WILKES UNIVERSITY NSG 526 EXAM 1 —
INDIVIDUAL PSYCHOTHERAPIES 200 Practice
Questions with Answers and Detailed Rationales
Course: NSG 526 – Clinical Modalities in Advanced Psychiatric Mental Health Nursing Practice
Institution: Wilkes University – Graduate PMHNP Program
Exam: Exam 1 – Individual Psychotherapies
Format: Multiple-choice, Select-All-That-Apply (SATA), and clinical scenario questions
Key Content Areas: Therapeutic relationship & Peplau's Theory, Psychotherapy foundations &
PMHNP roles, Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT),
Interpersonal Therapy (IPT), Eye Movement Desensitization and Reprocessing (EMDR), Brief
psychotherapy, Crisis intervention, Psychiatric assessment & MSE, DSM-5-TR classification,
Therapeutic communication & ethics
SECTION 1: FOUNDATIONS OF ADVANCED PSYCHIATRIC NURSING & THERAPEUTIC
RELATIONSHIP (Questions 1–35)
1. According to Peplau's Interpersonal Relations Theory, the nurse-patient relationship
progresses through which phases in correct order?
- A) Orientation → Working → Termination → Identification
- B) Orientation → Identification → Exploitation → Resolution
- C) Preorientation → Orientation → Working → Termination
- D) Orientation → Working → Resolution → Termination
Answer: C
Rationale: Peplau's theory identifies four sequential phases: Preorientation (preparation before
meeting the patient), Orientation (establishing rapport and defining the problem), Working
(active therapeutic work, including identification and exploitation of patterns), and Termination
(concluding the relationship and evaluating progress).
2. Which of the following is the PRIMARY goal of the orientation phase of the therapeutic
relationship?
,- A) To address transference issues
- B) To establish trust, rapport, and a therapeutic contract
- C) To implement specific therapeutic interventions
- D) To evaluate treatment outcomes
Answer: B
Rationale: The orientation phase is focused on establishing trust, building rapport, setting
boundaries, defining the therapeutic contract, and clarifying the purpose and goals of the
therapeutic relationship. Transference work occurs primarily in the working phase, and
evaluation occurs in the termination phase.
3. A PMHNP is working with a patient who consistently arrives late to sessions and cancels at
the last minute. This behavior is MOST likely an example of:
- A) Transference
- B) Resistance
- C) Countertransference
- D) Therapeutic alliance
Answer: B
Rationale: Resistance refers to behaviors that impede therapeutic progress, often unconsciously
motivated. Chronic lateness and frequent cancellations are common manifestations of
resistance, which may reflect underlying anxiety, ambivalence about change, or difficulty with
commitment to the therapeutic process.
4. When a patient unconsciously redirects feelings from a significant figure in their life onto the
PMHNP, this phenomenon is called:
- A) Countertransference
- B) Transference
- C) Projection
- D) Splitting
Answer: B
Rationale: Transference occurs when a patient unconsciously redirects feelings, expectations,
and attitudes from significant figures (e.g., parents, partners) onto the therapist.
Countertransference refers to the therapist's emotional reactions to the patient.
5. The PMHNP notices they are feeling overly protective and nurturing toward a patient who
reminds them of their younger sibling. This is an example of:
,- A) Transference
- B) Countertransference
- C) Empathy
- D) Therapeutic use of self
Answer: B
Rationale: Countertransference occurs when the therapist's own emotional responses, biases,
or unresolved conflicts are triggered by the patient. The PMHNP should recognize this, seek
supervision if needed, and maintain professional boundaries.
6. According to the therapeutic relationship literature, which of the following is considered the
"active ingredient" that facilitates change in psychotherapy?
- A) The therapist's theoretical orientation
- B) The therapeutic alliance
- C) The number of sessions
- D) The therapist's credentials
Answer: B
Rationale: Extensive research has demonstrated that the therapeutic alliance—the
collaborative, trusting relationship between therapist and patient—is one of the strongest
predictors of positive psychotherapy outcomes across all theoretical orientations.
7. The PMHNP is terminating a therapeutic relationship with a patient. Which of the following is
an appropriate intervention during this phase?
- A) Immediately ending the relationship without discussion
- B) Exploring feelings about termination and evaluating progress
- C) Continuing to meet indefinitely to avoid abandonment
- D) Referring the patient to another provider without preparation
Answer: B
Rationale: The termination phase should include exploration of the patient's feelings about
ending the relationship, review of progress made, reinforcement of gains, discussion of future
coping strategies, and planning for potential relapse prevention.
8. In the context of therapeutic communication, "active listening" involves:
- A) Offering advice and solutions to the patient
- B) Listening attentively, reflecting content and feelings, and providing feedback
- C) Taking detailed notes during the session
, - D) Minimizing patient concerns to reduce anxiety
Answer: B
Rationale: Active listening is a fundamental therapeutic communication skill that involves fully
attending to the patient, reflecting both the content and emotional tone of their message, and
providing thoughtful feedback that demonstrates understanding and empathy.
9. Which of the following is a boundary violation in the therapeutic relationship?
- A) Accepting a small gift from a patient at termination
- B) Self-disclosing personal information that does not serve the patient's benefit
- C) Extending a session by a few minutes when clinically indicated
- D) Maintaining a professional, warm demeanor
Answer: B
Rationale: Self-disclosure should only be used when it serves the patient's therapeutic needs,
not to meet the therapist's needs. Accepting small gifts at termination may be acceptable in
some contexts. Boundary violations involve exploitation or behavior that prioritizes the
therapist's needs over the patient's.
10. According to Peplau, the "exploitation" phase of the working phase is characterized by:
- A) The patient taking advantage of the therapeutic relationship
- B) The patient actively using the therapeutic relationship to explore and change patterns
- C) The therapist exploiting the patient for personal gain
- D) Termination of the therapeutic relationship
Answer: B
Rationale: Peplau's "exploitation" phase (part of the working phase) refers to the patient actively
using the therapeutic relationship and the therapist's assistance to identify, explore, and modify
maladaptive patterns of thinking, feeling, and behaving. It is a positive, productive phase of
therapy.
11. A patient tells the PMHNP, "You're the only person who really understands me. I don't know
what I'd do without you." This is MOST likely an example of:
- A) Therapeutic progress
- B) Idealizing transference
- C) Psychotic thinking
- D) Appropriate dependence
INDIVIDUAL PSYCHOTHERAPIES 200 Practice
Questions with Answers and Detailed Rationales
Course: NSG 526 – Clinical Modalities in Advanced Psychiatric Mental Health Nursing Practice
Institution: Wilkes University – Graduate PMHNP Program
Exam: Exam 1 – Individual Psychotherapies
Format: Multiple-choice, Select-All-That-Apply (SATA), and clinical scenario questions
Key Content Areas: Therapeutic relationship & Peplau's Theory, Psychotherapy foundations &
PMHNP roles, Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT),
Interpersonal Therapy (IPT), Eye Movement Desensitization and Reprocessing (EMDR), Brief
psychotherapy, Crisis intervention, Psychiatric assessment & MSE, DSM-5-TR classification,
Therapeutic communication & ethics
SECTION 1: FOUNDATIONS OF ADVANCED PSYCHIATRIC NURSING & THERAPEUTIC
RELATIONSHIP (Questions 1–35)
1. According to Peplau's Interpersonal Relations Theory, the nurse-patient relationship
progresses through which phases in correct order?
- A) Orientation → Working → Termination → Identification
- B) Orientation → Identification → Exploitation → Resolution
- C) Preorientation → Orientation → Working → Termination
- D) Orientation → Working → Resolution → Termination
Answer: C
Rationale: Peplau's theory identifies four sequential phases: Preorientation (preparation before
meeting the patient), Orientation (establishing rapport and defining the problem), Working
(active therapeutic work, including identification and exploitation of patterns), and Termination
(concluding the relationship and evaluating progress).
2. Which of the following is the PRIMARY goal of the orientation phase of the therapeutic
relationship?
,- A) To address transference issues
- B) To establish trust, rapport, and a therapeutic contract
- C) To implement specific therapeutic interventions
- D) To evaluate treatment outcomes
Answer: B
Rationale: The orientation phase is focused on establishing trust, building rapport, setting
boundaries, defining the therapeutic contract, and clarifying the purpose and goals of the
therapeutic relationship. Transference work occurs primarily in the working phase, and
evaluation occurs in the termination phase.
3. A PMHNP is working with a patient who consistently arrives late to sessions and cancels at
the last minute. This behavior is MOST likely an example of:
- A) Transference
- B) Resistance
- C) Countertransference
- D) Therapeutic alliance
Answer: B
Rationale: Resistance refers to behaviors that impede therapeutic progress, often unconsciously
motivated. Chronic lateness and frequent cancellations are common manifestations of
resistance, which may reflect underlying anxiety, ambivalence about change, or difficulty with
commitment to the therapeutic process.
4. When a patient unconsciously redirects feelings from a significant figure in their life onto the
PMHNP, this phenomenon is called:
- A) Countertransference
- B) Transference
- C) Projection
- D) Splitting
Answer: B
Rationale: Transference occurs when a patient unconsciously redirects feelings, expectations,
and attitudes from significant figures (e.g., parents, partners) onto the therapist.
Countertransference refers to the therapist's emotional reactions to the patient.
5. The PMHNP notices they are feeling overly protective and nurturing toward a patient who
reminds them of their younger sibling. This is an example of:
,- A) Transference
- B) Countertransference
- C) Empathy
- D) Therapeutic use of self
Answer: B
Rationale: Countertransference occurs when the therapist's own emotional responses, biases,
or unresolved conflicts are triggered by the patient. The PMHNP should recognize this, seek
supervision if needed, and maintain professional boundaries.
6. According to the therapeutic relationship literature, which of the following is considered the
"active ingredient" that facilitates change in psychotherapy?
- A) The therapist's theoretical orientation
- B) The therapeutic alliance
- C) The number of sessions
- D) The therapist's credentials
Answer: B
Rationale: Extensive research has demonstrated that the therapeutic alliance—the
collaborative, trusting relationship between therapist and patient—is one of the strongest
predictors of positive psychotherapy outcomes across all theoretical orientations.
7. The PMHNP is terminating a therapeutic relationship with a patient. Which of the following is
an appropriate intervention during this phase?
- A) Immediately ending the relationship without discussion
- B) Exploring feelings about termination and evaluating progress
- C) Continuing to meet indefinitely to avoid abandonment
- D) Referring the patient to another provider without preparation
Answer: B
Rationale: The termination phase should include exploration of the patient's feelings about
ending the relationship, review of progress made, reinforcement of gains, discussion of future
coping strategies, and planning for potential relapse prevention.
8. In the context of therapeutic communication, "active listening" involves:
- A) Offering advice and solutions to the patient
- B) Listening attentively, reflecting content and feelings, and providing feedback
- C) Taking detailed notes during the session
, - D) Minimizing patient concerns to reduce anxiety
Answer: B
Rationale: Active listening is a fundamental therapeutic communication skill that involves fully
attending to the patient, reflecting both the content and emotional tone of their message, and
providing thoughtful feedback that demonstrates understanding and empathy.
9. Which of the following is a boundary violation in the therapeutic relationship?
- A) Accepting a small gift from a patient at termination
- B) Self-disclosing personal information that does not serve the patient's benefit
- C) Extending a session by a few minutes when clinically indicated
- D) Maintaining a professional, warm demeanor
Answer: B
Rationale: Self-disclosure should only be used when it serves the patient's therapeutic needs,
not to meet the therapist's needs. Accepting small gifts at termination may be acceptable in
some contexts. Boundary violations involve exploitation or behavior that prioritizes the
therapist's needs over the patient's.
10. According to Peplau, the "exploitation" phase of the working phase is characterized by:
- A) The patient taking advantage of the therapeutic relationship
- B) The patient actively using the therapeutic relationship to explore and change patterns
- C) The therapist exploiting the patient for personal gain
- D) Termination of the therapeutic relationship
Answer: B
Rationale: Peplau's "exploitation" phase (part of the working phase) refers to the patient actively
using the therapeutic relationship and the therapist's assistance to identify, explore, and modify
maladaptive patterns of thinking, feeling, and behaving. It is a positive, productive phase of
therapy.
11. A patient tells the PMHNP, "You're the only person who really understands me. I don't know
what I'd do without you." This is MOST likely an example of:
- A) Therapeutic progress
- B) Idealizing transference
- C) Psychotic thinking
- D) Appropriate dependence
