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Walden NURS6640 Final Exam
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Walden NURS6640 Final Exam
NURS6640 Psychotherapy With Individuals
• Question 1 The PMHNP is caring for
a young adult patient with whom the PMHNP decides to use a dynamic supportive
therapy approach in addition to pharmacological intervention. Which therapeutic
action will the PMHNP take to employ the strategy of holding and containing the
• Question 2 A PMHNP is using Gestalt
therapy to communicate with a 42-year-old patient who is upset with her mother.
She says, “I want to tell her how hurt I feel when she doesn’t call me, but I
don’t want to upset her.” What technique can the PMHNP use to help Sasha
• Question 3 A 43-year-old single
mother is seeing the PMHNP at the request of her sister. “My sister thinks I
need to come here to talk about my feelings,” the patient reports. The PMHNP
learns that the patient has three children from three different men, but is
unable to collect appropriate child support payments from any of the biological
fathers. Additionally, the woman is barely able to afford her apartment or
utilities payments. What is the appropriate response from the PMHNP when using
the psychodynamic psychotherapy technique?
• Question 4 A PMHNP has been
treating a 9-year-old patient who was referred by her school. Students are
asked to raise their hands before speaking during group discussion, but the
patient seems to blurt out what she wants to say without being called on. She
also interrupts other children while they are talking instead of waiting her
turn. When the patient gets frustrated, she has trouble controlling her
emotions and cries often. Based on the initial information provided, the first
focus by PMHNP is the child’s ____________.
• Question 5 A PMHNP has been
treating a 14-year-old patient using interpersonal psychotherapy. The patient
has been depressed since the death of his grandmother. To help the patient
recover, the PMHNP has told the parents:
• Question 6 The PMHNP has been
treating a patient who is now being transferred to another provider. What is
the appropriate action made by the PMHNP?
• Question 7 The PMHNP is meeting
with a patient who has been diagnosed with depression. The patient is having
trouble adjusting to her new job and hasn’t made any new friends there. What
would an appropriate response be by the PMHNP using the interpersonal
• Question 8 A patient is finishing
the active treatment phase of interpersonal psychotherapy (IPT). After the
PMHNP reminds the patient that she has three sessions left, the patient says
nothing, but looks distressed. What would be the best reply by the PMHNP
following IPT protocol?
• Question 9 The PMHNP is initiating
a plan of care for Holly, a 73-year-old female patient who has late-life
bipolar disorder and reports consuming alcoholic beverages four times per week.
What is the focus of Holly’s therapy going to be?
• Question 10 A cocaine-addicted
female patient is entering residential treatment for substance abuse. Using the
10 guiding principles of recovery, an appropriate step by the PMHNP is to
• Question 11 The PMHNP has been
providing interpersonal psychotherapy (IPT) for a patient who the PMHNP
observes implementing new ways of being, such as interacting more with peers
and being less isolated in social scenarios. The PMHNP understands that the
patient is approaching termination. How does the PMHNP address termination with
• Question 12 A 55-year-old patient
recovering from substance abuse tells the PMHNP, “It’s impossible to meet new
people. I really hate being single.” Using existential psychotherapy, what
might the PMHNP say next?
• Question 13 A PMHNP is treating a
10-year-old boy who is exhibiting signs of aggression and attention problems.
What type of intervention will the PMHNP consider using a common elements
• Question 14 The PMHNP is
interviewing a patient with a history of substance abuse. He has attempted to
stop abusing drugs three times before. He states to the PMHNP, “I just cannot
change. How can you help me?!” As it applies to change, the PMHNP understands
the principle of evocation to mean:
• Question 15 A 38-year-old patient
has been having trouble communicating with his teenage daughter. Using a
solution-focused therapy approach, the PMHNP responds by saying, “When was a
time that a communication problem could have occurred, but did not?” In this
case, what type of question is the PMHNP asking?
• Question 16 A PMHNP is assessing a
40-year-old patient named Sarah who has a severe cocaine addiction and mild
depression. Using the four-quadrant model, what would be the most appropriate
setting to help the patient?
• Question 17 A PMHNP is using
emotion-focused therapy to help a 38-year-old patient who says, “I’ve been
feeling angry lately, but I’m not sure why.” The first attempt by the PMHNP is
• Question 18 An 8-year-old has been
having trouble making friends at school. His parents initiated treatment when
he also started acting out at home. Which is the most appropriate step that the
PMHNP takes during the assessment process when using an integrated approach?
• Question 19 The PMHNP meets with a
31-year-old woman who reports feeling as though she is “at her breaking point”
with work. The PMHNP learns that the woman works 12-hour days, including one
day on the weekend, because she is nervous about company layoffs. “I feel like
I need to work myself to death in order to prove that I am valuable to the
organization,” the woman says. Using the supportive psychodynamic therapy
approach, how does the PMHNP respond?
• Question 20 The PMHNP continues to
meet with Gerald, who is the patient with depression and mood disorder. The
PMHNP uses the CBT approach. Gerald is now meeting with the PMHNP for his fifth
session and feels comfortable with how the therapy works. What does the PMHNP
plan to do with Gerald over the course of the next several sessions?
• Question 21 While assessing a
patient using a humanistic-existential approach, a patient tells the PMHNP,
“For the past few weeks, I’ve felt anxious almost every single day.” What would
be an appropriate next step by the PMHNP?
• Question 22 The PMHNP is assessing
an older adult male patient with depression and comorbidities. According to the
medical chart, the patient takes medication to manage joint and bone pain. The
patient reports feeling “forgetful” and complains that he has a hard time
remembering where he puts things. What is the primary action by the PMHNP?
• Question 23 A 13-year-old patient
and his parents are meeting with a PMHNP. When the PMHNP says hello, the boy
just nods. His parents tell the PMHNP that he didn’t want to come to the
session, but they insisted. They explain that their son has been moody and
depressed at home, but is still getting good grades at school. Which of the
following would be the best response by the PMHNP?
• Question 24 The PMHNP is assessing
a new geriatric patient who reports symptoms of depression. The PMHNP wants to
identify the patient’s symptom severity over time. Which assessment tool will
the PMHNP use to collect this data on the patient?
• Question 25 The PMHNP is caring for
a geriatric patient who expresses symptoms of gastrointestinal problems, aches
and pains, and loss of appetite. The patient reports feeling lonely, as more of
his friends have been passing away over the recent months and years. The PMHNP
focuses on which therapeutic approach for this patient?
• Question 26 The PMHNP has been
providing supportive psychodynamic psychotherapy to a patient and is nearing
the termination stage. The PMHNP will use which criteria for determining that
the patient is ready for termination?
• Question 27 The PMHNP is treating
an older adult patient who reports experiencing nightmares associated with an
automobile accident he was in 20 years ago. As the PMHNP formulates the case
using the dynamic supportive therapy model, what questions will the PMHNP use
during the session?
• Question 28 A 25-year-old female
states, “I really need to lose weight. I know I’m the cause of our
problems, if I could just lose weight he
might be more attracted to me. Then we could start a family and we would be
happy. I’m sure of it, right, we would definitely be happy!” Which statement
shows the PMHNP’s ability to apply “summarizing”?
• Question 29 A PMHNP is treating a
25-year-old patient who has a compulsive urge to exercise to excess. When asked
to describe why she does so much exercise, she says, “I like the compliments I
receive from others on my new level of fitness, and the excitement of getting
more attention.” The PMHNP can use feeling-state therapy to help Monique
• Question 30 A 19-year-old female
patient named Anna, who was the victim of child abuse and neglect, is also in
treatment for substance abuse. At her most recent appointment, Anna confesses
to the PMHNP that she is having romantic fantasies about him, and explains the
he is one of the few people she trusts. She believes that he is interested in her
as well. What is the most appropriate response by the PMHNP in this situation?
• Question 31 The PMHNP is initiating
a plan of care for a patient who requires comprehensive psychotherapy to manage
his depression and mood disorder. Throughout the initial sessions, the patient
reports feeling as though he cannot be helped. The PMHNP is concerned about
premature termination initiated by the patient. What strategy can the PMHNP
employ to prevent or reduce premature termination?
• Question 32 Following an attempted
suicide, Mr. Durham was admitted to an acute psychiatric facility. After 4
weeks in treatment, he is preparing for discharge. He is beginning to miss
individual and group therapy sessions and has refused medications twice in the
past 2 days. The PMHNP demonstrates understanding in this phase by saying which
of the following statements?
• Question 33 The PMHNP is assessing
a 30-year-old client who reports feeling stressed out due to his current
employment situation. When asked about how he manages this work-related stress,
the patient says that exercise helps him feel less anxious, so he often spends 2
or more hours at the gym each night. After completing the patient assessment,
the PMHNP has determined that an existential psychotherapy approach may best
benefit this client. What is the PMHNP’s goal in employing this treatment
• Question 34 The PMHNP is caring for
an adult male patient whose wife left him several months ago. He recently
learned that his ex-wife is dating someone much younger. The man feels
belittled, sad, and lonely. He talks about trying to meet other women, but
says, “I can’t compete with the younger guys these days, with the cool clothes
and the vegan diets. I’m bald and overweight, and what woman is going to want
to be with me?” How does the PMHNP help raise the man’s self-esteem?
• Question 35 Mia is a 75-year-old
patient who has completed initial treatment for depression. What might a PMHNP
ask Mia when using a solution-focused therapy approach?
• Question 36 A PMHNP is treating a
12-year-old girl who witnessed the physical abuse of her sibling. She has been
anxious and irritable since the experience. After speaking with the PMHNP, the
patient says she keeps having anxiety-causing thoughts about the experience.
Using the PRACTICE technique, which skill will best help the patient interrupt
these negative thoughts?
• Question 37 A 35-year-old male
patient is being treated for alcohol addiction. He asks for the PMHNP’s cell
phone number to use in case of an emergency. When the PMHNP responds that
giving her number would be against therapeutic rules, the patient threatens an
act of violence to the therapist. What would be the most appropriate response
by the PMHNP?
• Question 38 The PMHNP is caring for
a patient who is histrionic. Using the supportive psychodynamic therapy model,
what is the best statement made by the PMHNP?
• Question 39 The PMHNP is caring for
an older patient with major depressive disorder, seasonal pattern. The patient
has been resolute about not taking medication to manage the depression brought
on by his illness, stating that it is against his yogic lifestyle. In addition
to psychotherapy, what can the PMHNP suggest to this patient?
• Question 40 The PMHNP uses the
cognitive behavioral therapy model with Gerald, an older adult patient who is
being treated for depression and mood disorder. What will the PMHNP do with the
patient during the first three sessions?
• Question 41 The PMHNP is caring for
an older adult patient who presents with mixed dysphoric states and whose
daughter reports “is becoming more irritable more easily.” When talking with
the patient, the PMHNP also recognizes displays of cognitive dysfunction. Which
treatment options will the PMHNP most likely suggest?
• Question 42 When preparing to
terminate a patient, what does the PMHNP do to organize thoughts about the
patient’s progress made during treatment?
• Question 43 In the planning phase
of change, a 42-year-old male client who struggles with gambling discusses how
he plans to abstain from gambling. He tells the PMHNP, “I am no longer going to
carry cash to the casino because you can’t spend what you don’t have.” The
PMHNP uses an affirming communication skill when she states:
• Question 44 The PMHNP is caring for
a patient who experiences depression caused by the traumatic experience of her
dog passing away. She reports not being able to eat or sleep, and sometimes
doesn’t want to leave the house at all. Which statement is most appropriate for
the PMHNP to maximize the patient’s adaptive coping mechanisms?
• Question 45 The PMHNP who practices
motivational interviewing understands its relationship to patient behaviors
and/or outcomes to mean which of the following?
• Question 46 A PMHNP is using
motivational interviewing (MI) with a 50-year-old patient named Dave to commit
to a healthy drug-free lifestyle. By using “change talk,” the PMHNP hopes to
help the patient build self-esteem and hope.
false: If Dave is resisting change, the PMHNP should challenge his resistance
in order for MI to be successfu
• Question 47 A PMHNP is using
Gestalt therapy to communicate with a 50-year-old patient who is going through
a divorce. As he is calmly sharing the details of his divorce, the PMHNP
notices that Dave is tapping his fingers on his legs. What is an appropriate
response by the PMHNP using the technique of focusing?
• Question 48 The PMHNP uses the
Adult Attachment Interview (AAI) with a male patient who reports having had a
difficult time being separated from his parents during his childhood. He
explains that going to school or visiting his relatives without his parents was
troublesome. The PMHNP characterizes the patient as unresolved/disorganized,
according to his outcomes on the AAI. What does the PMHNP anticipate from the patient?
• Question 49 A 21-year-old patient
is worried about starting a new job. She talks about her fears of failure and
not making friends at the office. Using a person-centered approach, an
appropriate response by the PMHNP is to ______________.
• Question 50 The PMHNP is
interviewing a patient who is in the process of successfully completing a
substance abuse program. During the interview, the patient states, “I wish I
was strong enough to keep the same friends I had before I came here for
treatment. I’m really afraid of being discharged because I’ll probably run into
my old friends again.” The PMHNP offers a complex reflection when she states
• Question 51 When completing this
exam, did you comply with Walden University’s Code of Conduct including the
expectations for academic integrity?
• Question 52 How does the PMHNP
approach termination with the patient who has been receiving intermittent
• Question 53 The PMHNP initiates
feeling-state therapy to help a 25-year-old patient named Monique who has a
compulsive urge to exercise. Using the Feeling-State Addiction Protocol, what
is an appropriate next step the PMHNP should take after identifying the
specific positive feeling linked with the addictive behavior and its Positive
Feeling Score level?
• Question 54 The PMHNP is assessing
a patient who requires cognitive behavioral therapy (CBT). Which of the
following statements made by the PMHNP approach the termination phase for this
• Question 55 A 12-year-old girl was
referred for treatment after witnessing the physical abuse of her sibling by
their mother. The patient has been anxious and irritable since the experience. What
evidence-based treatment would be most appropriate for the PMHNP to use?
• Question 56 The PMHNP is in the
process of terminating treatment with a patient who witnessed the death of her
parent who used to sexually abuse her. What does the PMHNP understand about
terminating this patient?
• Question 57 The PMHNP is caring for
an older adult patient who is in the acute phase of schizophrenia. Which
therapeutic model will the PMHNP employ with this patient?
• Question 58 The PMHNP is
terminating treatment with a patient who is aggressive and has a history of
anger. What does the PMHNP do when terminating treatment with this patient?
• Question 59 When recalling the
phases of change, the PMHNP demonstrates “open questioning” in the “engagement”
phase by making which statement?
• Question 60 A PMHNP is assessing a
60-year-old patient named Carlos. He has severe PTSD and mild substance abuse
issues. The most appropriate setting to treat Carlos would be a _________.
• Question 61 The PMHNP assesses a
27-year-old patient named Jeff, who was a victim of child abuse and neglect.
Jeff says that he remembers a traumatic situation that he wants to share, but
is having trouble talking about it. Which statement made by the PMHNP
demonstrates the use of emotion-focused therapy?
• Question 62 The PMHNP is meeting
with an older, female adult patient and her daughter. The patient has early
onset dementia. The daughter expresses concern, saying, “I don’t want you to
just stick my mother in a home and give her medicine. I’m worried that’s what
people are going to want to do.” What is the best response by the PMHNP to the
• Question 63 The PMHNP is communicating
with a middle-aged male patient who has a history of addiction to Percocet
(acetaminophen/oxycodone). The patient suddenly yells, “I do not have a problem
with pain pills! I’ve never had an overdose and no one even knows that I take
them unless I tell them.” The PMHNP understands that there are phases of change
and can best demonstrate “focusing” by responding with:
• Question 64 As part of the PMHNP’s
role in the clinic, the PMHNP oversees students that gain clinical experience
at the agency. The student is instructed to use the supportive psychodynamic
therapy approach with the patient. Which action made by the student causes the
PMHNP to intervene, after observing the student interacting with the patient?
• Question 65 The PMHNP is
terminating treatment for a patient who has been receiving eye movement
desensitization and reprocessing (EMDR) therapy. What action does the PMHNP
take at the final session to terminate treatment
• Question 66 The PMHNP is working
with a patient who describes having a painful and traumatic childhood
experience, which causes her to have anxiety as an adult. When asked how she
manages her anxiety, the patient dismisses it and denies that it is a problem.
Using the supportive psychotherapy approach, the PMHNP will do which of the
following when assessing the patient’s ego strength?
• Question 67 A 38-year-old patient
tells the PMHNP that her father went to jail for selling drugs when she was a
child. The patient is visibly upset when discussing what happened. Using a
humanistic-existential approach to psychotherapy, which of the following is the
most appropriate response by the PMHNP?
• Question 68 A patient’s depression
is affecting her relationship with her spouse. What might the PMHNP ask during
the initial sessions of interpersonal psychotherapy treatment?
• Question 69 The PMHNP is treating
an older adult patient who reports symptoms of late-life anxiety. What type of
treatment(s) will the PMHNP consider?
• Question 70 A 21-year-old patient
has been having trouble adjusting to college life. She tells the PMHNP that she
had five alcoholic drinks at a party this past weekend. She also acknowledges
that she drank the same amount of alcohol at a party the previous month. Based
on this information, what would the PMHNP most likely recommend
• Question 71 Linda is a 65-year-old
patient who has completed initial treatment for alcohol addiction and anxiety
problems. She is motivated to continue her treatment gains and have a healthy
lifestyle. How would the PMHNP apply a mindfulness approach to this case?
• Question 72 A PMHNP has been
working with a 50-year-old patient who has a stressful job and goes to the
casino on weekends to play poker with his friends, which he says relieves his
stress. Tim admits that he sometimes misses work on Monday when he stays out
too late at the casino on Sunday nights. In addition, he once was an avid
runner, and has given up running to spend more time gambling.
false: According to the PMHNP, the desired goal after treatment is not complete
abstinence from gambling, but reaching a healthy level of the behavior.
• Question 73 The PMHNP uses
therapeutic communication skills while ensuring that the patient understands
that he has choices. The PMHNP comprehends and practices motivational
interviewing. This is best understood as which of the following?
• Question 74 The PMHNP is actively
listening to Ms. Thomas who is detoxing from alcohol. Ms. Thomas is currently
discussing with the PMHNP the reasons why she feels guilty about her drinking.
Ms. Thomas tearfully states, “I have driven my family and friends away with
this terrible habit. I have no one left. I had more than enough chances and now
my children won’t even talk to me.” Which of the following statements demonstrate
a simple reflection?
• Question 75 The PMHNP is assessing
a patient who has been receiving months of outpatient psychotherapy. According
to the PMHNP’s assessment, the patient is nearing the termination phase of
their therapeutic relationship because the patient’s symptoms have improved,
and the patient shows progress managing behaviors and decision-making abilities
according to the diagnosis. How does the PMHNP approach termination with this
• Question 76 PMHNP is using
interpersonal psychotherapy with a 40-year-old patient having relationship
problems with his extended family. The patient shares that he has been using
the strategies they identified to reduce his distress, but they have not been
helping. He is frustrated and is considering stopping treatment. What would be
an appropriate step by the PMHNP?
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