Q&A's

A sample multiple-choice question with answers is provided for each of the first 55 vignettes.

The correct answer is identified with an explanation on why it is the correct answer.

Vignette #1

Question:

Which of the following best describes the psychosocial factors in this case and their interaction?

a) Since Denise works as a travel agent, she has probably picked up an exotic disease. She needs a complete medical evaluation to determine the disease and its treatment. Her fears of medical doctors may complicate this process.

b) Denise’s comments about her boyfriend may indicate domestic partner abuse. This abuse needs to be reported immediately by phone to law enforcement. As Denise has a fear of authority figures, she may not be willing to cooperate with law enforcement. If Denise refuses to cooperate the therapist does not need to report.

c) Denise’s comments about her family and boyfriend seem to indicate an abuse history. Abuse survivors are often fearful of authority figures and medical procedures. Denise’s fears may prevent her from obtaining medical help. Her self treatment with homeopathic medication and diet may be worsening her medical and mental health.

d) Denise obviously has an eating disorder. No evaluation of her past abuse or medical condition can be done until her eating disorder is addressed. Other issues should be put on hold until Denise can enter an eating disorder program at a psychiatric hospital.

Correct Answer:

c) is the only answer which describes an interaction, and which does not contain incorrect information.

Incorrect:

a) does describe an interaction, but it speculates about her symptoms being caused by travel. This information is not in the vignette.

b) is incorrect because the therapist is not obligated to report domestic abuse unless the therapist works in a medical setting. Therapy might involve empowering Denise to report the abuse or obtain a restraining order, but the question is asking for interactions.

d) is incorrect because good clinical practice is to address the major risk factors (possible abuse by ex-boyfriend, health issues) first. Possible eating disorder would be addressed second.

Remember:

If part of the answer is wrong = the whole answer is wrong. An answer can sound like a good intervention, but not be the right intervention at this time.

Vignette #2

Question:

What would be the initial steps to secure the risk factors in this case?

a) Evaluate Mr. Bellis’s potential for domestic violence, Mrs. Bellis’s potential for child abuse, and Sandra’s toilet training issues. For Sandra, is there a medical issue involved? Refer Mr. Bellis to anger management classes if needed. Involve law enforcement if needed. Involve CPS with Mrs. Bellis if needed. Obtain medical help for child if indicated. Determine if other supportive services such as caregiver help at home are available.

b) Evaluate Mr. Bellis’s potential for domestic violence, Mrs. Bellis’s potential for child abuse, and Sandra’s toilet training issues. Report suspected domestic violence to law enforcement. Report suspected child abuse to CPS within 24 hours. Help Mrs. Bellis sign up for depression support group.

c) Let the family know their reactions are normal responses to the stressors of a new baby and Mr. Bellis being out of work. Normalize and provide support so that a trusting relationship can develop with the therapist. Once trust is established, explore the traumatic childhoods of Mr. and Mrs. Bellis. Refer Mrs. Bellis to a grief group at a hospice center.

d) The unsafe neighborhood is the primary risk factor underlying the family stress. Engage family in applying for Section 8 housing and/or public housing. Providing concrete help will promote the family’s engagement in the therapy. Place children into foster care through CPS until parents are less stressed.

Correct Answer:

a) is the only answer which addresses the main risk factors of domestic violence, child abuse and possible medical problems. Note that the answer is tentative and exploratory in nature.

Incorrect:

b) is wrong because it states a definite course of action which is not clearly indicated by the material in the vignette.

c) sounds like a nice intervention, but it describes a longer course of action and does not address the obvious risk factors.

d) is wrong because housing is not the most important issue. Also, it is CPS’s decision to place children into foster care, not the therapist’s. Also, CPS would not usually place children that quickly due solely to parental stress.