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
1. A 42-year-old woman presents for psychotherapy after
stabilization of a major depressive episode. In the first three
sessions she describes feeling “flattened,” seeks clear direction
about tasks between sessions, and frequently asks the therapist
whether she is “doing it right.” As a nurse psychotherapist using
Wheeler’s holistic, relationship-based framework, which
therapist stance is most appropriate at this stage?
,A. Provide structured, behaviorally oriented homework and
frequent performance feedback to build competence.
B. Adopt a collaboratively exploratory stance that emphasizes
empathic connection, normalization of anxiety, and co-creating
treatment goals.
C. Maintain a neutral stance, focusing primarily on
interpretation of unconscious material to foster insight.
D. Reduce session length and encourage independent self-
management to promote resilience.
Correct answer: B
Rationales
• Correct (B): Wheeler’s framework emphasizes relationship,
resilience, and management of anxiety early in treatment;
a collaborative, empathic stance supports alliance, reduces
performance anxiety, and helps co-create realistic goals.
This fits PMHNP scope and fosters engagement.
• A: Prematurely prioritizes directive behavior change
without first establishing safety and alliance; may increase
the client’s performance anxiety.
• C: A neutral, interpretive psychodynamic stance risks
undermining rapport and is less consistent with an initial,
nurse-led, relationship-focused approach.
• D: Shortening sessions and pushing independence too
early may feel punitive and weaken the therapeutic
relationship.
,Teaching point: Early therapy prioritizes connection and co-
created goals before heavy directive interventions.
Citation (Simplified APA): Wheeler, K. (2023). Psychotherapy for
the Advanced Practice Psychiatric Nurse (3rd ed.). Ch. 1.
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
2. A 28-year-old man of a different cultural background
discloses family beliefs that mental suffering is a moral failing.
He questions the value of psychotherapy. According to the
chapter’s cultural lens and holistic model, what is the best initial
therapist action?
A. Challenge the family beliefs directly and provide
psychoeducation about biological models of illness.
B. Privilege the nurse’s clinical judgment and set the therapy
agenda toward symptom reduction.
C. Explore the client’s cultural narrative, validate its meaning,
and inquire how those beliefs influence help-seeking.
D. Immediately refer to community spiritual resources and
avoid discussing psychotherapy.
Correct answer: C
Rationales
• Correct (C): Wheeler emphasizes viewing mental health
through a cultural lens and using narrative to understand
, meaning; exploring and validating fosters trust and informs
culturally congruent interventions.
• A: Direct confrontation of cultural beliefs risks alienation
and overlooks cultural humility central to the nurse
psychotherapist role.
• B: Prioritizing the clinician’s agenda ignores client context
and undermines collaborative, culturally informed care.
• D: Referral without discussing psychotherapy abdicates the
nurse psychotherapist role and may deny useful integrated
options.
Teaching point: Use cultural narrative exploration to co-design
acceptable, effective care.
Citation: Wheeler, K. (2023). Ch. 1.
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
3. During supervision, a novice nurse psychotherapist expresses
anxiety about managing intense client affect and wonders
whether to avoid deeper material. Based on Wheeler’s
framework about managing therapist anxiety, which supervisor
suggestion best promotes competency?
A. Encourage the therapist to limit emotional engagement and
rely strictly on technique.
B. Recommend avoidance of cases with intense affect until
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
1. A 42-year-old woman presents for psychotherapy after
stabilization of a major depressive episode. In the first three
sessions she describes feeling “flattened,” seeks clear direction
about tasks between sessions, and frequently asks the therapist
whether she is “doing it right.” As a nurse psychotherapist using
Wheeler’s holistic, relationship-based framework, which
therapist stance is most appropriate at this stage?
,A. Provide structured, behaviorally oriented homework and
frequent performance feedback to build competence.
B. Adopt a collaboratively exploratory stance that emphasizes
empathic connection, normalization of anxiety, and co-creating
treatment goals.
C. Maintain a neutral stance, focusing primarily on
interpretation of unconscious material to foster insight.
D. Reduce session length and encourage independent self-
management to promote resilience.
Correct answer: B
Rationales
• Correct (B): Wheeler’s framework emphasizes relationship,
resilience, and management of anxiety early in treatment;
a collaborative, empathic stance supports alliance, reduces
performance anxiety, and helps co-create realistic goals.
This fits PMHNP scope and fosters engagement.
• A: Prematurely prioritizes directive behavior change
without first establishing safety and alliance; may increase
the client’s performance anxiety.
• C: A neutral, interpretive psychodynamic stance risks
undermining rapport and is less consistent with an initial,
nurse-led, relationship-focused approach.
• D: Shortening sessions and pushing independence too
early may feel punitive and weaken the therapeutic
relationship.
,Teaching point: Early therapy prioritizes connection and co-
created goals before heavy directive interventions.
Citation (Simplified APA): Wheeler, K. (2023). Psychotherapy for
the Advanced Practice Psychiatric Nurse (3rd ed.). Ch. 1.
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
2. A 28-year-old man of a different cultural background
discloses family beliefs that mental suffering is a moral failing.
He questions the value of psychotherapy. According to the
chapter’s cultural lens and holistic model, what is the best initial
therapist action?
A. Challenge the family beliefs directly and provide
psychoeducation about biological models of illness.
B. Privilege the nurse’s clinical judgment and set the therapy
agenda toward symptom reduction.
C. Explore the client’s cultural narrative, validate its meaning,
and inquire how those beliefs influence help-seeking.
D. Immediately refer to community spiritual resources and
avoid discussing psychotherapy.
Correct answer: C
Rationales
• Correct (C): Wheeler emphasizes viewing mental health
through a cultural lens and using narrative to understand
, meaning; exploring and validating fosters trust and informs
culturally congruent interventions.
• A: Direct confrontation of cultural beliefs risks alienation
and overlooks cultural humility central to the nurse
psychotherapist role.
• B: Prioritizing the clinician’s agenda ignores client context
and undermines collaborative, culturally informed care.
• D: Referral without discussing psychotherapy abdicates the
nurse psychotherapist role and may deny useful integrated
options.
Teaching point: Use cultural narrative exploration to co-design
acceptable, effective care.
Citation: Wheeler, K. (2023). Ch. 1.
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
3. During supervision, a novice nurse psychotherapist expresses
anxiety about managing intense client affect and wonders
whether to avoid deeper material. Based on Wheeler’s
framework about managing therapist anxiety, which supervisor
suggestion best promotes competency?
A. Encourage the therapist to limit emotional engagement and
rely strictly on technique.
B. Recommend avoidance of cases with intense affect until
