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 34-year-old woman with recurrent major depressive episodes
says in session, “I just want my sadness gone — I can’t sit with
it.” She has had several medication trials with partial benefit. As
a nurse psychotherapist working from a holistic, relationship-
based framework that views symptoms as communication,
,which therapist response most aligns with Wheeler’s
recommended approach at this stage of care?
A. Emphasize rapid symptom relief by increasing medication
dose and reducing focus on feelings in session.
B. Validate the distress, explore the meaning of the sadness,
and collaboratively set short-term safety/functional goals while
framing symptoms as communication.
C. Interpret the sadness as resistance to psychotherapy and
confront the patient’s avoidance directly.
D. Advise the patient to use distraction strategies between
sessions and postpone processing until she is less distressed.
Correct answer
B
Rationales
Correct (B): Validating distress while exploring meaning aligns
with Wheeler’s holistic model that treats symptoms as
communicative and prioritizes the therapeutic relationship and
collaborative goal setting. It balances immediate
safety/functional concerns with psychotherapeutic exploration.
A: Prematurely privileging medication without concurrent
relational work contradicts the chapter’s emphasis on
integration of relationship-based psychotherapy and symptom
meaning.
C: Confrontation is likely to damage alliance and is inconsistent
with a patient-centered, empowering nursing stance.
D: Avoiding processing may neglect the therapeutic opportunity
,to understand the symptom’s function and may inadvertently
reinforce avoidance.
Teaching point
Validate, explore meaning, and set collaborative short-term
goals while preserving alliance.
Citation
Wheeler, K. (2020). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 1.
2
Reference
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
Stem
A newly graduated PMHNP in clinic reports anxiety about taking
the lead in an initial psychotherapy intake. Using Benner’s
model and the stages of learning discussed in the chapter,
which supervisory recommendation best facilitates
development from novice to competent therapist?
A. Encourage independent practice immediately to accelerate
unconscious competence.
B. Provide structured observation, modeling, and graded
responsibilities with reflective supervision.
C. Recommend minimizing psychotherapy practice and focusing
instead on medication management.
, D. Suggest the clinician rely exclusively on manualized protocols
without adaptation to patient context.
Correct answer
B
Rationales
Correct (B): Wheeler discusses Benner’s stages and the value of
conscious competence gained through supervision, modeling,
and graded responsibility—strategies that reduce anxiety and
foster skill consolidation.
A: Promoting premature independence risks patient care and
clinician overwhelm; it bypasses essential supervised learning.
C: Avoids core PMHNP competency in psychotherapy; the
chapter highlights psychotherapy as integral.
D: Rigid fidelity without contextual clinical judgment
undermines holistic, relational care emphasized in the
framework.
Teaching point
Use graded responsibility and reflective supervision to build
psychotherapy competence.
Citation
Wheeler, K. (2020). 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 34-year-old woman with recurrent major depressive episodes
says in session, “I just want my sadness gone — I can’t sit with
it.” She has had several medication trials with partial benefit. As
a nurse psychotherapist working from a holistic, relationship-
based framework that views symptoms as communication,
,which therapist response most aligns with Wheeler’s
recommended approach at this stage of care?
A. Emphasize rapid symptom relief by increasing medication
dose and reducing focus on feelings in session.
B. Validate the distress, explore the meaning of the sadness,
and collaboratively set short-term safety/functional goals while
framing symptoms as communication.
C. Interpret the sadness as resistance to psychotherapy and
confront the patient’s avoidance directly.
D. Advise the patient to use distraction strategies between
sessions and postpone processing until she is less distressed.
Correct answer
B
Rationales
Correct (B): Validating distress while exploring meaning aligns
with Wheeler’s holistic model that treats symptoms as
communicative and prioritizes the therapeutic relationship and
collaborative goal setting. It balances immediate
safety/functional concerns with psychotherapeutic exploration.
A: Prematurely privileging medication without concurrent
relational work contradicts the chapter’s emphasis on
integration of relationship-based psychotherapy and symptom
meaning.
C: Confrontation is likely to damage alliance and is inconsistent
with a patient-centered, empowering nursing stance.
D: Avoiding processing may neglect the therapeutic opportunity
,to understand the symptom’s function and may inadvertently
reinforce avoidance.
Teaching point
Validate, explore meaning, and set collaborative short-term
goals while preserving alliance.
Citation
Wheeler, K. (2020). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 1.
2
Reference
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
Stem
A newly graduated PMHNP in clinic reports anxiety about taking
the lead in an initial psychotherapy intake. Using Benner’s
model and the stages of learning discussed in the chapter,
which supervisory recommendation best facilitates
development from novice to competent therapist?
A. Encourage independent practice immediately to accelerate
unconscious competence.
B. Provide structured observation, modeling, and graded
responsibilities with reflective supervision.
C. Recommend minimizing psychotherapy practice and focusing
instead on medication management.
, D. Suggest the clinician rely exclusively on manualized protocols
without adaptation to patient context.
Correct answer
B
Rationales
Correct (B): Wheeler discusses Benner’s stages and the value of
conscious competence gained through supervision, modeling,
and graded responsibility—strategies that reduce anxiety and
foster skill consolidation.
A: Promoting premature independence risks patient care and
clinician overwhelm; it bypasses essential supervised learning.
C: Avoids core PMHNP competency in psychotherapy; the
chapter highlights psychotherapy as integral.
D: Rigid fidelity without contextual clinical judgment
undermines holistic, relational care emphasized in the
framework.
Teaching point
Use graded responsibility and reflective supervision to build
psychotherapy competence.
Citation
Wheeler, K. (2020). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 1.
3
