National Clinical Mental Health
Counseling Examination (NCMHCE)
Comprehensive Practice Examination
1. A client reports persistent sadness, loss of interest, and insomnia for 3
weeks following a breakup. What is the most appropriate initial diagnosis?
A. Adjustment disorder with depressed mood
B. Major depressive disorder
C. Persistent depressive disorder
D. Bipolar II disorder
Answer: A. Adjustment disorder with depressed mood
Rationale: Symptoms are time-linked to a stressor and have not persisted long
enough to meet criteria for major depressive disorder (which requires ≥2 weeks
but also more pervasive impairment and symptom clustering). Adjustment
disorder fits acute emotional response to a clear stressor.
2. A client with panic attacks begins avoiding public transportation due to fear
of having another attack. What disorder is most likely?
A. Specific phobia
B. Panic disorder with agoraphobia
C. Generalized anxiety disorder
D. Social anxiety disorder
,Answer: B. Panic disorder with agoraphobia
Rationale: Panic attacks followed by avoidance of places where escape may be
difficult is characteristic of panic disorder with agoraphobic avoidance.
3. A client reports hearing voices that comment on their behavior. They are
also socially withdrawn and have flat affect. Most likely diagnosis?
A. Schizophrenia
B. Schizoaffective disorder
C. Major depressive disorder with psychotic features
D. Delusional disorder
Answer: A. Schizophrenia
Rationale: Hallucinations, negative symptoms (flat affect, withdrawal), and
functional decline for at least 6 months suggest schizophrenia.
4. A client reports excessive worry about multiple life areas for 8 months,
difficulty controlling worry, and muscle tension. Diagnosis?
A. Panic disorder
B. Generalized anxiety disorder
C. OCD
D. PTSD
Answer: B. Generalized anxiety disorder
Rationale: Chronic, excessive worry across domains with physical tension and
duration >6 months is consistent with GAD.
5. A client repeatedly checks locks for hours daily despite recognizing it is
excessive. Diagnosis?
,A. Obsessive-compulsive disorder
B. Generalized anxiety disorder
C. Delusional disorder
D. Body dysmorphic disorder
Answer: A. Obsessive-compulsive disorder
Rationale: Repetitive compulsions performed to reduce anxiety from intrusive
obsessions indicate OCD.
6. A client experienced a traumatic assault 2 weeks ago and now has
nightmares and hypervigilance. Diagnosis?
A. Acute stress disorder
B. PTSD
C. Adjustment disorder
D. Panic disorder
Answer: A. Acute stress disorder
Rationale: Symptoms occurring within 3 days to 1 month after trauma indicate
acute stress disorder.
7. A client has unstable relationships, fear of abandonment, and impulsive
self-harm behaviors. Diagnosis?
A. Narcissistic personality disorder
B. Borderline personality disorder
C. Histrionic personality disorder
D. Antisocial personality disorder
Answer: B. Borderline personality disorder
Rationale: Emotional instability, impulsivity, and fear of abandonment are
hallmark features of BPD.
, 8. A client believes the government implanted a chip in their brain, but no
hallucinations are present. Diagnosis?
A. Schizophrenia
B. Delusional disorder
C. Brief psychotic disorder
D. Schizophreniform disorder
Answer: B. Delusional disorder
Rationale: Non-bizarre delusions without prominent hallucinations or
disorganized behavior suggest delusional disorder.
9. A child shows persistent inattention, hyperactivity, and impulsivity across
home and school for 8 months. Diagnosis?
A. Oppositional defiant disorder
B. ADHD
C. Conduct disorder
D. Anxiety disorder
Answer: B. ADHD
Rationale: Symptoms across settings with duration >6 months indicate ADHD.
10.A client has periods of elevated mood lasting 5 days with increased energy
but no hospitalization. Diagnosis?
A. Bipolar I disorder
B. Bipolar II disorder
C. Cyclothymic disorder
D. Major depressive disorder
Answer: B. Bipolar II disorder
Rationale: Hypomanic episodes (≥4 days, no hospitalization) with depression
indicate Bipolar II.
Counseling Examination (NCMHCE)
Comprehensive Practice Examination
1. A client reports persistent sadness, loss of interest, and insomnia for 3
weeks following a breakup. What is the most appropriate initial diagnosis?
A. Adjustment disorder with depressed mood
B. Major depressive disorder
C. Persistent depressive disorder
D. Bipolar II disorder
Answer: A. Adjustment disorder with depressed mood
Rationale: Symptoms are time-linked to a stressor and have not persisted long
enough to meet criteria for major depressive disorder (which requires ≥2 weeks
but also more pervasive impairment and symptom clustering). Adjustment
disorder fits acute emotional response to a clear stressor.
2. A client with panic attacks begins avoiding public transportation due to fear
of having another attack. What disorder is most likely?
A. Specific phobia
B. Panic disorder with agoraphobia
C. Generalized anxiety disorder
D. Social anxiety disorder
,Answer: B. Panic disorder with agoraphobia
Rationale: Panic attacks followed by avoidance of places where escape may be
difficult is characteristic of panic disorder with agoraphobic avoidance.
3. A client reports hearing voices that comment on their behavior. They are
also socially withdrawn and have flat affect. Most likely diagnosis?
A. Schizophrenia
B. Schizoaffective disorder
C. Major depressive disorder with psychotic features
D. Delusional disorder
Answer: A. Schizophrenia
Rationale: Hallucinations, negative symptoms (flat affect, withdrawal), and
functional decline for at least 6 months suggest schizophrenia.
4. A client reports excessive worry about multiple life areas for 8 months,
difficulty controlling worry, and muscle tension. Diagnosis?
A. Panic disorder
B. Generalized anxiety disorder
C. OCD
D. PTSD
Answer: B. Generalized anxiety disorder
Rationale: Chronic, excessive worry across domains with physical tension and
duration >6 months is consistent with GAD.
5. A client repeatedly checks locks for hours daily despite recognizing it is
excessive. Diagnosis?
,A. Obsessive-compulsive disorder
B. Generalized anxiety disorder
C. Delusional disorder
D. Body dysmorphic disorder
Answer: A. Obsessive-compulsive disorder
Rationale: Repetitive compulsions performed to reduce anxiety from intrusive
obsessions indicate OCD.
6. A client experienced a traumatic assault 2 weeks ago and now has
nightmares and hypervigilance. Diagnosis?
A. Acute stress disorder
B. PTSD
C. Adjustment disorder
D. Panic disorder
Answer: A. Acute stress disorder
Rationale: Symptoms occurring within 3 days to 1 month after trauma indicate
acute stress disorder.
7. A client has unstable relationships, fear of abandonment, and impulsive
self-harm behaviors. Diagnosis?
A. Narcissistic personality disorder
B. Borderline personality disorder
C. Histrionic personality disorder
D. Antisocial personality disorder
Answer: B. Borderline personality disorder
Rationale: Emotional instability, impulsivity, and fear of abandonment are
hallmark features of BPD.
, 8. A client believes the government implanted a chip in their brain, but no
hallucinations are present. Diagnosis?
A. Schizophrenia
B. Delusional disorder
C. Brief psychotic disorder
D. Schizophreniform disorder
Answer: B. Delusional disorder
Rationale: Non-bizarre delusions without prominent hallucinations or
disorganized behavior suggest delusional disorder.
9. A child shows persistent inattention, hyperactivity, and impulsivity across
home and school for 8 months. Diagnosis?
A. Oppositional defiant disorder
B. ADHD
C. Conduct disorder
D. Anxiety disorder
Answer: B. ADHD
Rationale: Symptoms across settings with duration >6 months indicate ADHD.
10.A client has periods of elevated mood lasting 5 days with increased energy
but no hospitalization. Diagnosis?
A. Bipolar I disorder
B. Bipolar II disorder
C. Cyclothymic disorder
D. Major depressive disorder
Answer: B. Bipolar II disorder
Rationale: Hypomanic episodes (≥4 days, no hospitalization) with depression
indicate Bipolar II.
