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NSG 526 Exam 1: Questions & Answers 2026/2027
Comprehensive Exam for Psychiatric-Mental
Health Nurse Practitioner Students.
DOMAIN 1: THEORETICAL FRAMEWORKS & HUMAN DEVELOPMENT (14 Questions)
Question 1 (Multiple-Choice)
A 28-year-old patient with schizophrenia is admitted to the inpatient psychiatric unit. During the
first meeting, the PMHNP introduces herself, explains her role, discusses confidentiality, and
collaboratively establishes treatment goals with the patient. According to Peplau's Theory of
Interpersonal Relations, which phase of the nurse-patient relationship is being demonstrated?
A. Working phase B. Termination phase C. Orientation phase [CORRECT] D. Resolution phase
Rationale: The Orientation phase is the first meeting between the nurse and the patient, where
roles are clarified, trust is established, and treatment goals are collaboratively set. This phase
involves the nurse introducing herself, explaining her professional role, discussing confidentiality
parameters, and working with the patient to establish mutual treatment goals. The patient in
this vignette is experiencing the initial encounter characteristic of the Orientation phase.
Question 2 (Multiple-Choice)
A patient with borderline personality disorder has been working with a PMHNP for six months.
The patient recently began testing boundaries, expressing both idealization and devaluation
toward the nurse, and exploring deeper emotional issues related to childhood trauma.
According to Peplau's Theory of Interpersonal Relations, which phase is this patient most likely
experiencing?
A. Orientation phase B. Working phase [CORRECT] C. Termination phase D. Resolution phase
Rationale: The Working phase is characterized by the patient testing the relationship, exploring
deeper issues, and experiencing transference reactions such as idealization and devaluation.
This phase involves the most intensive therapeutic work, where the patient examines problems,
develops insight, and works through emotional conflicts. The six-month duration and the
described therapeutic dynamics are hallmarks of the Working phase.
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Question 3 (SATA)
Which of the following nursing actions are consistent with the Termination phase of Peplau's
Theory of Interpersonal Relations? Select all that apply.
A. The nurse facilitates the patient's transfer of learning to other relationships [CORRECT] B. The
nurse introduces herself and explains her professional role C. The nurse discusses the ending of
the therapeutic relationship and processes feelings of loss [CORRECT] D. The nurse helps the
patient generalize problem-solving skills to future situations [CORRECT] E. The nurse establishes
initial trust and confidentiality parameters
Rationale: The Termination phase involves the planned ending of the therapeutic relationship.
Key nursing actions include: (A) facilitating the transfer of learning to other relationships, which
helps the patient apply therapeutic gains beyond the nurse-patient relationship; (C) discussing
the ending of the relationship and processing feelings of loss, which is essential for healthy
termination; and (D) helping the patient generalize problem-solving skills to future situations,
promoting continued growth after termination. Options B and E describe Orientation phase
activities.
Question 4 (Multiple-Choice)
A 45-year-old male patient with paranoid schizophrenia accuses the PMHNP of "trying to poison
me with those medications." During the team meeting, the nurse reports that the patient
stated, "I know you're all plotting against me. You're the ones who are dangerous, not me."
Which Freudian defense mechanism is this patient demonstrating?
A. Displacement B. Projection [CORRECT] C. Denial D. Sublimation
Rationale: Projection is a primitive defense mechanism where the patient unconsciously
attributes their own unacceptable angry or hostile impulses onto another person—in this case,
the PMHNP and treatment team. The patient, who may be experiencing paranoid ideation and
hostility, externalizes these feelings by accusing others of the very thoughts and intentions he
himself harbors. This is distinct from displacement, which involves redirecting emotions from
the original source to a safer target.
Question 5 (Multiple-Choice)
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A 32-year-old patient with major depressive disorder becomes angry with her husband after he
forgets their anniversary. Later that day, she yells at the PMHNP for "being late" to their session
(the nurse was actually on time). Which Freudian defense mechanism is this patient
demonstrating?
A. Projection B. Displacement [CORRECT] C. Reaction formation D. Rationalization
Rationale: Displacement involves redirecting an emotional response from the original source to
a less threatening or safer target. In this vignette, the patient is angry with her husband (the
original source) but redirects that anger toward the PMHNP (a safer target), who was not
actually at fault. This differs from projection, where the patient would attribute her own anger
to the nurse (e.g., accusing the nurse of being angry with her).
Question 6 (Multiple-Choice)
During a group therapy session, a patient with antisocial personality disorder states, "Everyone
in this group is so hostile and aggressive. I can feel the anger radiating from all of you." Other
group members appear calm and are discussing coping strategies. Which Freudian defense
mechanism is this patient most likely demonstrating?
A. Displacement B. Projection [CORRECT] C. Regression D. Intellectualization
Rationale: The patient is demonstrating projection by attributing his own hostile and aggressive
feelings to the other group members. Despite the calm demeanor of the group, the patient
perceives hostility in others that actually originates from within himself. This unconscious
attribution of his own unacceptable impulses onto others is the hallmark of projection,
distinguishing it from displacement, which would involve redirecting his aggression to a
different, safer target.
Question 7 (SATA)
A PMHNP is caring for a patient who frequently accuses staff members of being "judgmental,"
"angry," and "critical" despite receiving compassionate, nonjudgmental care. The patient also
reports that "everyone is out to get me." Which of the following statements accurately describe
the defense mechanism of projection? Select all that apply.
A. The patient unconsciously attributes their own unacceptable feelings to others [CORRECT] B.
The patient redirects emotions from the original source to a safer target C. The patient
attributes their own hostile impulses onto the nurse [CORRECT] D. The patient is aware that
NSG 526 Exam 1: Questions & Answers 2026/2027
Comprehensive Exam for Psychiatric-Mental
Health Nurse Practitioner Students.
DOMAIN 1: THEORETICAL FRAMEWORKS & HUMAN DEVELOPMENT (14 Questions)
Question 1 (Multiple-Choice)
A 28-year-old patient with schizophrenia is admitted to the inpatient psychiatric unit. During the
first meeting, the PMHNP introduces herself, explains her role, discusses confidentiality, and
collaboratively establishes treatment goals with the patient. According to Peplau's Theory of
Interpersonal Relations, which phase of the nurse-patient relationship is being demonstrated?
A. Working phase B. Termination phase C. Orientation phase [CORRECT] D. Resolution phase
Rationale: The Orientation phase is the first meeting between the nurse and the patient, where
roles are clarified, trust is established, and treatment goals are collaboratively set. This phase
involves the nurse introducing herself, explaining her professional role, discussing confidentiality
parameters, and working with the patient to establish mutual treatment goals. The patient in
this vignette is experiencing the initial encounter characteristic of the Orientation phase.
Question 2 (Multiple-Choice)
A patient with borderline personality disorder has been working with a PMHNP for six months.
The patient recently began testing boundaries, expressing both idealization and devaluation
toward the nurse, and exploring deeper emotional issues related to childhood trauma.
According to Peplau's Theory of Interpersonal Relations, which phase is this patient most likely
experiencing?
A. Orientation phase B. Working phase [CORRECT] C. Termination phase D. Resolution phase
Rationale: The Working phase is characterized by the patient testing the relationship, exploring
deeper issues, and experiencing transference reactions such as idealization and devaluation.
This phase involves the most intensive therapeutic work, where the patient examines problems,
develops insight, and works through emotional conflicts. The six-month duration and the
described therapeutic dynamics are hallmarks of the Working phase.
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Question 3 (SATA)
Which of the following nursing actions are consistent with the Termination phase of Peplau's
Theory of Interpersonal Relations? Select all that apply.
A. The nurse facilitates the patient's transfer of learning to other relationships [CORRECT] B. The
nurse introduces herself and explains her professional role C. The nurse discusses the ending of
the therapeutic relationship and processes feelings of loss [CORRECT] D. The nurse helps the
patient generalize problem-solving skills to future situations [CORRECT] E. The nurse establishes
initial trust and confidentiality parameters
Rationale: The Termination phase involves the planned ending of the therapeutic relationship.
Key nursing actions include: (A) facilitating the transfer of learning to other relationships, which
helps the patient apply therapeutic gains beyond the nurse-patient relationship; (C) discussing
the ending of the relationship and processing feelings of loss, which is essential for healthy
termination; and (D) helping the patient generalize problem-solving skills to future situations,
promoting continued growth after termination. Options B and E describe Orientation phase
activities.
Question 4 (Multiple-Choice)
A 45-year-old male patient with paranoid schizophrenia accuses the PMHNP of "trying to poison
me with those medications." During the team meeting, the nurse reports that the patient
stated, "I know you're all plotting against me. You're the ones who are dangerous, not me."
Which Freudian defense mechanism is this patient demonstrating?
A. Displacement B. Projection [CORRECT] C. Denial D. Sublimation
Rationale: Projection is a primitive defense mechanism where the patient unconsciously
attributes their own unacceptable angry or hostile impulses onto another person—in this case,
the PMHNP and treatment team. The patient, who may be experiencing paranoid ideation and
hostility, externalizes these feelings by accusing others of the very thoughts and intentions he
himself harbors. This is distinct from displacement, which involves redirecting emotions from
the original source to a safer target.
Question 5 (Multiple-Choice)
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A 32-year-old patient with major depressive disorder becomes angry with her husband after he
forgets their anniversary. Later that day, she yells at the PMHNP for "being late" to their session
(the nurse was actually on time). Which Freudian defense mechanism is this patient
demonstrating?
A. Projection B. Displacement [CORRECT] C. Reaction formation D. Rationalization
Rationale: Displacement involves redirecting an emotional response from the original source to
a less threatening or safer target. In this vignette, the patient is angry with her husband (the
original source) but redirects that anger toward the PMHNP (a safer target), who was not
actually at fault. This differs from projection, where the patient would attribute her own anger
to the nurse (e.g., accusing the nurse of being angry with her).
Question 6 (Multiple-Choice)
During a group therapy session, a patient with antisocial personality disorder states, "Everyone
in this group is so hostile and aggressive. I can feel the anger radiating from all of you." Other
group members appear calm and are discussing coping strategies. Which Freudian defense
mechanism is this patient most likely demonstrating?
A. Displacement B. Projection [CORRECT] C. Regression D. Intellectualization
Rationale: The patient is demonstrating projection by attributing his own hostile and aggressive
feelings to the other group members. Despite the calm demeanor of the group, the patient
perceives hostility in others that actually originates from within himself. This unconscious
attribution of his own unacceptable impulses onto others is the hallmark of projection,
distinguishing it from displacement, which would involve redirecting his aggression to a
different, safer target.
Question 7 (SATA)
A PMHNP is caring for a patient who frequently accuses staff members of being "judgmental,"
"angry," and "critical" despite receiving compassionate, nonjudgmental care. The patient also
reports that "everyone is out to get me." Which of the following statements accurately describe
the defense mechanism of projection? Select all that apply.
A. The patient unconsciously attributes their own unacceptable feelings to others [CORRECT] B.
The patient redirects emotions from the original source to a safer target C. The patient
attributes their own hostile impulses onto the nurse [CORRECT] D. The patient is aware that
