Practice Exam B: The 2027 NCE Format

Part 1: Items 1–70

1. Item 1

   Anoushka, 33, joins her scheduled video session from her car while driving on the highway. She says the commute is the only free time she has this week. What is the counselor’s BEST response?

   ASwitch to audio only so that Anoushka can keep her eyes on the road while they talkBPause until Anoushka is parked in a safe, private place, or reschedule the sessionCContinue by video but keep to lighter topics until she reaches her destination
   Show answer and rationaleHide answer and rationale

   Answer: B. Telemental health requires a setting that is both safe and private, and a client driving on a highway has neither, so the counselor waits until Anoushka is parked somewhere private or reschedules; this expectation belongs in telemental health consent and in the counselor’s judgment that the format suits the client’s circumstances (American Counseling Association [ACA], 2014, Standards H.2.a, H.4.c).

   Why the wrong answers tempt you: A pulls because hands-free calls are common, but emotional material still divides her attention and audio does nothing for privacy, and C feels like a compromise, yet lighter topics make driving no safer and the car no more private.

   • Chapter(s): 4
   • 2027 NCE: 6.4 (also 2A.7)
   • Source(s): American Counseling Association (2014), Standards H.2.a, H.4.c; Barnett and Kolmes (2016)
2. Item 2

   For two months, Tomás has counseled a woman whose young son died in a house fire. Between sessions he keeps picturing the fire as she described it, startles at the smell of smoke, and has begun to dread her appointments. His caseload is manageable, and the rest of his work still feels rewarding. Which step BEST addresses his strain?

   ABring these reactions to supervision, and seek counseling of his own if they persistBAsk his supervisor to lighten his caseload and paperwork, since workload drives his strainCTransfer the client to a colleague, since his reactions show he cannot work with her
   Show answer and rationaleHide answer and rationale

   Answer: A. Intrusive images, a startle response, and dread tied to one client’s traumatic story are marks of secondary traumatic stress, the fear-driven part of compassion fatigue that comes from work-related exposure to people who have lived through traumatic events (Figley, 1995; Stamm, 2010). Supervision is the first place to bring such reactions, and counseling of his own is a sound next step if they persist.

   Why the wrong answers tempt you: B pulls because lightening the load is the remedy for burnout, which builds gradually from chronic job demands (Maslach & Leiter, 2016; Stamm, 2010), but his caseload is manageable and his reactions trace to one client’s trauma; C treats the reaction as disqualifying, when referral fits only if he cannot keep it from harming the client, a judgment supervision helps him make.

   • Chapter(s): 3 (Counselor wellness: three different kinds of wear; Self-regulation and self-care); also 1 (Impairment)
   • 2027 NCE: 1B.1 (also skill: recognizing vicarious trauma and burnout)
   • Source(s): Figley (1995); Maslach and Leiter (2016); Stamm (2010)
3. Item 3

   Teodor, 52, is referred by his physician, whose note reads “depression, rule out anxiety.” The counselor has already reviewed informed consent and the limits of confidentiality with him. What should the counselor do NEXT?

   AAsk Teodor to describe, in his own words, what brings him in and why nowBGive him a depression inventory to confirm the physician’s diagnosisCRecord the physician’s note as the presenting problem and move to his history
   Show answer and rationaleHide answer and rationale

   Answer: A. Once consent is complete, the counselor hears the presenting problem in the client’s own words, including why he is seeking help now, because client self-report is the primary source of intake data and a referral note is someone else’s impression (NBCC, 2026, task 2A.3).

   Why the wrong answers tempt you: B pulls because an instrument seems to add objectivity, but a screen flags a possible problem and cannot confirm a diagnosis, and C saves time yet replaces Teodor’s account with his physician’s.

   • Chapter(s): 5 (Tasks and their order; Self-report, barriers, and collateral information); also 8 (screens)
   • 2027 NCE: 2A.3 (skill: conducting a clinical/diagnostic interview)
   • Source(s): NBCC (2026)
4. Item 4

   In a couples session based on the Gottman method, Adaeze, 38, says to her husband, Chidi, “You never think about anyone but yourself. You left me alone with the kids all weekend again.” Which intervention BEST fits the Gottman method at this point?

   AAsk Chidi to describe how blame was handled in his family of origin, to trace where the pattern beganBCoach Adaeze to restate the complaint as a gentle start-up that names her feelings and what she needsCSuggest that the couple set the topic aside until both are calm, since raising complaints tends to escalate
   Show answer and rationaleHide answer and rationale

   Answer: B. Adaeze’s opening attacks Chidi’s character rather than a behavior, which is criticism, and the Gottman antidote is a gentle start-up: an “I” statement about a specific situation plus a positive need (The Gottman Institute, 2013).

   Why the wrong answers tempt you: A pulls because family-of-origin patterns matter in many models, but it is a Bowenian move that skips the in-the-moment skill the Gottman method builds, and C sounds calming, and Gottman does teach taking a break, but as the antidote to stonewalling when someone is flooded, which nothing here shows; for criticism the antidote is to complain without blame, not to set the complaint aside.

   • Chapter(s): 28 (The Gottman method)
   • 2027 NCE: 4.1
   • Source(s): The Gottman Institute (2013)
5. Item 5

   Joanna, a counselor at a community agency, is covering for a colleague who is on unexpected medical leave. Her first appointment today is with Teodoro, 46, whom she has never met. He has been in counseling for depression for 5 months. What should Joanna do FIRST?

   AReview his treatment plan, recent progress notes, and latest risk assessment before he arrivesBConduct a full intake interview so her impressions are not shaped by another counselor’s notesCAsk Teodoro at the start of the session to summarize what he has worked on so far
   Show answer and rationaleHide answer and rationale

   Answer: A. Reviewing the record before the session lets the plan, the latest risk assessment, and any open commitments shape the hour, and records exist to support continuity of care when a different counselor steps in (American Counseling Association [ACA], 2014, Standard A.1.b).

   Why the wrong answers tempt you: B sounds like admirable objectivity, but re-interviewing a client 5 months into treatment ignores the record and any risk history in it, and C is a reasonable thing to do once he arrives but not a replacement for preparing beforehand.

   • Chapter(s): 4 (also 21, disruption of service)
   • 2027 NCE: 5.6
   • Source(s): American Counseling Association (2014), Standard A.1.b
6. Item 6

   Thaddeus, a counselor at a community mental health agency, gets a call from the office of a psychiatrist who has just begun treating Thaddeus’s client Dariusz, 47. The caller asks for Dariusz’s most recent treatment summary and says Dariusz approved the request at his appointment. Agency policy requires a signed release on the agency’s form before any record leaves the agency. What is Thaddeus’s BEST response?

   AExplain the release requirement, and ask Dariusz to sign a release before sending the summaryBSend the summary today, since HIPAA permits disclosures to another provider for treatmentCDecline, and tell the caller that Dariusz must request his records from the agency in person
   Show answer and rationaleHide answer and rationale

   Answer: A. HIPAA permits a disclosure to another provider for treatment without the client’s authorization, but it does not require one, and the same rule lets a covered entity obtain the client’s consent first (Uses and Disclosures to Carry Out Treatment, Payment, or Health Care Operations, 2026). HIPAA is a floor: the agency’s stricter policy and the Code’s expectation of written permission before records go to third parties (Standard B.6.g) govern here, and a signed release also confirms that Dariusz actually agreed.

   Why the wrong answers tempt you: B is the strongest distractor because its statement of HIPAA is accurate (Uses and Disclosures to Carry Out Treatment, Payment, or Health Care Operations, 2026), yet task 6.2 is about following the agency’s own procedure, and C overcorrects by blocking a legitimate request instead of obtaining the release that allows it.

   • Chapter(s): 2 (also 4)
   • 2027 NCE: 6.2 (also 6.3, 5.3)
   • Source(s): American Counseling Association (2014), Standard B.6.g; Uses and Disclosures to Carry Out Treatment, Payment, or Health Care Operations, 45 C.F.R. § 164.506(b)(1), (c)(2) (2026)
7. Item 7

   Esperanza, 44, seeks counseling for insomnia, frequent arguments with her adult son, grief over her sister’s death last spring, and stress at work. A risk screening finds no suicidal thoughts, substance misuse, or safety concerns. She says, “If I could just sleep, I could handle the rest.” Which approach to ordering her concerns is BEST?

   ABegin with her grief, since unresolved loss most likely underlies the other three problems she describesBBegin with her sleep, since she ranks it first and it appears to worsen the other problemsCRotate among all four concerns from week to week, so that no single problem goes unaddressed for long
   Show answer and rationaleHide answer and rationale

   Answer: B. Once safety and basic needs are cleared, problems are ordered by the client’s own priorities weighed against what causes the most impairment or keeps other problems going, and her insomnia meets both tests (NBCC, 2026, task 3A.1).

   Why the wrong answers tempt you: A substitutes the counselor’s untested root-cause theory for the client’s ranking (her grief stays on the plan; it simply does not go first), and C sounds even-handed but avoids prioritizing at all.

   • Chapter(s): 20 (sleep concerns: 13)
   • 2027 NCE: 3A.1
   • Source(s): NBCC (2026)
8. Item 8

   A pediatric primary care clinic screens every patient age 12 and older with the Ask Suicide-Screening Questions (ASQ). Sienna, 14, answers yes to the item about wishing she were dead in the past few weeks and no to the other three items. Asked whether she is having thoughts of killing herself right now, she says no. What should happen NEXT?

   AArrange immediate emergency transport for a full psychiatric evaluationBRecord a negative screen, since she has no current thoughts of killing herselfCComplete a brief suicide safety assessment with her before she leaves the clinic
   Show answer and rationaleHide answer and rationale

   Answer: C. A yes to any of the four ASQ screening items makes the screen positive; a no to the acuity question (“right now”) makes it a non-acute positive, which calls for a brief suicide safety assessment before the patient leaves, to decide whether a full mental health evaluation is needed (Horowitz et al., 2012; National Institute of Mental Health [NIMH], n.d.).

   Why the wrong answers tempt you: A fits an acute positive (a yes to thoughts of killing herself right now), which calls for an urgent full safety evaluation, so it overreacts to her answers, while B treats the acuity question as the whole screen and ignores the yes the screen exists to catch.

   • Chapter(s): 5 (Suicide and violence risk: Ask directly); also 29
   • 2027 NCE: 2B.2 (also 2B.9)
   • Source(s): Horowitz et al. (2012); NIMH (n.d.)
9. Item 9

   Ji-woo, a licensed counselor who completed training in dialectical behavior therapy last year, wants a more experienced colleague’s help using behavior chain analysis with a client’s binge-eating episodes. Which approach to this consultation is MOST consistent with the ACA Code of Ethics?

   ASend the colleague the client’s full record so the advice reflects the whole caseBAsk the colleague to direct the client’s treatment until Ji-woo is confident with the techniqueCShare only the details the question requires, without identifying the client absent consent
   Show answer and rationaleHide answer and rationale

   Answer: C. When consulting, counselors share only what the consultation requires and do not disclose information that could identify the client without the client’s prior consent, unless disclosure cannot be avoided (American Counseling Association [ACA], 2014, Standards B.7.a, B.7.b). The consultee keeps responsibility for the client’s care.

   Why the wrong answers tempt you: A pulls because more information seems to produce better advice, but the full record discloses far more than a question about one technique needs; B confuses consultation with supervision or a transfer of care, when a consultant advises and the counselor stays responsible.

   • Chapter(s): 3 (Consultation: what makes it consultation); also 1 (Consultation as the default move)
   • 2027 NCE: 1A.1
   • Source(s): ACA (2014), Standards B.7.a, B.7.b
10. Item 10

    Ms. Lindqvist says her son, Erik, 14, ignores every rule she sets, and her husband agrees that the boy “walks all over her.” A structural family counselor wants to see, and begin to change, how the parents handle rule-setting. Which intervention BEST fits this approach?

    AHave the parents agree on Erik’s curfew together in the session while the counselor keeps Erik from interruptingBMeet with each family member alone, so that each one can describe the conflict without being interrupted by the othersCAsk each parent to draw a three-generation genogram showing how rules were handled in the families they grew up in
    Show answer and rationaleHide answer and rationale

    Answer: A. An enactment brings the problem interaction into the room so the counselor can see it and reshape it on the spot, and having the parents agree together while Erik is kept out strengthens the parental subsystem and its boundary (Minuchin, 1974; Minuchin & Fishman, 1981).

    Why the wrong answers tempt you: B gathers each person’s account but hides the live interaction a structural counselor works with, and C is a Bowenian assessment of multigenerational patterns rather than a structural intervention on present-day hierarchy.

    • Chapter(s): 28 (Minuchin: structural family therapy)
    • 2027 NCE: 4.1
    • Source(s): Minuchin (1974); Minuchin and Fishman (1981)
11. Item 11

    Ingrid holds a full license in her home state, a member of the Counseling Compact, and a privilege to practice in a neighboring member state, where she sees four clients by telehealth. After a recordkeeping complaint, her home-state board places her license on probation that restricts her practice. What happens to her privilege to practice in the neighboring state?

    AIt continues unchanged, because the neighboring state’s board has taken no action against herBIt continues for her current clients there, but she may not accept new clients in that stateCIt is lost until her home license is unencumbered and 2 years pass, so she must transition those clients
    Show answer and rationaleHide answer and rationale

    Answer: C. A Compact privilege rests on an unencumbered home-state license; probation that restricts practice is an encumbrance, and it ends the privilege in every remote state until the home license is no longer encumbered and she has had no encumbrance for 2 years (Counseling Compact, Section 4.E; Counseling Compact Commission, n.d.). Ingrid must stop practicing in the neighboring state and transition those clients so that they are not abandoned (Standard A.12).

    Why the wrong answers tempt you: A pulls because the remote state took no action, but the privilege depends on the home license, and B borrows the familiar idea of letting current clients finish, which the Compact does not provide.

    • Chapter(s): 4 (also 1)
    • 2027 NCE: 6.13 (also 6.6)
    • Source(s): Counseling Compact Commission (n.d.); American Counseling Association (2014), Standard A.12
12. Item 12

    A counselor’s draft objective for Seo-yeon, 15, reads: “Seo-yeon will participate more in class.” Which revision BEST meets SMART criteria?

    ASeo-yeon will feel much more comfortable speaking up in her classes by the end of the semesterBSeo-yeon will give a 10-minute talk to the entire student body at an assembly by the end of next weekCSeo-yeon will answer a question aloud in class on 4 of 5 days, per a teacher log, by March 1
    Show answer and rationaleHide answer and rationale

    Answer: C. A SMART objective names an observable behavior, a count, a data source, and a deadline, and it sets a target the client can realistically reach (NBCC, 2026).

    Why the wrong answers tempt you: A includes a deadline, so it looks time-bound, but “feel more comfortable” cannot be counted, while B is specific, measurable, and dated yet neither attainable nor realistic as a first step for a teen whose aim is to participate more in class.

    • Chapter(s): 20
    • 2027 NCE: 3A.2
    • Source(s): NBCC (2026)
13. Item 13

    Tomasz, 58, started a new antidepressant 4 weeks ago. In a session his wife attends at his invitation, he says the medication “has no side effects.” His wife says he has been dizzy when he stands up and nearly fell twice this week. How should the counselor document this?

    ARecord only Tomasz’s statement, since only the client’s own report of medication effects belongs in his recordBRecord his wife’s account as the finding, since family observations are more objective than self-reportCRecord both accounts, attributing each to its source, and with his consent inform his prescriber
    Show answer and rationaleHide answer and rationale

    Answer: C. Task 5.4 asks the counselor to record the client’s self-reported medication effects, and an accurate record also includes a family member’s report, attributed to its source rather than dropped or promoted to a finding (Standard A.1.b). Dizziness with near-falls is information the prescriber needs, and passing it on with Tomasz’s consent keeps the counselor in role, since judging whether the medication is the cause belongs to the prescriber (Standard C.2.a).

    Why the wrong answers tempt you: A pulls because task 5.4 centers on the client’s self-report, but leaving out a safety-relevant report makes the record incomplete, and B sounds rigorous, yet the counselor cannot know which account is accurate and should record each as reported.

    • Chapter(s): 14 (also 4)
    • 2027 NCE: 5.4 (also 5.1, 5.3)
    • Source(s): American Counseling Association (2014), Standards A.1.b, C.2.a
14. Item 14

    At the end of an intake, Nnenna, 39, a home health aide with no health insurance, says she wants weekly counseling. She adds that at the practice’s full fee she could afford only one session a month. What should the counselor do before setting up ongoing sessions?

    AOffer monthly sessions at the full fee, since the practice’s fees should be the same for every clientBDiscuss the cost openly and explore options such as a reduced fee, if the practice allows one, or an affordable community programCBegin weekly sessions now and take up the question of payment once she has seen whether counseling helps
    Show answer and rationaleHide answer and rationale

    Answer: B. Evaluating barriers to service, cost among them, is a named 2027 intake task, and when a counselor’s usual fees would create undue hardship, the Code allows adjusting the fee where legally permissible or helping the client find comparable, affordable services (NBCC, 2026, task 2A.2; American Counseling Association [ACA], 2014, Standard A.10.c).

    Why the wrong answers tempt you: A sounds fair and consistent, but it lets cost rather than her needs set the schedule without exploring the options the Code names, and C seems generous, yet fees and billing arrangements belong in informed consent before services begin (Standard A.2.b), and postponing the question builds a debt she has already said she cannot pay.

    • Chapter(s): 5 (Self-report, barriers, and collateral information); also 4 (Fees and the client)
    • 2027 NCE: 2A.2 (knowledge: barriers to service)
    • Source(s): NBCC (2026); ACA (2014), Standards A.2.b, A.10.c
15. Item 15

    Hyun-woo, 29, a Korean American graduate student, seeks help for anxiety. In the first session he says his parents believe that seeing a counselor brings shame on a family, and he has not told them he is coming. Which response BEST explores the impact of his cultural context?

    A“Attitudes about counseling have changed a great deal, so try not to let your parents’ view worry you.”B“Because that view is common in Korean families, we could call these sessions academic coaching if they ask.”C“What is it like to come here, knowing how your parents see it, and how does that shape what you hope for?”
    Show answer and rationaleHide answer and rationale

    Answer: C. Exploring culture means asking what his family’s view means to him and how it affects his goals, rather than assuming its weight or its source (Ratts et al., 2016; Sue et al., 2022).

    Why the wrong answers tempt you: A sounds supportive but dismisses a value that clearly matters to him, and B looks culturally sensitive but stereotypes Korean families and builds a cover story he never asked for.

    • Chapter(s): 33 (worldview; acculturation); also 34
    • 2027 NCE: 4.2
    • Source(s): Ratts et al. (2016); Sue et al. (2022)
16. Item 16

    Akira’s agency subscribes to an online service that scores the MMPI-3 and produces a narrative interpretive report. Akira has never been trained on the MMPI-3, but a coworker tells him the report “does the interpreting for you.” What should Akira do?

    AGive the test and rely on the report, since the publisher’s software has been validatedBGet training in the MMPI-3 before using it, or refer clients who need it to a qualified colleagueCGive the test and hand the client the report, so the client can judge its accuracy
    Show answer and rationaleHide answer and rationale

    Answer: B. Counselors use only assessments they are trained and competent to use, and a counselor who relies on a computer-generated interpretation must first be trained in the construct and the specific instrument. The counselor, not the software, remains responsible for interpretation (ACA, 2014, Standards E.2.a, E.2.b).

    Why the wrong answers tempt you: A pulls because publisher software sounds authoritative, but validated scoring does not make an untrained user able to judge whether the narrative fits this client; C hands an uninterpreted report to the person least equipped to evaluate it, when clients are owed an explanation of results and the basis for conclusions (Standard E.1.b).

    • Chapter(s): 8 (Using tests ethically: competence); also 7
    • 2027 NCE: 1B.8
    • Source(s): ACA (2014), Standards E.1.b, E.2.a, E.2.b
17. Item 17

    Kwesi’s practice uses an AI tool, with each client’s written consent, that drafts progress notes from session audio. In the draft for his session with Mirela, 52, he finds the line “Client denied suicidal ideation,” although suicide never came up in the session. What should Kwesi do FIRST?

    ACorrect the draft so that it reflects only what happened in the session before signing itBSign the draft, since recording no suicidal ideation is a safe default when no risk was observedCDelete the draft and leave the session undocumented until the vendor corrects the tool
    Show answer and rationaleHide answer and rationale

    Answer: A. The counselor is accountable for every note he signs, and records must accurately reflect the services provided (Standard A.1.b), so an AI draft that documents an assessment that never took place is corrected before signing; Kwesi can then report the error to the practice and decide whether to assess risk next session (ACA, 2024; NBCC, 2024).

    Why the wrong answers tempt you: B pulls because no risk was observed, but “denied suicidal ideation” records an answer to a question that was never asked, a false entry that could mislead anyone who later relies on the record, and C trades one documentation failure for another.

    • Chapter(s): 4
    • 2027 NCE: 6.19 (also 6.11, 5.8)
    • Source(s): American Counseling Association (2014), Standard A.1.b; American Counseling Association (2024); National Board for Certified Counselors (2024)
18. Item 18

    Ezekiel, 71, a deacon in his Baptist church, began counseling after the death of his wife of 45 years. He says, “The Lord doesn’t give us more than we can bear, so I shouldn’t need to be here.” His counselor does not share his faith. Which response BEST fits?

    AAsk how his faith has carried him through hard times before and whether he wants it to be part of counselingBGently point out that the belief is irrational, since it turns needing help into a failure of faithCSteer the conversation back to his grief symptoms, since religious beliefs fall outside the counselor’s role
    Show answer and rationaleHide answer and rationale

    Answer: A. Counselors explore a client’s spiritual beliefs as possible sources of strength and let the client decide whether and how they enter counseling, without imposing their own values (American Counseling Association [ACA], 2014, Standard A.4.b; Cashwell & Watts, 2010).

    Why the wrong answers tempt you: B borrows a disputing technique, but labeling a client’s faith irrational imposes the counselor’s worldview, and C feels like staying in one’s lane, yet avoiding religion ignores what is shaping how he grieves and whether he feels entitled to help.

    • Chapter(s): 34 (Religion and spirituality); also 15
    • 2027 NCE: 4.2
    • Source(s): ACA (2014), Standard A.4.b; Cashwell and Watts (2010)
19. Item 19

    Partway through an intake, Gloria, 70, mentions that last night she saw a man standing in her dark bedroom. When she switched on the lamp, she realized it was her coat hanging on the closet door, and she laughs about it now. On the mental status examination, this experience is BEST recorded as:

    AAn illusionBA visual hallucinationCA delusion
    Show answer and rationaleHide answer and rationale

    Answer: A. An illusion is a misperception of a real stimulus (the coat), whereas a hallucination is a perception with no external stimulus at all.

    Why the wrong answers tempt you: B pulls because she “saw a man” who was not there, but she misread a real object, and C confuses perception with thought content, since a delusion is a fixed false belief held despite contrary evidence, while Gloria dropped the idea as soon as the light came on.

    • Chapter(s): 5 (The mental status examination)
    • 2027 NCE: 2B.5
    • Source(s): Standard MSE terminology as taught in Chapter 5; no outside source needed
20. Item 20

    Yolanda, 52, was referred by her physician after blood tests showed elevated liver enzymes that the physician links to her drinking. At intake she says her drinking is “no worse than anyone else’s” and that she came only because her doctor insisted. Which initial treatment plan BEST fits her presentation?

    AA goal of complete abstinence within 30 days, with daily attendance at mutual-help meetingsBObjectives for exploring her own views of her drinking and its effects, using motivational interviewingCA referral to residential treatment, since her denial shows that outpatient counseling is unlikely to help
    Show answer and rationaleHide answer and rationale

    Answer: B. Yolanda’s statements fit the precontemplation stage, so an initial plan matched to her readiness targets awareness and ambivalence, the work motivational interviewing is built for, rather than action goals she has not chosen (Prochaska & DiClemente, 1983; Miller & Rollnick, 2023).

    Why the wrong answers tempt you: A sets the outcome her physician hopes for, but goals imposed before she is ready invite the discord that motivational interviewing works to avoid, and C treats low readiness as if it set the level of care, although placement rests on a multidimensional assessment, not on readiness alone (Mee-Lee et al., 2013).

    • Chapter(s): 20 (stages of change and level of care: 12; motivational interviewing: 27)
    • 2027 NCE: 3A.3
    • Source(s): Prochaska and DiClemente (1983); Miller and Rollnick (2023); Mee-Lee et al. (2013)
21. Item 21

    Soraya, an associate counselor, joined a group practice last month, and her application to a large insurer’s network is still pending. The practice owner, a fully licensed counselor in that network, proposes listing herself as the rendering provider on claims for Soraya’s sessions with clients on that plan. The insurer’s contract makes no provision for billing the services of supervised clinicians. What is Soraya’s BEST response?

    AAgree, because the owner supervises Soraya and is responsible for her clinical workBDecline, because a claim must name the clinician who actually provided the serviceCAgree for now, and resubmit the claims under Soraya’s name once she is credentialed
    Show answer and rationaleHide answer and rationale

    Answer: B. Counselors report their professional activities accurately to insurers (Standard C.6.b), and a claim that names a rendering clinician who did not provide the service, under a contract that does not allow supervised billing, is a false claim that can amount to insurance fraud, however closely the owner supervises. Until Soraya is credentialed, these clients can see an in-network clinician or use an arrangement the plan permits.

    Why the wrong answers tempt you: A pulls because supervisors really are responsible for supervisees’ work, but supervision does not make the owner the provider of a session she did not conduct, and C feels like a harmless bridge, yet each interim claim is false when it is submitted.

    • Chapter(s): 4
    • 2027 NCE: 6.7 (also 6.10)
    • Source(s): American Counseling Association (2014), Standard C.6.b
22. Item 22

    Lorena, a counselor in a rural county, still uses the referral list she compiled when she opened her practice 3 years ago. Which practice BEST keeps the list useful for her clients?

    AAdding every provider in the state’s online directory so that clients have more choicesBChecking entries at set intervals for changes in services, fees, insurance, wait times, and languagesCReplacing the list with the number of a statewide information line, since lists go out of date
    Show answer and rationaleHide answer and rationale

    Answer: B. Counselors must know culturally and clinically appropriate referral resources (Standard A.11.a), and a list stays useful only if it is checked regularly for the details that decide fit: services, cost, insurance, availability, and language.

    Why the wrong answers tempt you: A feels generous, but an unvetted list of names hands clients the work of finding a fit, and C pulls because information lines are helpful, yet they do not replace the counselor’s own knowledge of local resources and their fit for each client.

    • Chapter(s): 21
    • 2027 NCE: 5.5
    • Source(s): American Counseling Association (2014), Standard A.11.a
23. Item 23

    Ngozi, a counselor at a rural clinic, learns that a bill before the state legislature would close the only crisis stabilization unit in her region. Without identifying any client, she meets with her state legislators and testifies at a committee hearing about how the closure would affect people like her clients. In the ACA Advocacy Competencies, Ngozi’s action is:

    ASystems advocacyBCollective actionCSocial/political advocacy
    Show answer and rationaleHide answer and rationale

    Answer: C. Acting on behalf of clients in the public arena, such as meeting with legislators and testifying about a bill, is social/political advocacy in the ACA Advocacy Competencies (Toporek & Daniels, 2018).

    Why the wrong answers tempt you: B pulls because it is the other public-arena domain and can also involve lobbying legislators, but in collective action the counselor joins, as a group member, an affected group or community that has chosen to advocate, while Ngozi acts on her own and speaks for her clients; A, systems advocacy, operates at the school, community, or organization level, such as changing an agency’s policy.

    • Chapter(s): 33 (Advocacy)
    • 2027 NCE: 1A.5 (knowledge: levels of advocacy and social justice)
    • Source(s): Toporek and Daniels (2018); ACA (2014), Standards A.7.a, A.7.b
24. Item 24

    Kofi, 33, tells his counselor, “Work, my landlord, my car—everything is falling apart.” The counselor is teaching him a structured problem-solving method and has explained that problems are a normal part of life that can be worked on step by step. What should the counselor help Kofi do NEXT?

    ABrainstorm as many possible solutions as he can, without judging any of them yetBChoose one problem and state it in specific, concrete terms, including the outcome he wantsCWeigh the likely costs and benefits of each option and select the most workable one
    Show answer and rationaleHide answer and rationale

    Answer: B. In D’Zurilla and Goldfried’s (1971) problem-solving sequence, a general orientation to problems is followed by defining and formulating one problem concretely, then generating alternatives, deciding, and verifying the result.

    Why the wrong answers tempt you: A is the very next stage after definition, so it feels like the start of the “real” work, but brainstorming for a vague “everything” produces unfocused options, and C comes later still, after alternatives exist.

    • Chapter(s): 26 (skill teaching; stress inoculation); also 20
    • 2027 NCE: 4.3
    • Source(s): D’Zurilla and Goldfried (1971)
25. Item 25

    Ezra, 24, has an intellectual disability, and his mother is his court-appointed guardian. She has signed the consent forms for counseling. In the first session, Ezra seems unsure why he is there. What should the counselor do?

    AProceed with counseling, because his guardian’s signature completes informed consentBExplain counseling in words Ezra can understand and seek his agreement to take partCPostpone counseling until a court evaluates whether Ezra can consent for himself
    Show answer and rationaleHide answer and rationale

    Answer: B. When a client cannot legally consent, the counselor obtains the guardian’s consent and also seeks the client’s assent, explaining services in language he can understand and including him in decisions as far as he is able (ACA, 2014, Standards A.2.c, A.2.d).

    Why the wrong answers tempt you: A is tempting because the legal requirement has been met, but the Code asks for the client’s assent as well as the guardian’s signature, and C sounds protective, yet a court has already appointed a guardian, and a new competency proceeding is not how a counselor gains a client’s participation.

    • Chapter(s): 2 (Capacity, consent, and assent)
    • 2027 NCE: 2A.1
    • Source(s): ACA (2014), Standards A.2.c, A.2.d
26. Item 26

    Midway through an evening group at a community agency, the building’s fire alarm sounds. The agency’s emergency preparedness plan directs group leaders to take the attendance roster, lead members out by the posted route, and account for everyone at a designated meeting point. What should Rhys, the group leader, do FIRST?

    ALock the cabinet holding the group’s clinical files so that the records stay protectedBAsk members to wait while he calls the front desk to learn whether the alarm is a drillCTake the roster and lead the members out by the posted route to the meeting point
    Show answer and rationaleHide answer and rationale

    Answer: C. Task 6.1 is to follow (activate) the practice’s emergency plan when an incident occurs, and a fire alarm calls for immediate evacuation; taking the roster lets Rhys account for every member at the meeting point.

    Why the wrong answers tempt you: A pulls on counselors’ strong instinct to protect confidentiality, but records never come before people’s safety, and B sounds prudent, yet the plan calls for evacuation when the alarm sounds, not after a check, and calling first delays it.

    • Chapter(s): 4 (also 29)
    • 2027 NCE: 6.1
    • Source(s): National Board for Certified Counselors (2026)
27. Item 27

    Ifeoma, 45, wants to stop yelling at her teenage sons. At intake she mentions that two years ago she quit smoking by logging her cravings in a notebook and calling her sister whenever an urge hit. How should the counselor use this information in her treatment plan?

    ASet it aside as unrelated history, because quitting smoking calls for different skills than managing angerBBuild on it as a strength, adapting her logging and call-for-support method to her urges to yellCRecord it as a barrier, because leaning on her sister suggests that her own self-control is limited
    Show answer and rationaleHide answer and rationale

    Answer: B. Past successes, skills, and supports are strengths to build into the plan, and her self-monitoring and support-seeking transfer directly to managing urges to yell (NBCC, 2026, task 3A.4).

    Why the wrong answers tempt you: A assumes each new problem needs brand-new skills, and C recasts healthy support-seeking as a personal deficit.

    • Chapter(s): 20
    • 2027 NCE: 3A.4
    • Source(s): NBCC (2026)
28. Item 28

    Halfway through a session, Keanu describes the highway crash that injured his daughter. His counselor, who was hurt in a serious crash last year, notices her chest tightening and her thoughts drifting to her own accident. What should the counselor do FIRST?

    ASlow her breathing and ground herself, then return her full attention to KeanuBTell Keanu briefly about her own crash so that he knows she understandsCSteer the conversation toward a less distressing topic for the rest of the hour
    Show answer and rationaleHide answer and rationale

    Answer: A. Self-regulation is the in-the-moment skill of noticing a personal reaction in the body and steadying it, through slow breathing or grounding, so that attention returns to the client. The counselor then takes the reaction to supervision or consultation after the session (NBCC, 2026, skill: reflexivity/bracketing, e.g., emotional regulation).

    Why the wrong answers tempt you: B pulls because shared experience can feel like empathy, but disclosing her crash while she is still activated moves the focus to her own story; C protects her comfort at the cost of the topic Keanu needs to explore.

    • Chapter(s): 3 (Self-regulation and self-care); also 29 (De-escalation: regulate yourself first)
    • 2027 NCE: 1B.6
    • Source(s): NBCC (2026)
29. Item 29

    Over three sessions, Gustavo, 46, has learned progressive muscle relaxation and can calm himself with it in the office. He reports that when his supervisor criticizes him, “the relaxation does nothing.” He has not practiced between sessions. What is the BEST next step?

    AReplace relaxation with a different coping skill, since this one has not worked for him under real stressBAdvise him to save the technique for his most stressful moments, so that it stays effective when neededCHave him practice daily while calm, then use it in mildly stressful moments before harder ones
    Show answer and rationaleHide answer and rationale

    Answer: C. A coping skill has to be overlearned under low stress before it can hold up under high stress, so practice moves from calm moments to mild stressors to harder ones, as in the application phase of stress inoculation training (Meichenbaum, 1985).

    Why the wrong answers tempt you: A treats a skill that was never practiced as one that failed, and B sounds like saving the tool for when it counts, but an unrehearsed skill is least available at peak arousal.

    • Chapter(s): 26 (Meichenbaum: self-talk and stress inoculation); also 25
    • 2027 NCE: 4.3
    • Source(s): Meichenbaum (1985)
30. Item 30

    Rafael, 23, is on an inpatient psychiatric unit after a suicide attempt. At a team meeting, the counselor learns that the team plans to discharge him tomorrow, when his insurance authorization ends, without a scheduled outpatient appointment. The counselor believes this puts Rafael at risk. What should the counselor do FIRST?

    ARaise the concern with the team and propose arranging an aftercare appointment before dischargeBReport the team’s decision to the state licensing board as a possible ethics violationCTell Rafael privately that the plan is unsafe and that he should refuse to leave
    Show answer and rationaleHide answer and rationale

    Answer: A. When a team decision raises an ethical concern, counselors first try to resolve it within the team and pursue other avenues only if that fails (Standard D.1.d). An aftercare appointment before discharge matters because suicide risk is elevated in the period after psychiatric discharge (Chung et al., 2017).

    Why the wrong answers tempt you: B pulls because the concern is serious, but going outside the team is the step for after internal resolution fails, and C feels protective, yet it undermines the team and puts the burden of the dispute on Rafael.

    • Chapter(s): 21 (also 5)
    • 2027 NCE: 5.3 (also 3B.2, 3B.4)
    • Source(s): American Counseling Association (2014), Standard D.1.d; Chung et al. (2017)
31. Item 31

    Ignacio, 47, has drunk heavily every day for 2 years and reports 2 months of low mood, poor sleep, and guilt. Which information would MOST help the counselor determine whether his depression is alcohol-induced or an independent depressive disorder?

    AHow high his score falls on a standardized depression inventory compared with its normsBWhether his drinking now meets the criteria for a severe alcohol use disorderCWhether his low mood began before the heavy drinking or lasts about a month after he stops
    Show answer and rationaleHide answer and rationale

    Answer: C. DSM-5-TR treats depression as an independent disorder rather than substance-induced when the symptoms began before the substance use or persist for a substantial period, about 1 month, after acute withdrawal or severe intoxication ends (American Psychiatric Association [APA], 2022).

    Why the wrong answers tempt you: A pulls because a high score looks decisive, but severity cannot reveal the cause of the symptoms, and B describes his drinking rather than the origin of his depression, since a person with severe alcohol use disorder can have either kind.

    • Chapter(s): 12 (Intoxication, withdrawal, and substance-induced disorders); also 6 (Differential diagnosis and comorbidity) and 10
    • 2027 NCE: 2B.6 (knowledge: differential diagnoses, co-occurring diagnoses, and comorbidities)
    • Source(s): APA (2022)
32. Item 32

    Rosalba receives an order signed by a judge requiring her to produce the counseling records of Nadira, 38, in Nadira’s lawsuit against a driver who injured her. Nadira objects to releasing what she discussed in counseling about her childhood. What is Rosalba’s BEST course of action?

    ARefuse to produce the records, because Nadira has not given written consent to their releaseBInform Nadira, ask an attorney about seeking to limit the order, and release only what it requiresCSend the complete file right away, because a judge’s order overrides every confidentiality obligation
    Show answer and rationaleHide answer and rationale

    Answer: B. A judge’s order compels a response, but the Code still asks the counselor to seek the client’s written consent or to take steps to have the disclosure prohibited or limited as narrowly as possible (Standard B.2.d), and to release only the information required (Standard B.2.e); legal advice tells Rosalba how to ask the court to narrow the order.

    Why the wrong answers tempt you: A applies the rule for a subpoena, where the counselor asserts privilege until consent or a court order arrives, but this is the order, and C is right that the order must be obeyed but wrong that it erases the duty to limit what is disclosed.

    • Chapter(s): 2 (also 1)
    • 2027 NCE: 6.17 (also 6.3)
    • Source(s): American Counseling Association (2014), Standards B.2.d, B.2.e
33. Item 33

    Brynn, 31, sought counseling for “stress at work.” Her intake PCL-5 score is well above the level that suggests probable PTSD, and a clinical interview confirms the diagnosis. Her GAD-7 score is in the mild range. How should the counselor use these results in her treatment plan?

    ADiscuss the results with Brynn and, if she agrees, use the PCL-5 score as a baseline for a trauma objectiveBBuild the plan around work stress alone, since that is the concern she named when she first came inCFile the scores but leave them out of the plan, since a single administration is only a snapshot in time
    Show answer and rationaleHide answer and rationale

    Answer: A. Assessment results become baselines and targets in the plan, and discussing them first lets the client decide what she wants to work on (NBCC, 2026, tasks 3A.5 and 2B.10).

    Why the wrong answers tempt you: B honors her stated reason for coming but never tells her about a confirmed diagnosis, and C mistakes a reason to re-measure later for a reason to ignore the data now.

    • Chapter(s): 20 (also 8 and 11)
    • 2027 NCE: 3A.5
    • Source(s): NBCC (2026)
34. Item 34

    Olusegun, 30, is learning dialectical behavior therapy (DBT) interpersonal effectiveness skills. He wants to ask his older brother to repay a loan but worries about “ruining things” between them. Before helping him plan what to say, which question should the counselor ask FIRST?

    A“Why do you think your brother hasn’t paid you back yet?”B“Which matters most here: the money, the relationship, or your self-respect?”C“Would letting the loan go keep the peace between the two of you?”
    Show answer and rationaleHide answer and rationale

    Answer: B. DBT interpersonal effectiveness starts by clarifying priorities, deciding whether the objective, the relationship, or self-respect matters most in this situation, because that choice shapes which skills he uses and how hard he presses (Linehan, 2015).

    Why the wrong answers tempt you: A feels like gathering useful context but invites mind reading about his brother’s motives, and C offers relief from the anxiety by dropping the request, which is avoidance rather than skill.

    • Chapter(s): 26 (DBT); also 13
    • 2027 NCE: 4.4
    • Source(s): Linehan (2015)
35. Item 35

    Marguerite must complete continuing education before her license renewal next spring. Her caseload has shifted toward older adults, a population she has had little training to serve. Which plan BEST fits the purpose of continuing education?

    ACourses on aging and late-life concerns from a provider her state board acceptsBA free webinar series on brain health in aging, sponsored by a supplement companyCBoard-accepted courses in her long-standing specialty, since any approved hours count
    Show answer and rationaleHide answer and rationale

    Answer: A. Continuing education exists to keep counselors current and competent in the areas where they actually practice, including work with diverse populations (ACA, 2014, Standard C.2.f). Courses aimed at her new caseload, from a provider her board accepts, serve both renewal and competence.

    Why the wrong answers tempt you: C pulls because approved hours in any topic usually satisfy renewal, but they leave her gap with older adults unaddressed; B covers the right topic, but a series sponsored by a company that sells products to the same audience raises a conflict of interest, and selecting appropriate continuing education resources is a named Domain 1 skill (NBCC, 2026).

    • Chapter(s): 4 (Licensure maintenance and continuing education); also 1 (Boundaries of competence)
    • 2027 NCE: 1A.3 (skill: selecting appropriate continuing education resources)
    • Source(s): ACA (2014), Standard C.2.f; NBCC (2026)
36. Item 36

    Benedikt is retiring next month and closing his private practice. For 12 years he has carried a claims-made professional liability policy. Which step BEST protects him if a former client files a malpractice claim after he retires about work he did this year?

    ASecuring tail (extended reporting) coverage when the claims-made policy endsBLetting the policy lapse, since it covers any incident that occurred while it was in forceCSwitching to an occurrence-based policy for his final month to cover all of his past work
    Show answer and rationaleHide answer and rationale

    Answer: A. A claims-made policy covers only claims filed while it is in force, so a claim filed after the policy ends is uncovered unless Benedikt secures tail (extended reporting) coverage, which covers incidents during the policy period that are reported after it ends; depending on the insurer, the tail may be free when certain requirements are met or bought for a set period (Healthcare Providers Service Organization, n.d.).

    Why the wrong answers tempt you: B describes an occurrence-based policy, the most common mix-up between the two types, and C sounds clever, but a new occurrence policy covers only incidents during its own policy period, not past work.

    • Chapter(s): 1
    • 2027 NCE: 6.12
    • Source(s): Healthcare Providers Service Organization (n.d.)
37. Item 37

    Saoirse, 37, has seen her counselor in person for 3 months and asks to switch to video sessions after a job change. She shares a one-room studio apartment with her sister, who works from home. The counselor’s video platform meets HIPAA requirements and is covered by a business associate agreement. As they review consent for video sessions, which issue is MOST essential to settle?

    AWhere and when she can talk without being overheard, and what she will do if her privacy is interruptedBA reminder that the consent she signed at intake already covers every format of service the counselor offersCA signed release authorizing the platform company to access and store her health information
    Show answer and rationaleHide answer and rationale

    Answer: A. Counselors determine whether distance services suit the client’s circumstances, and telemental health consent covers the limits of confidentiality online; for someone who shares a one-room home, a private time and place to talk is the first condition for video sessions to work, alongside the other distance-specific elements such as a plan for technology failure and emergency procedures (ACA, 2014, Standards H.2.a, H.2.c, H.4.c; NBCC, 2026, task 2A.7).

    Why the wrong answers tempt you: B is tempting because consent was already obtained, but consent is ongoing (Standard A.2.a) and distance services add elements that in-person consent did not cover (Standard H.2.a), and C confuses a client release with the business associate agreement, which is the HIPAA mechanism that already governs the vendor’s handling of her information (Security and Privacy, 2025).

    • Chapter(s): 4 (Telemental health: Suitability; Informed consent for distance services; Location, identity, and platforms); also 2 (Elements and timing)
    • 2027 NCE: 2A.7 (knowledge: client suitability for telemental health services)
    • Source(s): ACA (2014), Standards A.2.a, H.2.a, H.2.c, H.4.c; NBCC (2026); 45 C.F.R. pts. 160, 164
38. Item 38

    Hye-jin, 31, is in counseling for panic disorder. Which progress note entry BEST reflects sound documentation practice?

    A“Client overreacts to ordinary body sensations, likely for attention, and remains resistant to treatment.”B“Client reports 3 panic attacks this week (6 at intake). Practiced interoceptive exposure; plan: daily practice.”C“Client described her sister’s affair and marital problems in detail; full account recorded for context.”
    Show answer and rationaleHide answer and rationale

    Answer: B. A sound note is factual, measurable, and tied to the treatment plan, so that it accurately reflects the client’s progress and the services provided (Standard A.1.b).

    Why the wrong answers tempt you: A sounds like a clinical impression, but it is a judgmental guess about motive that the client could read and that no data support, and C feels thorough, yet it records private details about a third person that the treatment does not need.

    • Chapter(s): 4 (also 11)
    • 2027 NCE: 5.8
    • Source(s): American Counseling Association (2014), Standard A.1.b
39. Item 39

    Ayesha, 27, texts her boyfriend repeatedly whenever he does not reply within an hour, then accuses him of losing interest. He has begun to pull away, and she wants to keep the relationship. Which intervention BEST helps her manage the relationship?

    AHelp her notice the fear behind the texting, practice tolerating the wait, and state her need to him directlyBSuggest that she answer his messages just as slowly for a while, so that he learns how the waiting feelsCAdvise her to end the relationship, since his slow replies show an avoidant style that is unlikely to change
    Show answer and rationaleHide answer and rationale

    Answer: A. Repeated texting and accusations are hyperactivating strategies typical of anxious attachment, so the work helps her recognize the fear, tolerate uncertainty, and ask for reassurance directly, which tends to draw closeness rather than push it away (Mikulincer & Shaver, 2016).

    Why the wrong answers tempt you: B gives her a sense of control but adds game playing to the cycle, and C pulls because it borrows attachment language, but it labels someone who is not in the room and overrides her stated goal.

    • Chapter(s): 16 (attachment, adult styles); also 28
    • 2027 NCE: 4.4
    • Source(s): Mikulincer and Shaver (2016)
40. Item 40

    Tamika, 38, a single mother who works two jobs, is in counseling for depression. Her counselor proposes evening walks in her neighborhood as part of behavioral activation. Tamika says the streets near her apartment are not safe after dark and that her only free time is late at night, after her children are asleep. The BEST response is to:

    AAsk which valued activities fit her schedule and surroundings, and build the plan around thoseBKeep the walks in the plan, because physical activity has strong research support for depressionCPostpone behavioral activation until her work hours change and she has more free time in her week
    Show answer and rationaleHide answer and rationale

    Answer: A. Behavioral activation schedules activities the client values and can actually do, so her schedule, safety, and resources shape the plan (Martell et al., 2001; NBCC, 2026, task 3A.6).

    Why the wrong answers tempt you: B leans on the evidence base, but support for an activity does not override the client’s context, and C leaves her depression untreated while waiting for circumstances that may never change.

    • Chapter(s): 20 (behavioral activation: 10)
    • 2027 NCE: 3A.6
    • Source(s): Martell et al. (2001); NBCC (2026)
41. Item 41

    Callum, 34, tells his counselor that he plans to kill himself tonight with a firearm he keeps at home. He refuses voluntary hospitalization and says he is leaving. The counselor’s state allows an emergency psychiatric evaluation without consent when a person poses an imminent danger to self. What is the counselor’s BEST action?

    ALet Callum leave, because a competent adult cannot be hospitalized against his willBSign an order committing Callum to a hospital, as licensed counselors may do for clients in dangerCInitiate the emergency evaluation process the state’s law provides, such as calling a mobile crisis team
    Show answer and rationaleHide answer and rationale

    Answer: C. When a client at imminent risk refuses voluntary care, the counselor initiates the emergency evaluation process that state law provides, which may run through a mobile crisis team, a designated examiner, or law enforcement, and does not leave the client alone if it is safe to stay; commitment itself is ordered under state law by a judge or someone acting in a judicial capacity, not by a counselor’s signature (Substance Abuse and Mental Health Services Administration [SAMHSA], 2019).

    Why the wrong answers tempt you: A applies the respect for autonomy that ordinarily governs, but state laws allow emergency evaluation without consent when a person is an imminent danger to self, and B overstates the counselor’s role: who may start an emergency hold varies by state, but commitment beyond a short hold generally requires a judicial process.

    • Chapter(s): 21 (also 5, 29)
    • 2027 NCE: 6.3 (also 2B.2, 4.10)
    • Source(s): Substance Abuse and Mental Health Services Administration (2019)
42. Item 42

    Asked about alcohol at intake, Paulo, 63, says he drinks “socially, like everybody.” What is the BEST follow-up?

    A“Do you think your drinking has become a problem for you or for the people around you?”B“That’s common enough. Let’s move on, then, and talk about how you’ve been sleeping.”C“On days you drink, how many drinks do you usually have, and how many days a week?”
    Show answer and rationaleHide answer and rationale

    Answer: C. A vague answer about drinking is clarified with specific, matter-of-fact questions about quantity and frequency, the same facts the first AUDIT items ask about (Babor et al., 2001).

    Why the wrong answers tempt you: A feels respectful, and his own view of his drinking does matter later (for example, in gauging readiness to change), but as a follow-up it is a yes-or-no request for a self-diagnosis that invites a defensive “no” and still leaves “socially” undefined, and B avoids awkwardness, yet “socially” can mean anything from an occasional glass to hazardous daily use, so dropping the topic leaves risk unassessed.

    • Chapter(s): 5 (Substance use screening); also 12
    • 2027 NCE: 2B.3
    • Source(s): Babor et al. (2001)
43. Item 43

    A prospective client calls Gideon, a counselor in solo practice, to ask about starting individual counseling. Which circumstance MOST clearly makes Gideon unsuitable as this person’s counselor?

    AThe caller is 30 years older than Gideon and grew up in a different eraBThe caller is the estranged husband of a current client, and the two are in a contested divorceCThe caller holds political views that Gideon strongly opposes and finds offensive
    Show answer and rationaleHide answer and rationale

    Answer: B. Counseling one spouse while already counseling the other through a contested divorce creates a conflict of interest that compromises objectivity and confidentiality. When roles may conflict, the Code directs counselors to clarify, adjust, or withdraw from them (ACA, 2014, Standard A.8).

    Why the wrong answers tempt you: C pulls because strong disagreement feels like a poor fit, but a difference in personal values alone is not grounds to decline or refer a prospective client (Standard A.11.b); A, an age difference, is a cultural consideration to explore, not a barrier to competent care.

    • Chapter(s): 3 (Bracketing and self-reflection: client-counselor suitability); also 28 (Standard A.8) and 1 (Personal values and referral)
    • 2027 NCE: 1B.7
    • Source(s): ACA (2014), Standards A.8, A.11.b
44. Item 44

    Three weeks into a closed interpersonal counseling group, Haruto tells Simone, “You always turn the conversation back to yourself.” Simone answers sharply, the room goes tense, and the other members look to the leader. Which leader response BEST fosters the group’s therapeutic process?

    ARemind members of the group’s norm of respect and move to a new topic, so that everyone feels safe againBState which of the two members was more out of line, so that the group learns what feedback is acceptableCHelp Haruto and Simone speak directly to each other about what just happened, then invite others’ reactions
    Show answer and rationaleHide answer and rationale

    Answer: C. Conflict is expected in the transition stage, and leaders foster the group process by helping members address each other directly and by using the conflict as here-and-now material for the whole group (Corey et al., 2018; Yalom & Leszcz, 2020).

    Why the wrong answers tempt you: A restores comfort quickly but teaches members that honest feedback is unsafe, and B sounds like modeling good feedback, but a leader acting as judge shuts down the exchange and invites members to take sides.

    • Chapter(s): 30 (Stages of group development); also 31
    • 2027 NCE: 4.5
    • Source(s): Corey et al. (2018); Yalom and Leszcz (2020)
45. Item 45

    A group practice is replacing the desktop computers on which counselors stored client notes before the practice moved to a cloud-based EHR. The office manager plans to donate the old computers to a local school after deleting the client folders and emptying the recycle bin. What is the BEST plan for the old computers?

    ADonate them as planned, since the school has no reason to search for client filesBHave the drives securely wiped or destroyed before the computers leave, and document itCKeep them in storage indefinitely, since devices that once held records must be retained
    Show answer and rationaleHide answer and rationale

    Answer: B. Deleting files and emptying the recycle bin usually leaves data recoverable, so drives that held client information are securely wiped or destroyed before the hardware is reused or given away, and the disposal is documented (Standard B.6.h; Security Standards for the Protection of Electronic Protected Health Information, 2026).

    Why the wrong answers tempt you: A pulls because the risk seems remote, but recoverable client records leaving the practice can be a breach whatever the recipient intends, and C confuses retaining records, which the EHR now does, with keeping old hardware.

    • Chapter(s): 4 (also 2)
    • 2027 NCE: 6.16 (also 6.18)
    • Source(s): American Counseling Association (2014), Standard B.6.h; Security Standards for the Protection of Electronic Protected Health Information, 45 C.F.R. pt. 164, subpt. C (2026)
46. Item 46

    Nadège, 35, moved from Haiti 8 years ago and speaks English at work. In her second session, she says she can “get by” in English but that talking about her son’s death feels impossible in any language but Haitian Creole. Her counselor does not speak Haitian Creole. The BEST response is to:

    AContinue in English, since Nadège is proficient enough to work and to give informed consentBInvite her cousin, who is fluent in both languages, to interpret at the next sessionCArrange a qualified interpreter, or offer a referral to a counselor who speaks Haitian Creole
    Show answer and rationaleHide answer and rationale

    Answer: C. Task 5.7 is about the client’s preferred language, not only the language a client can manage, and counselors arrange qualified interpreters when language limits understanding (Standard A.2.c; NBCC, 2026). Grief work depends on Nadège saying what she means, so a qualified interpreter or a Haitian Creole-speaking counselor serves her best. The referral is offered, not imposed, so it does not abandon her: Nadège chooses, and if she accepts, the counselor completes the transfer and keeps communication open with her and the new counselor (Standard A.11.d).

    Why the wrong answers tempt you: A pulls because she functions in English at work, but managing workplace English is not the same as expressing grief, and B feels warm and convenient, yet an untrained relative may soften or omit painful material and brings a family relationship into confidential sessions.

    • Chapter(s): 4 (also 21, 33, 34)
    • 2027 NCE: 5.7
    • Source(s): American Counseling Association (2014), Standards A.2.c, A.11.d; National Board for Certified Counselors (2026)
47. Item 47

    After two assessment sessions, a counselor has diagnosed Grady, 26, with generalized anxiety disorder and is preparing his first insurance claim. Grady has not yet been told the diagnosis. Before submitting the claim, the counselor should:

    ASubmit it as prepared, since clients can learn their diagnosis whenever they request their recordsBHold off on sharing the diagnosis until near the end of treatment, so that the label does not discourage himCExplain the diagnosis, how it will guide his plan, and that it will be reported to his insurer
    Show answer and rationaleHide answer and rationale

    Answer: C. Informed consent covers the implications of a diagnosis and the intended use of reports, so the counselor explains the diagnosis, its role in the plan, and its disclosure to the insurer before billing, which also lets Grady choose whether to use his insurance (American Counseling Association [ACA], 2014, Standard A.2.b).

    Why the wrong answers tempt you: B sounds protective, but withholding the diagnosis denies Grady an informed choice, and A treats the diagnosis as a billing detail rather than something to review with the client.

    • Chapter(s): 20 (also 2 and 6)
    • 2027 NCE: 3A.7
    • Source(s): ACA (2014)
48. Item 48

    The Delgado family begins counseling after Andrés, 15, is suspended from school. Both parents and Andrés’s sister, Luz, 8, will attend. Which approach to informed consent is BEST?

    AHave both parents sign the consent forms, since neither child can legally consent and children need not take part in the consent processBExplain counseling to each member at their level, get the parents’ consent and the children’s assent, and agree on a policy for private disclosuresCTreat Andrés as the identified client, obtain consent from him and his parents, and include Luz in sessions only when the counselor finds it useful
    Show answer and rationaleHide answer and rationale

    Answer: B. With a family, the counselor explains services in developmentally appropriate language, obtains the parents’ consent and the children’s assent, clarifies who the client is, and gets everyone’s written agreement on how information shared by one member will be handled (ACA, 2014, Standards A.2.c, A.2.d, B.4.b).

    Why the wrong answers tempt you: A is tempting because parents usually hold the legal right to consent for minors, but leaving the children out ignores assent, and C feels natural because Andrés’s suspension prompted the referral and Standard B.4.b does let the parties define who the client is, yet C has the counselor decide that alone, leaves Luz, who will be in the room, out of the consent process, and sets no shared rule for private disclosures; absent an agreement to the contrary, the family is the client.

    • Chapter(s): 2 (Couples and families; Capacity, consent, and assent); also 28 (ethics of couples and family work)
    • 2027 NCE: 2A.6 (also 2A.1)
    • Source(s): ACA (2014), Standards A.2.c, A.2.d, B.4.b
49. Item 49

    Devika wants to use a general-purpose generative AI chatbot to help draft treatment-plan wording for her clients. What should she do FIRST?

    APaste in the intake details after deleting the client’s name, which removes the identifying informationBRely on the vendor’s statement that the tool is “HIPAA compliant” and safe for client dataCLearn how the tool stores entered data, how it can err or show bias, and which rules apply
    Show answer and rationaleHide answer and rationale

    Answer: C. Competence comes before use: a counselor adopting a technology first learns its technical, ethical, and legal implications, including how it stores data and how it can produce biased or inaccurate content (ACA, 2014, Standards C.2.f, H.1.a; ACA, 2024; NBCC, 2024).

    Why the wrong answers tempt you: A pulls because deleting a name feels like de-identification, but intake details such as dates, places, and family facts can still identify a client, and HIPAA’s de-identification standard requires removing far more (Other Requirements Relating to Uses and Disclosures of Protected Health Information, 2026); B accepts a vendor’s marketing claim in place of the counselor’s own review of how the tool handles client data.

    • Chapter(s): 4 (Artificial intelligence)
    • 2027 NCE: 1A.7 (also 6.19)
    • Source(s): ACA (2014), Standards C.2.f, H.1.a; ACA (2024); NBCC (2024); 45 C.F.R. § 164.514(b)
50. Item 50

    In an open outpatient group for adults with opioid use disorder, a new member, Dwayne, says he has relapsed “a hundred times” and doubts that anything will work for him. The leader invites two members with more than a year of recovery to describe how their recovery began and what has kept it going. Which therapeutic factor is the leader drawing on MOST?

    AUniversalityBImparting informationCInstillation of hope
    Show answer and rationaleHide answer and rationale

    Answer: C. Seeing others who have improved with the same problem is how Yalom describes instillation of hope, and the leader chose members with long recovery to show Dwayne that change is possible (Yalom & Leszcz, 2020).

    Why the wrong answers tempt you: A pulls because hearing peers’ stories can ease his sense of being alone, but universality answers the belief that no one else shares the problem; Dwayne’s doubt is whether anything will work, and the leader chose members with long recovery to answer it with proof that recovery is possible. B fits didactic teaching or advice rather than personal stories of progress.

    • Chapter(s): 31 (Yalom’s therapeutic factors); also 12
    • 2027 NCE: 4.5
    • Source(s): Yalom and Leszcz (2020)
51. Item 51

    Toshiro ended counseling with Tobias 2 years ago. At a community fundraiser, Toshiro meets Tobias’s adult sister, Elise, who has never been Toshiro’s client, and the two want to start dating. Under the ACA Code of Ethics, such a relationship is:

    AProhibited until at least 5 years after Toshiro’s last professional contact with TobiasBPermitted, because the Code’s restrictions apply only to former clients themselvesCPermitted if Tobias consents in writing and Toshiro documents that it is not exploitative
    Show answer and rationaleHide answer and rationale

    Answer: A. The 5-year prohibition on sexual or romantic relationships after the last professional contact covers former clients’ family members as well as the clients themselves, and even after 5 years the counselor must show forethought and document that the relationship is not exploitative (Standard A.5.c).

    Why the wrong answers tempt you: B pulls because Elise was never a client, but the Code names family members explicitly, and C borrows the language of documentation and consent, which applies only after the 5 years have passed and never through the former client’s permission.

    • Chapter(s): 3
    • 2027 NCE: 6.5 (also 1B.9)
    • Source(s): American Counseling Association (2014), Standard A.5.c
52. Item 52

    Three months ago a neighbor’s dog attacked Ilan, 5, leaving bites that needed stitches. Since then he has played out the same scene again and again, making a toy dog “bite” a small doll. He seems calm while playing, but he now wakes at night and clings to his parents at bedtime. How should the counselor understand the repeated play?

    AAs a possible intrusion symptom, which young children may express through play reenactmentBAs evidence that he has worked through the attack, since he stays calm while playing it outCAs ordinary pretend play for his age, with no bearing on the trauma assessment
    Show answer and rationaleHide answer and rationale

    Answer: A. DSM-5-TR notes that in children 6 and younger, intrusive memories may be expressed through play reenactment and may not appear distressing; his new sleep problems and clinging add to a picture that warrants a fuller trauma assessment (APA, 2022).

    Why the wrong answers tempt you: B pulls because calm play looks like mastery, but the criteria specifically warn that young children’s reenactment may not look distressed, and C is tempting because pretend play with toy animals is common at his age, yet play that repeats the same trauma scene alongside new symptoms is assessment data.

    • Chapter(s): 11 (Trauma- and stressor-related disorders: PTSD; separate criteria for children 6 and younger); also 5 (Trauma and adverse childhood experiences)
    • 2027 NCE: 2B.1 (knowledge: symptoms of trauma)
    • Source(s): APA (2022)
53. Item 53

    Noemi, 24, wants help with a fear of needles; she has fainted during three blood draws. Her counselor plans to teach progressive muscle relaxation for Noemi to use during graded exposure to needles. Why should the counselor reconsider this plan?

    AExposure is contraindicated for blood-injection-injury fears, so relaxation training should be used aloneBRelaxation can deepen the drop in blood pressure that causes fainting, so applied tension is used insteadCHer fainting shows the fear is too severe for outpatient work, so a higher level of care is needed first
    Show answer and rationaleHide answer and rationale

    Answer: B. Blood-injection-injury fears often bring a vasovagal drop in blood pressure that leads to fainting, so exposure is paired with applied tension, which raises blood pressure, rather than with relaxation (American Psychiatric Association, 2022; Öst & Sterner, 1987).

    Why the wrong answers tempt you: A reverses the point, since exposure is the treatment and relaxation is the contraindicated piece, and C mistakes a typical feature of this phobia for a sign that outpatient care cannot work.

    • Chapter(s): 20 (also 11)
    • 2027 NCE: 3A.8
    • Source(s): American Psychiatric Association (2022); Öst and Sterner (1987)
54. Item 54

    Ten months after a sexual assault, Bianca, 26, meets the criteria for posttraumatic stress disorder (PTSD). She often says, “It happened because I drank too much. I should have known better.” Which approach BEST targets this belief with an empirically supported treatment?

    ACognitive processing therapy, which helps her examine and challenge stuck points such as self-blameBA single structured debriefing session in which she describes the assault in detail and vents her feelingsCSupportive counseling that steers away from the assault, since discussing it is likely to retraumatize her
    Show answer and rationaleHide answer and rationale

    Answer: A. Cognitive processing therapy is a first-line PTSD treatment that targets “stuck points,” including self-blame for the trauma, through structured examination of the belief (Resick & Schnicke, 1992; U.S. Department of Veterans Affairs & U.S. Department of Defense, 2023).

    Why the wrong answers tempt you: B sounds like a chance to process the event, but single-session debriefing has not been shown to prevent or treat PTSD (Rose et al., 2002), and C rests on the myth that trauma-focused therapy retraumatizes, which leaves her with a less effective treatment.

    • Chapter(s): 11 (trauma-focused treatments table)
    • 2027 NCE: 4.6
    • Source(s): Resick and Schnicke (1992); Rose et al. (2002); U.S. Department of Veterans Affairs and U.S. Department of Defense (2023)
55. Item 55

    Tavita, 22, has attention-deficit/hyperactivity disorder and is in counseling for depression. She lives with the grandmother who raised her and asks that her grandmother help her remember her between-session activities. What should the counselor do FIRST?

    AClarify with Tavita what she wants shared and her grandmother’s role, and document her consentBGive her grandmother access to her progress notes so that she can follow the planCExplain that involving family members would compromise the confidentiality of her counseling
    Show answer and rationaleHide answer and rationale

    Answer: A. Counselors consider enlisting family members as supports when appropriate and with the client’s consent (Standard A.1.d), so the first step is to settle with Tavita what will be shared and what her grandmother will do, sharing only what serves that purpose (Standard B.2.e).

    Why the wrong answers tempt you: B pulls because her grandmother is already part of her daily life, but full access to her notes far exceeds the role Tavita requested, and C sounds protective of confidentiality, yet the Code treats a consenting client’s support network as a resource.

    • Chapter(s): 21 (also 2)
    • 2027 NCE: 5.1
    • Source(s): American Counseling Association (2014), Standards A.1.d, B.2.e
56. Item 56

    Anders left a strict religious community in his twenties. He now counsels a client who is deciding whether to leave her own faith community. After each session, he journals about his reactions and examines with his supervisor how his history may shape what he emphasizes with her. Anders is practicing:

    AReflexivityBReflection of meaningCParallel process
    Show answer and rationaleHide answer and rationale

    Answer: A. Reflexivity, which the 2027 specification pairs with bracketing, is the ongoing examination of how the counselor’s own history, values, and reactions shape the work; journaling and supervision are standard tools for it (NBCC, 2026).

    Why the wrong answers tempt you: B pulls because the words sound alike, but reflection of meaning is a response to the client’s message, not an examination of the counselor’s own influence; C involves supervision, but parallel process means counseling dynamics replaying in the supervisory relationship, which the stem does not describe.

    • Chapter(s): 3 (Bracketing and self-reflection; parallel process); also 32 (The counselor as a person) and 22 (reflection of meaning)
    • 2027 NCE: 1B.11 (skill: reflexivity/bracketing)
    • Source(s): NBCC (2026)
57. Item 57

    Ximena bills most individual sessions with CPT code 90837, the code for about 60 minutes of psychotherapy. Her progress notes record the date, interventions, and the client’s response, but not how long each session lasted. Which change BEST ensures that her claims are supported by her documentation?

    AAdding estimated session lengths to her past notes from memory before an insurer audits themBBilling every session as 90834, the 45-minute code, so that she never overstates her timeCRecording each session’s start and stop times and billing the code that the time supports
    Show answer and rationaleHide answer and rationale

    Answer: C. Psychotherapy codes are time-based (90837 requires at least 53 minutes), so each note should show the time spent, and each claim should carry the code that the documented time supports (First Coast Service Options, 2025).

    Why the wrong answers tempt you: A is the most dangerous choice, because adding undated details to past notes before an audit looks like falsifying records (a genuine addition is a dated, labeled late entry), and B feels safely conservative, yet billing a code that does not match the service is also inaccurate.

    • Chapter(s): 4
    • 2027 NCE: 6.10 (also 6.7, 5.8)
    • Source(s): First Coast Service Options (2025)
58. Item 58

    A primary care clinic gives every adult the two-item Patient Health Questionnaire-2 (PHQ-2) at each annual visit. Bongani, 52, scores at the screen’s cutoff. What is the BEST next step?

    ARecord a diagnosis of major depressive disorder and refer him for medicationBFollow up with a fuller measure, such as the PHQ-9, and a clinical interviewCRescreen him at next year’s visit, since a two-item screen is too brief to act on
    Show answer and rationaleHide answer and rationale

    Answer: B. A positive PHQ-2 is a signal for a closer look; its developers recommend following a positive result with the PHQ-9 or a clinical interview to determine whether a depressive disorder is present (Kroenke et al., 2003, p. 1291).

    Why the wrong answers tempt you: A treats a two-item screen as a diagnosis and skips the assessment that should follow it, and C sounds cautious, but brevity is the point of a first-stage screen, and ignoring a positive result defeats the purpose of screening everyone.

    • Chapter(s): 5 (Screening versus assessment); also 8 (Symptom and outcome measures)
    • 2027 NCE: 2B.9
    • Source(s): Kroenke et al. (2003)
59. Item 59

    For 8 months, Arnav, 52, has had trouble falling and staying asleep most nights. His 2-week sleep diary shows that he spends about 9 hours in bed each night but sleeps only about 6. A medical evaluation found no sleep apnea or other medical cause. Which recommendation reflects the sleep restriction component of cognitive behavioral therapy for insomnia (CBT-I)?

    AStay in bed later on weekends to make up the sleep he loses during the week, so that his sleep debt does not buildBKeep a fixed wake time and limit his time in bed to about 6 hours, adding time back as his sleep grows more efficientCPractice progressive muscle relaxation in bed each night until he falls asleep, however long that takes
    Show answer and rationaleHide answer and rationale

    Answer: B. Sleep restriction builds sleep drive and consolidates sleep by limiting time in bed to the person’s average sleep time, estimated from a sleep diary, then adjusting it as sleep efficiency improves (Edinger et al., 2021); a fixed wake time, also part of stimulus control, anchors the schedule.

    Why the wrong answers tempt you: A feels like repaying a sleep debt, but extra time in bed loosens the schedule and weakens the sleep drive that restriction builds, and C uses relaxation, a real CBT-I tool, but lying in bed awake for as long as it takes keeps the bed linked with wakefulness, which runs against stimulus control.

    • Chapter(s): 13 (sleep–wake disorders and CBT-I)
    • 2027 NCE: 4.6
    • Source(s): Edinger et al. (2021)
60. Item 60

    A counselor using strategic family therapy is considering a paradoxical directive, prescribing the symptom, for Jade, 15. Her parents report that she has cut her arms several times this month after family arguments. Which principle should guide the counselor’s decision?

    AParadoxical directives work best with resistant adolescents, so the intervention suits Jade wellBParadoxical directives may proceed once both of Jade’s parents give informed consent to the techniqueCParadoxical directives are contraindicated when the symptom is dangerous, so safety comes first
    Show answer and rationaleHide answer and rationale

    Answer: C. Prescribing a symptom that causes injury invites harm, so self-harm calls for risk assessment and safety planning rather than paradox (ACA, 2014, Standard A.4.a).

    Why the wrong answers tempt you: A rests on paradox’s reputation with resistant clients, and B treats parental consent as if it could make a harmful technique appropriate.

    • Chapter(s): 20 (paradoxical directives: 28; self-harm risk: 5)
    • 2027 NCE: 3A.8
    • Source(s): ACA (2014)
61. Item 61

    Maeve, 29, who is Deaf and communicates in American Sign Language (ASL), asks a small private practice to provide an ASL interpreter for weekly counseling. The interpreter’s fee is higher than the practice’s fee for a session. What is the practice’s BEST response?

    AArrange a qualified ASL interpreter for each session at no charge to MaeveBOffer video sessions with the platform’s automatic captions in place of an interpreterCPropose exchanging written notes, since the interpreter costs more than the session earns
    Show answer and rationaleHide answer and rationale

    Answer: A. Under Title III of the Americans with Disabilities Act, a private practice provides the auxiliary aids needed for effective communication, such as a qualified interpreter, may not charge the client for them, and weighs undue burden against its overall resources rather than the fee for one session (Nondiscrimination on the Basis of Disability by Public Accommodations, 2026; U.S. Department of Justice, 2020).

    Why the wrong answers tempt you: C pulls because written notes can be an effective aid for brief, simple exchanges, but counseling is long and complex, and B looks like a modern fix, yet automatic captions render English text, which may not be Maeve’s strongest language, and they do not replace an interpreter.

    • Chapter(s): 4
    • 2027 NCE: 6.14 (also 5.7)
    • Source(s): Nondiscrimination on the Basis of Disability by Public Accommodations and in Commercial Facilities, 28 C.F.R. pt. 36 (2026); U.S. Department of Justice (2020)
62. Item 62

    Hannah, a licensed counselor who has worked only with adults, has completed graduate coursework in play therapy and wants to begin seeing children ages 4 to 8. Which arrangement BEST supports ethical practice while she develops this specialty?

    AConsulting a colleague whenever a child’s case becomes difficult or confusingBStudying current play therapy literature and reviewing her own session recordingsCOngoing supervision of her play therapy cases by an experienced play therapist
    Show answer and rationaleHide answer and rationale

    Answer: C. Counselors practice in a specialty new to them only after appropriate education, training, and supervised experience, and they protect clients while their skills develop (ACA, 2014, Standard C.2.b). Ongoing supervision by a qualified play therapist supplies the supervised experience her coursework lacks.

    Why the wrong answers tempt you: A pulls because consultation is so often the keyed move, but occasional, nonevaluative advice on hard cases does not provide the ongoing oversight a new specialty requires; B builds knowledge but gives her no feedback from someone competent in the specialty.

    • Chapter(s): 1 (Boundaries of competence); also 3 (Clinical supervision)
    • 2027 NCE: 1A.2 (also 1B.3)
    • Source(s): ACA (2014), Standard C.2.b
63. Item 63

    Selam, 30, has been in counseling for 6 months for nightmares and depression that began after she fled violence in her home country. With Selam’s signed release, her immigration attorney asks the counselor for a letter to support her asylum application. The counselor’s BEST response is to:

    AWrite that Selam’s account of persecution is credible and that she meets the standard for asylumBDecline, explaining that only a forensic evaluator may write letters for a legal proceedingCWrite a factual letter on her symptoms, diagnosis, and treatment, without offering a legal opinion
    Show answer and rationaleHide answer and rationale

    Answer: C. With a release, a treating counselor may give an attorney factual treatment information (Standards B.2.e, B.6.g), but counselors do not evaluate current clients for forensic purposes (Standard E.13.c), and whether Selam’s account is credible or meets the legal standard for asylum is for the officials deciding her case, not her counselor (Standard C.2.a).

    Why the wrong answers tempt you: A pulls because the counselor believes Selam and wants to help, but vouching for events the counselor did not witness and reaching a legal conclusion turn the treating counselor into a forensic evaluator, and B overcorrects, since working with a client’s attorney within a release is part of task 5.2 and a factual treatment letter is not a forensic evaluation.

    • Chapter(s): 1 (also 2)
    • 2027 NCE: 5.2 (also 6.17)
    • Source(s): American Counseling Association (2014), Standards B.2.e, B.6.g, C.2.a, E.13.c
64. Item 64

    Noor, 39, comes to individual counseling about constant arguments with her husband, who refuses to attend. She asks for “exercises to make him communicate better.” Which approach BEST fits the individual modality?

    AFocus on her own part in the pattern, and leave room for joint sessions later if her husband agreesBWrite treatment goals for changing her husband’s communication, since she describes his withdrawal as the main problemCExplain that relationship problems can be treated only in couples counseling, and refer her to a couples counselor
    Show answer and rationaleHide answer and rationale

    Answer: A. In individual counseling the client is the person in the room, so the work targets what Noor can change in her own part of the cycle, and couples work remains an option if both spouses later choose it (ACA, 2014, Standard A.1.c).

    Why the wrong answers tempt you: B takes her framing at face value, but no plan can set goals for someone who is not a client, and C sounds appropriately specialized, yet relationship concerns are routinely and effectively addressed in individual counseling.

    • Chapter(s): 20 (Anatomy of a treatment plan: modality); also 28 (Ethics with more than one client)
    • 2027 NCE: 4.7
    • Source(s): ACA (2014), Standard A.1.c
65. Item 65

    Tavi, 11, entered foster care 2 months ago. His foster mother brings him to counseling but knows little about his history. Which step BEST fills in the gaps?

    AAsk Tavi to describe, in detail, the events that led to his removal from his birth parents’ homeBRequest records from his child welfare caseworker, with authorization from whoever can legally consent for himCCall his birth parents directly for his developmental history, since they have known him the longest
    Show answer and rationaleHide answer and rationale

    Answer: B. Child and family services are a named source of collateral information at intake, and obtaining records requires authorization from the person or agency with legal authority to consent for a child in care (NBCC, 2026, task 2A.4; ACA, 2014, Standard B.5.c).

    Why the wrong answers tempt you: A seems to honor the child’s own account, but pressing an 11-year-old for a detailed trauma narrative at intake risks retraumatizing him (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014), and C is tempting because birth parents know his early history, but calling them without authorization discloses that he is in counseling and may cut across the court’s and agency’s authority over his care.

    • Chapter(s): 5 (Self-report, barriers, and collateral information); also 2 (Minors; Releases of information)
    • 2027 NCE: 2A.4
    • Source(s): NBCC (2026); ACA (2014), Standard B.5.c; SAMHSA (2014)
66. Item 66

    Nkechi, a counseling intern, starts at an agency before her account in the agency’s EHR has been set up. Her site supervisor tells her to log in with the supervisor’s username and password to enter her notes for the next week. What is Nkechi’s BEST response?

    AUse the supervisor’s login, starting each note with her own name so that authorship is clearBDecline to use the shared login, and ask how to document sessions until her account is activeCUse the supervisor’s login, since the supervisor is responsible for everything the intern records
    Show answer and rationaleHide answer and rationale

    Answer: B. The HIPAA Security Rule requires a unique user identification for each person who uses an electronic record system, so that access and entries can be traced through audit logs (Security Standards for the Protection of Electronic Protected Health Information, 2026), and an intern’s notes must show who actually provided the service.

    Why the wrong answers tempt you: A sounds like a workable fix, but the system would still attribute every entry to the supervisor, and C rests on a real fact, the supervisor’s responsibility for the intern’s work, which does not extend to sharing credentials.

    • Chapter(s): 4
    • 2027 NCE: 6.18 (also 6.16)
    • Source(s): Security Standards for the Protection of Electronic Protected Health Information, 45 C.F.R. pt. 164, subpt. C (2026)
67. Item 67

    Henrik, 39, has finished two assessment sessions for panic attacks. When his counselor turns to setting goals, he says, “You’re the expert. Just tell me what my goals should be.” What is the BEST response?

    ASet his goals from the assessment findings, since he has asked the counselor to take the leadBPostpone goal setting until he feels ready to propose goals of his own for the counselor to reviewCAsk what he hopes will be different after counseling, and shape the goals and objectives with him
    Show answer and rationaleHide answer and rationale

    Answer: C. Counselors and clients work jointly in devising counseling plans (ACA, 2014, Standard A.1.c), so a client who defers is drawn into the process with questions about what he wants to change, rather than handed goals or left to set them alone; goal consensus and collaboration are linked to better outcomes (Tryon et al., 2018).

    Why the wrong answers tempt you: A honors his request and draws on real assessment data, but setting goals for him skips the joint work the Code calls for (offering possible goals for him to react to and revise would be part of that joint work), and B sounds respectful of his autonomy but stalls treatment and leaves him to do alone what the counselor should do with him.

    • Chapter(s): 20
    • 2027 NCE: 3A.9
    • Source(s): ACA (2014); Tryon et al. (2018)
68. Item 68

    Two weeks into counseling, Rhiannon sends her counselor a friend request on the counselor’s personal social media account. The counselor’s BEST response is to:

    ADecline the request and, at the next session, explain her social media policy and why it existsBAccept the request but limit contact to occasional “likes” so Rhiannon does not feel rejectedCIgnore the request without mentioning it, so Rhiannon is spared any embarrassment
    Show answer and rationaleHide answer and rationale

    Answer: A. Counselors may not have personal virtual relationships with current clients, including through social media, and they keep personal and professional online presences separate (ACA, 2014, Standards A.5.e, H.6.a). Explaining the social media policy in session, as informed consent should already have done, protects the relationship (Standard H.6.b).

    Why the wrong answers tempt you: B pulls because it seems to spare Rhiannon’s feelings, but even limited contact is a personal virtual relationship the Code prohibits; C avoids an awkward moment, yet silence leaves her to guess at its meaning and misses a chance to discuss the boundary.

    • Chapter(s): 3 (Prohibited relationships); also 4 (Marketing and social media)
    • 2027 NCE: 1B.9
    • Source(s): ACA (2014), Standards A.5.e, H.6.a, H.6.b
69. Item 69

    Several weeks after moving to video sessions, a counselor notices that Gerald, 38, seldom responds to her reflections and twice reacted as if he had misread her tone. Only his face is visible on screen. Which adjustment BEST aligns her approach with the video modality?

    ASwitch to audio-only calls, so that he can focus on her words without the distraction of the screenBKeep her usual in-person style, since a strong working alliance carries over to video without changesCCheck in aloud more often about how her words land, since many cues are hidden off screen
    Show answer and rationaleHide answer and rationale

    Answer: C. Counselors who work at a distance consider how electronic communication differs from face-to-face contact, including lost visual and vocal cues, and work to prevent and address the misunderstandings that follow (ACA, 2014, Standard H.4.f); checking aloud more often how her words land is one way to do that.

    Why the wrong answers tempt you: A sounds like reducing distraction, but it removes the facial cues that remain, and B rests on the real strength of the alliance, but it ignores the signs that the medium itself is causing misreadings.

    • Chapter(s): 4 (telemental health); also 22
    • 2027 NCE: 4.7
    • Source(s): ACA (2014), Standard H.4.f
70. Item 70

    Theo, 58, divorced last year and lost his job in the spring. At intake he says he is “fine” and denies suicidal thoughts. Later he mentions that last week he gave his fishing gear and his dog to his brother “since I won’t be needing them.” What should the counselor do NEXT?

    AAccept his denial, document low risk, and reassess his mood at the next scheduled sessionBSchedule sessions twice a week so that his mood can be monitored closely over the next monthCAsk directly about suicidal thoughts, plans, and access to means, and explore his comment
    Show answer and rationaleHide answer and rationale

    Answer: C. Giving away important possessions is a recognized warning sign of suicide, and warning signs, unlike longer-standing risk factors, point to near-term risk; a verbal denial does not cancel one, so the counselor asks directly about suicidal thoughts, plans, intent, and access to means and explores what “since I won’t be needing them” meant (NIMH, 2025; Rudd et al., 2006).

    Why the wrong answers tempt you: A is tempting because Theo has denied suicidal thoughts, but denial alongside preparatory behavior is a reason to ask more, not less, and B adds contact that may belong in the plan but postpones the assessment his comment calls for today.

    • Chapter(s): 5 (Suicide and violence risk: Ask directly; Safety planning, lethal means, and 988)
    • 2027 NCE: 2B.2 (knowledge: risk assessment and risk factors or symptoms)
    • Source(s): NIMH (2025); Rudd et al. (2006)

End of Part 1. Check your flagged items now. When you start your break, your Part 1 answers are final.

Part 2: Items 71–140

Begin Part 2 only after you have finished Part 1 and taken your break. Do not return to Part 1.

71. Item 71

    Two months after ending counseling, Celestine, 41, calls her former counselor and asks that her records be destroyed because she worries about who might read them someday. Agency policy, consistent with state law, requires keeping adult records for 7 years after the last service. What is the counselor’s BEST response?

    AShred the records, because clients own the information in their counseling filesBRemove the most sensitive pages and keep the rest to satisfy the retention policyCExplain the retention rule, how the records are protected, and document her request
    Show answer and rationaleHide answer and rationale

    Answer: C. Counselors keep records after termination as federal and state laws and governing policies require (Standard B.6.h); clients have a right of access to their records (Standard B.6.e), not a right to early destruction, so the counselor explains the requirement and the safeguards and documents Celestine’s request.

    Why the wrong answers tempt you: A pulls because the file is about Celestine, but the agency maintains the record and the client holds access rights, and B looks like a compromise, yet removing pages alters the record and still violates the retention policy.

    • Chapter(s): 2
    • 2027 NCE: 6.2 (also 6.16)
    • Source(s): American Counseling Association (2014), Standards B.6.e, B.6.h
72. Item 72

    After a session with Omar, 52, his counselor writes a DAP note. Which sentence belongs in the Assessment section?

    A“Omar reports using time-outs twice this week and says arguments at home have decreased.”B“Omar’s use of time-outs and fewer arguments suggest progress toward his anger-management goal.”C“Omar will rate his anger daily and bring the log to next week’s session.”
    Show answer and rationaleHide answer and rationale

    Answer: B. In a DAP note, the Assessment section holds the counselor’s interpretation of the data, including progress toward treatment goals.

    Why the wrong answers tempt you: A pulls because it describes progress, but it reports what Omar said and so belongs in Data, and C describes next steps, which belong in Plan.

    • Chapter(s): 4
    • 2027 NCE: 5.8
    • Source(s): none needed beyond the chapter
73. Item 73

    After 8 weeks, Takeshi, 46, has met most of his objectives for work-related anxiety. Today he says his wife was just diagnosed with breast cancer, and he wants to focus on coping with her illness and supporting their children. The counselor should:

    ARevise the plan with Takeshi to add goals for the new concern, recording the date and reasonBFinish the anxiety objectives first, and then write a new plan once the original plan is completeCRefer him to a cancer support group, since the new concern falls outside his current treatment plan
    Show answer and rationaleHide answer and rationale

    Answer: A. Counselors and clients review and revise counseling plans together (ACA, 2014, Standard A.1.c; NBCC, 2026, task 3A.10), for example when goals are met, a new problem arises, or the client asks, and the revision is dated and explained in the record.

    Why the wrong answers tempt you: B sounds orderly but makes his most pressing concern wait, and C treats the plan as fixed, sending away a concern the counselor can address (a support group could be added, not substituted).

    • Chapter(s): 20 (also 21)
    • 2027 NCE: 3A.10
    • Source(s): ACA (2014); NBCC (2026)
74. Item 74

    At intake, Florencia, 37, gives vague answers about her address and job, glances at the door, and asks who will be able to see her file. Later she mentions that she is undocumented. Which response BEST integrates her context into the counseling relationship?

    APromise her that nothing she says will ever leave the room, so that she feels safe enough to open up to the counselorBAcknowledge that sharing may feel risky, explain who can see her file and the limits, and let her set the paceCDocument her vague answers as guardedness, and turn to lighter topics until she becomes more forthcoming with details
    Show answer and rationaleHide answer and rationale

    Answer: B. Her caution makes sense in her context, and honest, specific information about records and the limits of confidentiality, offered at a pace she controls, builds trust while respecting her right to decide what to share (ACA, 2014, Standards A.2.b, B.1.d; Sue et al., 2022).

    Why the wrong answers tempt you: A seems the fastest route to trust, but confidentiality has legal limits, and promising otherwise is inaccurate, while C pathologizes a reasonable, context-driven wariness.

    • Chapter(s): 34 (Age, social class, and immigration); also 2 (Confidentiality and its exceptions), 33
    • 2027 NCE: 4.8
    • Source(s): ACA (2014), Standards A.2.b, B.1.d; Sue et al. (2022)
75. Item 75

    Joaquín, a counselor in a primary care clinic, sees many adults with chronic insomnia. Before adding an intervention to his practice, he wants to know which counseling approaches have the strongest research support. Which source should he give the MOST weight?

    AA detailed case study by a well-known sleep expert describing one client’s dramatic improvementBA recent meta-analysis of randomized controlled trials comparing treatments for insomniaCSatisfaction ratings from thousands of people who use a popular sleep-tracking app
    Show answer and rationaleHide answer and rationale

    Answer: B. Randomized controlled trials are the standard for causal conclusions about whether an intervention works (APA Presidential Task Force on Evidence-Based Practice, 2006), and a meta-analysis pools many of them, which is why levels-of-evidence hierarchies place systematic reviews and meta-analyses of randomized trials at the top (Burns et al., 2011).

    Why the wrong answers tempt you: A pulls because of the expert’s reputation and the vivid result, but a single case cannot rule out other explanations for the change; C impresses with its large numbers, yet satisfaction ratings from self-selected users measure liking, not whether a treatment works.

    • Chapter(s): 9 (Evidence-based practice and reading research)
    • 2027 NCE: 1A.4
    • Source(s): APA Presidential Task Force on Evidence-Based Practice (2006); Burns et al. (2011)
76. Item 76

    A counselor’s intake summary for Joel, 50, describes his depressed mood, his prior counseling, his coping strategies, and a family history of depression. Which addition would MOST complete the summary as a biopsychosocial assessment?

    AHis medical conditions and medications, and his work, finances, housing, and relationshipsBA more detailed timeline of his depressive episodes and of what set off each oneCResults from a projective technique to uncover the conflicts beneath his low mood
    Show answer and rationaleHide answer and rationale

    Answer: A. A biopsychosocial assessment covers biological factors (medical conditions, medications, sleep, substance use), psychological factors, and social factors (work, finances, housing, relationships, culture), and Joel’s summary so far is almost entirely psychological (Engel, 1977).

    Why the wrong answers tempt you: B pulls because more detail feels more thorough, but it deepens the psychological domain already covered, and C sounds sophisticated, yet a projective technique adds nothing about the missing biological and social domains.

    • Chapter(s): 5 (The biopsychosocial assessment); also 20
    • 2027 NCE: 2B.4
    • Source(s): Engel (1977)
77. Item 77

    Aarav’s group practice uses a telehealth platform covered by a business associate agreement. The office manager turns on a new setting that automatically records every video session to the platform’s cloud storage so that “notes can be checked later.” What is Aarav’s BEST response?

    ALeave recording on, because the business associate agreement already covers the stored recordingsBAsk that the setting be turned off unless a client consents to recording for a specific purposeCLeave recording on, and mention it when the practice next updates its privacy notice
    Show answer and rationaleHide answer and rationale

    Answer: B. Counselors obtain clients’ permission before recording sessions (Standard B.6.c), and some states’ laws require every party’s consent to a recording, so a platform is used lawfully only when its settings match what clients have agreed to.

    Why the wrong answers tempt you: A pulls because the agreement does obligate the vendor to protect stored data, but it supplies no client consent, and C treats a privacy notice, which describes practices, as if it were informed consent to be recorded.

    • Chapter(s): 4 (also 2)
    • 2027 NCE: 6.9 (also 6.11)
    • Source(s): American Counseling Association (2014), Standard B.6.c
78. Item 78

    Mónica, 34, seeks counseling after months of sexual harassment by a male supervisor. Her counselor, a man, notices that she sits close to the door and answers briefly. Which response BEST reflects broaching?

    AName their gender difference in light of what she has faced, and ask how it feels to talk about it with himBLeave gender unmentioned, so that she does not feel he is assuming her discomfort has anything to do with himCArrange a transfer to a woman colleague, since her discomfort suggests that she would do better with a woman
    Show answer and rationaleHide answer and rationale

    Answer: A. Broaching means the counselor takes the initiative to raise sociopolitical factors, such as race, that may bear on the client’s concern and on the relationship, and invites the client to say how they matter (Day-Vines et al., 2007); here the factor is gender and the power difference it carries.

    Why the wrong answers tempt you: B pulls because it avoids presuming, but silence leaves her to raise the issue alone, which is the avoidant style broaching replaces, and C decides for her without asking, when she may prefer to continue; a transfer can be the right step if she asks for one once the topic is open.

    • Chapter(s): 22 (Broaching); also 33
    • 2027 NCE: 4.8
    • Source(s): Day-Vines et al. (2007)
79. Item 79

    Before a session, a counselor reviews her notes on Renata, 38. Last week Renata reported passive suicidal thoughts, and her safety plan included having her brother store her handgun before today’s appointment. How should this review MOST shape today’s session?

    AWait for Renata to raise the topic so that she continues to set the agendaBFollow the planned agenda and review the safety plan if time remains at the endCAsk early in the session whether the handgun was moved, and update the plan as needed
    Show answer and rationaleHide answer and rationale

    Answer: C. Reviewing documentation before a session is meant to carry open commitments into it, and checking on a lethal means step is part of following through on a safety plan (Stanley & Brown, 2012). Asking early leaves time to revise the plan if the handgun is still accessible.

    Why the wrong answers tempt you: A feels client-centered, but safety follow-up is the counselor’s responsibility, not something to leave to chance, and B keeps the agenda on track while risking that the check is rushed or skipped.

    • Chapter(s): 4 (also 5)
    • 2027 NCE: 5.6 (also 2B.2)
    • Source(s): Stanley and Brown (2012)
80. Item 80

    Mr. Ortiz, 31, has an intellectual disability and lives in a group home. A functional assessment found that he screams to get staff attention. Under his plan, day staff ignore the screaming and respond right away when he taps a staff member’s arm, the replacement behavior he was taught. Evening staff, however, rush to calm him whenever he screams. Screaming has dropped on day shifts but not on evenings. The BEST revision is to:

    AAdd a loss-of-privileges consequence for any screaming that occurs during evening shiftsBTrain evening staff to follow the same plan, and compare behavior data across all shiftsCWrite a separate evening plan that lets staff use whatever approach calms him the fastest
    Show answer and rationaleHide answer and rationale

    Answer: B. A behavioral management plan works only when everyone applies it the same way; evening attention reinforces screaming on an intermittent schedule, which makes the behavior more resistant to extinction (Ferster & Skinner, 1957).

    Why the wrong answers tempt you: A adds punishment instead of fixing the inconsistent reinforcement, and C sounds responsive but keeps paying off screaming with the very attention the plan is designed to withhold.

    • Chapter(s): 20 (also 25)
    • 2027 NCE: 3A.11
    • Source(s): Ferster and Skinner (1957)
81. Item 81

    Mariana learns from the state board’s website that her counseling license expired 5 days ago because she forgot to submit her renewal. The board’s rules provide no grace period, and she has 14 clients scheduled this week. What is her BEST course of action?

    AStop providing licensed services, arrange coverage or rescheduling, and begin reinstatementBKeep seeing clients while she renews, since her training and competence have not changedCKeep seeing clients, but hold all insurance claims until the board reactivates her license
    Show answer and rationaleHide answer and rationale

    Answer: A. Without a current license Mariana may not practice under state licensure law, and she may claim only licenses that are current and in good standing (Standard C.4.b), so she stops licensed services, protects her clients from abandonment by arranging coverage or rescheduling (Standard A.12), and starts the board’s reinstatement process.

    Why the wrong answers tempt you: B pulls because her skills are unchanged, but the license, not competence, is the legal authority to practice, and C treats the lapse as a billing problem, yet seeing clients without a license is unlicensed practice whoever pays.

    • Chapter(s): 4 (also 1)
    • 2027 NCE: 6.6 (also 6.3)
    • Source(s): American Counseling Association (2014), Standards A.12, C.4.b
82. Item 82

    At the start of her intake, Mariel, 29, receives the practice’s eight-page policy packet, which covers fees, cancellations, records, after-hours contact, and the limits of confidentiality. She signs the last page without reading it and says, “I trust you. Let’s just get started.” What should the counselor do?

    AAccept her signature, since the signed packet documents that she has agreed to the policiesBBegin the session as she asks and give her the packet to read at home before the next appointmentCGo over the key policies with her in plain language, invite her questions, and note the discussion in her record
    Show answer and rationaleHide answer and rationale

    Answer: C. Counselors review clients’ rights and responsibilities both in writing and verbally, use clear and understandable language, and document informed consent discussions; a signature on an unread packet does not show that she understands the policies, including the limits of confidentiality, that may shape what she chooses to share (ACA, 2014, Standards A.2.a, A.2.c; NBCC, 2026, task 2A.5).

    Why the wrong answers tempt you: A treats a signature as if it were understanding, and B honors her wish to start and can seem to fit the Code’s description of consent as ongoing, yet counselors explain the limits of confidentiality at the start of counseling (Standard B.1.d), and B would have her begin disclosing under policies she has not read.

    • Chapter(s): 2 (Informed consent: Elements and timing); also 5 (Tasks and their order)
    • 2027 NCE: 2A.5 (skill: explaining policies and procedures)
    • Source(s): ACA (2014), Standards A.2.a, A.2.c, B.1.d; NBCC (2026)
83. Item 83

    Keisha’s caseload at a sexual assault services center now consists almost entirely of survivors of sexual violence. She feels well but wants to stay alert to how the work affects her over time. Which plan BEST fits that goal?

    AWait to evaluate herself until symptoms such as intrusive images or new fears appearBSelf-assess regularly with a structured measure and review her exposure in supervisionCSteer clients away from traumatic details so that her own exposure stays manageable
    Show answer and rationaleHide answer and rationale

    Answer: B. Vicarious trauma builds gradually from cumulative exposure to clients’ traumatic material and can shift a counselor’s beliefs about safety and trust (McCann & Pearlman, 1990; Pearlman & Saakvitne, 1995), so the protective plan is ongoing self-assessment, for example with a structured measure such as the Professional Quality of Life Scale (ProQOL), which screens for compassion satisfaction, burnout, and secondary traumatic stress (Stamm, 2010), plus supervision that reviews her exposure and caseload balance.

    Why the wrong answers tempt you: A pulls because it avoids worrying over nothing, but waiting for symptoms means changes in her beliefs about safety and trust may already be under way; C protects the counselor by silencing clients, which can signal to survivors that their experiences are too terrible to speak about.

    • Chapter(s): 3 (Counselor wellness: three different kinds of wear; Self-regulation and self-care)
    • 2027 NCE: 1B.2 (skill: recognizing vicarious trauma and burnout)
    • Source(s): McCann and Pearlman (1990); Pearlman and Saakvitne (1995); Stamm (2010)
84. Item 84

    Bogdan, 50, came to counseling for work stress at his daughter’s urging and has never seen a counselor. He arrives unsure of what to expect. Which first-session step is MOST likely to reduce the chance that he drops out early?

    ALet him lead the session without structure, so that he does not feel the counselor is imposing an agendaBGive him a thorough packet on stress management, so that he leaves the session with something concreteCExplain how sessions work, what each of them will do, and that progress is often uneven
    Show answer and rationaleHide answer and rationale

    Answer: C. Role induction, which explains how counseling works, each person’s role, and what to expect about the course of progress, is one of the research-based recommendations for reducing premature termination (Swift et al., 2012).

    Why the wrong answers tempt you: A sounds client-centered, but a newcomer with no idea what to expect is left to guess, and B gives him something concrete, but information about stress does not tell him how counseling itself will work.

    • Chapter(s): 22 (Orienting the client)
    • 2027 NCE: 4.9
    • Source(s): Swift et al. (2012)
85. Item 85

    Loretta holds a master’s degree in clinical mental health counseling and a doctorate in music education. For her new private practice, she plans to use the title “Dr.” on her website and in her advertising. Under the ACA Code of Ethics, how should she present her credentials?

    AUse “Dr.” in all her advertising, since any earned doctorate entitles her to the titleBUse “Dr.” as long as her website notes that music is used in some counseling approachesCList her counseling master’s as her highest counseling degree and not use “Dr.” in her counseling work
    Show answer and rationaleHide answer and rationale

    Answer: C. Counselors state their highest earned degree in counseling or a closely related field and do not use “Dr.” in a counseling context to imply doctoral-level competence when the doctorate is in an unrelated field (Standard C.4.d); Loretta may still list the music doctorate accurately as a degree outside counseling (Standard C.4.a).

    Why the wrong answers tempt you: A pulls because the doctorate is genuinely earned, but in a counseling ad the title implies counseling expertise she earned at the master’s level (Standard C.3.a), and B tries to bridge the fields with a disclaimer, yet music education is not a closely related field, and the title still misleads.

    • Chapter(s): 1 (also 4)
    • 2027 NCE: 6.20 (also 6.5)
    • Source(s): American Counseling Association (2014), Standards C.3.a, C.4.a, C.4.d
86. Item 86

    During counseling for depression, Evelyn, 67, mentions that her husband, who has Parkinson’s disease, now needs help bathing and dressing, and that she has not had a day off in months. Which referral approach is BEST?

    AGive her the number of a national caregiver hotline and suggest she call it when she has a free momentBAsk what help she wants, offer specific respite and caregiver-support options, and follow up next sessionCContact her husband’s neurologist to begin arranging a nursing home placement so that she can rest
    Show answer and rationaleHide answer and rationale

    Answer: B. A referral is a process: explore what the client wants, offer specific community options such as respite care and caregiver support, and confirm that she connected (NBCC, 2026, task 3B.1).

    Why the wrong answers tempt you: A is technically a referral but leaves an exhausted caregiver to do all the work, and C jumps to a major decision that belongs to the couple and discloses client information to a physician without consent (ACA, 2014, Standard B.1.c).

    • Chapter(s): 21 (caregiving: 15)
    • 2027 NCE: 3B.1
    • Source(s): ACA (2014); NBCC (2026)
87. Item 87

    A school counselor is helping a teacher evaluate a new plan for Elias, 7, whose tantrums last anywhere from 2 to 25 minutes. The team’s goal is to shorten the tantrums, not to change how often they occur. Which observation method fits BEST?

    AEvent recordingBDuration recordingCMomentary time sampling
    Show answer and rationaleHide answer and rationale

    Answer: B. Duration recording measures how long each episode lasts, which matches a goal of shorter tantrums (Cooper et al., 2020).

    Why the wrong answers tempt you: A is the most familiar method, but event recording counts how often tantrums occur, which the team is not trying to change, and C estimates the share of time a behavior is present by checking at set moments, so it does not capture the length of each episode.

    • Chapter(s): 8 (Formal and informal observation); also 25
    • 2027 NCE: 2B.8 (skill: conducting formal assessments)
    • Source(s): Cooper et al. (2020)
88. Item 88

    The director of a new residential treatment center visits Yusuf, a counselor in private practice, and offers him $200 for each client he refers, asking in return that the center be featured on Yusuf’s referral list. Yusuf’s BEST response is to:

    AAccept the payment, provided he tells each referred client about the arrangementBDecline the payment and judge the center by the standards he applies to other resourcesCAccept the payment but refer only clients whose needs clearly call for residential care
    Show answer and rationaleHide answer and rationale

    Answer: B. Counselors do not give or receive commissions, rebates, or any other remuneration for referrals (Standard A.10.b), and a resource earns a place on the list by fitting clients’ needs, not by paying for it.

    Why the wrong answers tempt you: A pulls because transparency usually cures conflicts, but the Code bars referral payments outright, and C feels clinically sound, yet appropriate referrals do not make accepting the payment acceptable.

    • Chapter(s): 21 (also 4)
    • 2027 NCE: 5.5 (also 6.5)
    • Source(s): American Counseling Association (2014), Standard A.10.b
89. Item 89

    Ruth practices in a small rural town, where she often sees clients at the grocery store, school events, and church. Asked how she handles these overlaps, she says she “goes with her gut.” After an ethics training, which change would MOST strengthen her practice?

    ADeclining all contact with clients outside the office, since overlapping roles violate the CodeBContinuing to trust her intuition, since it has kept her free of complaints so farCUsing a decision-making model for these situations, consulting, and documenting her reasoning
    Show answer and rationaleHide answer and rationale

    Answer: C. Facing an ethical dilemma, counselors use and document an ethical decision-making model, with consultation as part of the process (ACA, 2014, Standard I.1.b), and Kitchener (1984) described sound ethical reasoning as moving beyond immediate intuition to a critical-evaluative level of rules and principles.

    Why the wrong answers tempt you: B pulls because Kitchener did treat intuition as the first level of ethical reasoning, but intuition alone gives Ruth no way to test or defend a choice; A sounds safely conservative, yet the Code does not forbid unavoidable community contact, and it asks counselors to weigh risks and benefits and take precautions rather than impose a blanket ban (Standard A.6.b).

    • Chapter(s): 1 (Ethical decision-making); also 3 (Extending boundaries and nonprofessional interactions)
    • 2027 NCE: 1A.6
    • Source(s): ACA (2014), Standards A.6.b, I.1.b; Kitchener (1984)
90. Item 90

    Rosalía, 28, is about to begin cognitive behavioral therapy (CBT) for depression. Which approach BEST orients her to CBT?

    AAssign a thought record right away, since she will learn how CBT works most quickly by actually doing itBUse an example from her week to link thoughts, feelings, and actions, and describe how sessions and homework workCExplain that early sessions will explore her childhood in depth before any work on her current problems begins
    Show answer and rationaleHide answer and rationale

    Answer: B. Socializing the client to CBT means teaching the cognitive model with her own example and explaining the structured, collaborative format, including between-session practice, so she knows what the work involves (Beck, 2021).

    Why the wrong answers tempt you: A captures CBT’s emphasis on action, but homework assigned before she understands the model often goes undone, and C describes a psychodynamic orientation rather than CBT’s present-focused approach.

    • Chapter(s): 26 (The cognitive model); also 22
    • 2027 NCE: 4.9
    • Source(s): Beck (2021)
91. Item 91

    Yesenia, 36, began video counseling after her husband pushed her during an argument. Halfway through today’s session, her answers grow short, and she keeps glancing off-screen. Earlier she mentioned that her husband stayed home sick today. What should the counselor do FIRST?

    AAsk Yesenia to describe last week’s argument in detail so that the risk can be documentedBCheck whether she can talk privately, using questions she can answer with yes or noCEnd the session and call the police to request a welfare check at Yesenia’s home
    Show answer and rationaleHide answer and rationale

    Answer: B. In telehealth the counselor cannot see who else is in the room, and a client living with violence may face greater danger if she is overheard, so the first step is to check privacy with questions she can answer safely, then shift to neutral topics, a prearranged code phrase, or a safer time if she cannot talk freely (NYC Mayor’s Office to End Domestic and Gender-Based Violence, 2020; Pennsylvania Coalition Against Rape, 2020).

    Why the wrong answers tempt you: A pulls because documenting risk matters, but detailed questions could endanger her if her husband is listening, and C feels protective, yet nothing suggests imminent danger, and an unrequested police visit could escalate the situation and override her choices.

    • Chapter(s): 4 (also 29)
    • 2027 NCE: 6.4 (also 2B.2)
    • Source(s): Barnett and Kolmes (2016); NYC Mayor’s Office to End Domestic and Gender-Based Violence (2020); Pennsylvania Coalition Against Rape (2020)
92. Item 92

    Aaliyah, 26, meets full criteria for posttraumatic stress disorder (PTSD) after an assault in a parking garage. She has had several panic attacks, each set off by a reminder such as entering a garage or hearing footsteps behind her; none has come out of the blue. Which diagnostic record is MOST accurate?

    APTSD, with panic attacksBPTSD and panic disorderCPTSD and agoraphobia, since she avoids garages
    Show answer and rationaleHide answer and rationale

    Answer: A. Panic attacks can occur within any mental disorder and are then recorded with the “with panic attacks” specifier, while panic disorder requires recurrent unexpected attacks and is not diagnosed when attacks occur only in response to trauma reminders, as in PTSD (APA, 2022).

    Why the wrong answers tempt you: B is tempting because she has both PTSD and panic attacks, but cued attacks do not make a second disorder, and C pulls because she avoids garages, yet avoiding trauma reminders is already a PTSD symptom.

    • Chapter(s): 11 (Panic attacks and panic disorder; PTSD); also 6 (Differential diagnosis and comorbidity)
    • 2027 NCE: 2B.6
    • Source(s): APA (2022)
93. Item 93

    Tyler, 19, is finishing a 28-day residential program for alcohol use disorder. He plans to move back into an apartment with two roommates who drink heavily most nights. Which aftercare plan BEST supports his recovery?

    AOutpatient counseling only, since where he chooses to live is a personal matter outside the planBA return to the apartment, since facing drinking at home will strengthen the skills he learned in treatmentCOutpatient care and mutual-help meetings, plus exploring recovery housing or another alcohol-free home
    Show answer and rationaleHide answer and rationale

    Answer: C. An aftercare plan carries treatment gains into the client’s everyday environment, and a home with heavy drinking most nights is a serious relapse risk, so the plan pairs continuing care with a safer place to live (Mee-Lee et al., 2013, recovery environment dimension; NBCC, 2026, task 3B.2).

    Why the wrong answers tempt you: A respects his autonomy, but the counselor can name the living situation as a risk and explore options while the choice stays with Tyler, and B borrows the logic of exposure therapy, yet nightly, unplanned contact with drinking in early recovery is a high-risk situation, not a treatment (Marlatt & Gordon, 1985).

    • Chapter(s): 21 (also 12)
    • 2027 NCE: 3B.2
    • Source(s): Mee-Lee et al. (2013); Marlatt and Gordon (1985); NBCC (2026)
94. Item 94

    Midway through a family session, Mr. Castellanos stands, raises his voice, and steps toward his 15-year-old daughter, who shrinks back in her chair. He has no weapon. What should the counselor do FIRST?

    AEncourage him to let all of his anger out, since expressing it fully will help him calm down soonerBAsk his daughter what she said that upset him, so that the conflict can be resolved quicklyCIn a calm, firm voice, ask him to step back and sit down, and offer a short break outside the room
    Show answer and rationaleHide answer and rationale

    Answer: C. Verbal de-escalation uses a calm voice, a clear limit, and an offered choice, and with a child in his path the first step is to stop the approach and lower the stimulation (Richmond et al., 2012).

    Why the wrong answers tempt you: A draws on the popular idea of catharsis, but venting anger tends to increase it (Bushman, 2002), and B treats the moment as a content problem to solve while the daughter’s safety is at stake.

    • Chapter(s): 29 (De-escalation); also 28
    • 2027 NCE: 4.10
    • Source(s): Richmond et al. (2012); Bushman (2002)
95. Item 95

    At intake, Farah, 34, tells the male counselor assigned to her that, because of her religious values, she would feel more comfortable discussing her marriage with a woman. She reports no safety concerns, and a female counselor at the agency has an opening in two weeks. The counselor’s BEST response is to:

    AAssure her that his multicultural training prepares him to help her, and begin the assessmentBExplain that the agency’s nondiscrimination policy rules out assignments based on genderCHonor her preference by arranging the female counselor, and give her crisis resources meanwhile
    Show answer and rationaleHide answer and rationale

    Answer: C. Suitability includes the client’s needs and sociocultural considerations; honoring a preference grounded in her religious values respects her autonomy and worldview, and accommodating client preferences is associated with lower dropout (Swift et al., 2018). The interim crisis resources cover the two-week wait.

    Why the wrong answers tempt you: A pulls because the counselor may well be competent, but competence does not override what the client says she needs to speak openly; B misreads nondiscrimination, which bars counselors from discriminating against clients (Standard C.5), not from honoring a client’s request.

    • Chapter(s): 3 (Bracketing and self-reflection: client-counselor suitability); also 33 (Culture in the plan and ethics)
    • 2027 NCE: 1B.5
    • Source(s): ACA (2014), Standard C.5; Swift et al. (2018)
96. Item 96

    Lakshmi, 50, begins counseling at an integrated primary care clinic. Her counselor, her physician, a nurse care manager, and a consulting psychiatrist review shared cases weekly. At the first session, what must the counselor make sure Lakshmi understands?

    AWho is on the team, what information they will share, and why it is sharedBNothing beyond the clinic’s privacy notice, since sharing among treating providers is routineCOnly the psychiatrist’s involvement, since the other members do not provide mental health care
    Show answer and rationaleHide answer and rationale

    Answer: A. When an interdisciplinary or treatment team is involved, the client is told the team exists, who is on it, what information is shared, and why (Standard B.3.b).

    Why the wrong answers tempt you: B pulls because HIPAA lets providers share information for treatment without an authorization (Uses and Disclosures to Carry Out Treatment, Payment, or Health Care Operations, 2026), but the ACA Code still requires telling the client about the team, and C wrongly treats the physician and care manager as outside the client’s care.

    • Chapter(s): 21 (also 2)
    • 2027 NCE: 5.3
    • Source(s): American Counseling Association (2014), Standard B.3.b; Uses and Disclosures to Carry Out Treatment, Payment, or Health Care Operations (2026)
97. Item 97

    Kalani wants to recommend a free mindfulness app that her clients can use between sessions. Which step is MOST important before she recommends it?

    AReviewing the app’s research support and privacy policy, and discussing its limits with clientsBConfirming that the app is labeled “HIPAA compliant,” since that label keeps clients’ data privateCChecking the app’s store ratings, since high ratings from many users show that it is effective
    Show answer and rationaleHide answer and rationale

    Answer: A. Counselors use interventions with a theoretical or empirical foundation (Standard C.7.a), understand the technology they use (Standard H.1.a), and inform clients of its benefits and limitations (Standard H.4.a); for an app, that means knowing its evidence and what data it collects and shares.

    Why the wrong answers tempt you: B pulls because “HIPAA compliant” sounds like a guarantee, but it is a vendor’s marketing claim, not a review of what the app shares, and C mistakes popularity for evidence.

    • Chapter(s): 4
    • 2027 NCE: 6.11 (also 1A.4)
    • Source(s): American Counseling Association (2014), Standards C.7.a, H.1.a, H.4.a
98. Item 98

    A counselor is preparing the informed consent discussion for a closed 10-week counseling group for adults going through divorce. Beyond what individual clients are told, which topic is MOST specific to the group format?

    AThe counselor’s credentials, training, and theoretical approachBThe fee, the cancellation policy, and how insurance claims are filedCExpectations about members’ contact with one another outside group sessions
    Show answer and rationaleHide answer and rationale

    Answer: C. Group consent covers matters that do not arise in individual counseling, including how members’ contact with one another outside sessions will be handled; ASGW guidance has leaders explain this in advance, and Yalom asks members to bring meaningful outside contact back into the group (McCarthy et al., 2022; Yalom & Leszcz, 2020).

    Why the wrong answers tempt you: A and B pull because both are real elements of informed consent, but they apply to every client and are not specific to group work.

    • Chapter(s): 31 (Contact outside the group); also 2 (Groups) and 30
    • 2027 NCE: 2A.6
    • Source(s): McCarthy et al. (2022); Yalom and Leszcz (2020)
99. Item 99

    Fifteen minutes after seeing a serious car crash in front of the school, Mateo, 16, is brought to the school counselor. He is shaking, breathing fast, and says he “can’t stop seeing it.” What should the counselor do FIRST?

    AHelp him slow his breathing and notice his surroundings, and stay with him until he is calmerBGive him the PCL-5 to screen for posttraumatic stress disorder while the reactions are freshCReassure him that the shaking is nothing to worry about, and send him back to class to keep his routine
    Show answer and rationaleHide answer and rationale

    Answer: A. Psychological first aid calls for staying with an overwhelmed survivor and helping him stabilize, for example by slowing his breathing and orienting to the present surroundings, before anything else (Brymer et al., 2006).

    Why the wrong answers tempt you: B sounds thorough, but PTSD cannot be diagnosed until symptoms last more than a month, so screening 15 minutes after the event is premature (American Psychiatric Association, 2022), and C restores routine before he is stable and dismisses a normal acute stress reaction.

    • Chapter(s): 29 (Disaster response); also 11
    • 2027 NCE: 4.10
    • Source(s): Brymer et al. (2006); American Psychiatric Association (2022)
100. Item 100

     Near the end of counseling for social anxiety, Valentina, 28, says, “You fixed me. I don’t know how I’ll manage without these sessions.” The counselor’s BEST response is to:

     AReassure her that she can keep coming weekly for as long as she feels she needs the supportBAccept the credit warmly, since her trust in counseling will help her if she ever needs to returnCHelp her name the steps she took that produced the change and plan how she will keep using them
     Show answer and rationaleHide answer and rationale

     Answer: C. Gains last when clients credit the change to their own efforts and know how they will keep using what worked; such mastery experiences (performance accomplishments) are a principal source of self-efficacy (Bandura, 1977).

     Why the wrong answers tempt you: A feels supportive but prolongs counseling she may no longer need (ACA, 2014, Standard A.11.c), and B is gracious but confirms her belief that the change came from the counselor.

     • Chapter(s): 21 (self-efficacy: 25)
     • 2027 NCE: 3B.3
     • Source(s): Bandura (1977); ACA (2014)
101. Item 101

     Faisal will be deposed as a fact witness in a workers’ compensation case brought by his client, Ilse, 49, who has signed a release. Reviewing his notes, Faisal sees that several entries are brief and could be misread. Which preparation is BEST?

     AAdding clarifying details to the brief entries so that the record is complete before he testifiesBBringing his full file and offering it to the opposing attorney to show he has nothing to hideCLeaving the records unchanged, consulting an attorney, and testifying only to facts he knows
     Show answer and rationaleHide answer and rationale

     Answer: C. Records are never rewritten after the fact, least of all before testimony, and any genuine amendment is noted as an amendment (Standard A.1.b); Faisal reviews them as they are, gets legal consultation (often available through a liability insurer), and, as a fact witness, testifies only to what he observed and did (Wheeler & Bertram, 2019).

     Why the wrong answers tempt you: A pulls because the notes really are thin and the Code does allow properly noted amendments (Standard A.1.b), but A writes new details into the original entries to prepare for testimony, which looks like tampering; Faisal can explain a brief entry when he testifies, and B confuses transparency with disclosure, since the release, not the opposing attorney’s interest, defines what may be shared (Standard B.2.e).

     • Chapter(s): 2 (also 1)
     • 2027 NCE: 6.17 (also 6.16)
     • Source(s): American Counseling Association (2014), Standards A.1.b, B.2.e; Wheeler and Bertram (2019)
102. Item 102

     According to the ACA Code of Ethics, counselor self-care is BEST described as:

     AA personal matter that falls outside the Code’s professional standardsBA way to maintain well-being so that counselors can meet their professional responsibilitiesCAn obligation that begins only after a counselor has been found to be impaired
     Show answer and rationaleHide answer and rationale

     Answer: B. The introduction to Section C of the Code says counselors engage in self-care to maintain and promote their mental, emotional, physical, and spiritual well-being so that they can best meet their professional responsibilities (ACA, 2014).

     Why the wrong answers tempt you: C pulls because the Code does address impairment directly (Standard C.2.g), but self-care is meant to come first and help prevent it; A treats self-care as private, when the Code ties it to the counselor’s duty to clients.

     • Chapter(s): 1 (Self-care and planning for the unexpected); also 3 (Self-regulation and self-care)
     • 2027 NCE: 1B.10
     • Source(s): ACA (2014), Section C introduction, Standard C.2.g
103. Item 103

     A school counselor wants a standardized measure of depressive symptoms for Ella, 9. The only depression measure the school owns is the Beck Depression Inventory-II (BDI-II), which was developed for ages 13 to 80. What should the counselor do?

     AGive Ella the BDI-II and read the items aloud so that she can understand themBChoose a depression measure developed and normed for children her ageCAsk her parents to complete the BDI-II, rating the symptoms they see in her
     Show answer and rationaleHide answer and rationale

     Answer: B. Counselors select instruments whose validity, reliability, and norms fit the client, including the client’s age, and the BDI-II was developed for ages 13 to 80 (ACA, 2014, Standards E.6.a, E.8; Beck et al., 1996).

     Why the wrong answers tempt you: A pulls because reading aloud seems to solve the problem, and the BDI-II may be given orally, but reading the items to her does not make norms built on ages 13 to 80 fit a 9-year-old, and C swaps in a different rater, so the scores no longer mean what the self-report norms assume.

     • Chapter(s): 8 (Symptom and outcome measures; Before testing); also 7 (norms)
     • 2027 NCE: 2B.11 (developmental considerations)
     • Source(s): ACA (2014), Standards E.6.a, E.8; Beck et al. (1996)
104. Item 104

     Grace, 27, takes a second-generation antipsychotic for bipolar I disorder, and her prescriber raised the dose 10 days ago. Since then, she reports an inner restlessness and an urge to keep moving, and she paces during the session. She has signed a release for her prescriber. Which response is BEST?

     ATeach progressive muscle relaxation, since the restlessness most likely reflects anxietyBSuggest that she return to her previous dose until she can see her prescriberCDocument her report and its timing, and with her knowledge contact the prescriber promptly
     Show answer and rationaleHide answer and rationale

     Answer: C. Inner restlessness and pacing that begin within weeks of an antipsychotic dose increase fit medication-induced acute akathisia (American Psychiatric Association, 2022). The counselor documents what Grace reports and when it began and promptly notifies the prescriber, who decides any change to the medication.

     Why the wrong answers tempt you: A pulls because restlessness looks like anxiety, but the timing points to the medication, and B sounds sensible, yet changing a dose is outside a counselor’s scope.

     • Chapter(s): 14
     • 2027 NCE: 5.4 (also 5.3)
     • Source(s): American Psychiatric Association (2022)
105. Item 105

     Halima, 29, has had three panic attacks, and each time she was sure she was having a heart attack. Her physician has ruled out heart disease. Which psychoeducation BEST fits the cognitive model of panic?

     ABecause her heart is healthy, the attacks are imaginary and will fade once she fully accepts that factBThe sensations are the body’s alarm response, and reading them as danger feeds a cycle that intensifies the attackCShe should avoid exercise and other activities that raise her heart rate, so that she does not trigger another attack
     Show answer and rationaleHide answer and rationale

     Answer: B. In the cognitive model of panic, attacks escalate when normal bodily sensations are misinterpreted as signs of catastrophe, so explaining the alarm response and that cycle is the core psychoeducation (Clark, 1986).

     Why the wrong answers tempt you: A starts from the right medical fact, but calling the sensations imaginary is inaccurate and dismissive, and C sounds protective, but avoiding sensations maintains the fear that drives panic.

     • Chapter(s): 11 (Panic attack, panic disorder, agoraphobia; Exposure, the common engine).
     • 2027 NCE: 4.11
     • Source(s): Clark (1986)
106. Item 106

     An ice storm cut power to a counseling practice for 3 days. The practice’s emergency preparedness plan told counselors to call clients from the contact list in the EHR, which no one could open without power or internet. Now that the office has reopened, what is the BEST next step?

     AReview the plan with staff and add secure offline access to client contact informationBKeep the plan as written, since outages lasting several days are rare in the areaCHave each counselor keep printed copies of full client records at home for emergencies
     Show answer and rationaleHide answer and rationale

     Answer: A. Task 6.15 is to review and update the emergency preparedness plan, and the outage exposed a single point of failure, so the practice revises the plan to include secure offline access to contact information and reviews it on a schedule; the HIPAA Security Rule likewise calls for contingency plans with procedures for testing and revising them (Security Standards for the Protection of Electronic Protected Health Information, 2026).

     Why the wrong answers tempt you: B pulls because rare events seem like poor planning targets, but this plan just failed, and C restores access at the cost of security by scattering full records in counselors’ homes (Standard B.6.b).

     • Chapter(s): 4
     • 2027 NCE: 6.15 (also 6.1, 3B.6)
     • Source(s): American Counseling Association (2014), Standard B.6.b; Security Standards for the Protection of Electronic Protected Health Information, 45 C.F.R. pt. 164, subpt. C (2026)
107. Item 107

     Odalys, 35, has spent 3 weeks in a partial hospitalization program for major depressive disorder. Which finding BEST indicates that she is ready for discharge to outpatient care?

     AShe has used all of the program days her insurance plan will authorize for this yearBShe has met her program objectives, denies suicidal intent, and has an outpatient appointment setCShe reports feeling much better after one good weekend and asks to return to work right away
     Show answer and rationaleHide answer and rationale

     Answer: B. Discharge readiness rests on the criteria set in the discharge plan: objectives met, risk managed, and the next level of care in place (NBCC, 2026, task 3B.4).

     Why the wrong answers tempt you: A reflects a real-world pressure, but an authorization limit is not clinical readiness, and C rightly values her report but treats one good weekend as if it met the criteria.

     • Chapter(s): 21
     • 2027 NCE: 3B.4
     • Source(s): NBCC (2026)
108. Item 108

     Dmitri, who has no military background, joins a clinic that serves veterans and their families. Which step BEST prepares him to work with this population?

     ATrain in military culture and examine his own assumptions about military serviceBRely on his graduate multicultural course, since the same principles apply to every groupCAsk his veteran clients to teach him about military culture during their sessions
     Show answer and rationaleHide answer and rationale

     Answer: A. Examining his own assumptions and training in military culture join the first two domains of the Multicultural and Social Justice Counseling Competencies, counselor self-awareness and knowledge of the client’s worldview (Ratts et al., 2016), and the Code expects counselors to stay informed about best practices with diverse populations (ACA, 2014, Standard C.2.f). Military life has its own norms, hierarchy, and language that civilian counselors need to learn (Hall, 2011).

     Why the wrong answers tempt you: C pulls because cultural humility treats clients as the experts on their own lives, but making clients his main teachers spends their session time on his education; B assumes general principles are enough and skips the population-specific learning that task 1A.8 names.

     • Chapter(s): 33 (Cultural humility and the MCO framework; From multicultural competence to social justice); also 15 (military families)
     • 2027 NCE: 1A.8
     • Source(s): ACA (2014), Standard C.2.f; Ratts et al. (2016); Hall (2011)
109. Item 109

     Hollis, 45, completed an anxiety inventory at intake, and his score falls in the severe range. When the counselor shares the result, Hollis frowns and says, “That’s not me. I’m just a busy guy.” What should the counselor do?

     AExplain that the inventory is well validated, so his reaction most likely reflects minimizingBDrop the score from his record, since his disagreement shows that the result is invalidCExplore his reaction, review the items behind the score, and weigh it with the interview
     Show answer and rationaleHide answer and rationale

     Answer: C. Clients have a right to understand their results, and good feedback invites the client’s reaction and treats a score as one source of data to weigh with others, such as the interview, while noting any doubts about validity (ACA, 2014, Standards E.1.b, E.6.a, E.9.a).

     Why the wrong answers tempt you: A leans on the test’s reputation and turns the client’s disagreement into a symptom, and B swings the other way, letting his reaction alone overrule data that may well be accurate.

     • Chapter(s): 8 (Sharing results and planning)
     • 2027 NCE: 2B.10
     • Source(s): ACA (2014), Standards E.1.b, E.6.a, E.9.a
110. Item 110

     Kiri, 48, has just learned that her father, who lives with her, has Alzheimer’s disease. She asks her counselor what she should expect as his caregiver. Which approach to psychoeducation is BEST?

     ARefer all of her questions to his neurologist, since teaching about a medical diagnosis is outside a counselor’s scopeBGive her a comprehensive written guide to the disease, and invite her to call with any questions after reading itCShare information in small, plain-language pieces tied to her situation, such as caregiver strain, and check understanding
     Show answer and rationaleHide answer and rationale

     Answer: C. Providing psychoeducation is a listed counselor task (NBCC, 2026, task 4.11). Small, plain-language pieces tied to her own situation, with a check on what she took in, let the counselor fit the information to her concerns and correct misunderstandings as they arise.

     Why the wrong answers tempt you: A pulls because the diagnosis is medical, but explaining what caregiving may involve and pointing to resources is within a counselor’s scope, while detailed medical questions can still go to the physician, and B is thorough but one-way, so it cannot fit her concerns or catch misunderstandings.

     • Chapter(s): 15 (Life transitions: caregiving); also 13 (Neurocognitive disorders), 26 (Teaching skills: psychoeducation versus skill development)
     • 2027 NCE: 4.11
     • Source(s): NBCC (2026)
111. Item 111

     Lachlan, 15, comes alone to a community counseling clinic, asks for help with anxiety, and says he does not want his parents to know. What MOST determines whether the counselor may begin counseling him without a parent’s consent?

     AThe ACA Code of Ethics, which allows minors who understand the services to consent for themselvesBThe state’s law on minors’ consent to outpatient mental health care, along with clinic policyCHIPAA, which gives minors age 14 and older the right to consent to their own health care
     Show answer and rationaleHide answer and rationale

     Answer: B. Whether a minor may consent to outpatient counseling without a parent depends on state law, which varies in the ages and conditions it sets, and on clinic policy; the Code asks counselors to balance minors’ rights with parents’ legal rights and responsibilities (Standard A.2.d).

     Why the wrong answers tempt you: A pulls because the Code values a minor’s assent and participation, but it does not grant minors consent authority, and C invents a federal age of consent, when HIPAA generally defers to state law on when a minor may consent (Uses and Disclosures of Protected Health Information: General Rules, 2026).

     • Chapter(s): 2
     • 2027 NCE: 6.3 (also 2A.1)
     • Source(s): American Counseling Association (2014), Standard A.2.d; Uses and Disclosures of Protected Health Information: General Rules, 45 C.F.R. § 164.502(g) (2026)
112. Item 112

     A community counseling agency now serves many Dari-speaking families who arrived in the past year. Its intake packet and consent forms exist only in English. Which plan BEST provides language access to these written materials?

     AHave a qualified translator translate the forms, and use qualified interpreters to review them with clientsBRun the forms through a free online translation tool and print the results for clientsCAsk a bilingual current client to translate the forms in exchange for reduced fees
     Show answer and rationaleHide answer and rationale

     Answer: A. When clients have difficulty understanding the language counselors use, counselors arrange a qualified interpreter or translator (Standard A.2.c); translators handle written materials, and interpreters handle spoken communication. For health programs that receive federal financial assistance, such as Medicaid payments, the Section 1557 rule requires qualified translators and human review of machine translations of critical documents (Meaningful Access for Individuals With Limited English Proficiency, 2026).

     Why the wrong answers tempt you: B pulls because it is free and fast, but errors in consent forms carry real consequences, and C uses a willing bilingual speaker, yet the agency rather than the client proposes the barter (Standard A.10.e), the client is not a qualified translator, and the arrangement adds a second relationship.

     • Chapter(s): 4 (also 34)
     • 2027 NCE: 5.7 (also 2A.1)
     • Source(s): American Counseling Association (2014), Standards A.2.c, A.10.e; Meaningful Access for Individuals With Limited English Proficiency (2026)
113. Item 113

     Delphine, 42, is preparing to end counseling after recovering from her third episode of major depression. Reviewing her history, she notices that each episode began with sleeping late, skipping choir rehearsals, and letting friends’ calls go unanswered. How should the counselor use this pattern?

     ABuild it into her relapse prevention plan as early warning signs, each linked to steps she will takeBAdvise her to seek help only if full symptoms last 2 weeks, so that ordinary low days cause no alarmCTreat it as past history, because her current scores are in the nonclinical range and she is ready to end
     Show answer and rationaleHide answer and rationale

     Answer: A. A relapse prevention plan lists the client’s personal early warning signs and high-risk situations, ties each to coping steps and supports, and states when to seek help (NBCC, 2026, task 3B.5).

     Why the wrong answers tempt you: B borrows the 2-week duration that defines a major depressive episode (American Psychiatric Association, 2022), but relapse prevention aims to act before full criteria return, and C overlooks that the time to plan is while she is well.

     • Chapter(s): 21 (also 10)
     • 2027 NCE: 3B.5
     • Source(s): American Psychiatric Association (2022)
114. Item 114

     For six sessions, Delia, 45, has given the Session Rating Scale the highest possible marks, yet she often arrives late and has canceled twice. What is the BEST way for the counselor to get more useful feedback?

     AStop using the scale, since her uniformly perfect ratings show it is not providing useful informationBTell her that criticism is welcome and helpful, and ask specifically what would make sessions fit her betterCTreat the lateness and cancellations as resistance, and add a goal about attendance to her treatment plan
     Show answer and rationaleHide answer and rationale

     Answer: B. Counselors often miss clients who are not doing well, which is why routine client feedback, especially on the relationship, matters (Lambert & Shimokawa, 2011). When perfect ratings clash with late arrivals and cancellations, the counselor makes clear that criticism is welcome and asks concrete questions, so that the top of the scale does not hide a problem.

     Why the wrong answers tempt you: A notices a real limitation, a ceiling effect, but abandons feedback instead of making it safer to give, and C locates the problem in the client before asking whether sessions are meeting her needs.

     • Chapter(s): 22 (Soliciting feedback); also 21
     • 2027 NCE: 4.12
     • Source(s): Lambert and Shimokawa (2011)
115. Item 115

     Brandon, 33, is in counseling after his girlfriend ended their relationship. He says he is furious and “can’t stop thinking about what she did,” but he denies any plan to hurt her. Which part of his history would MOST raise the counselor’s concern about his risk of violence toward her?

     AAn arrest 2 years ago for assaulting a previous girlfriendBA diagnosis of bipolar II disorder made in his twentiesCTears and a raised voice when he describes the breakup
     Show answer and rationaleHide answer and rationale

     Answer: A. A history of violent behavior is among the strongest predictors of future violence, whereas a psychiatric diagnosis by itself says little about an individual’s risk (Monahan et al., 2001). Brandon’s past assault was also against a girlfriend, the same role as the woman he is now furious with.

     Why the wrong answers tempt you: B draws on the stereotype linking mental illness and violence, which the research does not support as a predictor on its own, and C is tempting because visible emotion can seem dangerous, but tears and a raised voice while describing a breakup are expectable feelings, not evidence of intent.

     • Chapter(s): 5 (Violence and abuse); also 2 (Tarasoff and the duty to protect)
     • 2027 NCE: 2B.2 (knowledge: risk assessment and risk factors or symptoms)
     • Source(s): Monahan et al. (2001)
116. Item 116

     Nadia, licensed for six years, is asked by her agency director to begin supervising two associate counselors toward licensure next month. She is a skilled clinician but has never been trained in supervision. Her BEST response is to:

     AComplete training in supervision and meet her state board’s supervisor requirements firstBBegin supervising, since clinical skill is the main qualification for a supervisorCMeet with the associates but call it consultation until she finishes training
     Show answer and rationaleHide answer and rationale

     Answer: A. Before offering supervision, counselors are trained in supervision methods and techniques (ACA, 2014, Standard F.2.a), and state licensing boards set their own, varying requirements for supervisors whose hours count toward licensure.

     Why the wrong answers tempt you: B pulls because clinical skill does matter, but supervision is a distinct competence with its own models, evaluation duties, and gatekeeping responsibilities (Bernard & Goodyear, 2019); C relabels supervision as consultation, which misrepresents the arrangement, since consultation is nonevaluative and would not meet the associates’ licensure requirements.

     • Chapter(s): 3 (What supervision is; Ethical and legal duties of supervisors); also 1 (Boundaries of competence)
     • 2027 NCE: 1B.3
     • Source(s): ACA (2014), Standard F.2.a; Bernard and Goodyear (2019)
117. Item 117

     To make counseling more affordable, Ambrose, who is in network with several insurers, tells all his clients that he will waive their copays and bill each insurer his full contracted fee. Which statement BEST describes this practice?

     AIt is encouraged, because the ACA Code asks counselors to consider clients’ financial situationsBIt is acceptable as long as each client signs a form agreeing to have the copay waivedCIt can misrepresent his fees to insurers; waivers should follow a case-by-case hardship policy
     Show answer and rationaleHide answer and rationale

     Answer: C. Routinely waiving copays while billing insurers as if clients paid them can misrepresent the actual fee, breach network contracts, and, with federal health programs, raise fraud concerns (Office of Inspector General, 1994); a written policy for documented financial hardship, applied case by case, honors the Code’s call to consider clients’ finances (Standard A.10.c) without misstating fees.

     Why the wrong answers tempt you: A pulls because the Code does ask counselors to consider finances, but not by misstating fees to payers, and B adds client consent, which cannot cure a misrepresentation made to the insurer.

     • Chapter(s): 4
     • 2027 NCE: 6.7 (also 6.10)
     • Source(s): American Counseling Association (2014), Standard A.10.c; Office of Inspector General (1994)
118. Item 118

     Desta, 20, a community college student recently diagnosed with attention-deficit/hyperactivity disorder (ADHD), is failing two courses. She did not know that colleges offer disability services. Which response BEST supports her in advocating for her own needs?

     AHelp her learn which accommodations exist and rehearse requesting them from the disability services officeBWith her permission, call her instructors to explain her diagnosis and request extensions on her behalfCRecommend that she drop to part-time enrollment, so that her course load better fits her attention difficulties
     Show answer and rationaleHide answer and rationale

     Answer: A. Client empowerment in the ACA Advocacy Competencies means helping a client recognize a barrier and build the knowledge and skills to advocate for herself, and a college, unlike a school district, does not have to identify students with disabilities, so the student must tell the school and request accommodations through its procedures, often through a disability services office (Toporek & Daniels, 2018; U.S. Department of Education, Office for Civil Rights, 2011).

     Why the wrong answers tempt you: B is real advocacy and includes consent, but it acts for her when she is able to act, bypasses the office that grants accommodations, and discloses more than needed, and C adjusts her to the barrier instead of addressing it.

     • Chapter(s): 33 (ACA Advocacy Competencies); also 13 (ADHD)
     • 2027 NCE: 4.13
     • Source(s): Toporek and Daniels (2018); U.S. Department of Education, Office for Civil Rights (2011)
119. Item 119

     Staff Sergeant Kim, 29, a member of the Army National Guard, is midway through counseling for PTSD when he learns he will spend 4 months at a training site in another state. His counselor is licensed only in Kim’s home state and has no privilege or other legal authority to practice in the state where the site is located. What should the counselor do?

     APlan with him for the gap: crisis resources such as 988, a provider near the site, and a date to resumeBContinue weekly video sessions while he is at the training site, since his legal residence remains in the home stateCClose his case before he leaves and invite him to begin counseling again once he is back home
     Show answer and rationaleHide answer and rationale

     Answer: A. A plan for disruption of service keeps care going through an interruption with crisis resources, an alternative provider, and a plan to resume, consistent with the duty to arrange continued care during interruptions (ACA, 2014, Standard A.12).

     Why the wrong answers tempt you: B pulls because his residence has not changed, and the Code itself mentions the client’s “place of residence” (Standard H.1.b), but that standard names laws a counselor may also be subject to; authority to practice by telehealth generally depends on where the client is located during the session, and this counselor has no license, Counseling Compact privilege, or other legal authority in that state (Counseling Compact Commission, n.d.). C ends care midstream when an interruption calls for a bridge.

     • Chapter(s): 21 (telehealth jurisdiction: 4)
     • 2027 NCE: 3B.6
     • Source(s): ACA (2014); Counseling Compact Commission (n.d.)
120. Item 120

     Jae-won, 41, has attended weekly outpatient counseling for alcohol use disorder for 4 months. Despite real effort, he has returned to heavy drinking several times. He has no history of withdrawal symptoms or medical problems, his wife does not drink and supports his recovery, and he wants to keep his job. He asks for “more help.” Which level of care is MOST appropriate?

     AContinued weekly outpatient counseling, since he is not in medical dangerBAn intensive outpatient program that meets several evenings a weekCA 30-day residential program to remove him from his drinking triggers
     Show answer and rationaleHide answer and rationale

     Answer: B. Clients step up to a more intensive level of care when a lower level is not working, and an intensive outpatient program adds structure several days a week while he keeps his job and stays in a supportive, alcohol-free home (Mee-Lee et al., 2013).

     Why the wrong answers tempt you: A rightly notes that he is not in medical danger, but staying at a level that has failed several times ignores the evidence, and C pulls because it removes triggers, yet with no withdrawal risk, a supportive home, and a job to protect, residential care is more restrictive than his needs require.

     • Chapter(s): 21 (Levels of care); also 12 (Level of care: the ASAM Criteria)
     • 2027 NCE: 2B.7
     • Source(s): Mee-Lee et al. (2013)
121. Item 121

     Tunde, 41, tells his counselor that her typing during sessions makes him feel “like a case file” rather than a person. Her agency requires that each progress note be completed on the day of the session. The counselor’s BEST response is to:

     AExplain that notes must be typed during the session for the record to be accurateBAcknowledge his reaction, keep in-session notes brief, and finish the note right after the sessionCBegin audio-recording sessions so that the notes can be written from the recordings later
     Show answer and rationaleHide answer and rationale

     Answer: B. Task 5.8 covers documentation written during or after sessions, so the counselor can respond to Tunde’s feedback and still meet the same-day rule by writing the note promptly after the session, while details are fresh (Standard A.1.b).

     Why the wrong answers tempt you: A pulls because accuracy matters, but a note finished right after the session is accurate and timely, and insisting on typing dismisses his feedback, and C sounds efficient, yet recording requires his permission (Standard B.6.c), creates a more sensitive record, and does nothing about his sense of being processed rather than heard.

     • Chapter(s): 4 (also 2, 22)
     • 2027 NCE: 5.8 (also 4.12, 4.15)
     • Source(s): American Counseling Association (2014), Standards A.1.b, B.6.c
122. Item 122

     After Mireille’s intake, an AI feature in Ravi’s EHR suggests “borderline personality disorder” as a diagnosis, based on his intake note. Ravi has not yet assessed for personality disorders. What is the BEST way for Ravi to use the suggestion?

     ATreat it as one hypothesis to check against DSM-5-TR criteria in his own assessmentBRecord it as a provisional diagnosis, since AI trained on large data sets is more objectiveCTurn off the EHR’s AI features, since the ACA Code of Ethics forbids AI in diagnosis
     Show answer and rationaleHide answer and rationale

     Answer: A. An AI suggestion is a hypothesis, not a diagnosis: Ravi remains responsible for proper diagnosis (Standard E.5.a) and for recognizing historical and social prejudices in diagnosis (Standard E.5.c), which tools trained on past records can reproduce (ACA, 2024; NBCC, 2024).

     Why the wrong answers tempt you: B pulls because large data sets sound objective, but they also carry the biases in past diagnoses, and C overcorrects, since the 2014 Code predates generative AI and does not forbid it.

     • Chapter(s): 4 (also 6)
     • 2027 NCE: 6.19 (also 2B.12)
     • Source(s): American Counseling Association (2014), Standards E.5.a, E.5.c; American Counseling Association (2024); National Board for Certified Counselors (2024)
123. Item 123

     Marisol, 29, is court-ordered to counseling, and her counselor sends attendance and progress reports to her probation officer. Marisol agrees with every suggestion and has never voiced a goal of her own. Which response BEST reflects the counselor’s awareness of power dynamics in this relationship?

     ATake her agreement as a sign of strong motivation and move quickly to interventionsBConfront her about complying on the surface simply to satisfy the courtCAcknowledge how the reporting role may affect what she says, and invite her goals
     Show answer and rationaleHide answer and rationale

     Answer: C. When a counselor’s reports reach a court, the power differential grows, so naming the reporting role openly and inviting the client to shape the goals narrows the gap and makes honest engagement possible (ACA, 2014, Standards A.1.c, A.2.e).

     Why the wrong answers tempt you: A pulls because agreeable clients look motivated, but blanket agreement from someone whose freedom depends on reports more likely reflects the power differential; B confronts a response the counselor’s own role helped create and tends to increase discord (Miller & Rollnick, 2013).

     • Chapter(s): 3 (Power dynamics); also 2 (informed consent with mandated clients) and 27 (motivational interviewing)
     • 2027 NCE: 1B (knowledge statement: power dynamics in the counseling relationship); nearest task 1B.11
     • Source(s): ACA (2014), Standards A.1.c, A.2.e; Miller and Rollnick (2013)
124. Item 124

     Annika, 41, says, “I’m such a nag. I remind my son about his insulin five times a day.” Which counselor response is a reframe?

     A“You’re frustrated with yourself for reminding him so often.”B“How does your son react when you remind him?”C“Those reminders show how much his health matters to you.”
     Show answer and rationaleHide answer and rationale

     Answer: C. A reframe offers a new, more useful meaning for the same behavior, here recasting “nagging” as evidence of her care for her son’s health (Ivey et al., 2023).

     Why the wrong answers tempt you: A is accurate and empathic, but a reflection of feeling mirrors her view rather than offering a new one, and B is an open question that explores without changing the frame.

     • Chapter(s): 22 (Influencing skills)
     • 2027 NCE: 4.14
     • Source(s): Ivey et al. (2023)
125. Item 125

     Ayodele, a newly licensed counselor, joins a group practice where she will bill Medicaid and several commercial insurers for the first time. Her graduate program covered ethics but not billing. Which step BEST prepares her to bill in compliance with the rules?

     ARelying on the practice’s billing staff, since coding accuracy is the biller’s responsibilityBCompleting training on payer rules, coding, documentation, and fraud prevention before she billsCSubmitting claims and learning from any denials, since insurers explain what they will not pay
     Show answer and rationaleHide answer and rationale

     Answer: B. Task 6.8 names compliance training in insurance, credentialing, billing, and payment, and the clinician whose service and documentation support a claim shares responsibility for its accuracy, so Ayodele learns payer rules and fraud prevention before she bills (NBCC, 2026).

     Why the wrong answers tempt you: A pulls because billers do submit the claims, but they rely on the clinician’s documentation and code choice, and C treats denials as a teacher, yet the costly errors are the wrong claims that get paid, which audits can later require her to repay.

     • Chapter(s): 4
     • 2027 NCE: 6.8 (also 6.7, 1A.3)
     • Source(s): National Board for Certified Counselors (2026)
126. Item 126

     Desmond, 31, who is Black, scores well above average on a personality inventory scale that reflects suspiciousness and mistrust of others. In the interview, he describes being stopped by police many times in his own neighborhood. He is guarded early in the session but grows more open as it goes on. Which interpretation is MOST appropriate?

     AReport the elevation as evidence of paranoid traits, since the scale has strong validity evidenceBSet aside the whole inventory, since personality tests cannot be used fairly with Black clientsCConsider that the score may partly reflect realistic wariness, and weigh it with other data
     Show answer and rationaleHide answer and rationale

     Answer: C. Counselors recognize how culture and experiences of discrimination shape test responses, stay alert to the history of pathologizing marginalized groups, and place results in perspective with other data; cultural mistrust among African Americans can be a learned response to racism that is misread as paranoia (ACA, 2014, Standards E.5.b, E.5.c, E.8; Whaley, 2001).

     Why the wrong answers tempt you: A trusts the scale’s general validity evidence over the context of this client’s life, and B overcorrects, because concern about fairness calls for careful, contextual interpretation rather than discarding every result.

     • Chapter(s): 7 (Test bias and fairness); also 6 (Culture and diagnosis), 8, and 33
     • 2027 NCE: 2B.11 (also knowledge: cultural implications of diagnosis)
     • Source(s): ACA (2014), Standards E.5.b, E.5.c, E.8; Whaley (2001)
127. Item 127

     Agency policy requires a treatment plan review every 90 days. Counselor Cyrus completes each review in the electronic health record after hours, working from his notes, and then asks clients to sign the form at their next session. Which change BEST reflects sound practice?

     AShorten the review interval to every 30 days so that each client’s progress is checked more oftenBHave his supervisor complete the reviews so that the ratings of each client’s progress stay objectiveCComplete the review in session, going over each objective with the client and deciding next steps together
     Show answer and rationaleHide answer and rationale

     Answer: C. Task 3B.7 calls for engaging the client in reviewing progress at planned intervals, and counseling plans are reviewed and revised jointly with clients (ACA, 2014, Standard A.1.c).

     Why the wrong answers tempt you: A changes how often reviews happen but not who takes part, and B trades the client’s voice for a different kind of objectivity.

     • Chapter(s): 21
     • 2027 NCE: 3B.7
     • Source(s): ACA (2014)
128. Item 128

     Wen, a licensed counselor, wants to spend some of her volunteer time on advocacy for the counseling profession itself. Which activity BEST fits that goal?

     AHelping a client prepare to request a workplace accommodation from her employerBUrging state legislators, through her state counseling association, to adopt the Counseling CompactCCalling a client’s insurer, with the client’s consent, to appeal a denied claim
     Show answer and rationaleHide answer and rationale

     Answer: B. Advocacy for the profession works to strengthen counseling itself, for example through a shared professional identity, a positive public image, and each counselor’s participation in advocacy (Myers et al., 2002). Urging lawmakers, through a professional association, to adopt the Counseling Compact, which improves license portability, fits that aim.

     Why the wrong answers tempt you: C pulls because challenging an insurer feels like taking on the system, but appealing one client’s claim is advocacy on behalf of that client; A is client empowerment, helping her act for herself.

     • Chapter(s): 1 (Professional associations; Portability and the Counseling Compact); also 33 (Advocacy) and 4 (The Counseling Compact in practice)
     • 2027 NCE: 1A.5
     • Source(s): Myers et al. (2002)
129. Item 129

     Ana, 29, is in counseling for posttraumatic stress disorder. She is also working with a domestic violence advocate at a local shelter on a safety plan and a protective order, and she asks that her counselor and her advocate “be on the same page.” Which action BEST supports this collaboration?

     AWith Ana’s signed release, coordinate goals with the advocate and share only what Ana approvesBSend the advocate Ana’s complete counseling record so the safety plan reflects her historyCLeave the coordination to Ana, since advocates are not part of her clinical care
     Show answer and rationaleHide answer and rationale

     Answer: A. Collaborating with a client’s advocate toward shared goals is task 5.1, done only with the client’s consent, here a signed release (Standards B.1.c, B.6.g), and limited to the information she approves (Standard B.2.e).

     Why the wrong answers tempt you: B pulls because more information seems to help safety planning, but sending the whole record discloses far more than the purpose requires, and C feels respectful of her autonomy, yet she has asked for coordination, and advocates are named support systems in the task.

     • Chapter(s): 21 (also 2)
     • 2027 NCE: 5.1 (also 5.2)
     • Source(s): American Counseling Association (2014), Standards B.1.c, B.2.e, B.6.g
130. Item 130

     In a bereavement group, each time Lucía begins to cry while describing her son’s death, Martin quickly says, “It gets easier. Don’t cry,” and Lucía stops talking. Which leader response BEST fits?

     AThank Martin for his kindness, and move on to the next member so that Lucía can collect herself privatelyBGently stop Martin’s reassurance, invite Lucía to continue, and later explore what her tears stir in MartinCWait to see whether other members address the pattern, since a group should learn to manage itself over time
     Show answer and rationaleHide answer and rationale

     Answer: B. Blocking stops a behavior that harms the group’s work, here premature reassurance that shuts down Lucía’s grief, while protecting the person affected and later exploring the behavior with the member who did it (Corey et al., 2018).

     Why the wrong answers tempt you: A sounds kind to both members, but it rewards the rescue and confirms that tears should be hidden, and C trusts the group’s growth, but leaving a harmful pattern unchecked lets it become a norm.

     • Chapter(s): 31 (Leader skills in the room)
     • 2027 NCE: 4.14
     • Source(s): Corey et al. (2018)
131. Item 131

     Two sessions into counseling for job stress, Corbin, 30, asks his counselor for a letter stating that he needs an emotional support animal so that his landlord will waive a no-pets rule. The counselor has not assessed whether Corbin has a disability or a disability-related need for the animal. What is the counselor’s BEST response?

     AWrite the letter now, since a client’s request is enough to document the needBDecline, since counselors may not write letters supporting clients’ housing requestsCExplain that a letter must rest on an assessment of his need, and decide after assessing
     Show answer and rationaleHide answer and rationale

     Answer: C. A support letter is a report to a third party, so it must be accurate and rest on the counselor’s own assessment, within her competence and scope (Standards C.2.a, C.6.b); she explains this to Corbin and decides after assessing whether he has a disability-related need for the animal.

     Why the wrong answers tempt you: A pulls because the request is sincere and the counselor wants to help, but a letter written on request alone is an unsupported claim, and B overcorrects, since counselors may write such letters when an assessment supports them.

     • Chapter(s): 4 (also 1)
     • 2027 NCE: 6.5 (also 6.3)
     • Source(s): American Counseling Association (2014), Standards C.2.a, C.6.b; Fair Housing Act, 42 U.S.C. § 3601 et seq. (1968), § 3604(f)(3)(B)
132. Item 132

     Agnes, 61, describes her house as “a little cluttered, like anyone’s.” With Agnes’s consent, her daughter shows the counselor recent photos: stacks of newspapers, mail, and boxes fill the kitchen and living room, and Agnes now sleeps in a recliner because her bed is buried. Agnes grows distressed at any suggestion of throwing things out, saying she may need them someday. She reports no intrusive thoughts or other rituals, and her physician has found no medical or cognitive problems. Which diagnosis BEST fits all the available data?

     AObsessive-compulsive disorderBHoarding disorderCNo diagnosis, since she does not see the clutter as a problem
     Show answer and rationaleHide answer and rationale

     Answer: B. Hoarding disorder requires persistent difficulty discarding possessions because of a perceived need to save them and distress at discarding, clutter that congests active living areas and substantially compromises their use, and clinically significant distress or impairment (here, a bed she can no longer use); it is not diagnosed when a medical condition or another mental disorder, such as obsessions in OCD or cognitive deficits in a neurocognitive disorder, better explains the hoarding (APA, 2022). Her daughter’s photos supply what her self-report leaves out.

     Why the wrong answers tempt you: A pulls because hoarding disorder sits in the obsessive-compulsive and related disorders chapter, but Agnes reports no obsessions or other compulsions, and C trusts her self-report alone, although DSM-5-TR’s insight specifiers allow for a person who is convinced the clutter is not a problem despite evidence to the contrary.

     • Chapter(s): 11 (Obsessive-compulsive and related disorders); also 6 (Differential diagnosis and comorbidity)
     • 2027 NCE: 2B.12
     • Source(s): APA (2022)
133. Item 133

     Rashad, 48, began counseling for depression after a layoff. At intake, he and his counselor set the goal of resuming his job search by applying for at least two jobs a week. After 12 sessions, his score on a standardized depression measure has fallen by more than half, but he has not yet applied for any jobs. Which evaluation of his progress is MOST accurate?

     AHis symptoms have improved, but his functional goal is unmet, so the plan needs review with himBTreatment has succeeded, since a drop of more than half shows that his depression has resolvedCTreatment has failed, since he has not met his intake goal, so a referral elsewhere is needed
     Show answer and rationaleHide answer and rationale

     Answer: A. Effectiveness is judged against all of the plan’s goals, functioning as well as symptoms, so marked symptom relief with an unmet functional goal is a partial response that calls for exploring barriers and revising the plan with the client (ACA, 2014, Standard A.1.c; NBCC, 2026, task 3B.8).

     Why the wrong answers tempt you: B treats a large score drop as full recovery, but a sizable improvement is not the same as remission and a symptom score alone does not show restored functioning, and C overlooks real progress and jumps to referral before Rashad and the counselor have examined what is blocking his job search.

     • Chapter(s): 21 (also 20; outcome measures: 7)
     • 2027 NCE: 3B.8
     • Source(s): ACA (2014); NBCC (2026)
134. Item 134

     With 2 minutes left in a session, Arturo, 52, stands to leave and says, “Oh, by the way, my wife told me last night that she wants a divorce.” He denies thoughts of harming himself or anyone else. What is the BEST response?

     AAcknowledge how big the news is, confirm his support for the week, and plan to begin the next session with itBExtend the session by 45 minutes so that he can fully process the news while it is still fresh and rawCEnd the session on time without comment, so that he learns to raise important issues earlier in a session
     Show answer and rationaleHide answer and rationale

     Answer: A. Session management means honoring both the client’s disclosure and the session’s time frame: acknowledge the news, check that he has support until the next meeting, and make it the first item next time, extending only if safety requires it (NBCC, 2026, Domain 4 skill statements).

     Why the wrong answers tempt you: B feels caring, but with no risk present it abandons the time boundary and teaches that last-minute disclosures extend sessions, and C keeps the boundary but ignores a major disclosure and shames him for its timing.

     • Chapter(s): 22 (Silence and intense feelings: managing time so intense material is not opened in the final minutes)
     • 2027 NCE: 4.14
     • Source(s): NBCC (2026)
135. Item 135

     Reviewing a year of her clients’ outcome measures, Lorraine sees that clients with anxiety improve steadily, but most clients referred for anger concerns stop attending after two or three sessions. Which response BEST reflects an accurate assessment of her strengths and limitations?

     AConclude that clients referred for anger are often unmotivated, and keep her current approachBSeek peer supervision on these cases and pursue training in anger-focused interventionsCStop accepting anger referrals and list anxiety as her only area of practice
     Show answer and rationaleHide answer and rationale

     Answer: B. Counselors continually monitor their effectiveness, take steps to improve when necessary, and seek peer supervision to evaluate their efficacy (ACA, 2014, Standard C.2.d). A dropout pattern confined to one kind of concern points to a specific skill area to strengthen.

     Why the wrong answers tempt you: C pulls because Standard C.2.a limits practice to the boundaries of competence, but one weak result is a reason to take steps to improve, as Standard C.2.d directs, before narrowing her practice; A explains the pattern away by blaming clients, which leaves her own contribution unexamined.

     • Chapter(s): 1 (Boundaries of competence: monitoring effectiveness); also 21 (Measurement-based care)
     • 2027 NCE: 1B.4
     • Source(s): ACA (2014), Standards C.2.a, C.2.d
136. Item 136

     Lupe, a home-based family counselor, carries paper consent forms and session notes between client visits. Which practice BEST protects these records?

     ALeaving them in the trunk of her car between visits, since the trunk keeps them out of sightBCarrying only what each visit needs in a locked case, returned to secure storage that dayCPhotographing the forms with her personal phone and shredding the originals to avoid carrying paper
     Show answer and rationaleHide answer and rationale

     Answer: B. Counselors keep records in any medium secure and accessible only to authorized persons (Standard B.6.b), so a home-based counselor carries only what each visit needs, keeps it locked, and returns it to secure storage promptly.

     Why the wrong answers tempt you: A pulls because the trunk hides the papers, but cars are stolen and broken into, and C trades paper for an unsecured personal phone and destroys originals before they reach the official record.

     • Chapter(s): 2 (also 4)
     • 2027 NCE: 6.16 (also 6.2)
     • Source(s): American Counseling Association (2014), Standard B.6.b
137. Item 137

     Doris, 68, has missed three sessions since she stopped driving. She has tried, without success, to enroll in the county’s senior transportation program on her own. What is the BEST next step?

     AGive Doris a printed list of transportation programs and ask her to call them before next weekBReduce Doris’s sessions to once a month until she solves her transportation problemCWith Doris’s consent, call the program together during the session to start her enrollment
     Show answer and rationaleHide answer and rationale

     Answer: C. A referral to a community resource is a process, not a phone number. When a client cannot make the connection alone, counselors advocate to remove barriers that block access to services (Standard A.7.a), and they get the client’s consent before advocating for her (Standard A.7.b). Calling the program together, with Doris’s consent and disclosing only what enrollment requires (Standard B.2.e), turns the referral into access.

     Why the wrong answers tempt you: A feels empowering, and independence matters, but Doris has already tried to enroll on her own without success, so another list repeats a step that has failed and leaves the barrier in place, and B adjusts the schedule to the barrier instead of addressing it.

     • Chapter(s): 21 (also 33)
     • 2027 NCE: 5.2 (also 3B.1)
     • Source(s): American Counseling Association (2014), Standards A.7.a, A.7.b, B.2.e
138. Item 138

     At intake, Jonah, 40, describes depressed mood, loss of interest, insomnia, poor concentration, and feelings of worthlessness, but he cannot say how long they have lasted: “maybe a week, maybe longer.” His husband, who will join the next session with Jonah’s consent, can clarify the timeline. The counselor strongly expects that Jonah will meet full criteria for major depressive disorder. Which diagnosis is BEST to record for now?

     AMajor depressive disorder, provisionalBUnspecified depressive disorderCAdjustment disorder with depressed mood
     Show answer and rationaleHide answer and rationale

     Answer: A. The provisional specifier is used when there is a strong presumption that full criteria for a specific disorder will be met but not enough information is yet available, here the duration that his husband can help clarify (APA, 2022).

     Why the wrong answers tempt you: B is tempting because DSM-5-TR’s unspecified category does cover presentations with too little information for a more specific diagnosis (its example is an emergency room), but it names no disorder, so it fits when the counselor cannot yet tell which disorder applies; when one specific disorder is strongly presumed and the missing fact is expected soon, the provisional specifier records both the expectation and the uncertainty, and C misuses adjustment disorder as a placeholder when no identifiable stressor is described.

     • Chapter(s): 6 (Writing the diagnosis)
     • 2027 NCE: 2B.12
     • Source(s): APA (2022)
139. Item 139

     In the second session, a counselor asks Rhea, 33, “How does your husband feel about the move?” Rhea answers curtly, “My wife is fine with it,” and her answers stay short for the next 10 minutes. What is the BEST response?

     AContinue without mentioning the slip, so that it does not become a bigger issue than it needs to beBAcknowledge the assumption, apologize briefly, and ask how it affected her and how the session feels nowCExplain that the intake form was unclear and that the counselor fully supports same-sex marriages
     Show answer and rationaleHide answer and rationale

     Answer: B. The counselor’s heteronormative assumption set off a withdrawal rupture, marked by Rhea’s curt, short answers, and repair works best when the counselor names the slip, owns it without defending, and invites the client’s experience of it (Safran & Muran, 2000; Eubanks et al., 2018).

     Why the wrong answers tempt you: A hopes to spare her awkwardness, but her short answers show that the strain is already present, and C sounds reassuring, but it defends the counselor and centers the counselor’s feelings rather than hers.

     • Chapter(s): 22 (Ruptures and repair); also 33
     • 2027 NCE: 4.15
     • Source(s): Safran and Muran (2000); Eubanks et al. (2018)
140. Item 140

     In their second session, Farid, 33, a sales representative whose fear of flying has cost him promotions, agrees with his counselor on how they will know counseling is complete. Which termination criterion is MOST appropriate?

     AFarid completes two round-trip work flights, rating his peak fear at 4 or lower out of 10 on eachBThe counselor judges that the unconscious conflicts underlying Farid’s fear of flying have been fully resolvedCFarid has used all 12 of the sessions that his insurance plan covers for the current calendar year
     Show answer and rationaleHide answer and rationale

     Answer: A. Termination criteria are agreed on early, observable, and tied to the client’s own goal, so both people can tell when counseling is complete (NBCC, 2026, task 3B.9).

     Why the wrong answers tempt you: C is concrete but lets a benefit limit stand in for clinical criteria, and B rests on an unobservable judgment the counselor makes alone.

     • Chapter(s): 21
     • 2027 NCE: 3B.9
     • Source(s): NBCC (2026)

End of Practice Exam B. Score your answers below.