The Nurse Psychotherapist and a Framework for Practice

This quiz will cover the following topics, which relate to psychotherapy with individuals in the Wheeler textbook and the Fisher textbook excerpts:


1. The Nurse Psychotherapist and a Framework for Practice

1. Confidentiality Limits in Psychotherapy: Ethics Checklists for Mental Health Professionals

1. Assessment and Diagnosis

1. The Initial Contact and Maintaining the Frame

1. Cognitive Behavioral Therapy

1. Supportive and Psychodynamic Psychotherapy

1. Stabilization for Trauma and Dissociation

1. Motivational Interviewing

1. Psychotherapeutic Approaches for Addictions and Related Disorders

Wheeler, K. (Eds.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

1. Chapter 1, “The Nurse Psychotherapist and a Framework for Practice”

1. Chapter 3, “Assessment and Diagnosis”

1. Chapter 4, “The Initial Contact and Maintaining the Frame”

1. Chapter 5, “Supportive and Psychodynamic Psychotherapy”

1. Chapter 7, “Motivational Interviewing” (pp.299-312)

1. Chapter 8, “Cognitive Behavioral Therapy”

1. Chapter 13, “Stabilization for Trauma and Dissociation”

1. Chapter 16, “Psychotherapeutic Approaches for Addictions and Related Disorders”

Fisher, M. A. (2016). Introduction. In Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals (pp. 3–12). Washington, DC: American Psychological Association. doi:10.1037/14860-001

Fisher, M. A. (2016). The ethical ABCs of conditional confidentiality. In Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals (pp. 13–25). Washington, DC: American Psychological Association. doi:10.1037/14860-002

Question 1

1. After informing a prospective patient about limits of confidentiality, the patient consents to the “conditions” of confidentiality and signs an informed consent form. Several weeks later, a lawyer representing the patient’s spouse for a court case, asks the PMHNP for the disclosure of information about the patient. The PMHNP should:

A. Disclose all patient information as requested
B. Refuse to disclose any confidential information
C. Limit disclosure to the extent legally possible
D. Ignore the request based on ethical reasons

1 points

Question 2

1. The PMHNP is meeting with a new patient who is a young veteran back from serving two tours overseas. When reviewing the patient’s health history file that was sent from the VA, the PMHNP learns that several months ago, the patient was diagnosed with PTSD, but never followed up with treatment for it. After a comprehensive mental health assessment, the PMHNP confirms the PTSD diagnosis and understands that which therapeutic approach will be the most effective as a first-line treatment modality?

A. Performing a psychiatric debriefing on the patient
B. Employing cognitive behavioral therapy with the patient
C. Using psychodynamic psychotherapy with the patient
D. None of the above

1 points

Question 3

1. One of the strategies the PMHNP wants to try includes sleep restriction. What will the PMHNP suggest to follow sleep restriction therapy?

A. “Restrict sleep for 24 hours.”
B. “Restrict the amount of time you spend in bed.”
C. “Restrict the amount of exercise you do prior to going to bed.”
D. “Restrict the amount of food you eat before bedtime.”

1 points

Question 4

1. The PMHNP is conducting a peer review of another PMHNP’s medical charts. Upon review, the PMHNP notes that the peer often begins patient sessions late, as well as ends them later than scheduled. The PMHNP also found a comment in the chart regarding the patient sending text messages while in the middle of the session. Based on these findings, the feedback that the PMHNP will provide to the peer involves which therapeutic principle?

A. Assessing safety
B. Applying therapeutic communication
C. Using empathy
D. Maintaining the frame   32.The PMHNP is mentoring a student. After working with a patient during a session, the student laments about all the things she should have, or could have, said to the patient. “I feel guilty that I didn’t speak up more about the patient’s concern toward her son,” says the student. The PMHNP understands that the student is exhibiting signs of which therapeutic concept?

1 points

Question 5

1. True or false: If after a third round of processing followed by stabilization, a patient has increased anxiety that requires further interventions aimed at stabilization, the therapeutic relationship can no longer successfully provide therapeutic change.



1 points

Question 6

1. The PMHNP has been treating a 15-year-old patient with a history of abuse and neglect. Thirty minutes into their therapy session the patient jumps up and begins to pace around the room. Utilizing Socratic dialogue (SD) the PMHNP’s best action would be to:

A. Allow the patient time to process before speaking.
B. Ask, “Why don’t you come have a seat beside me?” while tapping the table.
C. Say, “I noticed a change. Can you tell me what happened?”
D. Say, “We can continue this session later if you prefer.”  

1 points

Question 7

1. The PMHNP is caring for a patient who the PMHNP believes would benefit from a relational psychodynamic approach to therapy. Which action made by the PMHNP demonstrates appropriate use and understanding of the relationship psychodynamic model?

A. Focusing the exploration on making the unconscious conscious
B. Focusing the exploration on the genetic roots of the patient’s problem
C. Focusing the exploration on here and now
D. None of the above

1 points

Question 8

1. The PMHNP is caring for a patient with borderline personality disorder. Using a psychoanalytic psychotherapy approach, the PMHNP attempts to intensify the patient’s transference to enhance emotional processing by:

A. Developing increased boundaries
B. Decreasing supportive psychotherapy
C. Scaling back contact with the patient
D. Increasing the number of sessions per week

1 points

Question 9

1. An elderly patient in a nursing home has been losing interest in activities and now refuses to leave his room. After a physical exam, he is referred to a PMHNP for an initial assessment. True or false: After speaking with the patient, an appropriate screening tool for the PMHNP  to use would be the Geriatric Depression Scale.



1 points

Question 10

1. A middle-aged man who works over 50 hours a week is being seen for depression and anger management. He states, “I am even more frustrated when I come home and my wife wants to argue about stupid stuff. All I want to do is come home, take a shower, and eat. Is that too much to ask?” The PMHNP explains that people can be assertive, aggressive, and passive. She encourages the patient to be more assertive and begins role-play with assertive training. The PMHNP determines that the patient is beginning to understand when he states:

A. “I am tired, I work very hard all day to support you and this family!”
B. “I come home and all you do is argue, but I don’t care.”
C. “I don’t know what I did. Why are you acting like this?!”
D. “I feel frustrated when I come home and we argue.”  

1 points

Question 11

1. The PMHNP is treating a patient with a substantial fear of feeling closed in (claustrophobia). Thus, the patient will not get into an elevator. The office where he works is on the 10th floor and this requires that he walk up and down the stairs in the morning and evening to get to his office. With permission from the patient, the PMHNP is beginning systematic desensitization to address the patient’s need to use the elevator. What is the PMHNP’s best plan of action?

A. Begin by having the patient stand in front of the elevator and write down his feelings
B. Complete a 30-minute therapy session in an elevator
C. Allow the patient to watch an elevator go up and down
D. Allow the patient to see the PMHNP getting into an elevator

1 points

Question 12

1. A PMHNP is assessing ego functioning of his 40-year-old patient by asking what she feels is the cause of her problems. She attributes her problems to her overprotective parents not letting her have enough freedom growing up. Based on her answer, the PMHNP is testing _____________.

A. adaptive regression in the service of the ego
B. regulation and control of affects and impulses
C. defensive and interpersonal functioning
D. sense of reality of the world and of the self

1 points

Question 13

1. The PMHNP meets with a 47-year-old male patient who is fearful of leaving the house after having witnessed his neighbor getting run over by a car. When the PMHNP asks why he is afraid to leave his house, the patient replies, “Because another accident might occur.” Which cognitive behavioral therapy (CBT) strategy does the PMHNP employ?

A. Pharmacological therapy
B. Stress inoculation therapy
C. Dialectical behavior therapy
D. All of the above

1 points

Question 14

1. A 62-year-old patient has been diagnosed with borderline personality disorder. Upon assessment, the PMHNP learns that he  participates in spending sprees and occasional binge eating, accompanied by rapid changes in self-image. Which evidence-based psychotherapeutic model does the PMHNP identify as effective and beneficial?

A. Cognitive behavioral therapy
B. Supportive therapy
C. Dialectical behavior therapy
D. Expressive therapy

1 points

Question 15

1. The PMHNP is working with a patient who witnessed her father pass away after suffering for several months from terminal cancer. The PMHNP sees this as a traumatic event. The patient reports sometimes feeling out of touch with surroundings; almost as if things feel like a dream. “Sometimes that sensation lingers for a while,” the patient says, “and other times I snap out of it quickly.” What does the PMHNP infer about the condition based on psychotherapy concepts for trauma?

A. The patient is having a balanced response to the trauma.
B. The patient is reporting signs of dissociation.
C. The patient is becoming unresponsive to the environment.
D. All of the above.

1 points

Question 16

1. The patient is a 56-year-old female patient diagnosed with panic disorder and reports symptoms that include heart palpitations, frequent trembling, and feelings of choking in stressful situations. What special consideration does the PMHNP make?

A. Using a special focus on transference as the agent promoting change
B. Confronting the emotional significance of the patient’s symptoms
C. Employing psychodynamic therapy combined with pharmacotherapy
D. A and B

1 points

Question 17

1. The PMHNP is meeting with a 38-year-old divorced, single mother who has been seeing the PMHNP for anxiety and anger management. During one of the sessions, the patient tells the PMHNP that she is having a problem getting her child support payments from her ex-husband, which is triggering increased anxiety and anger, which she admittedly takes out on her children. How does the PMHNP respond in a way that upholds the supportive psychodynamic psychotherapy approach?

A. Telling the patient to take a vacation to get away and relax
B. Suggesting that she seek legal help
C. Giving her advice about men and how to get them to pay child support
D. Suggesting that the patient start going to church to help find more solace.

1 points

Question 18

1. During a session, the PMHNP asks a patient with a history of sexual abuse to recall the relationship she had as a child with her parents. The patient responds by saying she has a headache and her stomach hurts, and starts talking about her physical ailments. What is the appropriate response by the PMHNP?

A. Assure the patient that she does not have to discuss these memories
B. Explain why it is important for the patient to discuss these memories openly
C. Tell the patient that she may not get better if she does not face her fears
D. Let the patient know that plenty of other people have similar painful memories, too

1 points

Question 19

1. The PMHNP is working with an adult patient who has somatic complaints caused by a history of childhood abuse. As part of the therapeutic process, what does the PMHNP do to assess and organize a trauma history?

A. Interview the patient’s family members
B. Construct a timeline of the patient’s life
C. Review the patient’s current stressors
D. Debrief with the patient

1 points

Question 20

1. During a therapy session with an 18-year-old female the PMHNP learns that she has lived in six different foster homes in the last 24 months. She states that her mother is in a correctional facility for drug abuse and prostitution. During the assessment, the PMHNP notices multiple superficial cuts to each wrist. The patient appears tearful, withdrawn, and never makes direct eye contact. The PMHNP believes that this patient may have feelings of insecurities as well as abandonment issues and is aware that which diagnosis is likely possible?

A. Narcissistic personality disorder
B. Obsessive-compulsive personality disorder
C. Borderline personality disorder
D. Paranoid personality disorder

1 points

Question 21

1. A patient named Steve is seeking therapy to get help with his home situation, stating that he has been stressed since his mother-in-law moved into the house. What can the PMHNP do to assist the patient in constructing a narrative?

A. Share a personal story about her home situation and family members
B. Elicit details so Steve becomes more self-disclosing and self-examining
C. Guide Steve through imagery exercises so he can decrease his stress
D. None of the above

1 points

Question 22

1. A 16-year-old female patient has had a stable therapeutic relationship with the PMHNP for several months. The PMHNP notices what appears to be fresh cigarette burns on the patient’s arm. When asked, the patient admits to this self-injurious behavior. Although the patient is still depressed, her mood seems to be somewhat better this week. True or false: The PMHNP would most likely consider this patient stabilized and ready to move to Stage II.



1 points

Question 23

1. The PMHNP is working with a patient who experiences abreactions when discussing repressed feelings of his sexual abuse as a child. What can the PMHNP do to manage the patient’s intense emotional reactions?

A. Sit closer to the patient so the patient does not feel isolated
B. Embrace the patient to provide physical comfort
C. Suggest a relaxation technique, such as yoga or meditation
D. All of the above

1 points

Question 24

1. A PMHNP has been working with a young female patient who suffers from depression to change self-defeating behaviors. By creating a presence of acceptance and using good listening skills, the PMHNP’s overall goal is to __________.

A. deepen the patient’s understanding of herself in order to cultivate empowerment
B. slowly transfer authority to the patient when the PMHNP feels that she is ready
C. remain caring, yet authoritative by making important decisions for the patient
D. all of the above

1 points

Question 25

1. During cognitive behavioral therapy (CBT), a 64-year-old male patient states, “I get so frustrated sometimes and I just blow up at everybody!” Which response by the PMHNP demonstrates translation of Socratic dialogue (SD)?

A. “Please explain how this affects the relationship with your wife.”
B. “When you say blow up, what exactly does blow up mean and  how does it feel to you?”
C. “What coping methods have you used in the past during times of frustration?”
D. “So you blow up when you become frustrated?”

1 points

Question 26

1. The PMHNP is mentoring a student. After working with a patient during a session, the student laments about all the things she should have, or could have, said to the patient. “I feel guilty that I didn’t speak up more about the patient’s concern toward her son,” says the student. The PMHNP understands that the student is exhibiting signs of which therapeutic concept?

A. Countertransference
B. Therapeutic communication
C. Empathy
D. Boundaries

1 points

Question 27

1. A 28-year-old male patient is experiencing distress related to the workplace. What might the PMHNP ask to assess affective development?

A. “How do you think your colleagues feel about you?”
B. “How do you calm yourself when you are upset at the office?”
C. “How do you think your colleague felt when you blamed her?”
D. All of the above.

1 points

Question 28

1. A PMHNP is preparing confidentiality forms for his patients. What is the most appropriate first step he should take?

A. Talk to potential patients to get their feedback and suggestions
B. Research his profession’s ethics code and state/federal laws
C. Use current patient interactions to decide what matters most
D. All of the above

1 points

Question 29

1. A PMHNP is caring for a 21-year-old woman who is suffering from anxiety and is having difficulty managing stress. Which of the following would be an appropriate step by the PMHNP?

A. Asking the patient what she does to relieve anxiety
B. Giving the patient basic stress management activities
C. Developing a plan together that is not overwhelming
D. All of the above

1 points

Question 30

1. The PMHNP is caring for a patient who has acute stress disorder after experiencing a traumatic event 1 week prior. The PMHNP wants to begin with a therapeutic framework that follows the adaptive information processing (AIP) model. What is the priority action for the PMHNP to take?

A. Focus on the patient’s safety and stabilization
B. Help the patient process painful memories
C. Encourage the patient to find ways to achieve personal growth
D. Assist the patient in planning for the future

1 points

Question 31

1. The PMHNP is working with a 43-year-old male patient who develops idiosyncratic transference over weeks of therapy. The best way for the PMHNP to respond to this patient is to ___________:

A. employ cognitive behavioral therapy
B. use empathy
C. utilize intersubjectivity
D. none of the above

1 points

Question 32

1. The PMHNP is working with a 56-year-old man who is being seen because of his anxiety and depression. During the therapy sessions, the PMHNP assists the patient in discussing his experiences and expanding on his thoughts and feelings. He tells the PMHNP stories about how he used to be teased by his coworkers at the office for becoming too anxious in large conference rooms. The PMHNP listens to the patient and helps focus on his strengths to promote self-understanding. Which principle best accounts for the PMHNP’s interactions with the patient?

A. Therapeutic communication
B. Maintaining the frame
C. Working with resistance
D. None of the above

1 points

Question 33

1. During a therapy session the patient is asked how she currently deals with stress, and she says, “Well, I don’t. I just let it build and build.” The PMHNP responds by asking how well this has been working out for her. The patient states, “Well, to be honest, it just feels like I’m drowning, you know what I mean.” Illustrating idiosyncratic meaning, the PMHNP responds with:

A. “Would you say you feel like you are suffocating?”
B. “No, I am not sure what you are saying. Can you please explain?”
C. “Sort of like a fish out of water?”
D. “When you say, ‘I just can’t breathe,’ you do understand, that is a form of anxiety?”  

1 points

Question 34

1. The PMHNP is having a therapy session with Charlotte, a 20-year-old victim of date rape. The patient states, “I shouldn’t have been there; I should have just gone home. This was all my fault; how could I have been so stupid?” Using the Socratic method, what is the PMHNP’s best response?

A. “If this had happened to someone else with the exact same circumstances, would you say this was her fault?”
B. “Can you recall exactly what stopped you from going home when you originally wanted to go home?”
C. ”Have you shared these thoughts about what you should have done with anybody other than me?”
D. “Do you understand that there is absolutely nothing that you could ever do to deserve to be treated the way you were treated?”

1 points

Question 35

1. At the initial interview with a patient, the PMHNP reviews the condition of receiving services, including limits that will be imposed on confidentiality. During the discussion, the patient shares information that the PMHNP is legally required to report. True or false: If the PMHNP does not report information that s/he is legally required to report, state laws govern the consequences which include penalties for not reporting, especially child and elder abuse.



1 points

Question 36

1. An initial evaluation reveals that an 11-year-old patient has moved to a new school after her parents’ recent divorce, and is having trouble making friends. The patient has normal mental status and exhibits appropriate behavior. What is the most appropriate scale for the PMHNP  to use to get more information?

A. Young Mania Rating Scale
B. Hamilton Anxiety Rating Scale
C. Dissociative Experiences Scale
D. Impact of Event Scale

1 points

Question 37

1. The PMHNP is meeting with a 42-year-old man with depression brought on by the recent passing of his wife. As he describes the circumstances surrounding his late wife’s death, the PMHNP begins to feel sad. The sadness lingers for several hours, and the PMHNP finds it difficult to focus on other patients for the rest of the day. What is the most appropriate explanation for the reaction that the PMHNP is experiencing?

A. Autognosis
B. Complementary identification
C. Concordant identification
D. Self-disclosure

1 points

Question 38

1. The PMHNP employs psychodynamic psychotherapy with a patient who experiences anxiety and depression. As the process enters the psychoanalytic end of the psychodynamic continuum, the PMNHP will focus on:

A. Interpreting unconscious conflict in the patient
B. Restoring the patient’s functioning and stabilization
C. Reducing the patient’s anxiety
D. Strengthening the patient’s defenses

1 points

Question 39

1. The PMHNP is working with a patient who experiences anxiety around her parents that later leads to poor impulse control. What will the PMHNP do to employ psychodynamic psychotherapy properly for this patient?

A. Emphasize the past
B. Focus on expressions of emotion
C. Identify patterns in relationships
D. All of the above

1 points

Question 40

1. A new patient has been informed of the limits of confidentiality, and has signed informed consent forms. No consent, however, has been obtained for voluntary “Release of Information.” The patient is 20 years old and still lives at home with his parents. He is being treated for depression, which he attributes to the trouble he’s had finding employment.  True or false: If the patient’s mother calls the PMHNP to check up on her son to see how he is doing, the therapist is required to protect patient confidentiality and not disclose information.



1 points

Question 41

1. A PMHNP is treating a 45-year-old female patient who is upset that her brother has not been calling since his divorce. When asked to describe her brother and what prompts him not to call as frequently, she says, “Everything is about him, not me. I think he’s jealous that I have a good marriage and he wants me to be unhappy, too. So he doesn’t call to upset me and ruin my relationships.” Based on this information, the PMHNP can conclude that the patient _________.

A. may lack ability to see independent motivations
B. has an insistent emphasis on the feelings of others
C. has an intrusive interpersonal relationship
D. all of the above

1 points

Question 42

1. The PMHNP is assessing a patient who grew up in a foster home because she was neglected and abused by her birth parents at a young age. The patient admits to having difficulty forming and maintaining relationships throughout her life. Understanding maladaptive schemas, which statement does the PMHNP predict that the patient is likely to make?

A. “I deserve the utmost respect from everyone who meets me.”
B. “I prefer doing everything on my own.”
C. “It takes me a while to warm up to people; people often wear masks.”
D. “I can’t seem to do anything on my own.”  

1 points

Question 43

1. A patient who has borderline personality disorder is meeting with the PMHNP. When asked about future goals, the patient responds, “I’d like to go back to school to do what you do. You know, talk to people all day about their problems. It seems pretty easy.” How does the PHMNP respond to the client in a way that is free from any stigmatizing beliefs or judgments?

A. “It is dangerous to fantasize about the future.”
B. “I think that’s an excellent idea! I can help you review the prerequisites!”
C. “You may want to explore the requirements for becoming a PMNHP.”
D. None of the above.

1 points

Question 44

1. True or false: A PMHNP may ask his patient to describe her relationship with her father, both as a child and now, in order to assess interpersonal style.



1 points

Question 45

1. A 41-year-old male patient is meeting with the PMHNP and reveals that he is homosexual. He begins telling the PMHNP about his feelings as a homosexual, middle-aged man. The PMHNP nods understandingly. Before long, the patient asks, “Are you gay? Are you married? Do you have kids?” What is the best response by the PMHNP?

A. Answer the patient’s questions honestly to establish trust
B. Mention that the patient seems quite curious, and ask him to discuss more about himself
C. Ignore the patient’s questions and move on to another topic
D. None of the above

1 points

Question 46

1. The PMHNP is working with a veteran who has posttraumatic stress disorder (PTSD). The PMHNP believes that dual awareness will be beneficial in allowing the patient to focus on the here and now. What strategies can the PMHNP use to develop dual awareness in the patient?

A. Asking the patient to recall a recent and mildly disturbing event
B. Having the patient focus on details of the room, such as how hot or cold it is
C. Telling the patient to rate the level of disturbance he feels from a mildly disturbing event
D. All of the above

1 points

Question 47

1. The PMHNP has been assisting a shy and timid 23-year-old male patient struggling with esteem and self-concept issues. Over the weekend, this patient was given the task of completing an exercise that would usually cause him distress and shame, also called a shame-attacking exercise. The PMHNP determines that this task has successfully been achieved when the patient states:

A. “I was able to eat in public yesterday despite how loudly I chew.”
B. “I confessed all of my infidelities to my ex-spouse yesterday.”
C. “I calmly sat through a conversation with my spouse in which she confessed all of her infidelities to me.”
D. “I journaled the shame and guilt that I’ve been feeling from my past that has been holding me back.”  

1 points

Question 48

1. A 35-year-old patient seeks treatment for depression and anxiety after an abusive relationship. To help empower the patient, the PMHNP wants to teach the safe-place exercise to create a feeling of calm. In order to walk the patient through the exercise, the PMHNP first says:

A. “Identify an image of a safe place that makes you feel calm.”
B. “Think about the things that cause you anxiety and let them go.”
C. “Take a deep breath and start to relax with each new breath.”
D. “Picture a beautiful beach and describe to me what you see.”

1 points

Question 49

1. When conducting an initial assessment, a PMHNP has finished conducting a mental status examination with 10 minutes left in the session. The patient is distressed and would like to continue sharing her personal history. True or false: An appropriate response that the PMHNP might tell the patient is, “I understand that you are upset. [Summarizes diagnosis, treatment recommendations, and follow-up plan.] We can continue the conversation next week. How does this time next Monday work for you?”



1 points

Question 50

1. A PMHNP’s patients have already signed confidentiality agreements, including limits that will be imposed on confidentiality. Months later, the state’s laws have changed that affect confidentiality promises the PMHNP has already made. What is an appropriate step for the PMHNP to take after finding out this information?

A. Revise intake forms to align with state laws
B. Review confidentiality revisions with patients
C. Have patients give informed consent again
D. All of the above

1 points

Question 51

1. A 65-year-old patient has suffered the loss of his wife. He is in a state of hyperarousal with increased sympathetic nervous system arousal. One or more interventions may help the patient to deal with this arousal. To decrease sympathetic nervous system arousal, the PMHNP’s treatment strategy is ___________.

A. mindfulness techniques
B. deep breathing exercises
C. self-regulation strategies
D. all of the above

1 points

Question 52

1. A PMHNP is treating a 50-year-old patient who suffers from depression. When he was growing up, he was often responsible for taking care of his three younger siblings. Since then, the patient puts other people’s needs before his own. Based on this information, the PMHNP would conclude that his interpersonal style is __________.

A. overly nurturing
B. nonassertive
C. exploitable
D. vindictive

1 points

Question 53

1. The PMHNP meets with an adolescent patient who has depression and often presents with resistance when discussing his parent’s divorce. For the past couple of sessions, the patient has been quiet, sometimes refusing to speak. To further support the therapeutic relationship, the PMNHP:

A. Observes and points out the behavior
B. Stays quiet until the patient is ready to speak
C. Brings in a colleague to help get the patient to talk
D. None of the above

1 points

Question 54

1. The PMHNP has a session with a patient who was injured and traumatized from an explosion at the industrial plant where he used to work. During the session, an outside noise startles the patient and he experiences a flashback of the loud boom from the explosion. The PMHNP witnesses the patient present with anxiety and belabored breathing. What is the appropriate action of the PMHNP?

A. Telling the patient there is no reason to be startled
B. Avoiding interrupting the flashback as it occurs
C. Asking the patient to describe the flashbacks
D. Have the patient use the relaxation response (take a deep breath, exhale long, and slow down)

1 points

Question 55

1. In your office, you see a 58-year-old patient with PTSD who reports having nightmares, making it impossible for her to sleep. What recommendations based on principles of sleep hygiene will the PMHNP make?

A. Eat a heavy meal before bedtime to induce sleepiness
B. Maintain a warm bedroom temperature
C. Avoid watching television or reading in bed
D. Try going to sleep at different times throughout the week to avoid monotony

1 points

Question 56

1. A 35-year-old patient has been seeking treatment for depression for several months. The PMHNP does an assessment to see if processing has led to adaptive change. The patient’s self-references are positive in relation to past events, work is productive, relationships are adaptive, and there is congruence between behavior, thoughts, and affect. Based on this information, the PMHNP decides the patient ____________.

A. will require more processing strategies
B. would benefit from the stabilization stage
C. is ready to move to Stage III, future visioning
D. no longer needs to continue with therapy

1 points

Question 57

1. The PMHNP is working with a patient who is living in poverty and abusing substances. According to the treatment hierarchy framework, what needs does the PMHNP need to attend to first?

A. Provide safety through case management strategies
B. Help the patient manage positive and negative emotions
C. Explore the meaning of significant adverse life experiences
D. Process all dimensions of memory associated with the trauma

1 points

Question 58

1. Your patient is a 65-year-old male who has a strained relationship with his son and daughter. His children refuse to participate in a family session. The PMHNP asks the patient to draw his family genogram as a next step to _______________.

A. assess the patient’s mental health status and functioning
B. explore the interpersonal styles of each family member
C. provide background information for the patient’s family structure
D. measure the patient’s quality of well-being and productivity

1 points

Question 59

1. During cognitive behavioral therapy (CBT), a 64-year-old male patient, states, “My wife hates me! She’s just waiting for me to die.” Using Socratic dialogue (SD) the PMHNP demonstrates understanding of analysis when she responds:

A. “Now, I’m sure your wife doesn’t hate you.”
B. “Where is the evidence that your wife hates you?”
C. “You seem convinced that your wife hates you.”
D. “What has your wife done to make you believe this?”  

1 points

Question 60

1. The PMHNP is working with a patient who has insomnia and battles going to sleep. The patient reports consistent self-defeating behaviors, and hates trying to go to sleep. Which action made by the PMHNP demonstrates the use of a paradoxical intervention?

A. Telling the patient to start trying to go to sleep earlier, since it takes long to fall asleep
B. Telling the patient to resist sleep and stay awake
C. Having the patient perform a relaxing ritual before bedtime
D. Instructing the patient to avoid stimulants and sugars for 3 hours before falling asleep

1 points

Question 61

1. The PMHNP is working with a patient who seems dissatisfied with the therapeutic relationship. The PMHNP invites the patient to discuss her feelings regarding the PMHNP openly and honestly. It becomes clear to the PMHNP that they are experiencing an alliance rupture. How does the PMHNP repair the therapeutic alliance?

A. Responding to the patient in a nondefensive manner and accepting responsibility for the PMHNP’s part in the tension
B. Emphasizing with the patient’s experiences and validating the patient for bringing it up
C. Considering changing the goals of the patient’s treatment
D. All of the above

1 points

Question 62

1. The patient attempts the PMHNP’s sleep hygiene recommendations for 2 weeks, but does not make any progress mitigating nightmares and hyperarousal. Which behavioral strategy does the PMHNP suggest next?

A. Progressive muscle relaxation exercises
B. Paradoxical interventions
C. Biofeedback
D. All of the above

1 points

Question 63

1. A PMHNP is taking a history and wants to assess how the patient copes with adversity. To do so, the therapist asks questions about the patient’s belief system. What would be an appropriate question to ask?

A. “What are your beliefs about therapy and seeking help?”
B. “To what extent do your religious beliefs give you comfort?”
C. “What gives you a sense of meaning and purpose in life?”
D. All of the above.

1 points

Question 64

1. An 11-year-old patient has been exhibiting low self-esteem at school and acting out. According to Maslow’s hierarchy of needs, which of the following questions would best be addressed first by the PMHNP?

A. “Are Joel’s peers including him at recess?”
B. “Does Joel feel safe and secure at school?”
C. “Is Joel getting enough sleep at home?”
D. “How can Joel feel that he is loved?”

1 points

Question 65

1. The PMHNP is treating a 35-year-old male officer in the military. He discloses that both of his parents are deceased and that he loved them. However, he says that he had feelings of inadequacy because his parents held him to a standard that he could never achieve. He went on to say that nothing he did ever felt good enough. The PMHNP assesses that this patient has perfect creases in his uniform with no strings or tags out of place; she also notices that he has perfect posture and questions him about ritualistic behaviors. She suspects that this patient has maladaptive responses to the expectations placed on him as a teenager and young adult. Which statements made by the patient would verify the PMHNP’s suspicion?

A. “I typically don’t listen to anyone. I take care of my own wants and needs so I feel like no one can judge me or criticize me, period.”
B. “I don’t mean to hurt other people’s feelings. When people cry or say that I have made them upset in some way, that’s not my fault; some people are just sensitive.”
C. “I like to listen to the beat of my own drum; I don’t mind spending most of my days alone. I don’t  need recognition or praise; I would just like to be left alone.”
D. “I believe in systems; I have to have order and rules in my everyday life. If a task must be completed, I will often complete it myself versus depending on someone else.”  

1 points

Question 66

1. The PMHNP is caring for a patient who seems to seek affection and attention from the PMHNP and others in the clinic, as well as displays heightened emotional responses to feelings of being excluded. What therapeutic approach does the PMHNP use to decrease autonomic arousal in the patient?

A. Group therapy
B. Controlled confrontation
C. A safe-place exercise
D. Body and energy work

1 points

Question 67

1. The PMHNP is caring for a patient with dissociated self-state that the PMHNP identifies as being associated with traumatic experiences in the patient’s past. What approach does the PMHNP use with the patient that is crucial to the psychodynamic therapy process?

A. Assisting the patient to experience and accept the various dimensions of the self through enhanced awareness of the traumatic states
B. Becoming a co-participant in the co-construction of the relationship with the patient, rather than an outside observer
C. Making associations between an event or situation and the patient’s feelings
D. Providing empathy, understanding, and soothing to help the patient identify the other self-states

1 points

Question 68

1. The PMHNP understands that anxiety and depression are two disorders in which their symptoms may overlap. When discussing this, you explain that the autonomic nervous system is activated and further helps distinguish anxiety symptoms by making the following points:

A. “You may experience an elevated heart rate, constant worrying, and diarrhea.”
B. “You may experience fear, sweating, and muscle tension.”
C. “You may experience an elevated heart rate, the need to urinate, and fear.”
D. “You may experience sleepiness, decreased blood pressure, and fear.”  

1 points

Question 69

1. The PMHNP is working with a patient who has dissociative disorder and requests pharmacological interventions for dealing with her trauma. What education does the PMHNP provide to the patient regarding medication therapy?

A. “The medication will help you forget the things that trigger your flashbacks.”
B. “The medication takes a while to build up in your system and cure you.”
C. “The medication may provide symptom relief, but you still need psychotherapy.”
D. All of the above.

1 points

Question 70

1. When a PMHNP is seeing a patient for the first time, what is an important step to assure that the patient and provider understand the limits of their discussion?

A. Assure the patient that she is safe to discuss her secrets
B. Talk about the importance of being truthful and open
C. Have a discussion about the confidentiality and its limits
D. Mention the possible need for selective self-disclosure

1 points

Question 71

1. During a clinical assessment of a 15-year-old patient, the PMHNP asks, “How can I help you?” The patient answers by saying, “Honestly, I don’t really think I need any help.” Which of the following is the most appropriate response by the PMHNP?

A. “That’s fine. Can you describe the depressive symptoms you’ve been having the past few months?”
B. “Since you’re already here, maybe we can try to figure out if there is anything else I can help you with.”
C. “You wouldn’t be here if you didn’t actually need help, right? So tell me, how can I be of assistance?”
D. None of the above.

1 points

Question 72

1. You are seeing a 29-year-old widow whose husband recently died overseas while serving his country in the military. She has been mourning the loss of her husband for several months, and continues to grieve. She refuses to go to group grieving sessions, but reports that she is still able to go to work and her fitness classes sometimes, and even makes attempts to stay social. She says, “Sometimes it’s like he’s not even gone. Other times it feels like it’s been an eternity since I’ve seen him. It’s hard to talk about this type of stuff with my girlfriends, especially since all of their husbands are still alive.” The PMHNP understands that it is appropriate to employ which therapeutic principle?

A. Encouraging catharsis
B. Encouraging abreaction to repressed feelings
C. Identifying conflict-resolution techniques
D. All of the above

1 points

Question 73

1. When the patient comes into the office, she says, “I just saw a friend of mine out in the waiting room. What’s wrong with him?” The PMHNP says, “He’ll be fine. He has mild depression.” Which of the following statement is correct related to confidentiality rights?

A. The PMHNP was not protecting patient confidentially rights.
B. The PMHNP was not using identifying information in the patient situation above.
C. Because the patient signed a consent form, the PMHNP was legally allowed to share information.
D. The PMHNP’s response was ethical and legal because she was trying to answer the question.

1 points

Question 74

1. The PMHNP is working with a school-aged child who has been diagnosed with depression. The child has attended several sessions with the PMNHP, but recently presents with avoidant behavior by showing increased distress and being late to sessions. What approach does the PMHNP need to employ with the child to continue making therapeutic progress?

A. Remaining quiet until the child is ready to talk
B. Using communication techniques that are expressive
C. Inviting the child’s parents to speak on behalf of the child
D. All of the above

1 points

Question 75

1. A 24-year-old female patient presents for her initial appointment with the PMHNP. Which action will the PMHNP take to establish therapeutic alliance?

A. Validating the patient’s affect
B. Asking the patient questions about her main concerns
C. Establishing a therapy process
D. All of the above