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Walden NURS6640 Midterm Exam
PMHNP is mentoring a student. After working with a patient during a session,
the student laments about all the things she should have, or could have, said
to the patient. “I feel guilty that I didn’t speak up more about the patient’s
concern toward her son,” says the student. The PMHNP understands that the
student is exhibiting signs of which therapeutic concept?
Question 2 The
PMHNP is working with a 56-year-old man who is being seen because of his
anxiety and depression. During the therapy sessions, the PMHNP assists the
patient in discussing his experiences and expanding on his thoughts and
feelings. He tells the PMHNP stories about how he used to be teased by his
coworkers at the office for becoming too anxious in large conference rooms. The
PMHNP listens to the patient and helps focus on his strengths to promote
self-understanding. Which principle best accounts for the PMHNP’s interactions
with the patient?
Question 3 During
a therapy session the patient is asked how she currently deals with stress, and
she says, “Well, I don’t. I just let it build and build.” The PMHNP responds by
asking how well this has been working out for her. The patient states, “Well,
to be honest, it just feels like I’m drowning, you know what I mean.”
Illustrating idiosyncratic meaning, the PMHNP responds with:
Question 4 The
PMHNP is working with a 43-year-old male patient who develops idiosyncratic
transference over weeks of therapy. The best way for the PMHNP to respond to
this patient is to ___________ :
Question 5 The
PMHNP is working with a patient who has insomnia and battles going to sleep.
The patient reports consistent self-defeating behaviors, and hates trying to go
to sleep. Which action made by the PMHNP demonstrates the use of a paradoxical
understands that anxiety and depression are two disorders in which their
symptoms may overlap. When discussing this, you explain that the autonomic
nervous system is activated and further helps distinguish anxiety symptoms by
making the following points:
patient has been informed of the limits of confidentiality, and has signed
informed consent forms. No consent, however, has been obtained for voluntary
“Release of Information.” The patient is 20 years old and still lives at home
with his parents. He is being treated for depression, which he attributes to
the trouble he’s had finding employment.
false: If the patient’s mother calls the PMHNP to check up on her son to see
how he is doing, the therapist is required to protect patient confidentiality
and not disclose information. Selected Answer:
A PMHNP is
taking a history and wants to assess how the patient copes with adversity. To
do so, the therapist asks questions about the patient’s belief system. What
would be an appropriate question to ask?
office, you see a 58-year-old patient with PTSD who reports having nightmares,
making it impossible for her to sleep. What recommendations based on principles
of sleep hygiene will the PMHNP make?
who has borderline personality disorder is meeting with the PMHNP. When asked
about future goals, the patient responds, “I’d like to go back to school to do
know, talk to people all day about their problems. It seems pretty easy.” How
does the PHMNP respond to the client in a way that is free from any
stigmatizing beliefs or judgments?
62-year-old patient has been diagnosed with borderline personality disorder.
Upon assessment, the PMHNP learns that he
participates in spending sprees and occasional binge eating, accompanied
by rapid changes in self-image. Which evidence-based psychotherapeutic model
does the PMHNP identify as effective and beneficial?
patient in a nursing home has been losing interest in activities and now
refuses to leave his room. After a physical exam, he is referred to a PMHNP for
an initial assessment.
false: After speaking with the patient, an appropriate screening tool for the
PMHNP to use would be the Geriatric
A PMHNP has
been working with a young female patient who suffers from depression to change
self-defeating behaviors. By creating a presence of acceptance and using good
listening skills, the PMHNP’s overall goal is to __________.
is working with a school-aged child who has been diagnosed with depression. The
child has attended several sessions with the PMNHP, but recently presents with
avoidant behavior by showing increased distress and being late to sessions.
What approach does the PMHNP need to employ with the child to continue making
patients have already signed confidentiality agreements, including limits that
will be imposed on confidentiality. Months later, the state’s laws have changed
that affect confidentiality promises the PMHNP has already made. What is an
appropriate step for the PMHNP to take after finding out this information?
evaluation reveals that an 11-year-old patient has moved to a new school after
her parents’ recent divorce, and is having trouble making friends. The patient
has normal mental status and exhibits appropriate behavior. What is the most
appropriate scale for the PMHNP to use
to get more information?
cognitive behavioral therapy (CBT), a 64-year-old male patient, states, “My
wife hates me! She’s just waiting for me to die.” Using Socratic dialogue (SD)
the PMHNP demonstrates understanding of analysis when she responds:
41-year-old male patient is meeting with the PMHNP and reveals that he is
homosexual. He begins telling the PMHNP about his feelings as a homosexual,
middle-aged man. The PMHNP nods understandingly. Before long, the patient asks,
“Are you gay? Are you married? Do you have kids?” What is the best response by
is working with a patient who is living in poverty and abusing substances.
According to the treatment hierarchy framework, what needs does the PMHNP need
to attend to first?
is having a therapy session with Charlotte, a 20-year-old victim of date rape.
The patient states, “I shouldn’t have been there; I should have just gone home.
This was all my fault; how could I have been so stupid?” Using the Socratic
method, what is the PMHNP’s best response?
is working with an adult patient who has somatic complaints caused by a history
of childhood abuse. As part of the therapeutic process, what does the PMHNP do
to assess and organize a trauma history?
employs psychodynamic psychotherapy with a patient who experiences anxiety and
depression. As the process enters the psychoanalytic end of the psychodynamic
continuum, the PMNHP will focus on:
false: A PMHNP may ask his patient to describe her relationship with her
father, both as a child and now, in order to assess interpersonal style.
35-year-old patient has been seeking treatment for depression for several
months. The PMHNP does an assessment to see if processing has led to adaptive
change. The patient’s self-references are positive in relation to past events,
work is productive, relationships are adaptive, and there is congruence between
behavior, thoughts, and affect. Based on this information, the PMHNP decides
the patient ____________.
65-year-old patient has suffered the loss of his wife. He is in a state of
hyperarousal with increased sympathetic nervous system arousal. One or more
interventions may help the patient to deal with this arousal. To decrease
sympathetic nervous system arousal, the PMHNP’s treatment strategy is
clinical assessment of a 15-year-old patient, the PMHNP asks, “How can I help
you?” The patient answers by saying, “Honestly, I don’t really think I need any
help.” Which of the following is the most appropriate response by the PMHNP?
patient is a 65-year-old male who has a strained relationship with his son and
daughter. His children refuse to participate in a family session. The PMHNP
asks the patient to draw his family genogram as a next step to _______________.
is working with a patient who witnessed her father pass away after suffering
for several months from terminal cancer. The PMHNP sees this as a traumatic
event. The patient reports sometimes feeling out of touch with surroundings;
almost as if things feel like a dream. “Sometimes that sensation lingers for a
while,” the patient says, “and other times I snap out of it quickly.” What does
the PMHNP infer about the condition based on psychotherapy concepts for trauma?
24-year-old female patient presents for her initial appointment with the PMHNP.
Which action will the PMHNP take to establish therapeutic alliance?
false: If after a third round of processing followed by stabilization, a
patient has increased anxiety that requires further interventions aimed at
stabilization, the therapeutic relationship can no longer successfully provide
meets with a 47-year-old male patient who is fearful of leaving the house after
having witnessed his neighbor getting run over by a car. When the PMHNP asks
why he is afraid to leave his house, the patient replies, “Because another
accident might occur.” Which cognitive behavioral therapy (CBT) strategy does
the PMHNP employ?
A PMHNP is
treating a 45-year-old female patient who is upset that her brother has not
been calling since his divorce. When asked to describe her brother and what
prompts him not to call as frequently, she says, “Everything is about him, not
me. I think he’s jealous that I have a good marriage and he wants me to be
unhappy, too. So he doesn’t call to upset me and ruin my relationships.” Based
on this information, the PMHNP can conclude that the patient _________.
cognitive behavioral therapy (CBT), a 64-year-old male patient states, “I get
so frustrated sometimes and I just blow up at everybody!” Which response by the
PMHNP demonstrates translation of Socratic dialogue (SD)?
16-year-old female patient has had a stable therapeutic relationship with the
PMHNP for several months. The PMHNP notices what appears to be fresh cigarette
burns on the patient’s arm. When asked, the patient admits to this
self-injurious behavior. Although the patient is still depressed, her mood
seems to be somewhat better this week. True or false: The PMHNP would most
likely consider this patient stabilized and ready to move to Stage II.
A PMHNP is
caring for a 21-year-old woman who is suffering from anxiety and is having
difficulty managing stress. Which of the following would be an appropriate step
by the PMHNP?
has been treating a 15-year-old patient with a history of abuse and neglect.
Thirty minutes into their therapy session the patient jumps up and begins to
pace around the room. Utilizing Socratic dialogue (SD) the PMHNP’s best action
would be to:
attempts the PMHNP’s sleep hygiene recommendations for 2 weeks, but does not
make any progress mitigating nightmares and hyperarousal. Which behavioral
strategy does the PMHNP suggest next?
is caring for a patient who seems to seek affection and attention from the
PMHNP and others in the clinic, as well as displays heightened emotional
responses to feelings of being excluded. What therapeutic approach does the
PMHNP use to decrease autonomic arousal in the patient?
is meeting with a 38-year-old divorced, single mother who has been seeing the
PMHNP for anxiety and anger management. During one of the sessions, the patient
tells the PMHNP that she is having a problem getting her child support payments
from her ex-husband, which is triggering increased anxiety and anger, which she
admittedly takes out on her children. How does the PMHNP respond in a way that
upholds the supportive psychodynamic psychotherapy approach?
therapy session with an 18-year-old female the PMHNP learns that she has lived
in six different foster homes in the last 24 months. She states that her mother
is in a correctional facility for drug abuse and prostitution. During the
assessment, the PMHNP notices multiple superficial cuts to each wrist. The
patient appears tearful, withdrawn, and never makes direct eye contact. The
PMHNP believes that this patient may have feelings of insecurities as well as
abandonment issues and is aware that which diagnosis is likely possible?
is working with a veteran who has posttraumatic stress disorder (PTSD). The
PMHNP believes that dual awareness will be beneficial in allowing the patient
to focus on the here and now. What strategies can the PMHNP use to develop dual
awareness in the patient?
is conducting a peer review of another PMHNP’s medical charts. Upon review, the
PMHNP notes that the peer often begins patient sessions late, as well as ends
them later than scheduled. The PMHNP also found a comment in the chart
regarding the patient sending text messages while in the middle of the session.
Based on these findings, the feedback that the PMHNP will provide to the peer
involves which therapeutic principle?
conducting an initial assessment, a PMHNP has finished conducting a mental
status examination with 10 minutes left in the session. The patient is
distressed and would like to continue sharing her personal history.
false: An appropriate response that the PMHNP might tell the patient is, “I
understand that you are upset. [Summarizes diagnosis, treatment
recommendations, and follow-up plan.] We can continue the conversation next
week. How does this time next Monday work for you?”
is working with a patient who experiences anxiety around her parents that later
leads to poor impulse control. What will the PMHNP do to employ psychodynamic
psychotherapy properly for this patient?
A PMHNP is
treating a 50-year-old patient who suffers from depression. When he was growing
up, he was often responsible for taking care of his three younger siblings.
Since then, the patient puts other people’s needs before his own. Based on this
information, the PMHNP would conclude that his interpersonal style is
is caring for a patient with borderline personality disorder. Using a
psychoanalytic psychotherapy approach, the PMHNP attempts to intensify the
patient’s transference to enhance emotional processing by:
middle-aged man who works over 50 hours a week is being seen for depression and
anger management. He states, “I am even more frustrated when I come home and my
wife wants to argue about stupid stuff. All I want to do is come home, take a
shower, and eat. Is that too much to ask?” The PMHNP explains that people can
be assertive, aggressive, and passive. She encourages the patient to be more
assertive and begins role-play with assertive training. The PMHNP determines
that the patient is beginning to understand when he states:
is caring for a patient who the PMHNP believes would benefit from a relational
psychodynamic approach to therapy. Which action made by the PMHNP demonstrates
appropriate use and understanding of the relationship psychodynamic model?
has been assisting a shy and timid 23-year-old male patient struggling with
esteem and self-concept issues. Over the weekend, this patient was given the
task of completing an exercise that would usually cause him distress and shame,
also called a shame-attacking exercise. The PMHNP determines that this task has
successfully been achieved when the patient states:
informing a prospective patient about limits of confidentiality, the patient
consents to the “conditions” of confidentiality and signs an informed consent
form. Several weeks later, a lawyer representing the patient’s spouse for a
court case, asks the PMHNP for the disclosure of information about the patient.
The PMHNP should:
is treating a 35-year-old male officer in the military. He discloses that both
of his parents are deceased and that he loved them. However, he says that he
had feelings of inadequacy because his parents held him to a standard that he
could never achieve. He went on to say that nothing he did ever felt good
enough. The PMHNP assesses that this patient has perfect creases in his uniform
with no strings or tags out of place; she also notices that he has perfect
posture and questions him about ritualistic behaviors. She suspects that this
patient has maladaptive responses to the expectations placed on him as a
teenager and young adult. Which statements made by the patient would verify the
28-year-old male patient is experiencing distress related to the workplace.
What might the PMHNP ask to assess affective development?
11-year-old patient has been exhibiting low self-esteem at school and acting
out. According to Maslow’s hierarchy of needs, which of the following questions
would best be addressed first by the PMHNP?
A PMHNP is
assessing ego functioning of his 40-year-old patient by asking what she feels
is the cause of her problems. She attributes her problems to her overprotective
parents not letting her have enough freedom growing up. Based on her answer,
the PMHNP is testing _____________.
is working with a patient who seems dissatisfied with the therapeutic
relationship. The PMHNP invites the patient to discuss her feelings regarding
the PMHNP openly and honestly. It becomes clear to the PMHNP that they are
experiencing an alliance rupture. How does the PMHNP repair the therapeutic
is treating a patient with a substantial fear of feeling closed in
(claustrophobia). Thus, the patient will not get into an elevator. The office
where he works is on the 10th floor and this requires that he walk up and down
the stairs in the morning and evening to get to his office. With permission
from the patient, the PMHNP is beginning systematic desensitization to address
the patient’s need to use the elevator. What is the PMHNP’s best plan of
35-year-old patient seeks treatment for depression and anxiety after an abusive
relationship. To help empower the patient, the PMHNP wants to teach the
safe-place exercise to create a feeling of calm. In order to walk the patient
through the exercise, the PMHNP first says:
initial interview with a patient, the PMHNP reviews the condition of receiving
services, including limits that will be imposed on confidentiality. During the
discussion, the patient shares information that the PMHNP is legally required
false: If the PMHNP does not report information that s/he is legally required
to report, state laws govern the consequences which include penalties for not
reporting, especially child and elder abuse.
is working with a patient who has dissociative disorder and requests
pharmacological interventions for dealing with her trauma. What education does
the PMHNP provide to the patient regarding medication therapy?
is caring for a patient who has acute stress disorder after experiencing a
traumatic event 1 week prior. The PMHNP wants to begin with a therapeutic
framework that follows the adaptive information processing (AIP) model. What is
the priority action for the PMHNP to take?
is a 56-year-old female patient diagnosed with panic disorder and reports
symptoms that include heart palpitations, frequent trembling, and feelings of
choking in stressful situations. What special consideration does the PMHNP
session, the PMHNP asks a patient with a history of sexual abuse to recall the
relationship she had as a child with her parents. The patient responds by
saying she has a headache and her stomach hurts, and starts talking about her
physical ailments. What is the appropriate response by the PMHNP?
One of the
strategies the PMHNP wants to try includes sleep restriction. What will the
PMHNP suggest to follow sleep restriction therapy?
is meeting with a 42-year-old man with depression brought on by the recent
passing of his wife. As he describes the circumstances surrounding his late
wife’s death, the PMHNP begins to feel sad. The sadness lingers for several
hours, and the PMHNP finds it difficult to focus on other patients for the rest
of the day. What is the most appropriate explanation for the reaction that the
PMHNP is experiencing?
has a session with a patient who was injured and traumatized from an explosion
at the industrial plant where he used to work. During the session, an outside
noise startles the patient and he experiences a flashback of the loud boom from
the explosion. The PMHNP witnesses the patient present with anxiety and
belabored breathing. What is the appropriate action of the PMHNP?
is assessing a patient who grew up in a foster home because she was neglected and
abused by her birth parents at a young age. The patient admits to having
difficulty forming and maintaining relationships throughout her life.
Understanding maladaptive schemas, which statement does the PMHNP predict that
the patient is likely to make?
is caring for a patient with dissociated self-state that the PMHNP identifies
as being associated with traumatic experiences in the patient’s past. What
approach does the PMHNP use with the patient that is crucial to the
psychodynamic therapy process?
meets with an adolescent patient who has depression and often presents with
resistance when discussing his parent’s divorce. For the past couple of
sessions, the patient has been quiet, sometimes refusing to speak. To further
support the therapeutic relationship, the PMNHP:
is meeting with a new patient who is a young veteran back from serving two
tours overseas. When reviewing the patient’s health history file that was sent
from the VA, the PMHNP learns that several months ago, the patient was
diagnosed with PTSD, but never followed up with treatment for it. After a
comprehensive mental health assessment, the PMHNP confirms the PTSD diagnosis
and understands that which therapeutic approach will be the most effective as a
first-line treatment modality?
seeing a 29-year-old widow whose husband recently died overseas while serving
his country in the military. She has been mourning the loss of her husband for
several months, and continues to grieve. She refuses to go to group grieving
sessions, but reports that she is still able to go to work and her fitness
classes sometimes, and even makes attempts to stay social. She says, “Sometimes
it’s like he’s not even gone. Other times it feels like it’s been an eternity
since I’ve seen him. It’s hard to talk about this type of stuff with my
girlfriends, especially since all of their husbands are still alive.” The PMHNP
understands that it is appropriate to employ which therapeutic principle?
PMHNP is seeing a patient for the first time, what is an important step to
assure that the patient and provider understand the limits of their discussion?
completing this exam, did you comply with Walden University’s Code of Conduct
including the expectations for academic integrity?
A PMHNP is
preparing confidentiality forms for his patients. What is the most appropriate
first step he should take?
is working with a patient who experiences abreactions when discussing repressed
feelings of his sexual abuse as a child. What can the PMHNP do to manage the
patient’s intense emotional reactions?
named Steve is seeking therapy to get help with his home situation, stating
that he has been stressed since his mother-in-law moved into the house. What
can the PMHNP do to assist the patient in constructing a narrative?
patient comes into the office, she says, “I just saw a friend of mine out in
the waiting room. What’s wrong with him?” The PMHNP says, “He’ll be fine. He
has mild depression.” Which of the following statement is correct related to
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