NR 605 Diagnosis and Management in Psychiatric-Mental
Health Across the Lifespan I Practicum
SECTION I: FOUNDATIONAL CONCEPTS & THERAPEUTIC ALLIANCE (Questions 1–
25)
1. A 28-year-old client states, "I just feel like nobody understands what I'm going
through." Which response by the PMHNP best demonstrates the therapeutic
communication technique of reflection?
A. "Why do you think nobody understands you?"
B. "It sounds like you're feeling very isolated and alone right now."
C. "You shouldn't feel that way; your family cares about you."
D. "Have you tried talking to your friends about this?"
Rationale: Reflection involves restating the client's message in the
PMHNP's own words to convey understanding and encourage further expression.
Option B accurately mirrors the client's emotional content (isolation) without
introducing judgment or advice. Option A is a "why" question, which can feel
confrontational. Option C minimizes the client's feelings. Option D offers
unsolicited advice, which is nontherapeutic.
2. During the orientation phase of the therapeutic relationship, which action is
the PRIORITY for the PMHNP?
A. Establishing trust and defining the boundaries of the relationship
B. Challenging the client's maladaptive defense mechanisms
C. Interpreting unconscious conflicts from childhood
D. Terminating the relationship and summarizing progress
Rationale: Peplau's Interpersonal Relations Theory identifies the
orientation phase as the period when the nurse and client establish trust, identify
the client's needs, and clarify roles and boundaries. Challenging defenses (B) and
interpreting unconscious conflicts (C) occur in the working phase. Termination (D)
is the final phase.
,3. A client asks the PMHNP, "Have you ever experienced depression yourself?"
What is the MOST therapeutic response?
A. "Yes, I have, so I know exactly how you feel."
B. "That's not something I'm comfortable discussing."
C. "I'd like to focus on your experience and what brought you here today."
D. "Why are you asking me that question?"
Rationale: Self-disclosure should be limited and used only when it serves
the client's therapeutic interests. Redirecting the focus to the client maintains
appropriate boundaries and prioritizes the client's needs. Option A risks role
reversal and over-identification. Option B may feel dismissive. Option D can feel
defensive and may discourage further disclosure.
4. Which of the following are core processes of Acceptance and Commitment
Therapy (ACT)? Select all that apply.
A. Cognitive defusion
B. Acceptance
C. Contact with the present moment
D. Systematic desensitization
E. Values clarification
Rationale: ACT's six core processes are cognitive defusion, acceptance,
contact with the present moment, self-as-context, values, and committed action.
Systematic desensitization (D) is a behavioral technique associated with exposure
therapy, not ACT.
5. The PMHNP is meeting a new client for the first time. Which action best
establishes the therapeutic alliance?
A. Immediately reviewing the client's past psychiatric records in detail
B. Asking the client what they hope to achieve from treatment
C. Explaining the PMHNP's personal therapeutic philosophy
D. Administering a comprehensive battery of psychological tests
, Rationale: The therapeutic alliance is built on collaboration, trust, and
shared goal-setting. Asking about the client's goals demonstrates respect for the
client's perspective and begins the collaborative process. The other options are
either premature or provider-centered.
6. A client states, "I just can't seem to talk about what's bothering me." Which
therapeutic communication technique should the PMHNP use to encourage
elaboration without leading the conversation?
A. "Tell me more about that."
B. "You should try to open up more."
C. "Is it about your childhood?"
D. "Don't worry, you can trust me."
Rationale: "Tell me more about that" is a broad opening that invites the
client to elaborate without imposing direction. Option B is advice-giving. Option C
is leading and presumes the content. Option D offers false reassurance.
7. A PMHNP is conducting a 360-degree peer review to provide constructive
feedback to a psychiatric nurse colleague regarding clinical documentation and
patient interactions. Which principle of peer review is MOST important to
uphold?
A. Maintaining confidentiality and focusing on professional growth
B. Ensuring that all feedback is anonymous
C. Comparing the colleague's performance to that of other nurses
D. Reporting all deficiencies directly to the state board of nursing
Rationale: Peer review is designed to promote professional development
and quality improvement within a confidential framework. Confidentiality and a
growth-oriented focus are foundational. Anonymity (B) is not always required,
and comparison (C) is not the purpose of peer review. Reporting to the board (D)
is reserved for serious violations, not routine review.
, 8. According to Peplau's Interpersonal Relations Theory, which of the following is
the PRIMARY role of the PMHNP during the orientation phase?
A. Stranger
B. Resource person
C. Counselor
D. Teacher
Rationale: In Peplau's theory, the nurse assumes multiple roles
throughout the therapeutic relationship. During the orientation phase, the
primary role is that of the "stranger," where the nurse establishes trust and learns
about the client. The roles of resource person, counselor, and teacher emerge in
later phases.
9. A client asks the PMHNP why the therapist does not voice personal opinions
about the patient's decision to divorce. What is the MOST appropriate
explanation?
A. "Therapy is about your choices, not mine; my role is to help you explore your
own values."
B. "Therapists are not allowed to have opinions."
C. "I don't know enough about your marriage to have an opinion."
D. "You should do whatever makes you happiest."
Rationale: Maintaining therapeutic neutrality allows clients to explore
their own values, feelings, and decisions without imposition of the therapist's
beliefs. Option A articulates this principle clearly. Option B is inaccurate. Option C
deflects the question. Option D offers advice, which is not therapeutic neutrality.
10. Which of the following are considered nontherapeutic communication
techniques? Select all that apply.
A. Giving false reassurance
B. Asking "why" questions
C. Active listening
Health Across the Lifespan I Practicum
SECTION I: FOUNDATIONAL CONCEPTS & THERAPEUTIC ALLIANCE (Questions 1–
25)
1. A 28-year-old client states, "I just feel like nobody understands what I'm going
through." Which response by the PMHNP best demonstrates the therapeutic
communication technique of reflection?
A. "Why do you think nobody understands you?"
B. "It sounds like you're feeling very isolated and alone right now."
C. "You shouldn't feel that way; your family cares about you."
D. "Have you tried talking to your friends about this?"
Rationale: Reflection involves restating the client's message in the
PMHNP's own words to convey understanding and encourage further expression.
Option B accurately mirrors the client's emotional content (isolation) without
introducing judgment or advice. Option A is a "why" question, which can feel
confrontational. Option C minimizes the client's feelings. Option D offers
unsolicited advice, which is nontherapeutic.
2. During the orientation phase of the therapeutic relationship, which action is
the PRIORITY for the PMHNP?
A. Establishing trust and defining the boundaries of the relationship
B. Challenging the client's maladaptive defense mechanisms
C. Interpreting unconscious conflicts from childhood
D. Terminating the relationship and summarizing progress
Rationale: Peplau's Interpersonal Relations Theory identifies the
orientation phase as the period when the nurse and client establish trust, identify
the client's needs, and clarify roles and boundaries. Challenging defenses (B) and
interpreting unconscious conflicts (C) occur in the working phase. Termination (D)
is the final phase.
,3. A client asks the PMHNP, "Have you ever experienced depression yourself?"
What is the MOST therapeutic response?
A. "Yes, I have, so I know exactly how you feel."
B. "That's not something I'm comfortable discussing."
C. "I'd like to focus on your experience and what brought you here today."
D. "Why are you asking me that question?"
Rationale: Self-disclosure should be limited and used only when it serves
the client's therapeutic interests. Redirecting the focus to the client maintains
appropriate boundaries and prioritizes the client's needs. Option A risks role
reversal and over-identification. Option B may feel dismissive. Option D can feel
defensive and may discourage further disclosure.
4. Which of the following are core processes of Acceptance and Commitment
Therapy (ACT)? Select all that apply.
A. Cognitive defusion
B. Acceptance
C. Contact with the present moment
D. Systematic desensitization
E. Values clarification
Rationale: ACT's six core processes are cognitive defusion, acceptance,
contact with the present moment, self-as-context, values, and committed action.
Systematic desensitization (D) is a behavioral technique associated with exposure
therapy, not ACT.
5. The PMHNP is meeting a new client for the first time. Which action best
establishes the therapeutic alliance?
A. Immediately reviewing the client's past psychiatric records in detail
B. Asking the client what they hope to achieve from treatment
C. Explaining the PMHNP's personal therapeutic philosophy
D. Administering a comprehensive battery of psychological tests
, Rationale: The therapeutic alliance is built on collaboration, trust, and
shared goal-setting. Asking about the client's goals demonstrates respect for the
client's perspective and begins the collaborative process. The other options are
either premature or provider-centered.
6. A client states, "I just can't seem to talk about what's bothering me." Which
therapeutic communication technique should the PMHNP use to encourage
elaboration without leading the conversation?
A. "Tell me more about that."
B. "You should try to open up more."
C. "Is it about your childhood?"
D. "Don't worry, you can trust me."
Rationale: "Tell me more about that" is a broad opening that invites the
client to elaborate without imposing direction. Option B is advice-giving. Option C
is leading and presumes the content. Option D offers false reassurance.
7. A PMHNP is conducting a 360-degree peer review to provide constructive
feedback to a psychiatric nurse colleague regarding clinical documentation and
patient interactions. Which principle of peer review is MOST important to
uphold?
A. Maintaining confidentiality and focusing on professional growth
B. Ensuring that all feedback is anonymous
C. Comparing the colleague's performance to that of other nurses
D. Reporting all deficiencies directly to the state board of nursing
Rationale: Peer review is designed to promote professional development
and quality improvement within a confidential framework. Confidentiality and a
growth-oriented focus are foundational. Anonymity (B) is not always required,
and comparison (C) is not the purpose of peer review. Reporting to the board (D)
is reserved for serious violations, not routine review.
, 8. According to Peplau's Interpersonal Relations Theory, which of the following is
the PRIMARY role of the PMHNP during the orientation phase?
A. Stranger
B. Resource person
C. Counselor
D. Teacher
Rationale: In Peplau's theory, the nurse assumes multiple roles
throughout the therapeutic relationship. During the orientation phase, the
primary role is that of the "stranger," where the nurse establishes trust and learns
about the client. The roles of resource person, counselor, and teacher emerge in
later phases.
9. A client asks the PMHNP why the therapist does not voice personal opinions
about the patient's decision to divorce. What is the MOST appropriate
explanation?
A. "Therapy is about your choices, not mine; my role is to help you explore your
own values."
B. "Therapists are not allowed to have opinions."
C. "I don't know enough about your marriage to have an opinion."
D. "You should do whatever makes you happiest."
Rationale: Maintaining therapeutic neutrality allows clients to explore
their own values, feelings, and decisions without imposition of the therapist's
beliefs. Option A articulates this principle clearly. Option B is inaccurate. Option C
deflects the question. Option D offers advice, which is not therapeutic neutrality.
10. Which of the following are considered nontherapeutic communication
techniques? Select all that apply.
A. Giving false reassurance
B. Asking "why" questions
C. Active listening
