National Counselor Examination (NCE) — All Questions

During a mental status exam, a client says her mood is "fine" while tears run down her face. How should the counselor describe this in the MSE?

• a.Mood and affect are incongruent✓
• b.Thought content is delusional
• c.Perceptual disturbance is present
• d.Insight is intact and mood is euthymic

In the MSE, mood is what the client subjectively reports and affect is the emotion others can observe; a mismatch between them is noteworthy and is recorded as incongruence. Nothing in the scenario suggests a fixed false belief (thought content) or hallucinations (perception), and calling mood euthymic would ignore the visible distress.

A counselor asks a client what the saying "People in glass houses shouldn't throw stones" means. The client says, "Glass breaks easily." This response most directly suggests difficulty with:

• a.attention span
• b.long-term memory recall
• c.orientation
• d.abstract thinking✓

Proverb interpretation assesses abstract thinking; a literal, concrete answer suggests the client does not grasp the larger meaning. Long-term memory is assessed through past life events, attention through tasks such as simple calculations, and orientation through awareness of person, place, and time.

A client earns a T-score of 60 on a normally distributed scale (mean 50, SD 10). Approximately what percentile is this?

• a.60th
• b.84th✓
• c.98th
• d.70th

A T-score of 60 is one standard deviation above the mean (z = (60 - 50) / 10 = +1). In a normal distribution about 50% of scores fall below the mean and about 34% fall between the mean and +1 SD, so 50 + 34 = about the 84th percentile. The 98th percentile corresponds to about +2 SD, and 60th or 70th confuses the raw T value with a percentile.

On an intelligence test with a mean of 100 and a standard deviation of 15, a client scores 70. Approximately what percentile is this score?

• a.70th
• b.16th
• c.2nd✓
• d.30th

A score of 70 is two standard deviations below the mean (z = (70 - 100) / 15 = -2). About 2.3% of a normal distribution falls below -2 SD, so the score is near the 2nd percentile. The 16th percentile corresponds to -1 SD (a score of 85), and 30th or 70th treats the score itself as a percentile.

A counselor gives the same anxiety inventory to a group twice, two weeks apart, and correlates the two sets of scores. What is being estimated?

• a.Predictive validity
• b.Internal consistency reliability
• c.Test-retest reliability✓
• d.Interrater reliability

Correlating scores from two administrations of the same test to the same people over time estimates test-retest reliability, or stability. Internal consistency comes from a single administration (for example, coefficient alpha). Predictive validity correlates scores with a later criterion, and interrater reliability compares different scorers.

An employer correlates applicants' scores on a screening test with their job performance ratings one year later. This study provides evidence of:

• a.face validity
• b.test-retest reliability
• c.predictive validity✓
• d.content validity

Predictive validity is a type of criterion-related validity in which test scores are correlated with a criterion measured later, such as job performance. Content validity concerns how well items sample the domain, test-retest reliability concerns score stability, and face validity is only whether a test appears to measure its target.

A client's observed score is 100 on a test whose standard error of measurement (SEM) is 3. Which range gives an approximately 95% confidence band for the client's true score?

• a.91 to 109
• b.94 to 106✓
• c.98 to 102
• d.97 to 103

A 95% band is about the observed score plus or minus 2 SEM (1.96 more precisely): 100 plus or minus 6 gives 94 to 106. Plus or minus 1 SEM (97 to 103) gives only about a 68% band, plus or minus 3 SEM (91 to 109) gives about 99.7%, and 98 to 102 matches no standard band.

A licensure exam sets a fixed passing score based on mastery of required content, regardless of how other candidates perform. This is an example of:

• a.ipsative interpretation
• b.percentile-rank interpretation
• c.criterion-referenced interpretation✓
• d.norm-referenced interpretation

Criterion-referenced interpretation compares performance with a fixed standard of mastery. Norm-referenced interpretation, including percentile ranks, compares a person with a reference group. Ipsative interpretation compares a person's scores with their own other scores.

A counselor wants to use a depression inventory with a recent immigrant client, but the instrument was normed only on U.S.-born adults. According to the ACA Code of Ethics, what is appropriate?

• a.Use it as normal, since standardized norms apply to all clients
• b.Use it with caution and interpret results in light of the client's culture✓
• c.Rely on the score alone to avoid subjective bias
• d.Translate the items into her language and score them with the published U.S. norms

ACA Code E.8 directs counselors to select and use with caution assessment techniques normed on populations other than the client's, and to consider culture, language and other factors when interpreting, placing results in perspective with other information. Assuming norms fit everyone ignores E.8. Translating items without permission violates E.10, and relying on a single score conflicts with E.6.a's preference for multiple sources of data.

To accommodate a client with a visual impairment, a counselor reads a standardized inventory aloud instead of having the client complete it as standardized. What does the ACA Code require?

• a.Report the scores without comment, since the accommodation was ethical
• b.Discard the results, since only standard administration is permitted
• c.Note the nonstandard conditions in the interpretation✓
• d.Rescore the inventory using norms for clients with disabilities

ACA Code E.7.a states that when assessments are not administered under standard conditions, as may be needed to accommodate clients with disabilities, those conditions are noted in interpretation and the results may be designated invalid or of questionable validity. Reporting without comment hides the change; accommodations are expressly contemplated, so discarding is not required; and no alternate norm set is assumed to exist.

According to SAMHSA TIP 50, which client behavior is a DIRECT warning sign of acute suicide risk?

• a.Looking for ways to obtain a firearm✓
• b.Driving recklessly after drinking
• c.Showing more irritability than usual
• d.Withdrawing from friends over several weeks

TIP 50 lists direct warning signs as suicidal communication, seeking access to a method (such as firearms or pills), and making preparations; these get the highest priority. Withdrawal, recklessness, and anger or mood changes are indirect warning signs in the IS PATH WARM mnemonic; they still require follow-up questions.

A client scores 16 on the PHQ-9. Using the severity bands published by the instrument's developers, this score indicates depression that is:

• a.severe
• b.moderate
• c.mild
• d.moderately severe✓

Kroenke, Spitzer and Williams (2001) set PHQ-9 cut points of 5, 10, 15 and 20 for mild, moderate, moderately severe and severe depression, so 15 to 19 is moderately severe. A score of 16 is above the moderate range (10 to 14) and below the severe range (20 to 27). The screen informs, but does not replace, a diagnostic interview.

A counselor wants a brief screening tool for hazardous and harmful alcohol use that was developed by the World Health Organization. Which instrument fits?

• a.BDI-II
• b.MMPI
• c.AUDIT✓
• d.Strong Interest Inventory

The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item screen developed by the WHO covering alcohol consumption, dependence symptoms, and alcohol-related harm. The BDI-II measures depressive symptoms, the Strong Interest Inventory measures career interests, and the MMPI is a broad personality and psychopathology inventory.