CRC Exam (Certified Rehabilitation Counselor) — All Questions

A client sustained a spinal cord injury at the cervical level and has paralysis affecting all four limbs. This condition is called:

• a.Paraplegia
• b.Hemiplegia
• c.Monoplegia
• d.Tetraplegia✓

NINDS explains that injury to the upper part of the spinal cord can cause paralysis affecting all limbs (tetraplegia, also called quadriplegia), while injury lower on the cord may affect only the lower body and legs (paraplegia). Hemiplegia is paralysis of one side of the body, typical after stroke, and monoplegia affects a single limb.

A client with a high thoracic spinal cord injury suddenly develops a pounding headache, flushing, sweating, and a sharp rise in blood pressure at work. Which condition should the counselor recognize as a medical emergency?

• a.Orthostatic hypotension
• b.Spasticity
• c.A pressure injury
• d.Autonomic dysreflexia✓

NINDS describes autonomic dysreflexia as a life-threatening reflex reaction, mainly in people with injuries to the neck or upper back, with symptoms such as flushing or sweating, pounding headache, anxiety, and a sudden increase in blood pressure. Orthostatic hypotension is a drop in blood pressure, spasticity is increased muscle tone, and pressure injuries are skin breakdown without this acute blood-pressure surge.

A newly diagnosed client with multiple sclerosis has had attacks of blurred vision and leg weakness followed by periods of partial or total recovery. According to NINDS, which course of MS does this describe, and how common is it at diagnosis?

• a.Relapsing-remitting; most people are first diagnosed with it✓
• b.Primary-progressive; most people are first diagnosed with it
• c.Secondary-progressive; it is the rarest course at diagnosis
• d.Relapsing-remitting; it is the rarest course at diagnosis

NINDS describes relapsing-remitting MS as recurrent attacks with total or partial recovery and states that most people with MS are initially diagnosed with this form. Primary-progressive MS worsens from the start without noticeable acute attacks and is less common, secondary-progressive MS evolves later from relapsing-remitting MS, and NINDS identifies radiologically isolated syndrome as the rarest course.

A medical report states that a client has dysphagia after a stroke. What limitation should the counselor anticipate?

• a.Difficulty speaking
• b.Difficulty reading
• c.Difficulty swallowing✓
• d.Difficulty walking

Dysphagia means difficulty swallowing (from the Greek 'phagein', to eat), which can affect eating at work and may require diet or schedule adjustments. Difficulty producing or understanding language is aphasia, difficulty with speech articulation is dysarthria, difficulty reading is alexia or dyslexia, and difficulty walking is a gait disorder.

A counselor uses the World Health Organization's International Classification of Functioning, Disability and Health (ICF) to plan services. How does the ICF view disability?

• a.As a fixed trait determined solely by the diagnosed medical condition
• b.As a label that applies only to people who are unable to work at all
• c.As an interaction between a health condition and contextual factors✓
• d.As a legal status granted once a physician certifies the impairment

The ICF describes functioning and disability as the result of a dynamic interaction between health conditions and contextual factors, both environmental and personal, across body functions and structures, activities, and participation. It rejects a purely medical, fixed-trait view, is not tied to work capacity, and is a classification rather than a legal status.

A client with schizophrenia who has taken a first-generation antipsychotic for many years develops involuntary movements of the lips, tongue, and face. Which side effect does this most likely represent?

• a.Tardive dyskinesia✓
• b.Serotonin syndrome
• c.Orthostatic hypotension
• d.Lithium toxicity

NIMH's guide to mental health medications notes that long-term use of antipsychotics can cause tardive dyskinesia, a condition of uncontrollable muscle movements, commonly around the mouth. Serotonin syndrome is linked to serotonergic drugs and causes agitation and fever, orthostatic hypotension is a blood-pressure drop on standing, and lithium toxicity occurs with lithium rather than antipsychotics.

A client reports two weeks of depressed mood and loss of interest nearly every day that is interfering with her work. Another client has had milder depressive symptoms for three years. According to NIMH, which pairing is correct?

• a.Persistent depressive disorder; major depression
• b.Seasonal affective disorder; major depression
• c.Major depression; persistent depressive disorder✓
• d.Bipolar disorder; seasonal affective disorder

NIMH describes major depression as depressed mood or loss of interest most of the time for at least 2 weeks that interferes with daily activities, and persistent depressive disorder (dysthymia) as less severe symptoms lasting at least 2 years. The reversed pairing mismatches the durations, seasonal affective disorder follows a seasonal pattern, and bipolar disorder requires manic or hypomanic episodes.

A client who is Deaf tells her CRC she prefers to be described as "Deaf" rather than as "a person with hearing loss." What does the CRCC Code direct?

• a.Use person-first language, because the Code requires it in all records
• b.Use whichever term appears in the client's audiology report
• c.Avoid naming the disability in conversations with the client
• d.Use the affirming language the client prefers✓

Standard D.3.e directs CRCs to recognize the evolving nature of identity language and use sensitive, affirming language aligned with the client's preference, giving person-first and identity-first language as examples; the Glossary cites 'Deaf' as an identity-first example. The Code does not mandate person-first language, defer to an audiology report, or require avoiding the topic.

An employer tells a CRC, "People in wheelchairs can't handle stress, so I only put them in back-office jobs." Which barrier does this illustrate, and what does the CRCC Code expect?

• a.An architectural barrier that the CRC reports to building inspectors
• b.A legal barrier that only the client's attorney can address
• c.A programmatic barrier outside the CRC's professional role
• d.An attitudinal barrier that the CRC recognizes and addresses✓

Standard C.1.a directs CRCs to recognize and address attitudinal barriers, including stigma, stereotyping, and discrimination, in settings such as employment. The employer's statement is a stereotype, not a physical feature of a building, and the Code treats addressing it as part of the CRC's advocacy role rather than something reserved for attorneys or outside the role.

Under the ADA as amended, a client with epilepsy whose seizures are fully controlled by medication asks whether she can still be considered to have a disability. What is correct?

• a.Yes, because mitigating measures such as medication are not considered✓
• b.No, because a controlled condition cannot substantially limit anything
• c.No, because epilepsy is covered only if seizures occur at work
• d.Yes, but only if she has also been denied a job in the past

Under 29 CFR 1630.2(j)(1)(vi), whether an impairment substantially limits a major life activity is determined without regard to the ameliorative effects of mitigating measures such as medication (ordinary eyeglasses are the exception), and 1630.2(j)(3)(iii) states epilepsy substantially limits neurological function. Coverage does not depend on seizures at work or on a prior job denial.