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NRNP 6645
PSYCHOTHERAPY WITH MULTIPLE MODALITIES
FINAL EXAM – 3 VERSIONS
2026/2027 EDITION
300 Original Practice Questions | 3 Versions | Integrated Answers & Rationales
CBT • DBT • Psychodynamic • Family • Trauma-Informed Care
PMHNP • EVIDENCE-INFORMED PSYCHOTHERAPY • CLINICAL REASONING
• • • • • • • •
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• • • • • • • •
◆
• • • • • • • •
• • • • • • • • • 01 •
• • • • • • • •
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• • • • • • • •
• • • • • • • •
,NRNP 6645 | PSYCHOTHERAPY WITH MULTIPLE MODALITIES
Section 1: Brief Introduction
This 300-question NRNP 6645 practice exam presents three distinct 100-question forms in
psychotherapy with multiple modalities. Topic coverage draws on the ANCC PMHNP Test
Content Outline and selected clinical guidance, and includes psychotherapy foundations, CBT,
DBT, psychodynamic and humanistic approaches, family and group work, motivational
interviewing, trauma-informed care, crisis response, ethics, and lifespan applications. Each
original practice item has four answer choices followed by an integrated answer and rationale.
Section 2: Version A – Final Exam Questions (A1–A100)
Select the single best response. The correct option is highlighted and stated after each item, followed by a concise
rationale.
A1. A patient who has attended three sessions says, “You keep asking me to track my thoughts,
but it feels like you do not hear how exhausting my job is.” What is the therapist’s best next
response?
A. Interpret the complaint as resistance and continue with the planned CBT exercise.
B. End CBT and refer immediately for a different therapy without further discussion.
C. Acknowledge the mismatch, invite the patient’s view of what felt unhelpful, and
collaboratively reset the session agenda.
D. Explain that thought records are essential and ask the patient to complete one before the
next visit.
Answer: C. Acknowledge the mismatch, invite the patient’s view of what felt unhelpful, and
collaboratively reset the session agenda.
Rationale: A rupture is best addressed with curiosity, validation, and collaborative repair
before returning to technique; the patient’s feedback may reveal a needed adjustment in focus
or pacing. Norcross and Wampold emphasize responsiveness and the working alliance,
whereas labeling disagreement as resistance can deepen the rupture.
A2. At intake, a patient asks whether CBT or interpersonal psychotherapy is “the one right
treatment” for recurrent depression. Which response best supports evidence-based shared
decision-making?
A. Delay treatment until the patient can select a modality without any clinician input.
B. State that CBT is always superior and begin it without exploring the patient’s goals.
C. Offer whichever modality the clinician most enjoys, because therapist preference predicts
outcome.
D. Compare suitable evidence-based options, likely goals and burdens, and the patient’s
preferences, then choose a plan together.
Answer: D. Compare suitable evidence-based options, likely goals and burdens, and the
patient’s preferences, then choose a plan together.
Rationale: Evidence-based practice integrates research, clinical expertise, patient
characteristics, and informed preference rather than declaring one universal modality. The
ANCC PMHNP outline and psychotherapy relationship research support a collaborative
treatment plan; therapist preference alone or unsupported claims of universal superiority do
not.
NRNP 6645 • 2026/2027 | Page 2
,NRNP 6645 | PSYCHOTHERAPY WITH MULTIPLE MODALITIES
A3. A patient’s PHQ-9 score falls from 18 to 16 after four CBT sessions, while the patient reports
no meaningful improvement and increasing hopelessness. What is the best action?
A. Discharge the patient because the score has improved by two points.
B. Continue the exact plan for several months because a lower score proves the treatment is
working.
C. Increase the frequency of thought records without reviewing the patient’s feedback.
D. Review the score and the patient’s experience together, reassess safety and barriers,
and collaboratively revise the formulation or treatment plan.
Answer: D. Review the score and the patient’s experience together, reassess safety and
barriers, and collaboratively revise the formulation or treatment plan.
Rationale: Measurement-based care uses scores as one source of information, not a
replacement for clinical interview, suicide-risk reassessment, or shared decision-making.
Beck’s collaborative empiricism supports revisiting the case formulation when progress is
limited; a small score change alone does not establish response.
A4. Before beginning exposure therapy, a patient asks whether the clinician may deliberately
provoke anxiety and whether the patient can pause. Which response best reflects informed
consent?
A. Explain the rationale, expected distress, alternatives, risks, and the patient’s control
over pacing, then confirm understanding and consent.
B. Avoid discussing distress so the patient does not become more anxious.
C. Obtain a general signature and proceed because exposure is a standard treatment.
D. Say that exposure works only when the patient agrees to complete every exercise without
stopping.
Answer: A. Explain the rationale, expected distress, alternatives, risks, and the patient’s
control over pacing, then confirm understanding and consent.
Rationale: Informed consent is an ongoing discussion of the intervention, expected discomfort,
alternatives, and the patient’s right to participate in decisions. CBT exposure is collaborative
and graded; minimizing risk or framing consent as a one-time form undermines autonomy and
alliance.
A5. A patient with depression says, “I made a mistake at work, so I am a complete failure.”
Which CBT response most directly uses collaborative empiricism?
A. Ask what evidence supports and does not support the conclusion and develop a more
balanced interpretation together.
B. Reassure the patient that the mistake will not matter and change the subject.
C. Tell the patient the thought is irrational and replace it with a positive affirmation.
D. Ask the patient to avoid thinking about work until mood improves.
Answer: A. Ask what evidence supports and does not support the conclusion and develop a
more balanced interpretation together.
Rationale: Collaborative empiricism tests the meaning and evidence of an automatic thought
rather than arguing with or suppressing it. Beck’s CBT model favors guided discovery and a
balanced alternative over forced positivity or reassurance.
NRNP 6645 • 2026/2027 | Page 3
, NRNP 6645 | PSYCHOTHERAPY WITH MULTIPLE MODALITIES
A6. During a CBT session, a patient says, “If I ask a question in class, everyone will think I am
stupid.” What should the therapist first help the patient identify?
A. A childhood event that must have caused the belief.
B. A personality disorder that explains the statement.
C. The specific automatic prediction and the situation that triggers it.
D. A coping skill to use without clarifying the thought or context.
Answer: C. The specific automatic prediction and the situation that triggers it.
Rationale: CBT begins by linking a situation with the person’s automatic thoughts, emotions,
bodily responses, and behavior so the target is concrete and testable. Beck’s cognitive
formulation does not require an immediate childhood interpretation or diagnostic label.
A7. A patient with social anxiety predicts that asking a coworker to lunch will lead to rejection.
Which intervention is the clearest behavioral experiment?
A. Have the patient specify the prediction, make a manageable invitation, and record
what actually happens and what is learned.
B. Ask the patient to wait until confidence is high before inviting anyone.
C. Tell the patient that coworkers usually accept invitations and therefore the prediction is
false.
D. Have the patient repeat a reassuring statement until the anxiety disappears.
Answer: A. Have the patient specify the prediction, make a manageable invitation, and
record what actually happens and what is learned.
Rationale: A behavioral experiment tests a stated prediction through an observable action
and then reviews the outcome, including learning that may not eliminate anxiety. CBT uses
experience as evidence; reassurance and waiting for certainty can preserve avoidance.
A8. A patient with major depression has stopped cooking, seeing friends, and walking the dog.
Which initial behavioral-activation assignment is most appropriate?
A. Wait for motivation to return before planning any activity.
B. Require the patient to resume every previous activity this week to break the depressive
cycle.
C. Focus only on disputing negative thoughts because activity planning is not CBT.
D. Collaboratively schedule one small, meaningful activity and monitor both completion
and mood or mastery.
Answer: D. Collaboratively schedule one small, meaningful activity and monitor both
completion and mood or mastery.
Rationale: Behavioral activation uses graded, values- or reinforcement-linked activity
scheduling and tracks behavior and mood to reverse withdrawal. Beck’s CBT framework
supports manageable tasks, whereas overwhelming demands or waiting for motivation can
reinforce inactivity.
NRNP 6645 • 2026/2027 | Page 4
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╲╲╲╲╲╲╲╲╲
NRNP 6645
PSYCHOTHERAPY WITH MULTIPLE MODALITIES
FINAL EXAM – 3 VERSIONS
2026/2027 EDITION
300 Original Practice Questions | 3 Versions | Integrated Answers & Rationales
CBT • DBT • Psychodynamic • Family • Trauma-Informed Care
PMHNP • EVIDENCE-INFORMED PSYCHOTHERAPY • CLINICAL REASONING
• • • • • • • •
◆
• • • • • • • •
◆
• • • • • • • •
• • • • • • • • • 01 •
• • • • • • • •
◆
• • • • • • • •
• • • • • • • •
,NRNP 6645 | PSYCHOTHERAPY WITH MULTIPLE MODALITIES
Section 1: Brief Introduction
This 300-question NRNP 6645 practice exam presents three distinct 100-question forms in
psychotherapy with multiple modalities. Topic coverage draws on the ANCC PMHNP Test
Content Outline and selected clinical guidance, and includes psychotherapy foundations, CBT,
DBT, psychodynamic and humanistic approaches, family and group work, motivational
interviewing, trauma-informed care, crisis response, ethics, and lifespan applications. Each
original practice item has four answer choices followed by an integrated answer and rationale.
Section 2: Version A – Final Exam Questions (A1–A100)
Select the single best response. The correct option is highlighted and stated after each item, followed by a concise
rationale.
A1. A patient who has attended three sessions says, “You keep asking me to track my thoughts,
but it feels like you do not hear how exhausting my job is.” What is the therapist’s best next
response?
A. Interpret the complaint as resistance and continue with the planned CBT exercise.
B. End CBT and refer immediately for a different therapy without further discussion.
C. Acknowledge the mismatch, invite the patient’s view of what felt unhelpful, and
collaboratively reset the session agenda.
D. Explain that thought records are essential and ask the patient to complete one before the
next visit.
Answer: C. Acknowledge the mismatch, invite the patient’s view of what felt unhelpful, and
collaboratively reset the session agenda.
Rationale: A rupture is best addressed with curiosity, validation, and collaborative repair
before returning to technique; the patient’s feedback may reveal a needed adjustment in focus
or pacing. Norcross and Wampold emphasize responsiveness and the working alliance,
whereas labeling disagreement as resistance can deepen the rupture.
A2. At intake, a patient asks whether CBT or interpersonal psychotherapy is “the one right
treatment” for recurrent depression. Which response best supports evidence-based shared
decision-making?
A. Delay treatment until the patient can select a modality without any clinician input.
B. State that CBT is always superior and begin it without exploring the patient’s goals.
C. Offer whichever modality the clinician most enjoys, because therapist preference predicts
outcome.
D. Compare suitable evidence-based options, likely goals and burdens, and the patient’s
preferences, then choose a plan together.
Answer: D. Compare suitable evidence-based options, likely goals and burdens, and the
patient’s preferences, then choose a plan together.
Rationale: Evidence-based practice integrates research, clinical expertise, patient
characteristics, and informed preference rather than declaring one universal modality. The
ANCC PMHNP outline and psychotherapy relationship research support a collaborative
treatment plan; therapist preference alone or unsupported claims of universal superiority do
not.
NRNP 6645 • 2026/2027 | Page 2
,NRNP 6645 | PSYCHOTHERAPY WITH MULTIPLE MODALITIES
A3. A patient’s PHQ-9 score falls from 18 to 16 after four CBT sessions, while the patient reports
no meaningful improvement and increasing hopelessness. What is the best action?
A. Discharge the patient because the score has improved by two points.
B. Continue the exact plan for several months because a lower score proves the treatment is
working.
C. Increase the frequency of thought records without reviewing the patient’s feedback.
D. Review the score and the patient’s experience together, reassess safety and barriers,
and collaboratively revise the formulation or treatment plan.
Answer: D. Review the score and the patient’s experience together, reassess safety and
barriers, and collaboratively revise the formulation or treatment plan.
Rationale: Measurement-based care uses scores as one source of information, not a
replacement for clinical interview, suicide-risk reassessment, or shared decision-making.
Beck’s collaborative empiricism supports revisiting the case formulation when progress is
limited; a small score change alone does not establish response.
A4. Before beginning exposure therapy, a patient asks whether the clinician may deliberately
provoke anxiety and whether the patient can pause. Which response best reflects informed
consent?
A. Explain the rationale, expected distress, alternatives, risks, and the patient’s control
over pacing, then confirm understanding and consent.
B. Avoid discussing distress so the patient does not become more anxious.
C. Obtain a general signature and proceed because exposure is a standard treatment.
D. Say that exposure works only when the patient agrees to complete every exercise without
stopping.
Answer: A. Explain the rationale, expected distress, alternatives, risks, and the patient’s
control over pacing, then confirm understanding and consent.
Rationale: Informed consent is an ongoing discussion of the intervention, expected discomfort,
alternatives, and the patient’s right to participate in decisions. CBT exposure is collaborative
and graded; minimizing risk or framing consent as a one-time form undermines autonomy and
alliance.
A5. A patient with depression says, “I made a mistake at work, so I am a complete failure.”
Which CBT response most directly uses collaborative empiricism?
A. Ask what evidence supports and does not support the conclusion and develop a more
balanced interpretation together.
B. Reassure the patient that the mistake will not matter and change the subject.
C. Tell the patient the thought is irrational and replace it with a positive affirmation.
D. Ask the patient to avoid thinking about work until mood improves.
Answer: A. Ask what evidence supports and does not support the conclusion and develop a
more balanced interpretation together.
Rationale: Collaborative empiricism tests the meaning and evidence of an automatic thought
rather than arguing with or suppressing it. Beck’s CBT model favors guided discovery and a
balanced alternative over forced positivity or reassurance.
NRNP 6645 • 2026/2027 | Page 3
, NRNP 6645 | PSYCHOTHERAPY WITH MULTIPLE MODALITIES
A6. During a CBT session, a patient says, “If I ask a question in class, everyone will think I am
stupid.” What should the therapist first help the patient identify?
A. A childhood event that must have caused the belief.
B. A personality disorder that explains the statement.
C. The specific automatic prediction and the situation that triggers it.
D. A coping skill to use without clarifying the thought or context.
Answer: C. The specific automatic prediction and the situation that triggers it.
Rationale: CBT begins by linking a situation with the person’s automatic thoughts, emotions,
bodily responses, and behavior so the target is concrete and testable. Beck’s cognitive
formulation does not require an immediate childhood interpretation or diagnostic label.
A7. A patient with social anxiety predicts that asking a coworker to lunch will lead to rejection.
Which intervention is the clearest behavioral experiment?
A. Have the patient specify the prediction, make a manageable invitation, and record
what actually happens and what is learned.
B. Ask the patient to wait until confidence is high before inviting anyone.
C. Tell the patient that coworkers usually accept invitations and therefore the prediction is
false.
D. Have the patient repeat a reassuring statement until the anxiety disappears.
Answer: A. Have the patient specify the prediction, make a manageable invitation, and
record what actually happens and what is learned.
Rationale: A behavioral experiment tests a stated prediction through an observable action
and then reviews the outcome, including learning that may not eliminate anxiety. CBT uses
experience as evidence; reassurance and waiting for certainty can preserve avoidance.
A8. A patient with major depression has stopped cooking, seeing friends, and walking the dog.
Which initial behavioral-activation assignment is most appropriate?
A. Wait for motivation to return before planning any activity.
B. Require the patient to resume every previous activity this week to break the depressive
cycle.
C. Focus only on disputing negative thoughts because activity planning is not CBT.
D. Collaboratively schedule one small, meaningful activity and monitor both completion
and mood or mastery.
Answer: D. Collaboratively schedule one small, meaningful activity and monitor both
completion and mood or mastery.
Rationale: Behavioral activation uses graded, values- or reinforcement-linked activity
scheduling and tracks behavior and mood to reverse withdrawal. Beck’s CBT framework
supports manageable tasks, whereas overwhelming demands or waiting for motivation can
reinforce inactivity.
NRNP 6645 • 2026/2027 | Page 4
