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 client with chronic major depressive disorder
describes starting therapy with guarded optimism but later
reports disappointment when initial sessions focused on
diagnosis and medication. As the nurse psychotherapist, you
reflect that the client’s disengagement may relate to
,expectations and the therapeutic frame. Which immediate
therapist action best realigns the alliance while honoring the
framework for practice?
A. Reassure the client that medication is essential and request
they continue without changing the plan.
B. Explore the client’s expectations about therapy, validate
disappointment, and collaboratively renegotiate goals and
roles.
C. Terminate therapy because the client is nonadherent and
refer back to the prescribing psychiatrist.
D. Increase session frequency immediately to try to build
rapport faster.
Correct answer
B
Rationales
Correct (B): Exploring expectations and validating
disappointment aligns with nurse psychotherapist emphasis on
alliance, collaborative goal setting, and adapting the therapeutic
frame to client needs; this preserves engagement and follows
Wheeler’s framework for negotiated treatment planning.
A: Reassurance that medication is essential without addressing
the client’s disappointment neglects therapeutic alliance and
shared decision-making; it is directive and misaligned with
collaborative psychotherapy.
C: Immediate termination is premature and ethically
inappropriate; referral may be considered only after attempts to
,repair alliance and renegotiate.
D: Increasing frequency may help in some cases but is a
structural change that should follow discussion and mutual
agreement rather than be an immediate corrective assumed to
fix alliance issues.
Teaching point
Repair alliance by exploring expectations, validating feelings,
and collaboratively renegotiating goals.
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 intake, a client from a collectivist culture emphasizes
family decision-making about treatment. You are uncertain how
family involvement affects confidentiality and consent. What
action best reflects the nurse psychotherapist’s ethical
framework and culturally informed practice?
A. Insist on individual consent only and refuse family
participation to protect confidentiality.
B. Assume family involvement equals coercion and decline to
, include them.
C. Explore family roles and decision processes, explain
confidentiality limits, and negotiate a consent plan that honors
client autonomy and cultural values.
D. Obtain verbal consent from family members in place of the
client’s documented consent.
Correct answer
C
Rationales
Correct (C): This option demonstrates cultural humility and
aligns with Wheeler’s framework: assess cultural context,
transparently explain confidentiality, and co-create a consent
approach that balances autonomy with cultural norms.
A: Insisting on individual consent without cultural exploration
risks alienation and undermines engagement; it fails to respect
culturally mediated decision-making.
B: Assuming coercion without assessment is biased and may
wrongly exclude supportive family resources.
D: Replacing client consent with family consent violates ethical
and legal standards regarding informed consent and the
therapeutic frame.
Teaching point
Use cultural assessment to co-create consent and
confidentiality plans that respect autonomy and family roles.
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 client with chronic major depressive disorder
describes starting therapy with guarded optimism but later
reports disappointment when initial sessions focused on
diagnosis and medication. As the nurse psychotherapist, you
reflect that the client’s disengagement may relate to
,expectations and the therapeutic frame. Which immediate
therapist action best realigns the alliance while honoring the
framework for practice?
A. Reassure the client that medication is essential and request
they continue without changing the plan.
B. Explore the client’s expectations about therapy, validate
disappointment, and collaboratively renegotiate goals and
roles.
C. Terminate therapy because the client is nonadherent and
refer back to the prescribing psychiatrist.
D. Increase session frequency immediately to try to build
rapport faster.
Correct answer
B
Rationales
Correct (B): Exploring expectations and validating
disappointment aligns with nurse psychotherapist emphasis on
alliance, collaborative goal setting, and adapting the therapeutic
frame to client needs; this preserves engagement and follows
Wheeler’s framework for negotiated treatment planning.
A: Reassurance that medication is essential without addressing
the client’s disappointment neglects therapeutic alliance and
shared decision-making; it is directive and misaligned with
collaborative psychotherapy.
C: Immediate termination is premature and ethically
inappropriate; referral may be considered only after attempts to
,repair alliance and renegotiate.
D: Increasing frequency may help in some cases but is a
structural change that should follow discussion and mutual
agreement rather than be an immediate corrective assumed to
fix alliance issues.
Teaching point
Repair alliance by exploring expectations, validating feelings,
and collaboratively renegotiating goals.
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 intake, a client from a collectivist culture emphasizes
family decision-making about treatment. You are uncertain how
family involvement affects confidentiality and consent. What
action best reflects the nurse psychotherapist’s ethical
framework and culturally informed practice?
A. Insist on individual consent only and refuse family
participation to protect confidentiality.
B. Assume family involvement equals coercion and decline to
, include them.
C. Explore family roles and decision processes, explain
confidentiality limits, and negotiate a consent plan that honors
client autonomy and cultural values.
D. Obtain verbal consent from family members in place of the
client’s documented consent.
Correct answer
C
Rationales
Correct (C): This option demonstrates cultural humility and
aligns with Wheeler’s framework: assess cultural context,
transparently explain confidentiality, and co-create a consent
approach that balances autonomy with cultural norms.
A: Insisting on individual consent without cultural exploration
risks alienation and undermines engagement; it fails to respect
culturally mediated decision-making.
B: Assuming coercion without assessment is biased and may
wrongly exclude supportive family resources.
D: Replacing client consent with family consent violates ethical
and legal standards regarding informed consent and the
therapeutic frame.
Teaching point
Use cultural assessment to co-create consent and
confidentiality plans that respect autonomy and family roles.
