Wheeler k 2014 psychotherapy for the advanced practice psychiatric nurse

Psychiatric Nursing Questions

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?”