PSYCHOTHERAPY FOR THE ADVANCED
PRACTICE PSYCHIATRIC NURSE
A HOW-TO GUIDE FOR EVIDENCE-BASED
PRACTICE
3RD EDITION
• AUTHOR(S)KATHLEEN WHEELER
TEST BANK
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice — Item 1
Stem: A 34-year-old client with longstanding major depressive
disorder arrives late to session and offers several vague reasons.
As a nurse psychotherapist establishing treatment boundaries
and alliance, which therapist response best demonstrates use
of professional stance while exploring function of lateness?
A. Express disappointment and inform the client that future
lateness will reduce session time.
B. Immediately confront the client about avoidance and
,demand punctuality.
C. Validate the client’s difficulty, name observed pattern, and
collaboratively explore what lateness means for therapy now.
D. Ignore the lateness to avoid reinforcing dependency and
continue with the planned intervention.
Correct answer: C
Rationale — Correct: Naming the behavior, validating, and
collaboratively exploring its meaning preserves alliance while
addressing function—consistent with Wheeler’s emphasis on
therapeutic stance and reflective practice. This balances
boundaries with curiosity and invites client collaboration in
treatment planning.
Rationale — A (Incorrect): Focuses on sanctioning rather than
exploration; risks rupturing alliance and reduces curiosity about
underlying function.
Rationale — B (Incorrect): Confrontation is premature and may
escalate defensiveness; misaligned with nursing-psychotherapy
emphasis on collaborative inquiry.
Rationale — D (Incorrect): Avoiding the issue sacrifices
therapeutic opportunity and neglects professional responsibility
to address behaviors that affect treatment.
Teaching point: Use validation plus exploration to address
behavior while preserving the alliance.
,Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice — Item 2
Stem: During intake a client discloses childhood physical abuse
and asks the nurse psychotherapist not to record details in the
chart for privacy. What action best aligns with professional,
ethical, and legal frameworks discussed in the chapter?
A. Honor the client’s request and omit abuse history from
charting to protect trust.
B. Refuse to treat the client unless they consent to full
disclosure in the chart.
C. Explain documentation limits, document relevant clinical
information factually, and discuss confidentiality and reporting
obligations.
D. Provide a verbal summary only and keep no written record.
Correct answer: C
Rationale — Correct: The nurse psychotherapist must balance
confidentiality with legal/ethical duties; factual documentation
and clear discussion about limits protects client and clinician,
consistent with Wheeler’s framework on documentation and
ethics.
Rationale — A (Incorrect): Omitting clinically relevant
information undermines safety and professional standards.
Rationale — B (Incorrect): Coercive stance threatens access to
care and is ethically inappropriate.
Rationale — D (Incorrect): Lack of written record fails
, professional standards and continuity of care; offers no legal
protection.
Teaching point: Document factually and discuss confidentiality
and legal obligations transparently.
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice — Item 3
Stem: A client from a cultural background that values indirect
communication expresses suicidal ideation in ambiguous terms.
According to a culturally informed nurse-psychotherapist
framework, which therapist action best demonstrates culturally
responsive safety assessment?
A. Treat the ambiguous statements as low risk because they
were indirect.
B. Ask clarifying, culturally sensitive questions about intent and
supports, adjusting language to the client’s style.
C. Insist the client use direct suicidal language before taking
safety measures.
D. Refer immediately for emergency evaluation without further
assessment.
Correct answer: B
Rationale — Correct: Culturally informed care requires adapting
assessment methods to communication style—eliciting
clarification with sensitivity addresses safety and respects
cultural norms, per Wheeler’s guidance on cultural
PRACTICE PSYCHIATRIC NURSE
A HOW-TO GUIDE FOR EVIDENCE-BASED
PRACTICE
3RD EDITION
• AUTHOR(S)KATHLEEN WHEELER
TEST BANK
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice — Item 1
Stem: A 34-year-old client with longstanding major depressive
disorder arrives late to session and offers several vague reasons.
As a nurse psychotherapist establishing treatment boundaries
and alliance, which therapist response best demonstrates use
of professional stance while exploring function of lateness?
A. Express disappointment and inform the client that future
lateness will reduce session time.
B. Immediately confront the client about avoidance and
,demand punctuality.
C. Validate the client’s difficulty, name observed pattern, and
collaboratively explore what lateness means for therapy now.
D. Ignore the lateness to avoid reinforcing dependency and
continue with the planned intervention.
Correct answer: C
Rationale — Correct: Naming the behavior, validating, and
collaboratively exploring its meaning preserves alliance while
addressing function—consistent with Wheeler’s emphasis on
therapeutic stance and reflective practice. This balances
boundaries with curiosity and invites client collaboration in
treatment planning.
Rationale — A (Incorrect): Focuses on sanctioning rather than
exploration; risks rupturing alliance and reduces curiosity about
underlying function.
Rationale — B (Incorrect): Confrontation is premature and may
escalate defensiveness; misaligned with nursing-psychotherapy
emphasis on collaborative inquiry.
Rationale — D (Incorrect): Avoiding the issue sacrifices
therapeutic opportunity and neglects professional responsibility
to address behaviors that affect treatment.
Teaching point: Use validation plus exploration to address
behavior while preserving the alliance.
,Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice — Item 2
Stem: During intake a client discloses childhood physical abuse
and asks the nurse psychotherapist not to record details in the
chart for privacy. What action best aligns with professional,
ethical, and legal frameworks discussed in the chapter?
A. Honor the client’s request and omit abuse history from
charting to protect trust.
B. Refuse to treat the client unless they consent to full
disclosure in the chart.
C. Explain documentation limits, document relevant clinical
information factually, and discuss confidentiality and reporting
obligations.
D. Provide a verbal summary only and keep no written record.
Correct answer: C
Rationale — Correct: The nurse psychotherapist must balance
confidentiality with legal/ethical duties; factual documentation
and clear discussion about limits protects client and clinician,
consistent with Wheeler’s framework on documentation and
ethics.
Rationale — A (Incorrect): Omitting clinically relevant
information undermines safety and professional standards.
Rationale — B (Incorrect): Coercive stance threatens access to
care and is ethically inappropriate.
Rationale — D (Incorrect): Lack of written record fails
, professional standards and continuity of care; offers no legal
protection.
Teaching point: Document factually and discuss confidentiality
and legal obligations transparently.
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice — Item 3
Stem: A client from a cultural background that values indirect
communication expresses suicidal ideation in ambiguous terms.
According to a culturally informed nurse-psychotherapist
framework, which therapist action best demonstrates culturally
responsive safety assessment?
A. Treat the ambiguous statements as low risk because they
were indirect.
B. Ask clarifying, culturally sensitive questions about intent and
supports, adjusting language to the client’s style.
C. Insist the client use direct suicidal language before taking
safety measures.
D. Refer immediately for emergency evaluation without further
assessment.
Correct answer: B
Rationale — Correct: Culturally informed care requires adapting
assessment methods to communication style—eliciting
clarification with sensitivity addresses safety and respects
cultural norms, per Wheeler’s guidance on cultural
