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 — Stem
A 34-year-old client with recurrent major depressive episodes
asks whether therapy or medication should be started first.
They report prior partial response to an SSRI and strong
preference to avoid medication side effects. As a nurse
psychotherapist working in integrated care, which immediate
approach best reflects the nurse-psychotherapist framework?
,A. Begin an evidence-based psychotherapy (CBT) while
coordinating with the prescribing provider to review prior
medication response.
B. Defer to the primary care prescriber and recommend
medication initiation before psychotherapy.
C. Agree to provide only supportive counseling and avoid
discussing medication to respect client preference.
D. Encourage discontinuation of any prior medications and start
an intensive psychotherapy immediately.
Correct answer: A
Rationale — Correct Option:
Beginning an evidence-based psychotherapy while actively
coordinating with the prescriber integrates psychotherapeutic
intervention and collaborative medical management, consistent
with the nurse-psychotherapist role. It respects the client’s
preference, uses prior medication history to guide joint
decision-making, and applies measurement-based monitoring.
This maintains scope of practice and collaborative care
principles from Wheeler’s framework.
Rationale — Incorrect Options:
B. Deferring entirely to the prescriber fails to use the nurse-
psychotherapist’s psychotherapeutic expertise and undermines
collaborative practice.
C. Providing only supportive counseling without discussing
evidence-based options is less effective for recurrent major
depression and limits informed consent.
,D. Urging medication discontinuation without prescriber
coordination risks destabilization and exceeds psychotherapy
scope.
Teaching point:
Coordinate psychotherapy with prescribers; integrate client
preference and prior medication history.
Citation:
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 — Stem
During the second session a 45-year-old client discloses being a
survivor of childhood sexual abuse and becomes visibly
distressed. The client asks the therapist not to document the
trauma because they fear it may be accessed by employers.
How should the nurse psychotherapist respond to balance
clinical documentation, safety, and confidentiality?
A. Respect the request and omit any mention of abuse from the
clinical record.
B. Explain mandatory documentation limits, document
objective facts necessary for safety and treatment planning, and
discuss confidentiality boundaries.
C. Insist on full written documentation of the trauma and refuse
, to continue if the client disagrees.
D. Record only coded or vague language to obscure trauma
while avoiding discussion with the client about risks.
Correct answer: B
Rationale — Correct Option:
Explaining confidentiality limits and documenting objective
facts needed for safety and treatment preserves ethical
documentation and informed consent while addressing the
client’s concern. The nurse-psychotherapist must balance client
autonomy with legal/ethical requirements and treatment
needs—consistent with Wheeler’s guidance on documentation
and trauma-informed care.
Rationale — Incorrect Options:
A. Omitting relevant clinical information can endanger safety
and undermine care continuity.
C. Forcing documentation or threatening termination neglects
collaborative therapeutic alliance and informed consent.
D. Using vague or coded records may obscure continuity of care
and is ethically problematic if it misleads other clinicians.
Teaching point:
Document objective, treatment-relevant information and clarify
confidentiality limits early.
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
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
1 — Stem
A 34-year-old client with recurrent major depressive episodes
asks whether therapy or medication should be started first.
They report prior partial response to an SSRI and strong
preference to avoid medication side effects. As a nurse
psychotherapist working in integrated care, which immediate
approach best reflects the nurse-psychotherapist framework?
,A. Begin an evidence-based psychotherapy (CBT) while
coordinating with the prescribing provider to review prior
medication response.
B. Defer to the primary care prescriber and recommend
medication initiation before psychotherapy.
C. Agree to provide only supportive counseling and avoid
discussing medication to respect client preference.
D. Encourage discontinuation of any prior medications and start
an intensive psychotherapy immediately.
Correct answer: A
Rationale — Correct Option:
Beginning an evidence-based psychotherapy while actively
coordinating with the prescriber integrates psychotherapeutic
intervention and collaborative medical management, consistent
with the nurse-psychotherapist role. It respects the client’s
preference, uses prior medication history to guide joint
decision-making, and applies measurement-based monitoring.
This maintains scope of practice and collaborative care
principles from Wheeler’s framework.
Rationale — Incorrect Options:
B. Deferring entirely to the prescriber fails to use the nurse-
psychotherapist’s psychotherapeutic expertise and undermines
collaborative practice.
C. Providing only supportive counseling without discussing
evidence-based options is less effective for recurrent major
depression and limits informed consent.
,D. Urging medication discontinuation without prescriber
coordination risks destabilization and exceeds psychotherapy
scope.
Teaching point:
Coordinate psychotherapy with prescribers; integrate client
preference and prior medication history.
Citation:
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 — Stem
During the second session a 45-year-old client discloses being a
survivor of childhood sexual abuse and becomes visibly
distressed. The client asks the therapist not to document the
trauma because they fear it may be accessed by employers.
How should the nurse psychotherapist respond to balance
clinical documentation, safety, and confidentiality?
A. Respect the request and omit any mention of abuse from the
clinical record.
B. Explain mandatory documentation limits, document
objective facts necessary for safety and treatment planning, and
discuss confidentiality boundaries.
C. Insist on full written documentation of the trauma and refuse
, to continue if the client disagrees.
D. Record only coded or vague language to obscure trauma
while avoiding discussion with the client about risks.
Correct answer: B
Rationale — Correct Option:
Explaining confidentiality limits and documenting objective
facts needed for safety and treatment preserves ethical
documentation and informed consent while addressing the
client’s concern. The nurse-psychotherapist must balance client
autonomy with legal/ethical requirements and treatment
needs—consistent with Wheeler’s guidance on documentation
and trauma-informed care.
Rationale — Incorrect Options:
A. Omitting relevant clinical information can endanger safety
and undermine care continuity.
C. Forcing documentation or threatening termination neglects
collaborative therapeutic alliance and informed consent.
D. Using vague or coded records may obscure continuity of care
and is ethically problematic if it misleads other clinicians.
Teaching point:
Document objective, treatment-relevant information and clarify
confidentiality limits early.
Citation:
Wheeler, K. (2023). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 1.
