Louisiana Clinical Social Worker Exam
Practice Questions And Correct Answers
(Verified Answers) Plus Rationale Q&A
1. A client with recurrent panic attacks reports that the attacks occur only in
social-evaluative situations and fears negative judgment. Which DSM-5-TR specifier
most precisely captures this presentation?
A. Panic disorder with agoraphobia
B. Social anxiety disorder (social phobia) with panic attacks
C. Panic disorder without agoraphobia
D. Agoraphobia without history of panic disorder
Answer: B. Social anxiety disorder (social phobia) with panic attacks
Rationale: The panic attacks are situationally bound to social-evaluative contexts and
driven by fear of negative evaluation, meeting criteria for social anxiety disorder; panic
attacks are a specifier, not a separate disorder. Panic disorder requires unexpected attacks,
and agoraphobia requires fear of escape difficulty, neither of which is present.
2. A client on fluoxetine reports new-onset agitation and diaphoresis after adding
tramadol. Which serotonergic syndrome feature most urgently dictates
discontinuation of the serotonergic agents?
A. Mild restlessness with intact orientation
B. Clonus and hyperthermia
C. Transient nausea without vital sign changes
D. Dry mucous membranes and constipation
Answer: B. Clonus and hyperthermia
Rationale: Clonus and hyperthermia indicate moderate-to-severe serotonin syndrome,
requiring immediate discontinuation and possible cyproheptadine; mild restlessness or
nausea alone may be monitored. Anticholinergic signs (dryness, constipation) suggest a
different toxidrome and do not reflect serotonin excess.
Page 1 of 78
,3. Under Louisiana law, which circumstance most clearly mandates a clinical social
worker to breach confidentiality without client consent?
A. Client discloses past marijuana use without current impairment
B. Client states intent to seriously harm an identifiable person
C. Client reports suicidal ideation without plan or intent
D. Client admits to a past misdemeanor theft conviction
Answer: B. Client states intent to seriously harm an identifiable person
Rationale: Louisiana's duty-to-warn/protect statute permits disclosure when a client
communicates a serious threat of physical violence against a reasonably identifiable
victim. Past drug use, passive suicidal ideation without plan, and past minor crimes do not
independently override confidentiality.
4. A supervisee proposes using exposure and response prevention for a client with
compulsive rituals. Which theoretical mechanism best explains the treatment's
efficacy?
A. Extinction of conditioned fear through repeated non-reinforced exposure
B. Reinforcement of avoidance behavior to reduce distress
C. Cognitive restructuring of core beliefs before behavioral tasks
D. Interpretation of unconscious conflict driving ritualized behavior
Answer: A. Extinction of conditioned fear through repeated non-reinforced exposure
Rationale: ERP works by blocking rituals (response prevention) while exposing the client
to feared stimuli, allowing fear extinction and disconfirmation of threat expectancies.
Avoidance reinforcement, pre-behavioral cognitive restructuring, and psychodynamic
interpretation are not the primary mechanisms of ERP.
Page 2 of 78
,5. A client's depression has not responded to two adequate trials of SSRIs of different
classes. According to current STAR*D-informed sequencing, which next step is most
evidence-based?
A. Augment with a second SSRI
B. Switch to a tricyclic antidepressant
C. Augment with bupropion or switch to an SNRI
D. Add a benzodiazepine for mood stabilization
Answer: C. Augment with bupropion or switch to an SNRI
Rationale: STAR*D and subsequent guidelines support augmentation with bupropion or
switching to an SNRI after two failed SSRI trials. Combining two SSRIs increases serotonin
toxicity risk, TCAs are not first-line due to safety, and benzodiazepines do not treat
depression.
6. A clinical social worker terminates with a client who has borderline personality
features. Which termination approach best aligns with Linehan's dialectical behavior
therapy principles?
A. Abrupt discharge to prevent dependency
B. Collaborative planning with validation of abandonment fears
C. Extending therapy indefinitely to avoid abandonment
D. Referral without discussion to minimize emotional intensity
Answer: B. Collaborative planning with validation of abandonment fears
Rationale: DBT emphasizes validation of the client's emotional experience while
collaboratively planning termination to build distress tolerance and reduce abandonment
panic. Abrupt discharge, indefinite extension, and silent referral undermine therapeutic
alliance and skills generalization.
Page 3 of 78
, 7. Which assessment instrument is most appropriate for measuring severity of
generalized anxiety symptoms and monitoring treatment response in adults?
A. GAD-7
B. MMPI-3
C. MoCA
D. CAGE
Answer: A. GAD-7
Rationale: The GAD-7 is a validated, brief self-report measure of generalized anxiety
severity and treatment response. The MMPI-3 is a broad personality measure, the MoCA
assesses cognition, and the CAGE screens for alcohol misuse.
8. A client from a collectivist cultural background minimizes individual symptoms and
emphasizes family harmony. Which culturally responsive approach should the
clinician prioritize?
A. Insist on individual symptom disclosure as a treatment prerequisite
B. Frame goals around family functioning and interdependence
C. Diagnose a personality disorder due to limited self-disclosure
D. Refer to a clinician of the same ethnicity without further assessment
Answer: B. Frame goals around family functioning and interdependence
Rationale: Culturally responsive practice aligns treatment goals with the client's
collectivist values, integrating family and interdependence rather than imposing
individualistic norms. Insisting on disclosure, pathologizing limited disclosure, or making
ethnicity-based referrals without assessment are clinically inappropriate.
Page 4 of 78
Practice Questions And Correct Answers
(Verified Answers) Plus Rationale Q&A
1. A client with recurrent panic attacks reports that the attacks occur only in
social-evaluative situations and fears negative judgment. Which DSM-5-TR specifier
most precisely captures this presentation?
A. Panic disorder with agoraphobia
B. Social anxiety disorder (social phobia) with panic attacks
C. Panic disorder without agoraphobia
D. Agoraphobia without history of panic disorder
Answer: B. Social anxiety disorder (social phobia) with panic attacks
Rationale: The panic attacks are situationally bound to social-evaluative contexts and
driven by fear of negative evaluation, meeting criteria for social anxiety disorder; panic
attacks are a specifier, not a separate disorder. Panic disorder requires unexpected attacks,
and agoraphobia requires fear of escape difficulty, neither of which is present.
2. A client on fluoxetine reports new-onset agitation and diaphoresis after adding
tramadol. Which serotonergic syndrome feature most urgently dictates
discontinuation of the serotonergic agents?
A. Mild restlessness with intact orientation
B. Clonus and hyperthermia
C. Transient nausea without vital sign changes
D. Dry mucous membranes and constipation
Answer: B. Clonus and hyperthermia
Rationale: Clonus and hyperthermia indicate moderate-to-severe serotonin syndrome,
requiring immediate discontinuation and possible cyproheptadine; mild restlessness or
nausea alone may be monitored. Anticholinergic signs (dryness, constipation) suggest a
different toxidrome and do not reflect serotonin excess.
Page 1 of 78
,3. Under Louisiana law, which circumstance most clearly mandates a clinical social
worker to breach confidentiality without client consent?
A. Client discloses past marijuana use without current impairment
B. Client states intent to seriously harm an identifiable person
C. Client reports suicidal ideation without plan or intent
D. Client admits to a past misdemeanor theft conviction
Answer: B. Client states intent to seriously harm an identifiable person
Rationale: Louisiana's duty-to-warn/protect statute permits disclosure when a client
communicates a serious threat of physical violence against a reasonably identifiable
victim. Past drug use, passive suicidal ideation without plan, and past minor crimes do not
independently override confidentiality.
4. A supervisee proposes using exposure and response prevention for a client with
compulsive rituals. Which theoretical mechanism best explains the treatment's
efficacy?
A. Extinction of conditioned fear through repeated non-reinforced exposure
B. Reinforcement of avoidance behavior to reduce distress
C. Cognitive restructuring of core beliefs before behavioral tasks
D. Interpretation of unconscious conflict driving ritualized behavior
Answer: A. Extinction of conditioned fear through repeated non-reinforced exposure
Rationale: ERP works by blocking rituals (response prevention) while exposing the client
to feared stimuli, allowing fear extinction and disconfirmation of threat expectancies.
Avoidance reinforcement, pre-behavioral cognitive restructuring, and psychodynamic
interpretation are not the primary mechanisms of ERP.
Page 2 of 78
,5. A client's depression has not responded to two adequate trials of SSRIs of different
classes. According to current STAR*D-informed sequencing, which next step is most
evidence-based?
A. Augment with a second SSRI
B. Switch to a tricyclic antidepressant
C. Augment with bupropion or switch to an SNRI
D. Add a benzodiazepine for mood stabilization
Answer: C. Augment with bupropion or switch to an SNRI
Rationale: STAR*D and subsequent guidelines support augmentation with bupropion or
switching to an SNRI after two failed SSRI trials. Combining two SSRIs increases serotonin
toxicity risk, TCAs are not first-line due to safety, and benzodiazepines do not treat
depression.
6. A clinical social worker terminates with a client who has borderline personality
features. Which termination approach best aligns with Linehan's dialectical behavior
therapy principles?
A. Abrupt discharge to prevent dependency
B. Collaborative planning with validation of abandonment fears
C. Extending therapy indefinitely to avoid abandonment
D. Referral without discussion to minimize emotional intensity
Answer: B. Collaborative planning with validation of abandonment fears
Rationale: DBT emphasizes validation of the client's emotional experience while
collaboratively planning termination to build distress tolerance and reduce abandonment
panic. Abrupt discharge, indefinite extension, and silent referral undermine therapeutic
alliance and skills generalization.
Page 3 of 78
, 7. Which assessment instrument is most appropriate for measuring severity of
generalized anxiety symptoms and monitoring treatment response in adults?
A. GAD-7
B. MMPI-3
C. MoCA
D. CAGE
Answer: A. GAD-7
Rationale: The GAD-7 is a validated, brief self-report measure of generalized anxiety
severity and treatment response. The MMPI-3 is a broad personality measure, the MoCA
assesses cognition, and the CAGE screens for alcohol misuse.
8. A client from a collectivist cultural background minimizes individual symptoms and
emphasizes family harmony. Which culturally responsive approach should the
clinician prioritize?
A. Insist on individual symptom disclosure as a treatment prerequisite
B. Frame goals around family functioning and interdependence
C. Diagnose a personality disorder due to limited self-disclosure
D. Refer to a clinician of the same ethnicity without further assessment
Answer: B. Frame goals around family functioning and interdependence
Rationale: Culturally responsive practice aligns treatment goals with the client's
collectivist values, integrating family and interdependence rather than imposing
individualistic norms. Insisting on disclosure, pathologizing limited disclosure, or making
ethnicity-based referrals without assessment are clinically inappropriate.
Page 4 of 78
