PSYCHOTHERAPY FOR THE ADVANCED
PRACTICE PSYCHIATRIC NURSE
A HOW-TO GUIDE FOR EVIDENCE-BASED
PRACTICE
3RD EDITION
• AUTHOR(S)KATHLEEN WHEELER
TEST BANK
1
Reference
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
Stem
A 34-year-old woman with recurrent major depression presents
for an initial psychotherapy session with you, a PMHNP who will
integrate medication management and psychotherapy. She is
guarded, asks whether you will "fix" her quickly, and wants to
,know what role you will play. What is the most appropriate
opening therapeutic action to establish a collaborative
framework while managing expectations?
A. Offer a brief timeline of expected symptom reduction and
promise close follow-up medication adjustments.
B. Explain your dual role (prescriber and psychotherapist),
outline boundaries and informed consent, and invite her goals
for therapy.
C. Defer discussion about roles until after a full diagnostic
assessment to avoid influencing her expectations.
D. Emphasize that psychotherapy will be the primary treatment
and that medication is secondary.
Correct answer
B
Rationales
Correct (B): Explicitly stating your dual role, discussing
boundaries and informed consent, and eliciting the client's
goals establishes clarity, respects autonomy, and fosters
therapeutic alliance consistent with Wheeler’s framework for
nurse psychotherapists integrating care. This balances
transparency with collaborative treatment planning.
Incorrect (A): Promising a timeline and focusing narrowly on
medication may create unrealistic expectations and undermine
the therapeutic alliance when change does not follow the
promised timeline.
Incorrect (C): Deferring role clarification risks early confusion
,and may impede trust; brief role-setting is ethically and
clinically appropriate at the outset.
Incorrect (D): Prioritizing one modality prescriptively without
negotiation ignores the client’s preferences and the integrated
scope of PMHNP practice.
Teaching Point
State your roles, boundaries, and jointly set goals at the first
session.
Citation
Wheeler, K. (2023). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 1.
2
Reference
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
Stem
During early sessions a client repeatedly brings material about
past trauma but resists focused trauma processing. As the nurse
psychotherapist, how should you prioritize interventions to be
trauma-informed, maintain safety, and progress treatment?
A. Begin targeted trauma processing because exposure yields
faster symptom reduction.
B. Focus first on stabilization, grounding, and building coping
skills while monitoring readiness for trauma work.
, C. Refer immediately to a trauma specialist and discontinue
psychotherapy to avoid harm.
D. Encourage the client to recount the trauma fully in session to
desensitize them.
Correct answer
B
Rationales
Correct (B): A trauma-informed framework emphasizes safety,
stabilization, and skill building before trauma processing; this
aligns with Wheeler’s recommendations for pacing
interventions according to client readiness and safety.
Incorrect (A): Immediate exposure can retraumatize when
stabilization is insufficient; timing matters.
Incorrect (C): Automatic referral may fragment care; the
PMHNP can continue to provide stabilization and collaborative
referral if specialized trauma processing is indicated.
Incorrect (D): Unstructured pushing to recount can harm the
alliance and increase dysregulation.
Teaching Point
Prioritize stabilization and readiness before trauma-focused
interventions.
Citation
Wheeler, K. (2023). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 1.
PRACTICE PSYCHIATRIC NURSE
A HOW-TO GUIDE FOR EVIDENCE-BASED
PRACTICE
3RD EDITION
• AUTHOR(S)KATHLEEN WHEELER
TEST BANK
1
Reference
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
Stem
A 34-year-old woman with recurrent major depression presents
for an initial psychotherapy session with you, a PMHNP who will
integrate medication management and psychotherapy. She is
guarded, asks whether you will "fix" her quickly, and wants to
,know what role you will play. What is the most appropriate
opening therapeutic action to establish a collaborative
framework while managing expectations?
A. Offer a brief timeline of expected symptom reduction and
promise close follow-up medication adjustments.
B. Explain your dual role (prescriber and psychotherapist),
outline boundaries and informed consent, and invite her goals
for therapy.
C. Defer discussion about roles until after a full diagnostic
assessment to avoid influencing her expectations.
D. Emphasize that psychotherapy will be the primary treatment
and that medication is secondary.
Correct answer
B
Rationales
Correct (B): Explicitly stating your dual role, discussing
boundaries and informed consent, and eliciting the client's
goals establishes clarity, respects autonomy, and fosters
therapeutic alliance consistent with Wheeler’s framework for
nurse psychotherapists integrating care. This balances
transparency with collaborative treatment planning.
Incorrect (A): Promising a timeline and focusing narrowly on
medication may create unrealistic expectations and undermine
the therapeutic alliance when change does not follow the
promised timeline.
Incorrect (C): Deferring role clarification risks early confusion
,and may impede trust; brief role-setting is ethically and
clinically appropriate at the outset.
Incorrect (D): Prioritizing one modality prescriptively without
negotiation ignores the client’s preferences and the integrated
scope of PMHNP practice.
Teaching Point
State your roles, boundaries, and jointly set goals at the first
session.
Citation
Wheeler, K. (2023). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 1.
2
Reference
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
Stem
During early sessions a client repeatedly brings material about
past trauma but resists focused trauma processing. As the nurse
psychotherapist, how should you prioritize interventions to be
trauma-informed, maintain safety, and progress treatment?
A. Begin targeted trauma processing because exposure yields
faster symptom reduction.
B. Focus first on stabilization, grounding, and building coping
skills while monitoring readiness for trauma work.
, C. Refer immediately to a trauma specialist and discontinue
psychotherapy to avoid harm.
D. Encourage the client to recount the trauma fully in session to
desensitize them.
Correct answer
B
Rationales
Correct (B): A trauma-informed framework emphasizes safety,
stabilization, and skill building before trauma processing; this
aligns with Wheeler’s recommendations for pacing
interventions according to client readiness and safety.
Incorrect (A): Immediate exposure can retraumatize when
stabilization is insufficient; timing matters.
Incorrect (C): Automatic referral may fragment care; the
PMHNP can continue to provide stabilization and collaborative
referral if specialized trauma processing is indicated.
Incorrect (D): Unstructured pushing to recount can harm the
alliance and increase dysregulation.
Teaching Point
Prioritize stabilization and readiness before trauma-focused
interventions.
Citation
Wheeler, K. (2023). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 1.
