NRNP 6645 Final Exam 2026/2027 | Psychotherapy with
Multiple Modalities | Walden University PMHNP Study Guide
& Practice Test | NRNP 6645 Exam Questions, CBT, DBT,
Psychodynamic, Family & Group Therapy
Question 1: A 34-year-old patient with major depressive disorder tells the
PMHNP, "You actually listen to me instead of just pushing pills." Which element
of Bordin's therapeutic alliance is the patient most directly describing?
A. The agreed-upon goals of treatment
B. The structured tasks and homework assigned each week
C. The affective bond of trust and feeling understood
D. The pharmacologic management of symptoms
E. The therapist's adherence to session time limits
CORRECT ANSWER: C. The affective bond of trust and feeling understood
Rationale: Bordin's therapeutic alliance consists of bond, goals, and tasks. The
patient's statement that the therapist listens reflects the affective bond of trust
and feeling understood. Goals refer to what the pair agrees to accomplish, tasks
refer to what they do, and pharmacologic management is outside the alliance
construct .
Question 2: A PMHNP candidate asks why the therapist does not voice personal
opinions about a patient's decision to divorce. Which component of the
therapeutic frame is this practice primarily preserving?
A. Anonymity, which requires the therapist to hide credentials
B. Neutrality, which keeps the therapist from imposing values
C. Non-intrusiveness, which forbids direct questions
D. Confidentiality, which prevents disclosure to third parties
E. Competence, which ensures proper licensure
CORRECT ANSWER: B. Neutrality, which keeps the therapist from imposing
values
Rationale: Neutrality means the therapist refrains from imposing personal values
or taking sides, allowing the patient's own meaning to emerge. Anonymity
concerns limiting personal self-disclosure rather than hiding credentials, non-
intrusiveness does not forbid all direct questions, and confidentiality governs
outside disclosure .
,Question 3: During the final month of a 16-week course of psychotherapy, a
patient brings gifts, misses a session, and says, "I guess I never really needed
this anyway." The PMHNP recognizes these behaviors as most characteristic of
which phase?
A. The initial phase, when the frame is being established
B. The working phase, when core conflicts are interpreted
C. The termination phase, when loss and autonomy are negotiated
D. The pretreatment engagement phase
E. The assessment phase, when diagnosis is formulated
CORRECT ANSWER: C. The termination phase, when loss and autonomy are
negotiated
Rationale: Bringing gifts, missed sessions, and devaluing the work are classic signs
of the termination phase, in which the patient negotiates loss, separation, and
growing autonomy. These are not initial-phase frame-setting or working-phase
conflict interpretation .
Question 4: According to Benner's model of skill acquisition, a PMHNP who can
no longer articulate explicit rules but intuitively reads a suicidal patient's subtle
shifts in risk is functioning at which level?
A. Novice
B. Advanced beginner
C. Competent
D. Proficient
E. Expert
CORRECT ANSWER: E. Expert
Rationale: Benner's expert operates from a deep intuitive grasp of the situation,
having moved past reliance on explicit rules and principles. The novice follows
rigid rules, the advanced beginner uses guidelines but lacks prioritization, and the
competent clinician consciously plans using rules .
Question 5: A patient with panic disorder asks whether therapy can help "if the
problem is really just a chemical imbalance." A psychosocial framework would
respond that:
,A. Meaning, relationships, and learned patterns are central to understanding and
changing symptoms
B. Symptoms are purely biochemical and require medication alone
C. The therapist should defer entirely to the prescribing provider
D. Psychosocial factors are irrelevant once a biological diagnosis is made
E. Only genetic factors determine treatment response
CORRECT ANSWER: A. Meaning, relationships, and learned patterns are central
to understanding and changing symptoms
Rationale: A psychosocial framework recognizes that meaning, relationships, and
learned patterns of responding are central to understanding and changing
symptoms, alongside biological factors. This does not negate biology but
integrates it with psychological and social dimensions .
Question 6: A 28-year-old patient reports feeling "stuck" and unable to make
decisions about career and relationships. The therapist uses reflection and
validation and helps the patient explore values and what gives life meaning.
This approach is most consistent with which therapeutic modality?
A. Cognitive Behavioral Therapy
B. Psychodynamic Therapy
C. Existential Therapy
D. Dialectical Behavior Therapy
E. Behavioral Activation
CORRECT ANSWER: C. Existential Therapy
Rationale: Existential therapy focuses on helping clients find meaning, embrace
freedom and responsibility, and confront existential anxieties. The exploration of
values and meaning-making is central to this approach. CBT focuses on thought
patterns, psychodynamic on unconscious conflicts, and DBT on emotion
regulation .
Question 7: A therapist notices that a patient consistently responds to the
therapist with anger and criticism, similar to how the patient responded to their
critical father. This phenomenon is best described as:
, A. Countertransference
B. Transference
C. Projection
D. Resistance
E. Sublimation
CORRECT ANSWER: B. Transference
Rationale: Transference occurs when a patient unconsciously projects feelings,
attitudes, and expectations from past relationships onto the therapist.
Countertransference refers to the therapist's emotional reactions to the patient.
Projection involves attributing one's own unacceptable feelings to others .
Question 8: Which of the following is considered a core condition of person-
centered therapy as described by Carl Rogers?
A. Interpretation of unconscious conflicts
B. Unconditional positive regard
C. Cognitive restructuring
D. Behavioral activation
E. Systematic desensitization
CORRECT ANSWER: B. Unconditional positive regard
Rationale: Carl Rogers identified three core conditions for therapeutic change:
unconditional positive regard, empathy, and congruence. Interpretation of
unconscious conflicts is associated with psychodynamic therapy, cognitive
restructuring with CBT, and behavioral activation with behavioral therapy .
Question 9: A PMHNP is facilitating a therapy group and notices that members
are beginning to challenge each other and express conflict openly. The group is
most likely in which stage of group development?
A. Forming
B. Storming
C. Norming
D. Performing
E. Adjourning
CORRECT ANSWER: B. Storming
Multiple Modalities | Walden University PMHNP Study Guide
& Practice Test | NRNP 6645 Exam Questions, CBT, DBT,
Psychodynamic, Family & Group Therapy
Question 1: A 34-year-old patient with major depressive disorder tells the
PMHNP, "You actually listen to me instead of just pushing pills." Which element
of Bordin's therapeutic alliance is the patient most directly describing?
A. The agreed-upon goals of treatment
B. The structured tasks and homework assigned each week
C. The affective bond of trust and feeling understood
D. The pharmacologic management of symptoms
E. The therapist's adherence to session time limits
CORRECT ANSWER: C. The affective bond of trust and feeling understood
Rationale: Bordin's therapeutic alliance consists of bond, goals, and tasks. The
patient's statement that the therapist listens reflects the affective bond of trust
and feeling understood. Goals refer to what the pair agrees to accomplish, tasks
refer to what they do, and pharmacologic management is outside the alliance
construct .
Question 2: A PMHNP candidate asks why the therapist does not voice personal
opinions about a patient's decision to divorce. Which component of the
therapeutic frame is this practice primarily preserving?
A. Anonymity, which requires the therapist to hide credentials
B. Neutrality, which keeps the therapist from imposing values
C. Non-intrusiveness, which forbids direct questions
D. Confidentiality, which prevents disclosure to third parties
E. Competence, which ensures proper licensure
CORRECT ANSWER: B. Neutrality, which keeps the therapist from imposing
values
Rationale: Neutrality means the therapist refrains from imposing personal values
or taking sides, allowing the patient's own meaning to emerge. Anonymity
concerns limiting personal self-disclosure rather than hiding credentials, non-
intrusiveness does not forbid all direct questions, and confidentiality governs
outside disclosure .
,Question 3: During the final month of a 16-week course of psychotherapy, a
patient brings gifts, misses a session, and says, "I guess I never really needed
this anyway." The PMHNP recognizes these behaviors as most characteristic of
which phase?
A. The initial phase, when the frame is being established
B. The working phase, when core conflicts are interpreted
C. The termination phase, when loss and autonomy are negotiated
D. The pretreatment engagement phase
E. The assessment phase, when diagnosis is formulated
CORRECT ANSWER: C. The termination phase, when loss and autonomy are
negotiated
Rationale: Bringing gifts, missed sessions, and devaluing the work are classic signs
of the termination phase, in which the patient negotiates loss, separation, and
growing autonomy. These are not initial-phase frame-setting or working-phase
conflict interpretation .
Question 4: According to Benner's model of skill acquisition, a PMHNP who can
no longer articulate explicit rules but intuitively reads a suicidal patient's subtle
shifts in risk is functioning at which level?
A. Novice
B. Advanced beginner
C. Competent
D. Proficient
E. Expert
CORRECT ANSWER: E. Expert
Rationale: Benner's expert operates from a deep intuitive grasp of the situation,
having moved past reliance on explicit rules and principles. The novice follows
rigid rules, the advanced beginner uses guidelines but lacks prioritization, and the
competent clinician consciously plans using rules .
Question 5: A patient with panic disorder asks whether therapy can help "if the
problem is really just a chemical imbalance." A psychosocial framework would
respond that:
,A. Meaning, relationships, and learned patterns are central to understanding and
changing symptoms
B. Symptoms are purely biochemical and require medication alone
C. The therapist should defer entirely to the prescribing provider
D. Psychosocial factors are irrelevant once a biological diagnosis is made
E. Only genetic factors determine treatment response
CORRECT ANSWER: A. Meaning, relationships, and learned patterns are central
to understanding and changing symptoms
Rationale: A psychosocial framework recognizes that meaning, relationships, and
learned patterns of responding are central to understanding and changing
symptoms, alongside biological factors. This does not negate biology but
integrates it with psychological and social dimensions .
Question 6: A 28-year-old patient reports feeling "stuck" and unable to make
decisions about career and relationships. The therapist uses reflection and
validation and helps the patient explore values and what gives life meaning.
This approach is most consistent with which therapeutic modality?
A. Cognitive Behavioral Therapy
B. Psychodynamic Therapy
C. Existential Therapy
D. Dialectical Behavior Therapy
E. Behavioral Activation
CORRECT ANSWER: C. Existential Therapy
Rationale: Existential therapy focuses on helping clients find meaning, embrace
freedom and responsibility, and confront existential anxieties. The exploration of
values and meaning-making is central to this approach. CBT focuses on thought
patterns, psychodynamic on unconscious conflicts, and DBT on emotion
regulation .
Question 7: A therapist notices that a patient consistently responds to the
therapist with anger and criticism, similar to how the patient responded to their
critical father. This phenomenon is best described as:
, A. Countertransference
B. Transference
C. Projection
D. Resistance
E. Sublimation
CORRECT ANSWER: B. Transference
Rationale: Transference occurs when a patient unconsciously projects feelings,
attitudes, and expectations from past relationships onto the therapist.
Countertransference refers to the therapist's emotional reactions to the patient.
Projection involves attributing one's own unacceptable feelings to others .
Question 8: Which of the following is considered a core condition of person-
centered therapy as described by Carl Rogers?
A. Interpretation of unconscious conflicts
B. Unconditional positive regard
C. Cognitive restructuring
D. Behavioral activation
E. Systematic desensitization
CORRECT ANSWER: B. Unconditional positive regard
Rationale: Carl Rogers identified three core conditions for therapeutic change:
unconditional positive regard, empathy, and congruence. Interpretation of
unconscious conflicts is associated with psychodynamic therapy, cognitive
restructuring with CBT, and behavioral activation with behavioral therapy .
Question 9: A PMHNP is facilitating a therapy group and notices that members
are beginning to challenge each other and express conflict openly. The group is
most likely in which stage of group development?
A. Forming
B. Storming
C. Norming
D. Performing
E. Adjourning
CORRECT ANSWER: B. Storming
