NSG 526 Exam 2 Actual Questions and Answers:
Clinical Modalities in Advanced Psychiatric Mental
Health Nursing (Latest 2026/2027) – Verified
PMHNP Content for Wilkes University
Section 1: Individual Psychotherapy Modalities (CBT, DBT, Psychodynamic,
IPT) — 10 Questions
Q1: A 32-year-old patient with borderline personality disorder presents with chronic
suicidal ideation, intense fear of abandonment, and recent non-suicidal self-injury. The
PMHNP is selecting an evidence-based therapeutic approach. Which modality is most
appropriate as a first-line treatment?
A. Classic psychoanalysis focusing on early childhood experiences
B. Cognitive Behavioral Therapy (CBT) targeting thought restructuring
C. Dialectical Behavior Therapy (DBT) emphasizing skills training and validation
D. Supportive therapy providing unconditional positive regard
[CORRECT: C]
Rationale: DBT is the gold-standard, evidence-based treatment for borderline personality
disorder, specifically designed to address emotional dysregulation, self-harm, and
interpersonal chaos. It combines individual therapy with skills groups (mindfulness,
distress tolerance, emotion regulation, interpersonal effectiveness). Option A
,(psychoanalysis) requires a level of ego strength and insight typically lacking in acute
BPD and may destabilize the patient through regressive techniques. Option B (CBT)
addresses cognitive distortions but lacks DBT's emphasis on validation and emotion
regulation skills essential for BPD. Option D (supportive therapy) may maintain rapport
but does not provide the structured skills training needed for symptom reduction. Key
concept: DBT balances acceptance (validation) with change (behavioral skills),
addressing the dialectical tension central to BPD treatment.
Q2: During a therapy session, a patient states, "I just can't do anything right. I failed my
exam, my boss criticized my project, and now my partner is upset with me. Everything is
my fault." Using a CBT approach, what is the PMHNP's most therapeutic response?
A. "It sounds like you're feeling overwhelmed. Let's explore what's causing these
feelings."
B. "Tell me more about your childhood experiences with failure and criticism."
C. "What evidence supports the belief that everything is your fault? What evidence
contradicts it?"
D. "I hear your pain. Let's focus on breathing exercises to help you relax right now."
[CORRECT: C]
Rationale: This response utilizes CBT's core technique of cognitive restructuring by
examining evidence for and against an automatic thought ("everything is my fault"). It
helps the patient identify cognitive distortions (overgeneralization, personalization) and
develop more balanced thinking through Socratic questioning. Option A uses supportive
counseling but does not actively challenge the distorted cognition driving the distress.
Option B shifts to a psychodynamic approach exploring early experiences, which is not
,the immediate CBT intervention and may lead to avoidance of current thought patterns.
Option D introduces a relaxation technique more appropriate for anxiety/panic or as an
adjunct, but does not address the cognitive distortion driving the depressive symptoms.
Key technique: Socratic questioning helps patients examine the validity of their
automatic thoughts rather than accepting them as facts.
Q3: A 45-year-old patient with chronic depression has been in psychodynamic
psychotherapy for six months. During a session, she becomes tearful and says, "I feel
like you're the only one who truly understands me. Sometimes I imagine what it would
be like if we could meet for coffee and just talk as friends." What is the PMHNP's most
appropriate interpretation of this phenomenon?
A. The patient is experiencing negative transference due to unresolved anger
B. This represents erotic transference requiring immediate referral
C. The patient is demonstrating positive transference, which can be explored
therapeutically
D. This indicates the therapy has failed to maintain appropriate boundaries
[CORRECT: C]
Rationale: This scenario illustrates positive transference, where the patient redirects
feelings and patterns from past relationships (likely longing for
understanding/connection) onto the therapist. In psychodynamic therapy, transference
is not pathology but a therapeutic tool to be explored and interpreted to gain insight into
interpersonal patterns. Option A (negative transference) involves anger/hostility, not
present here. Option B (erotic transference) would involve sexual/romantic fantasies,
which are not described. Option D incorrectly views transference as boundary failure
, rather than an expected phenomenon in depth psychology. Key concept: Transference
provides a "living laboratory" to examine and modify maladaptive relational patterns in
the here-and-now of the therapeutic relationship.
Q4: A patient with major depressive disorder and interpersonal conflict with his wife is
beginning Interpersonal Therapy (IPT). In the initial sessions, the PMHNP should focus
primarily on:
A. Identifying and restructuring negative automatic thoughts
B. Exploring early childhood attachment patterns with parents
C. Assessing current interpersonal relationships and identifying problem areas
D. Teaching mindfulness meditation techniques for stress reduction
[CORRECT: C]
Rationale: IPT focuses specifically on current interpersonal relationships and their
connection to depressive symptoms. The initial phase involves conducting an
interpersonal inventory to identify problem areas (grief, role disputes, role transitions,
interpersonal deficits). Option A describes CBT, not IPT. Option B describes
psychodynamic or attachment-based therapy. Option D describes mindfulness-based
interventions. Key distinction: IPT is time-limited (12-16 weeks), targets current
interpersonal functioning, and links mood symptoms to relationship problems, making it
distinct from cognitive or psychodynamic approaches.
Q5: A 28-year-old patient with panic disorder reports, "When I feel my heart racing, I
immediately think I'm having a heart attack and going to die. I avoid exercise and any
Clinical Modalities in Advanced Psychiatric Mental
Health Nursing (Latest 2026/2027) – Verified
PMHNP Content for Wilkes University
Section 1: Individual Psychotherapy Modalities (CBT, DBT, Psychodynamic,
IPT) — 10 Questions
Q1: A 32-year-old patient with borderline personality disorder presents with chronic
suicidal ideation, intense fear of abandonment, and recent non-suicidal self-injury. The
PMHNP is selecting an evidence-based therapeutic approach. Which modality is most
appropriate as a first-line treatment?
A. Classic psychoanalysis focusing on early childhood experiences
B. Cognitive Behavioral Therapy (CBT) targeting thought restructuring
C. Dialectical Behavior Therapy (DBT) emphasizing skills training and validation
D. Supportive therapy providing unconditional positive regard
[CORRECT: C]
Rationale: DBT is the gold-standard, evidence-based treatment for borderline personality
disorder, specifically designed to address emotional dysregulation, self-harm, and
interpersonal chaos. It combines individual therapy with skills groups (mindfulness,
distress tolerance, emotion regulation, interpersonal effectiveness). Option A
,(psychoanalysis) requires a level of ego strength and insight typically lacking in acute
BPD and may destabilize the patient through regressive techniques. Option B (CBT)
addresses cognitive distortions but lacks DBT's emphasis on validation and emotion
regulation skills essential for BPD. Option D (supportive therapy) may maintain rapport
but does not provide the structured skills training needed for symptom reduction. Key
concept: DBT balances acceptance (validation) with change (behavioral skills),
addressing the dialectical tension central to BPD treatment.
Q2: During a therapy session, a patient states, "I just can't do anything right. I failed my
exam, my boss criticized my project, and now my partner is upset with me. Everything is
my fault." Using a CBT approach, what is the PMHNP's most therapeutic response?
A. "It sounds like you're feeling overwhelmed. Let's explore what's causing these
feelings."
B. "Tell me more about your childhood experiences with failure and criticism."
C. "What evidence supports the belief that everything is your fault? What evidence
contradicts it?"
D. "I hear your pain. Let's focus on breathing exercises to help you relax right now."
[CORRECT: C]
Rationale: This response utilizes CBT's core technique of cognitive restructuring by
examining evidence for and against an automatic thought ("everything is my fault"). It
helps the patient identify cognitive distortions (overgeneralization, personalization) and
develop more balanced thinking through Socratic questioning. Option A uses supportive
counseling but does not actively challenge the distorted cognition driving the distress.
Option B shifts to a psychodynamic approach exploring early experiences, which is not
,the immediate CBT intervention and may lead to avoidance of current thought patterns.
Option D introduces a relaxation technique more appropriate for anxiety/panic or as an
adjunct, but does not address the cognitive distortion driving the depressive symptoms.
Key technique: Socratic questioning helps patients examine the validity of their
automatic thoughts rather than accepting them as facts.
Q3: A 45-year-old patient with chronic depression has been in psychodynamic
psychotherapy for six months. During a session, she becomes tearful and says, "I feel
like you're the only one who truly understands me. Sometimes I imagine what it would
be like if we could meet for coffee and just talk as friends." What is the PMHNP's most
appropriate interpretation of this phenomenon?
A. The patient is experiencing negative transference due to unresolved anger
B. This represents erotic transference requiring immediate referral
C. The patient is demonstrating positive transference, which can be explored
therapeutically
D. This indicates the therapy has failed to maintain appropriate boundaries
[CORRECT: C]
Rationale: This scenario illustrates positive transference, where the patient redirects
feelings and patterns from past relationships (likely longing for
understanding/connection) onto the therapist. In psychodynamic therapy, transference
is not pathology but a therapeutic tool to be explored and interpreted to gain insight into
interpersonal patterns. Option A (negative transference) involves anger/hostility, not
present here. Option B (erotic transference) would involve sexual/romantic fantasies,
which are not described. Option D incorrectly views transference as boundary failure
, rather than an expected phenomenon in depth psychology. Key concept: Transference
provides a "living laboratory" to examine and modify maladaptive relational patterns in
the here-and-now of the therapeutic relationship.
Q4: A patient with major depressive disorder and interpersonal conflict with his wife is
beginning Interpersonal Therapy (IPT). In the initial sessions, the PMHNP should focus
primarily on:
A. Identifying and restructuring negative automatic thoughts
B. Exploring early childhood attachment patterns with parents
C. Assessing current interpersonal relationships and identifying problem areas
D. Teaching mindfulness meditation techniques for stress reduction
[CORRECT: C]
Rationale: IPT focuses specifically on current interpersonal relationships and their
connection to depressive symptoms. The initial phase involves conducting an
interpersonal inventory to identify problem areas (grief, role disputes, role transitions,
interpersonal deficits). Option A describes CBT, not IPT. Option B describes
psychodynamic or attachment-based therapy. Option D describes mindfulness-based
interventions. Key distinction: IPT is time-limited (12-16 weeks), targets current
interpersonal functioning, and links mood symptoms to relationship problems, making it
distinct from cognitive or psychodynamic approaches.
Q5: A 28-year-old patient with panic disorder reports, "When I feel my heart racing, I
immediately think I'm having a heart attack and going to die. I avoid exercise and any
