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 chronic dysthymia says in session
she “just can’t trust anyone” and expects therapists to “give up”
on her. As a PMHNP beginning treatment, you want to establish
a practice framework that supports long-term engagement and
safety. Which therapist stance and immediate action best aligns
,with Wheeler’s relationship-based framework for nurse
psychotherapists?
A. Maintain strict neutrality and limit self-disclosure to avoid
fostering dependency.
B. Offer a consistent, predictable schedule and explicitly discuss
expectations and partnership in care.
C. Emphasize problem-solving homework from session one to
produce rapid symptom change.
D. Refer immediately to long-term psychodynamic
psychotherapy without initiating treatment.
Correct answer: B
Rationale — Correct (B)
Wheeler’s framework emphasizes a relationship-based,
resilience-oriented, and patient-centered approach; offering
predictability and collaboratively setting expectations supports
alliance-building and engagement, particularly with clients who
distrust clinicians. Explicit partnership attends to safety and
helps scaffold later interventions.
Rationale — Incorrect
A. Overly neutral stance without structure may feel distant and
confirm the client’s expectation of abandonment.
C. Beginning with homework without establishing alliance and
shared goals is premature and risks dropout.
D. Immediate referral without an initial therapeutic offer wastes
a therapeutic window and abandons the PMHNP’s scope to
establish engagement.
,Teaching point
Early predictability and collaborative expectations strengthen
alliance and retention.
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 19-year-old college student discloses a history
of complex childhood trauma and avoids eye contact when you
ask direct questions. You suspect trauma-related hyperarousal.
According to the chapter’s trauma-informed, neurobiologically
informed framework, what is the most appropriate therapist
priority in the first three sessions?
A. Conduct an exhaustive trauma narrative to identify all
adverse events.
B. Establish safety, orientation to the therapy process, and teach
grounding/self-regulation techniques.
C. Immediately start exposure-based processing techniques to
prevent avoidance.
, D. Focus only on medication management and postpone
psychotherapy.
Correct answer: B
Rationale — Correct (B)
Wheeler advocates trauma-informed practice grounded in
neurophysiology; early sessions should prioritize safety and
affect regulation so the client can tolerate subsequent
therapeutic work. Teaching grounding techniques aligns with
stabilizing the window of tolerance.
Rationale — Incorrect
A. Exhaustive trauma narrative early risks retraumatization
without stabilization.
C. Exposure without prior stabilization and consent is unsafe
and misaligned with trauma-informed care.
D. Avoiding psychotherapy neglects the nurse-psychotherapist
role and misses chance to build therapeutic resources.
Teaching point
Prioritize safety and regulation before trauma processing.
Citation
Wheeler, K. (2023). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 1.
3
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 chronic dysthymia says in session
she “just can’t trust anyone” and expects therapists to “give up”
on her. As a PMHNP beginning treatment, you want to establish
a practice framework that supports long-term engagement and
safety. Which therapist stance and immediate action best aligns
,with Wheeler’s relationship-based framework for nurse
psychotherapists?
A. Maintain strict neutrality and limit self-disclosure to avoid
fostering dependency.
B. Offer a consistent, predictable schedule and explicitly discuss
expectations and partnership in care.
C. Emphasize problem-solving homework from session one to
produce rapid symptom change.
D. Refer immediately to long-term psychodynamic
psychotherapy without initiating treatment.
Correct answer: B
Rationale — Correct (B)
Wheeler’s framework emphasizes a relationship-based,
resilience-oriented, and patient-centered approach; offering
predictability and collaboratively setting expectations supports
alliance-building and engagement, particularly with clients who
distrust clinicians. Explicit partnership attends to safety and
helps scaffold later interventions.
Rationale — Incorrect
A. Overly neutral stance without structure may feel distant and
confirm the client’s expectation of abandonment.
C. Beginning with homework without establishing alliance and
shared goals is premature and risks dropout.
D. Immediate referral without an initial therapeutic offer wastes
a therapeutic window and abandons the PMHNP’s scope to
establish engagement.
,Teaching point
Early predictability and collaborative expectations strengthen
alliance and retention.
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 19-year-old college student discloses a history
of complex childhood trauma and avoids eye contact when you
ask direct questions. You suspect trauma-related hyperarousal.
According to the chapter’s trauma-informed, neurobiologically
informed framework, what is the most appropriate therapist
priority in the first three sessions?
A. Conduct an exhaustive trauma narrative to identify all
adverse events.
B. Establish safety, orientation to the therapy process, and teach
grounding/self-regulation techniques.
C. Immediately start exposure-based processing techniques to
prevent avoidance.
, D. Focus only on medication management and postpone
psychotherapy.
Correct answer: B
Rationale — Correct (B)
Wheeler advocates trauma-informed practice grounded in
neurophysiology; early sessions should prioritize safety and
affect regulation so the client can tolerate subsequent
therapeutic work. Teaching grounding techniques aligns with
stabilizing the window of tolerance.
Rationale — Incorrect
A. Exhaustive trauma narrative early risks retraumatization
without stabilization.
C. Exposure without prior stabilization and consent is unsafe
and misaligned with trauma-informed care.
D. Avoiding psychotherapy neglects the nurse-psychotherapist
role and misses chance to build therapeutic resources.
Teaching point
Prioritize safety and regulation before trauma processing.
Citation
Wheeler, K. (2023). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 1.
3
