PSYCHOTHERAPY FOR THE ADVANCED
PRACTICE PSYCHIATRIC NURSE
A HOW-TO GUIDE FOR EVIDENCE-BASED
PRACTICE
3RD EDITION
• AUTHOR(S)KATHLEEN WHEELER
TEST BANK
1
Reference
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
Stem
A 32-year-old client with a history of recurrent major depressive
episodes says in the second session, “I tried everything you
suggested last week but nothing helped — maybe therapy
won’t work for me.” As the nurse psychotherapist, you sense
the client’s discouragement and notice they are avoiding eye
,contact. Which therapist response best aligns with an early-
phase, evidence-based therapeutic stance that preserves
alliance and encourages collaboration?
A. Reassure the client that change is slow and normalize their
disappointment.
B. Explore the client’s belief about “trying everything” and
collaboratively set a small, achievable goal for the week.
C. Point out the client’s avoidance and confront them about
inconsistency with treatment goals.
D. Schedule more frequent sessions to intensify treatment
because current work is ineffective.
Correct Answer
B
Rationales
Correct (B): This option uses collaborative problem-solving and
behavioral activation principles appropriate to early therapy: it
explores the client’s belief (cognitive test) and sets a small,
achievable goal, preserving alliance and enhancing self-efficacy.
It aligns with Wheeler’s emphasis on collaborative formulation
and early behavior-oriented experiments.
Incorrect (A): Reassurance alone may be empathic but is
passive and fails to engage clinical reasoning or behavioral
activation; it risks colluding with helplessness.
Incorrect (C): Confrontation early in therapy can damage the
alliance and is misaligned with trauma-informed and
relationally sensitive practice.
,Incorrect (D): Increasing session frequency without addressing
engagement or specific interventions is premature and may be
inefficient or burdensome.
Teaching Point
Collaborate to test beliefs and set small, achievable tasks to
rebuild agency and alliance.
Citation
Wheeler, K. (2023). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 1.
2
Reference
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
Stem
During intake, a client discloses childhood physical abuse and
expresses ambivalence about discussing it. As a nurse
psychotherapist practicing within Wheeler’s framework, what is
the most appropriate immediate approach?
A. Refer the client to trauma-focused therapy immediately and
discontinue your work.
B. Validate safety concerns, explain trauma-informed limits of
immediate processing, and collaboratively plan pacing.
C. Ask detailed questions about the abuse to build a thorough
trauma history today.
, D. Reassure the client that detailed trauma disclosure is always
necessary for effective therapy.
Correct Answer
B
Rationales
Correct (B): Trauma-informed practice prioritizes safety,
consent, and pacing; validating and collaboratively planning
aligns with Wheeler’s emphasis on containment and the
therapeutic frame before deep trauma processing.
Incorrect (A): Immediate referral might be unnecessary and
could disrupt the therapeutic relationship; assessment of needs
and readiness should precede referral.
Incorrect (C): Detailed probing before establishing safety and
stabilization risks re-traumatization; it is premature.
Incorrect (D): Asserting that detailed disclosure is always
necessary is false and disregards client autonomy and trauma-
informed care.
Teaching Point
Prioritize safety, consent, and pacing when trauma is disclosed;
avoid premature probing.
Citation
Wheeler, K. (2023). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 1.
3
PRACTICE PSYCHIATRIC NURSE
A HOW-TO GUIDE FOR EVIDENCE-BASED
PRACTICE
3RD EDITION
• AUTHOR(S)KATHLEEN WHEELER
TEST BANK
1
Reference
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
Stem
A 32-year-old client with a history of recurrent major depressive
episodes says in the second session, “I tried everything you
suggested last week but nothing helped — maybe therapy
won’t work for me.” As the nurse psychotherapist, you sense
the client’s discouragement and notice they are avoiding eye
,contact. Which therapist response best aligns with an early-
phase, evidence-based therapeutic stance that preserves
alliance and encourages collaboration?
A. Reassure the client that change is slow and normalize their
disappointment.
B. Explore the client’s belief about “trying everything” and
collaboratively set a small, achievable goal for the week.
C. Point out the client’s avoidance and confront them about
inconsistency with treatment goals.
D. Schedule more frequent sessions to intensify treatment
because current work is ineffective.
Correct Answer
B
Rationales
Correct (B): This option uses collaborative problem-solving and
behavioral activation principles appropriate to early therapy: it
explores the client’s belief (cognitive test) and sets a small,
achievable goal, preserving alliance and enhancing self-efficacy.
It aligns with Wheeler’s emphasis on collaborative formulation
and early behavior-oriented experiments.
Incorrect (A): Reassurance alone may be empathic but is
passive and fails to engage clinical reasoning or behavioral
activation; it risks colluding with helplessness.
Incorrect (C): Confrontation early in therapy can damage the
alliance and is misaligned with trauma-informed and
relationally sensitive practice.
,Incorrect (D): Increasing session frequency without addressing
engagement or specific interventions is premature and may be
inefficient or burdensome.
Teaching Point
Collaborate to test beliefs and set small, achievable tasks to
rebuild agency and alliance.
Citation
Wheeler, K. (2023). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 1.
2
Reference
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
Stem
During intake, a client discloses childhood physical abuse and
expresses ambivalence about discussing it. As a nurse
psychotherapist practicing within Wheeler’s framework, what is
the most appropriate immediate approach?
A. Refer the client to trauma-focused therapy immediately and
discontinue your work.
B. Validate safety concerns, explain trauma-informed limits of
immediate processing, and collaboratively plan pacing.
C. Ask detailed questions about the abuse to build a thorough
trauma history today.
, D. Reassure the client that detailed trauma disclosure is always
necessary for effective therapy.
Correct Answer
B
Rationales
Correct (B): Trauma-informed practice prioritizes safety,
consent, and pacing; validating and collaboratively planning
aligns with Wheeler’s emphasis on containment and the
therapeutic frame before deep trauma processing.
Incorrect (A): Immediate referral might be unnecessary and
could disrupt the therapeutic relationship; assessment of needs
and readiness should precede referral.
Incorrect (C): Detailed probing before establishing safety and
stabilization risks re-traumatization; it is premature.
Incorrect (D): Asserting that detailed disclosure is always
necessary is false and disregards client autonomy and trauma-
informed care.
Teaching Point
Prioritize safety, consent, and pacing when trauma is disclosed;
avoid premature probing.
Citation
Wheeler, K. (2023). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 1.
3
