Psychiatric Nursing Questions (Final)

Quiz: Final Exam

 

 

 

This exam will cover the following topics from the Wheeler textbook, which relate to psychotherapy of individuals:

 

 

· Supportive and Psychodynamic Psychotherapy

· Interpersonal Psychotherapy

· Humanistic-Existential and Solution-Focused Approaches to Psychotherapy

· Psychotherapy With Children

· Psychotherapy With Older Adults

· Termination and Outcome Evaluation

 

Learning Resources

 

Required Readings

Wheeler, K. (Ed.). (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. 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 ___________.

	A.	return to a normal system of functioning
	B.	break the feeling/behavior connection
	C.	use more appropriate ways to satisfy needs
	D.	all of the above

1 points

Question 2

1. 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?

	A.	Suggesting that the patient goes to church to pray for God’s help
	B.	Telling the patient to write letters to the biological fathers requesting money
	C.	Suggesting that the patient seek professional legal help
	D.	Asking the patient why she thinks it is so hard to get the money she deserves

1 points

Question 3

1. 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?

	A.	Immediately report the threat to the local police department
	B.	Allow the patient to explore his feelings
	C.	Review the therapeutic treatment frame
	D.	Call the patient the next day to follow up

1 points

Question 4

1. 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?

	A.	“Express your emotion, and do not hold anything back.”
	B.	“Let’s not think too much about emotion right now. Let’s focus on what got you upset in the first place.”
	C.	A and B
	D.	None of the above

1 points

Question 5

1. 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?

	A.	“How were you feeling at the time when that happened?”
	B.	“What are you experiencing now as you share this story?”
	C.	“Did you allow yourself to feel anger when your father left?”
	D.	“Are able to let go of the painful emotions you felt as a child?”

1 points

Question 6

1. 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?

	A.	Give the patient as much time needed to respond to questions and comments.
	B.	A statement that both challenges the patient’s resistance and offers an opportunity to discuss the issues allows the patient to argue with him/herself to help produce a desired change.
	C.	You must give full attention to the patient because nonverbal and verbal reactions are equally important.
	D.	The PMHNP should be ready with a response when communicating with the patient. She understands that silence is also a therapeutic response.

1 points

Question 7

1. The PMHNP who practices motivational interviewing understands its relationship to patient behaviors and/or outcomes to mean which of the following?

	A.	An increased use of motivational interviewing is linked to inconsistent behaviors in the patient. This is related to decreased client engagement and poor outcomes.
	B.	A decreased use of motivational interviewing is linked to more consistent behaviors in the patient. This is related to decreased client engagement and poor outcomes.
	C.	There is a higher incidence of inconsistent behaviors with motivational interviewing. This is related to client engagement and better outcomes.
	D.	There is a lower incidence of inconsistent behaviors with motivational interviewing. This is related to client engagement and better outcomes.

1 points

Question 8

1. 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?

	A.	Mood Disorder Questionnaire
	B.	Montgomery-Asberg Depression Rating Scale
	C.	AB Clinician Depression Screen
	D.	Brief Psychiatric Rating Scale

1 points

Question 9

1. 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 _________.

	A.	primary health care setting with some specialized care
	B.	state psychiatric hospital and/or emergency room
	C.	substance abuse treatment system
	D.	mental health system of care

1 points

Question 10

1. 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 ______________.

	A.	focus on the substance abuse problem before addressing any trauma
	B.	integrate services that encompass mind, body, spirit, and community
	C.	help the patient use fear of relapse to provide motivation for recovery
	D.	none of the above

1 points

Question 11

1. 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?

	A.	“I noticed that your fingers were tapping. Can you give a voice to your fingers?”
	B.	“I’m going to ask you to exaggerate the movement of tapping your fingers.”
	C.	“Explore what is emerging in your body now. What are you experiencing right now?”
	D.	None of the above.

1 points

Question 12

1. 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:

	A.	“I sincerely commend you for being here and seeking treatment; this is a great first step.”
	B.	“If no one knows about your substance usage, why are you here?”
	C.	“Just because no one knows about your drug usage does not mean you do not have a problem.”
	D.	“I am wondering if your use of pain medication has ever prompted you to seek medical attention.”

1 points

Question 13

1. 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 approach?

	A.	Behavioral
	B.	Cognitive
	C.	Pyschoeducational
	D.	All of the above

1 points

Question 14

1. 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 patient?

	A.	Address the termination phase with the patient at the last session
	B.	Manage termination issues as part of the treatment
	C.	Determine the PMHNP’s readiness to terminate the therapeutic relationship
	D.	None of the above

1 points

Question 15

1. 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?

	A.	Cognitive behavioral therapy (CBT)
	B.	Interpersonal psychotherapy (IPT)
	C.	Combination of CBT and IPT
	D.	Combination of CBT and medication

1 points

Question 16

1. 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?

	A.	“You may want to look into therapeutic oils and aromatherapy as an alternative to medication.”
	B.	“Some patients have good results with medicine. Are you sure you don’t want to try it?”
	C.	“You can try taking natural supplements in addition to the medicine I prescribe you.”
	D.	All of the above.

1 points

Question 17

1. 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?

	A.	Individual CBT
	B.	Group CBT
	C.	Both A and B
	D.	None of the above

1 points

Question 18

1. 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?

	A.	“Let’s see if we can come up with some ideas for you to feel safe telling your story.”
	B.	“Jeff, it’s okay for you to not talk about your past here; this is a safe space, whether you feel like sharing or not.”
	C.	“Jeff, can you tell me what was going on during your childhood that caused you to be a victim of neglect and abuse?”
	D.	None of the above.

1 points

Question 19

1. The PMHNP is treating an older adult patient who reports symptoms of late-life anxiety. What type of treatment(s) will the PMHNP consider?

	A.	Employ cognitive behavioral therapy
	B.	Use relaxation training
	C.	Initiate modular interventions
	D.	All of the above

1 points

Question 20

1. 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?

	A.	Trauma-focused CBT
	B.	Interpersonal psychotherapy
	C.	Psychodynamic therapy
	D.	Behavioral parent training

1 points

Question 21

1. 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?

	A.	He will have lapses in his memory of his childhood.
	B.	He will be able to describe his childhood in great detail.
	C.	He will need less active interventions.
	D.	None of the above.

1 points

Question 22

1. 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?

	A.	“Think of something funny every time you feel sad.”
	B.	“My cat passed away last year, and it’s been hard to adjust to her being gone.”
	C.	“It’s important to be mindful of how you feel and then to determine what causes those feelings.”
	D.	B and C

1 points

Question 23

1. 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”?

	A.	“You believe that your weight is a cause of your marital problems.”
	B.	“How would starting a family contribute to your overall happiness?
	C.	“You have identified your weight as a problem in your marriage and but believe that losing weight will gain happiness.”
	D.	“Part of you believes that losing weight will bring you happiness, while the other part believes that may not be true.”

1 points

Question 24

1. 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?

	A.	Managing health and substance abuse
	B.	Maintaining meaningful relationships
	C.	Skills for daily living
	D.	All of the above

1 points

Question 25

1. A 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?

	A.	Encourage the patient to continue treatment by using alternative strategies
	B.	Restart the process at the assessment phase to formulate a new treatment plan
	C.	Explain how the originally identified strategies will address the focus problem
	D.	None of the above

1 points

Question 26

1. 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?

	A.	Build a therapeutic alliance
	B.	Build behavioral skills to increase pleasant activities
	C.	Build cognitive skills to challenge negative thinking
	D.	Build social skills to improve problem solving

1 points

Question 27

1. When preparing to terminate a patient, what does the PMHNP do to organize thoughts about the patient’s progress made during treatment?

	A.	Interviews the patient’s family, caregiver, or friends regarding the patient’s progress outside of the sessions
	B.	Reviews the patient’s file to identify issues and important themes that were highlighted throughout treatment
	C.	Requests a peer to review the patient’s file to double check that the PMHNP has not overlooked anything
	D.	All of the above

1 points

Question 28

1. 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?

	A.	“Where are you experiencing unhappiness in your body?
	B.	“So you feel frustrated and unhappy being single. Is that right?”
	C.	“Are you willing to say, ‘I’m having a hard time meeting people’?”
	D.	“What might help you to live a more meaningful life?”

1 points

Question 29

1. 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 approach?

	A.	Help the patient eliminate anxiety from his life
	B.	Help the patient be aware of his anxiety and embrace it
	C.	Help the patient find alternative ways to de-stress
	D.	None of the above

1 points

Question 30

1. 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?

	A.	Incorporate patient preferences as to the type of therapy used
	B.	Educate the patient about the duration and pattern of change
	C.	Foster a therapeutic alliance with the patient
	D.	All of the above

1 points

Question 31

1. 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?

	A.	Makes a list of all the positive things the patient gained from treatment
	B.	Does not recognize the patient’s emotions so as to not encourage the onset of anger
	C.	Emphasizes and validates the patient’s feelings of anger that may emerge
	D.	Avoids upsetting the patient by keeping an open door policy

1 points

Question 32

1. 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?

	A.	Ask the patient to leave the room to speak with his parents
	B.	Tell the patient that he shouldn’t be upset at his parents
	C.	Compliment the patient on his academic achievement
	D.	All of the above

1 points

Question 33

1. 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 psychotherapy approach?

	A.	“For homework, please write a list of qualities you’d find in a good friend.”
	B.	“Describe the friendships you had growing up, both as a child and teenager.”
	C.	“Tell me more about why you’re having trouble making new friends at work.”
	D.	All of the above.

1 points

Question 34

1. 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?

	A.	Evaluate the patient for having the coping skills to manage feelings
	B.	Perform eye movement sets until the Positive Feeling Score level drops
	C.	Locate and identify any physical sensations created by the positive feelings
	D.	Have the patient visualize performing the addictive behavior

1 points

Question 35

1. 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. True or false: According to the PMHNP, the desired goal after treatment is not complete abstinence from gambling, but reaching a healthy level of the behavior.

True

False

1 points

Question 36

1. When recalling the phases of change, the PMHNP demonstrates “open questioning” in the “engagement” phase by making which statement?

	A.	“What plans have you made to make this change?”
	B.	“What occurred to cause you to seek treatment?”
	C.	“What concerns you the most about these subjects?”
	D.	“What do you want do you want be different?”

1 points

Question 37

1. 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 to say:

	A.	“Focus on your anger, take a deep breath, and allow an image to emerge.”
	B.	“Sit in these two chairs to have a conversation with your anger.”
	C.	“Please tell me in detail about your anger and confusion.”
	D.	“Your experience of anger and confusion is normal.”

1 points

Question 38

1. 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?

	A.	Coping question
	B.	Joining question
	C.	Exception question
	D.	Miracle question

1 points

Question 39

1. 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?

	A.	Transference neurosis has been resolved.
	B.	Symptoms have improved.
	C.	Core conflicts have been reduced.
	D.	Self-analytic capacity has been developed.

1 points

Question 40

1. 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?

	A.	Collaborating with the patient’s caregiver to discuss a treatment approach
	B.	Prescribing an antidepressant to address the patient’s symptoms
	C.	Determining if the patient’s medications can be causing memory problems
	D.	All of the above

1 points

Question 41

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 patient?

	A.	Encouraging and nurturing the patient
	B.	Asking the patient how the patient feels
	C.	Discussing why the patient is not taking the medication as directed
	D.	Teaching the patient about medication side effects

1 points

Question 42

1. 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. True or false: If Dave is resisting change, the PMHNP should challenge his resistance in order for MI to be successful.

True

False

1 points

Question 43

1. 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 daughter?

	A.	“Most of the time, institutionalization cannot be prevented.”
	B.	“The type of treatment depends on the stage of dementia and safety considerations.”
	C.	“Don’t worry; I do not believe in hospitalizing my patients.”
	D.	“The treatment decision will be up to your mother and what she wants.”

1 points

Question 44

1. 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?

	A.	“What specific improvements have you noticed in your mood since you made the call to see me?”
	B.	“On a scale of 1–10 (with 1 being little to no improvement to 10 being a great deal of improvement) how much has your mood changed since we started working together?”
	C.	“What needs to happen today in order for you to feel that is was a productive session?”
	D.	All of the above.

1 points

Question 45

1. 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:

	A.	“Keep your expectations high to show that you believe in his abilities.”
	B.	“Modify your expectations at home and school until the depression lifts.”
	C.	“Don’t put expectations on him while he is showing signs of depression.”
	D.	“Allow him to be an active participant by setting his own expectations.”

1 points

Question 46

1. 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 ______________.

	A.	give the patient advice based on the therapist’s experiences
	B.	persuade the patient to release her unfounded fears and worries
	C.	ask the patient to reflect on and explore what she is experiencing
	D.	all of the above

1 points

Question 47

1. 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?

	A.	Group therapy
	B.	Peer support
	C.	Hospitalization
	D.	None of the above

1 points

Question 48

1. 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?

	A.	“What can you tell me about this room?”
	B.	“You might benefit from a sleep aid.”
	C.	“Let’s talk about what kinds of things are triggering you now.”
	D.	“Do I have your permission to advocate for you with your primary care physician?”

1 points

Question 49

1. 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 this patient?

	A.	Give the patient an option about terminating the therapy
	B.	Allow the patient to bring up termination on his/her own
	C.	Embed the termination into the work of the therapeutic phase
	D.	None of the above

1 points

Question 50

1. 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?

	A.	Set treatment goals with Gerald
	B.	Identify barriers to treatment
	C.	Develop cognitive skills to challenge Gerald’s negative thinking
	D.	None of the above

1 points

Question 51

1. 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?

	A.	Supportive therapy
	B.	Problem-solving therapy
	C.	Cognitive behavioral therapy
	D.	All of the above

1 points

Question 52

1. 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:

	A.	The patient can choose to leave the program whenever he wants because changing is his choice.
	B.	The patient already has everything needed and the PMHNP would like to help him facilitate his own inner coping.
	C.	If the patient tries, he will one day become successful; he must not give up.
	D.	The patient must evolve and change with the times to successfully change his way of thinking.

1 points

Question 53

1. A patient’s depression is affecting her relationship with her spouse. What might the PMHNP ask during the initial sessions of interpersonal psychotherapy treatment?

	A.	“What expectations do you have of your spouse?”
	B.	“How is your depression affecting the relationship with your spouse?”
	C.	“What changes would you and your spouse like to see in the relationship?”
	D.	All of the above.

1 points

Question 54

1. 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?

	A.	Helps the patient create a future template
	B.	Discusses all issues that have been addressed
	C.	Asks the patient to take a new assessment
	D.	All of the above

1 points

Question 55

1. 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 the following:

	A.	“You feel as though you are weak and you wish that you were strong.”
	B.	“The thought of being discharged scares you because you don’t feel strong enough.”
	C.	“You’d like to keep your old friends but know being around them may lead you to abuse substances again.”
	D.	“You believe that you’ll run into your old friends if you’re discharged.”

1points

Question 56

1. 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 patient?

	A.	“Although it’s your first session, we will discuss how termination of your treatment will go.”
	B.	“Now that you are feeling more stable, let’s talk about terminating these sessions.”
	C.	“We will wait to discuss terminating the treatment until you’ve attended at least five sessions.”
	D.	None of the above.

1 points

Question 57

1. 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?

	A.	“You feel that your children have given you many chances.”
	B.	“You believe that you have no one to support you through this.”
	C.	“You feel that your use of alcohol is a terrible habit.”
	D.	All the above.

1 points

Question 58

1. How does the PMHNP approach termination with the patient who has been receiving intermittent therapy?

	A.	Uses the word “interrupt” instead of “terminate” with the patient
	B.	Requires the therapy be resumed in several months
	C.	Encourages the patient to check in with the PMHNP about his/her progress
	D.	A and C

1 points

Question 59

1. 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?

	A.	Relaxation
	B.	Affect modulation
	C.	Enhancing safety
	D.	Trauma narrative

1 points

Question 60

1. 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?

	A.	The patient should be made aware that he/she may have trouble managing the trauma.
	B.	The patient will have to resume treatment with a different provider for further treatment.
	C.	The patient can be weaned off from therapy, but cannot receive treatment indefinitely.
	D.	The patient may need to have follow-up sessions every few months.

1 points

Question 61

1. 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?

	A.	Encourage her to focus on therapy and keep the conversation professional
	B.	Explain that he must terminate counseling because of the therapeutic frame
	C.	Guide the patient to examine her feelings and explore the underlying meaning
	D.	None of the above

1 points

Question 62

1. 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?

	A.	Help Linda develop an awareness of triggers in order to have greater control over physical and emotional responses
	B.	Encourage Linda to have her husband and children participate in family therapy to facilitate her integration into the community
	C.	Ask Linda to do homework to elicit any other feelings related to her addictive behavior and evaluate her progress
	D.	All of the above

1 points

Question 63

1. 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?

	A.	Focusing too heavily on defenses
	B.	Talking to the patient about the use of problem-solving strategies
	C.	Inviting the patient to emote about thoughts and fantasies
	D.	Asking the patient about the patient’s work stress

1 points

Question 64

1. 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 ____________.

	A.	memory
	B.	self-regulation
	C.	language skills
	D.	social system

1 points

Question 65

1. 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?

	A.	Correcting cognitive distortions
	B.	Using role-playing techniques
	C.	Unraveling unconscious guilt
	D.	All of the above

1 points

Question 66

1. 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?

	A.	“You need to find a new place to work.”
	B.	“Who cares about getting laid off? Then you can collect unemployment benefits.”
	C.	“I’m sure you have parents or a husband to take care of you if you lose your job.”
	D.	“That must be a very tiring work schedule. How do you feel about working so much?”

1 points

Question 67

1. The PMHNP has been treating a patient who is now being transferred to another provider. What is the appropriate action made by the PMHNP?

	A.	Introducing the patient to the new provider
	B.	Leaving the door open for the patient to return at any time
	C.	Having the new provider come to a few sessions
	D.	A and C

1 points

Question 68

1. 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?

	A.	“Maybe we should extend your active treatment phase.”
	B.	“Remember that the end of treatment is not a time to grieve.”
	C.	“Don’t worry. Finishing therapy means you’ve met your goals.”
	D.	“You seem upset. Tell me what seems to be bothering you.”

1 points

Question 69

1. 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:

	A.	“Not gambling is a tough habit to break; not carrying cash is a big step in the right direction.”
	B.	“Are you saying that you will still go to a casino: however, you will only have a debit card in terms of funds?”
	C.	“This is a great technique, though it may not work if there is an ATM in the casino you go to.”
	D.	“Why don’t we try to deal with your addiction to gambling before you go into a casino to decrease your temptation?”

1 points

Question 70

1. 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 express herself?

	A.	Language of responsibility
	B.	Empty-chair dialogue
	C.	Dreamwork
	D.	Focusing

1 points

Question 71

1. 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?

	A.	Primary health care settings with some specialized care
	B.	State psychiatric hospitals and emergency rooms
	C.	Substance abuse treatment system
	D.	The mental health system of care

1 points

Question 72

1. 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?

	A.	Collect information from the patient, his parents, and school
	B.	Rule out medical issues that may affect behavior
	C.	Get a measure of the patient’s developmental level
	D.	All of the above

1 points

Question 73

1. 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?

	A.	“It is your choice whether to continue to take your medications.”
	B.	“Have you thought of how you will continue your treatment plans?”
	C.	“Are you upset with someone here? Tell me more about this.”
	D.	“Are you sure you no longer want to go to therapy?”

1 points

Question 74

1. 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?

	A.	Identify the primary defenses the patient uses to ward off anxiety
	B.	Focus on the patient’s attachment to the anxiety and memories of her childhood
	C.	Identify whether the patient has an unresolved or disorganized attachment style
	D.	All of the above

1 points

Question 75

1. 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?

	A.	Try to provide a diagnosis based on the patient’s description of daily anxiety
	B.	Give the patient some possible solutions they might use for feeling less anxious
	C.	Use traditional assessment procedures, such as giving a psychometric test
	D.	Encourage the patient to clarify by asking, “You constantly feel anxious?”

· 1 out of 1 points

	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 2

1 out of 1 points

	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 3

0 out of 1 points

	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?
	Response Feedback: “A” is the correct answer. According to the therapeutic frame, counseling is terminated if “threats are made or acts of violence are committed against the counselor,” but the immediate threat calls for notification of the police. The safety of the PMHNP is essential. “B,” “C,” and “D,” are incorrect—the patient has made threats to the PMHNP, so the most appropriate response would be reporting the threat to the local police. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 16 pages 587-588 for further information.

· Question 4

0 out of 1 points

	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?
	Response Feedback: The correct answer is “B.” For patients who are histrionic or overly emotional, the PMHNP contains the emotion rather than allowing it to be expressed freely. For histrionic patients, affect regulation strategies may need to be employed.  See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 5 page 242 for further information.

· Question 5

1 out of 1 points

	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 6

1 out of 1 points

	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 7

1 out of 1 points

	The PMHNP who practices motivational interviewing understands its relationship to patient behaviors and/or outcomes to mean which of the following?

· Question 8

1 out of 1 points

	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 9

1 out of 1 points

	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 10

1 out of 1 points

	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

0 out of 1 points

	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?
	Response Feedback: “A” is the correct answer. “Focusing” is a Gestalt therapy technique used to deepen contact with alienated aspects of self. “B” is incorrect—exaggerating body movements is part of the “body awareness” technique. “C” is incorrect—asking Dave what his is experiencing in his body is also part of body awareness. “D” is incorrect because “A” is the correct answer.  See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 10 page 382 for further information.

· Question 12

0 out of 1 points

	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:
	Response Feedback: “D” is the correct answer—this is a way to diffuse resistance by means of using reflection. It allows the PMHNP to help focus and/or guide the patient in a direction for change. “A” is incorrect—this is a statement that may be made to a patient in the initial phase of change (engagement). “B” is incorrect—this can be viewed as confrontational and nontherapeutic. “C” is incorrect—this is a confrontational statement and goes against the principles of motivational interviewing. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 7 pages 303-304 for further information.

· Question 13

1 out of 1 points

	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 approach?

· Question 14

1 out of 1 points

	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 patient?

· Question 15

1 out of 1 points

	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 16

1 out of 1 points

	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 17

0 out of 1 points

	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?
	Response Feedback: “D” is the correct answer. Cognitive behavioral therapy, including individual and group CBT, can be an effective treatment approach for geriatric patients with schizophrenia who are at a stable point in their illness, but CBT is not a good option for patients at recent onset of symptoms, or who are in an acute phase of their symptoms, such as the patient in this scenario. Therefore, neither individual nor group CBT would be appropriate for this patient. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 18 page 635 for further information.

· Question 18

0 out of 1 points

	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?
	Response Feedback: “A” is the correct answer. According to emotion-focused therapy, trauma narrative is an in-session marker; it’s when the patient has internal pressure to tell a traumatic life story, but has difficulty doing so. The PMHNP’s intervention is to assist the patient to retell the trauma narrative. “B” and “C” are incorrect, as these statements do not support the use of emotion-focused therapy since they do not encourage the patient to retell the traumatic narrative. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 10 page 392 for further information.

· Question 19

0 out of 1 points

	The PMHNP is treating an older adult patient who reports symptoms of late-life anxiety. What type of treatment(s) will the PMHNP consider?
	Response Feedback: “A” is the correct answer. Cognitive behavioral therapy (CBT) is the only treatment based on evidence-based practices. “B,” “C,” and “D” are incorrect because relaxation training and modular interventions are suggestions, but not evidence-based practices. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 18 page 634 for further information.

· Question 20

1 out of 1 points

	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 21

0 out of 1 points

	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?
	Response Feedback: “A” is the correct answer. For persons with unresolved/disorganized attachment styles, they are often unable to form a coherent narrative about their lives due to lapses in memory because they are flooded with emotion. Therefore, the PMHNP anticipates the patient will have lapses in his memory of his childhood. “B” is incorrect, as this is the opposite of what the PMHNP anticipates. “C” is incorrect, as this patient will likely need more active interventions. “D” is incorrect because there is clearly a correct answer. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 5 page 239 for further information.

· Question 22

0 out of 1 points

	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?
	Response Feedback: The correct answer is “C.” The most appropriate action is for the PMHNP to teach the patient about developing mindfulness in order to maximize adaptive coping mechanisms. Encouraging the patient to use humor as a way to deny her sadness is not therapeutic, so “A” is incorrect. Using self-disclosure to discuss how the PMHNP lost a pet recently is not therapeutic in this instance, so “B” is incorrect. Therefore, “D” is incorrect. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 5 pages 240-241 for further information.

· Question 23

1 out of 1 points

	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 24

1 out of 1 points

	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 25

0 out of 1 points

	A 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?
	Response Feedback: “A” is the correct answer. During the active treatment phase of interpersonal psychotherapy, the patient is encouraged to use alternative strategies in the case that originally identified strategies are not helping to reduce the distress surrounding the focus problem. “B” is incorrect—the PMHNP does not need to restart the assessment phase to treat a patient. “C” is incorrect—if a strategy is not successful, it does not need to be adhered to. “D” is incorrect because “A” is the correct answer. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 9 page 360 for further information.

· Question 26

0 out of 1 points

	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?
	Response Feedback: The correct answer is “A.” When using the CBT approach with geriatric patients, there are three phases for which the sessions take place. The first three sessions are the first phase, and focus on building a therapeutic alliance and getting the patient familiar with psychotherapy. Answers “B,” “C,” and “D” are incorrect, as these actions come during the second phase of CBT, which is after the first three sessions. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 18 page 641 for further information.

· Question 27

0 out of 1 points

	When preparing to terminate a patient, what does the PMHNP do to organize thoughts about the patient’s progress made during treatment?
	Response Feedback: The correct answer is “B.” The PMHNP organizes thoughts about the patient’s progress that was made during treatment, by reviewing the patient’s file to identify issues and important themes that were highlighted throughout treatment. The PMHNP also reflects and reminisces with the patient regarding how the patient is functioning better. “A” is incorrect, as the PMHNP does not interview the patient’s family, friends, or caregiver as part of organizing thoughts about the patient’s progress. “C” is incorrect, as the PMHNP does not request a peer to evaluate the decision to terminate by reviewing the patient’s file. Therefore, “D” is incorrect.   See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 20 page 699 for further information.

· Question 28

1 out of 1 points

	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 29

0 out of 1 points

	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 approach?
	Response Feedback: “B” is the correct answer. The goal of existential psychotherapy is to be aware of anxiety and embrace it, not to eliminate it. Therefore, “A” is incorrect, as the PMHNP does not aim to help the patient eliminate anxiety from his life completely, as this is not the goal of existential psychotherapy. “C” is incorrect, because although it is helpful for patients to have multiple outlets for coping with stress, this is not the primary goal of employing existential psychotherapy. “D” is incorrect because there is clearly a correct answer here. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 10 page 386 for further information.

· Question 30

1 out of 1 points

	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 31

1 out of 1 points

	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 32

1 out of 1 points

	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 33

0 out of 1 points

	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 psychotherapy approach?
	Response Feedback: “C” is the correct answer. Interpersonal psychotherapy (IPT) focuses on the patient’s current life. “A” is incorrect—specific homework is not part of IPT. “B” is incorrect—IPT focuses on the present, not the past causes of problems. “D” is incorrect because “C” is the only correct answer. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 9 page 354 for further information.

· Question 34

0 out of 1 points

	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?
	Response Feedback: “C” is the correct answer. Using the Feeling-State Addiction Protocol, after identifying the specific positive feeling linked with the addictive behavior and its Positive Feeling Score level, the PMHNP should have the patient locate and identify any physical sensations created by the positive feelings. “A” is incorrect—that step comes before “identifying the specific positive feeling linked with the addictive behavior and its Positive Feeling Score level.” “B” and “D” are incorrect—those steps come after the patient locates and identifies any physical sensations created by the positive feelings. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 16 page 585 for further information.

· Question 35

1 out of 1 points

	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. True or 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 36

0 out of 1 points

	When recalling the phases of change, the PMHNP demonstrates “open questioning” in the “engagement” phase by making which statement?
	Response Feedback: “B” is correct—this is an example of open questioning in the engagement phase. The engagement phase is the introductory phase and is meant to establish a relationship as well as trust. “A” is incorrect—this is an example of open questioning in the planning phase. “C” is incorrect—this is an example of open questioning in in the focusing phase. “D” is incorrect—this is an example of open questioning in the evoking phase. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 7 pages 303-305 for further information.

· Question 37

1 out of 1 points

	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 to say:

· Question 38

0 out of 1 points

	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?
	Response Feedback: “C” is the correct answer. An exception question encourages the patient to describe what has worked in the past to make future improvements. “A” is incorrect—a coping question includes a validating statement and question about the patient’s coping skills that have gone unnoticed. “B” is incorrect—a joining question’s purpose is to connect and accommodate to the patient’s world. “D” is incorrect—a miracle question asks the patient to imagine a future if the problem were solved. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 10 page 395 for further information.

· Question 39

1 out of 1 points

	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 40

0 out of 1 points

	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?
	Response Feedback: “C” is the correct answer. Because many older adult patients have comorbidities, it is important for the PMHNP to distinguish between physical and emotional manifestations of symptoms, and determine if certain symptoms can be caused by other medications the patient is taking. The PMHNP must consult guidelines and reference materials to help identify the information needed, but this is the primary action so that the PMHNP knows how to go about treating the patient properly and safely. “A” is incorrect—collaboration is an important part of the PMHNP’s role with older adult patients, but this is not the primary action for the scenario. “B” is incorrect—this patient should not be prescribed antidepressants until the PMHNP has a better understanding of what could be causing the memory loss. Therefore, “D” is incorrect. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 18 page 638 for further information.

· Question 41

0 out of 1 points

	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 patient?
	Response Feedback: “B” is the correct answer. For dynamic supportive therapy, the PMHNP allows the patient to emote by asking the patient how the patient feels as part of the holding and containing strategy. For the holding and containing approach, the PMHNP provides empathy and understanding, as well as by restricting the patient when the patient becomes impulsive or acts out. “A” is incorrect—encouraging and nurturing the patient is assuming a parental role and is part of the “be a good parent” strategy. “C” is incorrect—discussing why the patient is not taking the medication as directed is addressing treatment noncompliance, which is part of focusing on the here and now. “D” is incorrect—teaching the patient about medication side effects is part of educating the patient and family, which is not part of holding and containing the patient. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 5 pages 240-241 for further information.

· Question 42

1 out of 1 points

	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. True or false: If Dave is resisting change, the PMHNP should challenge his resistance in order for MI to be successful.

· Question 43

1 out of 1 points

	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 daughter?

· Question 44

1 out of 1 points

	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 45

0 out of 1 points

	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:
	Response Feedback: “B” is the correct answer. For treating adolescent depression with interpersonal psychotherapy (IPT), parents are encouraged to modify home and school expectations while depression is active. “A” is incorrect—expectations should be modified until the depression lifts. “C” and “D” are incorrect—the IPT model does not recommend eliminating expectations or having adolescents set their own expectations. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 9 page 357 for further information.

· Question 46

1 out of 1 points

	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 47

0 out of 1 points

	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?
	Response Feedback: “D” is the correct answer. The patient has been binge drinking, which is when a person consumes five or more drinks on one occasion at least one time during the past month. Binge drinking twice over a period of 2 months is not enough to be considered a maladaptive pattern of substance abuse. Therefore, though the patient might need individual therapy to help her adjust to college life, the PMHNP would not recommend group therapy, peer support, or hospitalization for an alcohol-related problem. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 16 pages 567 and 569 for further information.

· Question 48

1 out of 1 points

	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 49

1 out of 1 points

	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 this patient?

· Question 50

0 out of 1 points

	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?
	Response Feedback: The correct answer is “C.” Once patients are comfortable with how the therapy works, it is appropriate to move into the second phase of CBT, in which the PMHNP will focus on developing cognitive skills to challenge the patient’s negative thinking. “A” and “B” are incorrect, as these are actions the PMHNP takes during the first phase of CBT.   See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 18 page 641 for further information.

· Question 51

1 out of 1 points

	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 52

0 out of 1 points

	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:
	Response Feedback: “B” is correct—the principle of evocation suggests that the patient has all the tools needed to change and the PMHNP just needs to “draw it out” of the patient. “A” is incorrect—this is the patient’s right; however, it does not apply to the principle of evocation. “C” is incorrect—this is not the principle of evocation and it also a form of nontherapeutic communication because it offers false reassurance. “D” is incorrect—this is not the principle of evocation. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 7 page 299 for further information.

· Question 53

1 out of 1 points

	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 54

0 out of 1 points

	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?
	Response Feedback: “B” is the correct answer. For patients receiving EMDR, the PMHNP discusses all issues that have been addressed throughout the treatment at the final session to prepare for termination. “A” is incorrect, as the future template is developed during therapy prior to the final session. “C” is incorrect, as the patient is not asked to take a new assessment. Rather, during the final session, the patient is asked to retake assessment measures that were taken at the beginning of therapy. Therefore, “D” is also incorrect. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 20 page 695 for further information.

· Question 55

1 out of 1 points

	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 the following:

· Question 56

1 out of 1 points

	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 patient?

· Question 57

1 out of 1 points

	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 58

1 out of 1 points

	How does the PMHNP approach termination with the patient who has been receiving intermittent therapy?

· Question 59

0 out of 1 points

	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?
	Response Feedback: “B” is the correct answer. Affect modulation provides the patient with skills to control thoughts related to anxious feelings. “A” is incorrect—relaxation skills help the patient learn to feel calm, but do not directly teach how to interrupt anxiety-causing thoughts. “C” is incorrect—enhancing safety teaches the patient safety skills. “D” is incorrect—trauma narrative helps the patient correct inaccuracies about the trauma experience. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 17 page 609 for further information.

· Question 60

1 out of 1 points

	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 61

0 out of 1 points

	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?
	Response Feedback: “C” is the correct answer. Because the patient is a victim of child abuse/neglect, she is most likely misinterpreting cues from the PMHNP and is using a romantic fantasy to reduce tension from her substance abuse recovery. By maintaining professional boundaries, the therapist can help guide the patient to examine her feelings and explore the underlying meaning. “A” is incorrect—the PMHNP can use the conversation as a teachable moment to help the patient. “B” is incorrect—terminating counseling is not necessary. “D” is incorrect because “C” is correct. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 16 page 588 for further information.

· Question 62

0 out of 1 points

	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?
	Response Feedback: “A” is the correct answer. A mindfulness approach helps the patient develop an awareness of triggers in order to have greater control over physical and emotional responses. “B” is incorrect—though family therapy can be integrated with other therapies, it is not a part of the mindfulness approach. “C” is incorrect—it is part of the feeling-state addiction therapy, not the mindfulness approach. “D” is incorrect because “A” is correct. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 16 page 587 for further information.

· Question 63

1 out of 1 points

	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 64

1 out of 1 points

	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 65

1 out of 1 points

	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 66

1 out of 1 points

	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 67

1 out of 1 points

	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 68

1 out of 1 points

	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 69

1 out of 1 points

	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 70

0 out of 1 points

	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 express herself?
	Response Feedback: “B” is the correct answer. Empty-chair dialogue is a Gestalt therapy technique used to help a person who is having trouble expressing feelings to another person. “A” is incorrect—the language of responsibility technique is used to help increase awareness. “C” is incorrect—dreamwork is a technique used to focus on dreams. “D” is incorrect—focusing is a technique used to deepen contact with alienated aspects of self.  See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 10 page 382 for further information.

· Question 71

1 out of 1 points

	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 72

1 out of 1 points

	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 73

1 out of 1 points

	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 74

0 out of 1 points

	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?
	Response Feedback: “A” is the correct answer. When assessing the strength of the ego, the PMHNP will identify the primary defenses the patient uses to ward off anxiety. “B” and “C” are incorrect, as attachment style has to do with the person’s fear of rejection, intimacy, and interpersonal distance in relationships, and is not involved in assessing the strength of the patient’s ego. See Wheeler, K., Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, Chapter 5 page 239 for further information.

· Question 75

1 out of 1 points

	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?