NRNP 6675 Week 6 Midterm Exam Questions and
Revised Correct Answers
() – 100 % Updated Version.
Graduate-level PMHNP psychotherapy & multimodal reasoning | 50 original
items.
Question 1:
A 24-year-old graduate student presents with excessive worry, muscle tension, and difficulty
concentrating for six months. She rates her anxiety as 7/10 daily. Which first-line CBT technique
best targets the cognitive component of generalized anxiety disorder?
A. Progressive muscle relaxation
B. Socratic questioning to examine probability over-estimation
C. In-vivo exposure to worry triggers
D. Scheduled “worry time” only
Correct Answer: B
Rationale: Socratic questioning challenges distorted probability estimates, directly addressing
pathological worry cognition. Progressive muscle relaxation (A) targets somatic symptoms, while
exposure (C) and worry time (D) are behavioral adjuncts.
Question 2:
During DBT skills group, a client with borderline personality disorder shouts, “This is stupid!”
and storms out after receiving feedback. The therapist follows the DBT consultation-to-the-
client model and:
A. Terminates the client from the program
B. Phones the client within 24 hours to conduct behavioral analysis
C. Immediately suspends group for safety
D. Labels the behavior as manipulative in the next session
Correct Answer: B
Rationale: DBT mandates therapist outreach after therapy-interfering behavior to conduct chain
analysis, reinforce skills, and maintain engagement. Termination (A) is premature; suspension
(C) disrupts milieu; labeling (D) is non-validating.
,Question 3:
A 35-year-old veteran with chronic pain states, “My mind is a battlefield.” During ACT, the
clinician asks him to notice thoughts non-judgmentally and choose values-based action. This
intervention targets which ACT core process?
A. Cognitive defusion
B. Committed action
C. Self-as-context
D. Willingness
Correct Answer: A
Rationale: Noticing thoughts without fusion exemplifies cognitive defusion, reducing literal
belief in painful cognitions. Committed action (B) follows defusion; self-as-context (C) is
observer stance; willingness (D) is openness to experience.
Question 4:
A 45-year-old woman with treatment-resistant depression begins psychodynamic therapy. She
arrives 15 minutes late and forgets homework. The therapist interprets this as unconscious
avoidance of dependency. This interpretation is grounded in which psychodynamic concept?
A. Transference
B. Resistance
C. Working alliance rupture
D. Projective identification
Correct Answer: B. Resistance
Rationale: Lateness and forgetting are behavioral expressions of resistance—unconscious
avoidance of therapeutic material. Transference (A) involves feelings toward therapist; rupture
(C) is alliance break; projective identification (D) is interpersonal defense.
Question 5:
A 19-year-old college athlete reports vaping cannabis daily to “turn off my brain.” Motivational
interviewing is initiated. Which clinician response best demonstrates reflective listening?
A. “You use cannabis to quiet mental noise.”
B. “Why don’t you just stop vaping?”
C. “Cannabis is harming your lungs.”
D. “Many students vape; it’s normal.”
, Correct Answer: A. “You use cannabis to quiet mental noise.”
Rationale: Reflection captures the client’s stated function without judgment, maintaining MI
spirit. Questioning (B), warning (C), or normalizing (D) evoke resistance.
Question 6:
A 28-year-old man with panic disorder fears heart attacks. CBT interoceptive exposure is
planned. The first session should:
A. Begin 30-second treadmill run in-office
B. Teach diaphragmatic breathing only
C. Provide psycho-education on panic physiology
D. Prescribe propranolol prophylaxis
Correct Answer: C. Provide psycho-education on panic physiology
Rationale: Psycho-education normalizes symptoms and prepares client for exposure. Immediate
treadmill (A) is unsafe without assessment; breathing only (B) is insufficient; medication (D) is
not first-line CBT.
Question 7:
During family therapy for adolescent depression, parents repeatedly speak for the teen. The
therapist asks, “Whose voice is missing from this room?” This intervention targets which
systemic concept?
A. Triangulation
B. Hierarchy
C. Enmeshment
D. Boundary ambiguity
Correct Answer: C. Enmeshment
Rationale: Over-involvement and speaking for the teen reflect enmeshed boundaries.
Triangulation (A) involves third-party conflict; hierarchy (B) is parental authority; boundary
ambiguity (D) is role confusion.
Question 8:
A 32-year-old woman with PTSD avoids grocery stores after a robbery. During prolonged
exposure, the clinician constructs an in-vivo hierarchy. Session 1 should:
A. Begin imaginal exposure to robbery memory
B. Drive to grocery parking lot for 5 minutes
Revised Correct Answers
() – 100 % Updated Version.
Graduate-level PMHNP psychotherapy & multimodal reasoning | 50 original
items.
Question 1:
A 24-year-old graduate student presents with excessive worry, muscle tension, and difficulty
concentrating for six months. She rates her anxiety as 7/10 daily. Which first-line CBT technique
best targets the cognitive component of generalized anxiety disorder?
A. Progressive muscle relaxation
B. Socratic questioning to examine probability over-estimation
C. In-vivo exposure to worry triggers
D. Scheduled “worry time” only
Correct Answer: B
Rationale: Socratic questioning challenges distorted probability estimates, directly addressing
pathological worry cognition. Progressive muscle relaxation (A) targets somatic symptoms, while
exposure (C) and worry time (D) are behavioral adjuncts.
Question 2:
During DBT skills group, a client with borderline personality disorder shouts, “This is stupid!”
and storms out after receiving feedback. The therapist follows the DBT consultation-to-the-
client model and:
A. Terminates the client from the program
B. Phones the client within 24 hours to conduct behavioral analysis
C. Immediately suspends group for safety
D. Labels the behavior as manipulative in the next session
Correct Answer: B
Rationale: DBT mandates therapist outreach after therapy-interfering behavior to conduct chain
analysis, reinforce skills, and maintain engagement. Termination (A) is premature; suspension
(C) disrupts milieu; labeling (D) is non-validating.
,Question 3:
A 35-year-old veteran with chronic pain states, “My mind is a battlefield.” During ACT, the
clinician asks him to notice thoughts non-judgmentally and choose values-based action. This
intervention targets which ACT core process?
A. Cognitive defusion
B. Committed action
C. Self-as-context
D. Willingness
Correct Answer: A
Rationale: Noticing thoughts without fusion exemplifies cognitive defusion, reducing literal
belief in painful cognitions. Committed action (B) follows defusion; self-as-context (C) is
observer stance; willingness (D) is openness to experience.
Question 4:
A 45-year-old woman with treatment-resistant depression begins psychodynamic therapy. She
arrives 15 minutes late and forgets homework. The therapist interprets this as unconscious
avoidance of dependency. This interpretation is grounded in which psychodynamic concept?
A. Transference
B. Resistance
C. Working alliance rupture
D. Projective identification
Correct Answer: B. Resistance
Rationale: Lateness and forgetting are behavioral expressions of resistance—unconscious
avoidance of therapeutic material. Transference (A) involves feelings toward therapist; rupture
(C) is alliance break; projective identification (D) is interpersonal defense.
Question 5:
A 19-year-old college athlete reports vaping cannabis daily to “turn off my brain.” Motivational
interviewing is initiated. Which clinician response best demonstrates reflective listening?
A. “You use cannabis to quiet mental noise.”
B. “Why don’t you just stop vaping?”
C. “Cannabis is harming your lungs.”
D. “Many students vape; it’s normal.”
, Correct Answer: A. “You use cannabis to quiet mental noise.”
Rationale: Reflection captures the client’s stated function without judgment, maintaining MI
spirit. Questioning (B), warning (C), or normalizing (D) evoke resistance.
Question 6:
A 28-year-old man with panic disorder fears heart attacks. CBT interoceptive exposure is
planned. The first session should:
A. Begin 30-second treadmill run in-office
B. Teach diaphragmatic breathing only
C. Provide psycho-education on panic physiology
D. Prescribe propranolol prophylaxis
Correct Answer: C. Provide psycho-education on panic physiology
Rationale: Psycho-education normalizes symptoms and prepares client for exposure. Immediate
treadmill (A) is unsafe without assessment; breathing only (B) is insufficient; medication (D) is
not first-line CBT.
Question 7:
During family therapy for adolescent depression, parents repeatedly speak for the teen. The
therapist asks, “Whose voice is missing from this room?” This intervention targets which
systemic concept?
A. Triangulation
B. Hierarchy
C. Enmeshment
D. Boundary ambiguity
Correct Answer: C. Enmeshment
Rationale: Over-involvement and speaking for the teen reflect enmeshed boundaries.
Triangulation (A) involves third-party conflict; hierarchy (B) is parental authority; boundary
ambiguity (D) is role confusion.
Question 8:
A 32-year-old woman with PTSD avoids grocery stores after a robbery. During prolonged
exposure, the clinician constructs an in-vivo hierarchy. Session 1 should:
A. Begin imaginal exposure to robbery memory
B. Drive to grocery parking lot for 5 minutes
