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: Professional Role and
Scope
Stem
A newly credentialed nurse psychotherapist is asked by clinic
leadership to offer psychotherapeutic intake sessions while also
carrying a caseload of medication follow-ups. The clinic’s
policies allow dual roles. The clinician is uncertain how to
proceed to protect the therapeutic frame and patient safety.
,Which action best reflects professional scope and ethical
practice?
A. Accept both roles for efficiency and schedule separate
therapy and medication visits without disclosing dual role to
patients.
B. Decline the psychotherapy caseload and continue only with
medication follow-ups to avoid any possible boundary conflicts.
C. Accept psychotherapy caseload, document role distinctions
clearly in the record, obtain informed consent addressing dual
roles, and arrange supervision/consultation.
D. Offer brief supportive therapy within medication visits and
avoid separate psychotherapy sessions to minimize role
confusion.
Correct answer
C
Rationale — Correct
Documenting role distinctions, obtaining informed consent that
explains the dual role, and arranging supervision reflects ethical
practice, clarifies scope, and manages risks to the therapeutic
frame. Wheeler emphasizes transparent role definition and
supervisory support when clinicians function in overlapping
roles.
Rationale — Incorrect
A — Failing to disclose dual roles breaches informed consent
and risks harming the alliance.
B — Automatic declination may unnecessarily limit access to
,care when safe mitigation (consent, documentation,
supervision) is possible.
D — Blurring therapy into medication visits without explicit
agreement undermines the therapeutic contract and denies
patients a clear modality of care.
Teaching point
Disclose, document, and supervise when working in
overlapping clinical roles.
Citation
Wheeler, K. (2023). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 1.
2.
Reference
Ch. 1 — The Nurse Psychotherapist: Therapeutic Frame and
Boundaries
Stem
A patient with complex trauma begins weekly therapy and
frequently requests extended phone contact between sessions
for crisis support. The nurse psychotherapist wants to maintain
safety while preserving the therapeutic alliance. What is the
best immediate therapist response?
A. Promise unlimited phone access to avoid abandonment
reactions.
B. Clarify expected channels and limits of between-session
, contact, create a safety plan, and document the agreement.
C. Refuse any phone contact and instruct the patient to use
emergency services only.
D. Redirect the patient to text messages for quicker responses
and provide the therapist’s personal number.
Correct answer
B
Rationale — Correct
Setting explicit limits, establishing a safety plan, and
documenting maintains boundaries while addressing safety and
alliance—consistent with trauma-informed care and the
therapeutic frame described by Wheeler.
Rationale — Incorrect
A — Unlimited access fosters dependency and clinician burnout
and breaches professional boundaries.
C — Absolute refusal without safety planning risks patient harm
and ruptures the alliance.
D — Giving a personal number or using unsecured text
bypasses professional boundaries and confidentiality
safeguards.
Teaching point
Set and document clear between-session contact limits and a
safety plan.
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: Professional Role and
Scope
Stem
A newly credentialed nurse psychotherapist is asked by clinic
leadership to offer psychotherapeutic intake sessions while also
carrying a caseload of medication follow-ups. The clinic’s
policies allow dual roles. The clinician is uncertain how to
proceed to protect the therapeutic frame and patient safety.
,Which action best reflects professional scope and ethical
practice?
A. Accept both roles for efficiency and schedule separate
therapy and medication visits without disclosing dual role to
patients.
B. Decline the psychotherapy caseload and continue only with
medication follow-ups to avoid any possible boundary conflicts.
C. Accept psychotherapy caseload, document role distinctions
clearly in the record, obtain informed consent addressing dual
roles, and arrange supervision/consultation.
D. Offer brief supportive therapy within medication visits and
avoid separate psychotherapy sessions to minimize role
confusion.
Correct answer
C
Rationale — Correct
Documenting role distinctions, obtaining informed consent that
explains the dual role, and arranging supervision reflects ethical
practice, clarifies scope, and manages risks to the therapeutic
frame. Wheeler emphasizes transparent role definition and
supervisory support when clinicians function in overlapping
roles.
Rationale — Incorrect
A — Failing to disclose dual roles breaches informed consent
and risks harming the alliance.
B — Automatic declination may unnecessarily limit access to
,care when safe mitigation (consent, documentation,
supervision) is possible.
D — Blurring therapy into medication visits without explicit
agreement undermines the therapeutic contract and denies
patients a clear modality of care.
Teaching point
Disclose, document, and supervise when working in
overlapping clinical roles.
Citation
Wheeler, K. (2023). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 1.
2.
Reference
Ch. 1 — The Nurse Psychotherapist: Therapeutic Frame and
Boundaries
Stem
A patient with complex trauma begins weekly therapy and
frequently requests extended phone contact between sessions
for crisis support. The nurse psychotherapist wants to maintain
safety while preserving the therapeutic alliance. What is the
best immediate therapist response?
A. Promise unlimited phone access to avoid abandonment
reactions.
B. Clarify expected channels and limits of between-session
, contact, create a safety plan, and document the agreement.
C. Refuse any phone contact and instruct the patient to use
emergency services only.
D. Redirect the patient to text messages for quicker responses
and provide the therapist’s personal number.
Correct answer
B
Rationale — Correct
Setting explicit limits, establishing a safety plan, and
documenting maintains boundaries while addressing safety and
alliance—consistent with trauma-informed care and the
therapeutic frame described by Wheeler.
Rationale — Incorrect
A — Unlimited access fosters dependency and clinician burnout
and breaches professional boundaries.
C — Absolute refusal without safety planning risks patient harm
and ruptures the alliance.
D — Giving a personal number or using unsecured text
bypasses professional boundaries and confidentiality
safeguards.
Teaching point
Set and document clear between-session contact limits and a
safety plan.
