness, anhedonia, sleep disturbances, and reports that symptoms have been present for 3 weeks. Which diagnosis is MOST appropriate at this time?
- Major Depressive Disorder
- Persistent Depressive Disorder (Dysthymia)
- Adjustment Disorder with Depressed Mood
- Unspecified Depressive Disorder (Correct answer)
Correct answer: Unspecified Depressive Disorder
MDD requires symptoms for at least 2 weeks, but since a full diagnostic picture cannot be confirmed without ruling out other conditions, Unspecified Depressive Disorder is used when criteria are nearly but not fully met or information is insufficient.
Question 2: During a clinical intake, a counselor notices a client uses vague language, avoids eye contact, and provides minimal responses. The BEST next step is to:
- Confront the client about their resistance
- Use open-ended questions and reflective listening to build rapport (Correct answer)
- Immediately administer a structured diagnostic interview
- Refer the client to a psychiatrist
Correct answer: Use open-ended questions and reflective listening to build rapport
Building rapport through open-ended questions and reflective listening encourages a reluctant client to engage more openly during intake.
Question 3: Which DSM-5 criterion differentiates Bipolar I Disorder from Bipolar II Disorder?
- Presence of hypomanic episodes only in Bipolar I
- Presence of at least one full manic episode in Bipolar I (Correct answer)
- Depressive episodes are required only in Bipolar II
- Psychotic features occur only in Bipolar II
Correct answer: Presence of at least one full manic episode in Bipolar I
Bipolar I requires at least one full manic episode (lasting ≥7 days or requiring hospitalization), while Bipolar II involves hypomanic but not full manic episodes.
Question 4: A counselor is completing a biopsychosocial assessment. Which of the following best represents the 'social' component?
- Client's history of head trauma
- Client's cognitive distortions about failure
- Client's current employment status and family support system (Correct answer)
- Client's prescribed psychotropic medications
Correct answer: Client's current employment status and family support system
The social component of a biopsychosocial assessment covers environmental factors such as relationships, employment, housing, and support systems.
Question 5: A client reports hearing voices that comment on their behavior and expresses the belief that a TV news anchor is sending them secret messages. These symptoms are MOST consistent with:
- Delusional Disorder
- Brief Psychotic Disorder
- Schizophrenia (Correct answer)
- Schizophreniform Disorder
Correct answer: Schizophrenia
Third-person auditory hallucinations and ideas of reference are hallmark positive symptoms of Schizophrenia, especially when persistent.
Question 6: When assessing a client for Posttraumatic Stress Disorder (PTSD), the counselor must confirm that the traumatic event meets which DSM-5 Criterion A requirement?
- The client must have directly experienced the trauma
- Exposure must involve actual or threatened death, serious injury, or sexual violence (Correct answer)
- The client must have lost consciousness during the event
- The trauma must have occurred within the past 6 months
Correct answer: Exposure must involve actual or threatened death, serious injury, or sexual violence
DSM-5 Criterion A for PTSD specifies exposure to actual or threatened death, serious injury, or sexual violence through direct experience, witnessing, indirect learning, or repeated exposure.
Question 7: A client scores 22 on the PHQ-9 during intake. What does this score indicate, and what is the counselor's PRIORITY action?
- Mild depression; schedule a follow-up in 4 weeks
- Moderate depression; initiate CBT immediately
- Severe depression; conduct a suicide risk assessment (Correct answer)
- Minimal depression; provide psychoeducation only
Correct answer: Severe depression; conduct a suicide risk assessment
A PHQ-9 score of 20–27 indicates severe depression, and the counselor's priority is to assess for suicidality given the elevated risk.
NCMHCE - National Clinical Mental Health Counseling Examination Intake, Assessment, and Diagnosis 3
A client presents with persistent sadness, anhedonia, sleep disturbances, and reports that symptoms have been present for 3 weeks.
Which diagnosis is MOST appropriate at this time?