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Walden nurs6640 final exam

Walden nurs6640 final exam


Walden nurs6640 final exam: QUESTION 1

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:

2. 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. 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?

2. 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. 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:

2. A. Disclose all patient information as

B. Refuse to disclose any confidential

C. Limit disclosure to the extent
legally possible

D. Ignore the request based on ethical


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?

2. 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. 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?

2. A. “Are Joel’s peers including him at

B. “Does Joel feel safe and secure at

C. “Is Joel getting enough sleep at

D. “How can Joel feel that he is


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?

2. 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. 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. 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:

2. A. Developing increased boundaries

B. Decreasing supportive psychotherapy

C. Scaling back contact with the

D. Increasing the number of sessions
per week


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. 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?

2. 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

D. Have the patient use the relaxation
response (take a deep breath, exhale long, and slow down)


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?

2. 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. 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 _______________.

2. 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. 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?

2. A. Encouraging catharsis

B. Encouraging abreaction to repressed

C. Identifying conflict-resolution

D. All of the above


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

2. A. mindfulness techniques

B. deep breathing exercises

C. self-regulation strategies

D. all of the above


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?

2. 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

D. None of the above


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:

2. 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. 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?

2. 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. 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:

2. 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. 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?

2. 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. 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?

2. 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. 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?

2. A. Pharmacological therapy

B. Stress inoculation therapy

C. Dialectical behavior therapy

D. All of the above


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 _____________.

2. A. adaptive regression in the service
of the ego

B. regulation and control of affects
and impulses

C. defensive and interpersonal

D. sense of reality of the world and of
the self


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

2. 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


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?

2. 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. 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:

2. 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. 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. 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?

2. 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. 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?

2. 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. 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?

2. 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. 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?

2. A. Progressive muscle relaxation

B. Paradoxical interventions

C. Biofeedback

D. All of the above


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?

2. A. Emphasize the past

B. Focus on expressions of emotion

C. Identify patterns in relationships

D. All of the above


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?

2. A. Therapeutic communication

B. Maintaining the frame

C. Working with resistance

D. None of the above


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?

2. 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. 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)?

2. 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


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:

2. A. “Would you say you feel like you are

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?”


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

2. 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. 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?

2. A. Narcissistic personality disorder

B. Obsessive-compulsive personality

C. Borderline personality disorder

D. Paranoid personality disorder


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. 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?

2. A. Interview the patient’s family

B. Construct a timeline of the
patient’s life

C. Review the patient’s current

D. Debrief with the patient


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?

2. A. Young Mania Rating Scale

B. Hamilton Anxiety Rating Scale

C. Dissociative Experiences Scale

D. Impact of Event Scale


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:

2. 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. 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:

2. 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. 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. 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

2. A. Responding to the patient in a
nondefensive manner and accepting responsibility for the PMHNP’s part in the

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. 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?

2. 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. 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?

2. 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

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


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. 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?

2. A. Group therapy

B. Controlled confrontation

C. A safe-place exercise

D. Body and energy work


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:

2. 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. 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?

2. A. Revise intake forms to align with
state laws

B. Review confidentiality revisions
with patients

C. Have patients give informed consent

D. All of the above


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

2. 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. 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?

2. 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


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?

2. A. Focus on the patient’s safety and

B. Help the patient process painful

C. Encourage the patient to find ways
to achieve personal growth

D. Assist the patient in planning for
the future


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


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 __________.

2. 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. 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?

2. A. “I deserve the utmost respect from
everyone who meets me.”

B. “I prefer doing everything on my

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


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 ___________:

2. A. employ cognitive behavioral therapy

B. use empathy

C. utilize intersubjectivity

D. none of the above


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?

2. 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. 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?

2. 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. 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

2. 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


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 _________.

2. A. may lack ability to see independent

B. has an insistent emphasis on the
feelings of others

C. has an intrusive interpersonal

D. all of the above


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?

2. 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. 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?

2. 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. 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?

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

2. 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


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?

2. A. The patient is having a balanced
response to the trauma.

B. The patient is reporting signs of

C. The patient is becoming unresponsive
to the environment.

D. All of the above.


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. 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. 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 ____________.

2. A. will require more processing

B. would benefit from the stabilization

C. is ready to move to Stage III,
future visioning

D. no longer needs to continue with


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

2. 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. 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?

2. A. Autognosis

B. Complementary identification

C. Concordant identification

D. Self-disclosure


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?

2. 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


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?

2. 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. 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:

2. 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.”


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