NURS 753 PMHNP Final Exam | 100 Actual
Questions and Answers | 2026/27 Update | 100%
Correct
NURS 753 PMHNP FINAL EXAM PREP 2026
COMPLETE PRACTICE EXAM: QUESTIONS 1-100
1. A PMHNP is working with a client who reports, "I'm a failure because I didn't
get that promotion." The PMHNP asks the client to examine the evidence for
and against this belief. Which CBT technique is being used?
A) Behavioral activation
B) Exposure therapy
C) Cognitive restructuring
D) Mindfulness
Rationale: Cognitive restructuring involves identifying and challenging irrational or
maladaptive thoughts and replacing them with more balanced, realistic thinking.
The PMHNP is directly challenging the client's cognitive distortion ("I'm a failure")
by asking for evidence, which is a core component of cognitive restructuring.
Behavioral activation focuses on increasing engagement in positive activities,
exposure therapy involves confronting feared stimuli, and mindfulness focuses on
present-moment awareness without judgment .
2. A client with social anxiety disorder avoids attending work meetings. The
PMHNP helps the client create a hierarchy of feared situations and gradually
confronts them. This is an example of:
A) Flooding
,B) Systematic desensitization
C) Aversion therapy
D) Modeling
Rationale: Systematic desensitization is a behavioral technique that pairs
relaxation with gradual exposure to a hierarchy of anxiety-provoking stimuli. The
client learns to remain relaxed while imagining or experiencing progressively more
challenging situations. Flooding involves immediate, intense exposure without a
hierarchy. Aversion therapy pairs an unwanted behavior with an unpleasant
stimulus. Modeling involves learning by observing others .
3. The PMHNP asks a depressed client to schedule pleasurable activities and
record their mood before and after each activity. This intervention is known as:
A) Cognitive restructuring
B) Activity scheduling and behavioral activation
C) Thought stopping
D) Cognitive rehearsal
Rationale: Activity scheduling is a core behavioral activation technique used in CBT
for depression. It helps clients increase their exposure to potentially rewarding
experiences, counteract avoidance, and gather evidence that their mood can
improve with activity. Thought stopping is used to interrupt repetitive negative
thoughts, and cognitive rehearsal involves mentally practicing coping skills .
4. Which of the following best describes the primary dialectic in DBT?
A) Past versus present
B) Acceptance versus change
C) Individual versus group
D) Medication versus therapy
Rationale: The central dialectic in DBT is the tension between accepting the client
as they are (validation) and simultaneously pushing for change (problem-solving).
The therapist balances these seemingly opposing forces to help the client move
,toward a more effective life. This is reflected in the four modules: mindfulness
(acceptance) and distress tolerance, emotion regulation, interpersonal
effectiveness (change) .
5. A client with borderline personality disorder reports chronic feelings of
emptiness and fears of abandonment. The PMHNP teaches the client to observe
and describe these feelings without judgment. Which DBT skill module is being
used?
A) Distress tolerance
B) Emotion regulation
C) Interpersonal effectiveness
D) Mindfulness
Rationale: Mindfulness skills are foundational in DBT and involve learning to
observe, describe, and participate in the present moment without judgment. These
skills help clients become more aware of their internal experiences (emotions,
thoughts) without being controlled by them. The three "what" skills are observe,
describe, and participate .
6. A client who self-harms when experiencing intense anger is taught to splash
cold water on their face or hold ice cubes. This is an example of which DBT
distress tolerance skill?
A) Radical acceptance
B) TIPP (Temperature, Intense exercise, Paced breathing, Progressive muscle
relaxation)
C) Willingness
D) Half-smile
Rationale: TIPP is a set of crisis survival skills that use body chemistry to rapidly
reduce intense emotional arousal. Changing body temperature (cold water),
engaging in intense exercise, paced breathing, and progressive muscle relaxation
, can quickly shift the physiological state, making it easier to ride out a crisis without
engaging in maladaptive behaviors .
7. In DBT, "wise mind" is the integration of:
A) Reasonable mind and emotion mind
B) Conscious mind and unconscious mind
C) Logical mind and intuitive mind
D) Past mind and present mind
Rationale: Wise mind is the integration of reasonable mind (logical, factual
thinking) and emotion mind (feelings-driven thinking). The goal is to find the
middle path where both logic and emotions are considered in decision-making.
This concept is central to DBT's mindfulness module .
8. A PMHNP is treating a patient who refuses medication but agrees to therapy.
The patient asks, "Can you pray with me?" The PMHNP is Christian but unsure of
hospital policy. What is the most ethical action?
A) Pray immediately to build rapport
B) Decline and redirect to evidence-based therapy
C) Explore the patient's spiritual needs and consult policy
D) Refer the patient to a chaplain without discussion
Rationale: Spirituality is part of holistic care. The PMHNP should first understand
the patient's request, then follow institutional guidelines and professional
boundaries (APA ethics code 2.01, boundaries of competence). This approach
respects the patient's autonomy while maintaining professional boundaries .
9. Which of the following best defines evidence-based practice in therapeutic
modalities?
A) Using only randomized controlled trials to guide therapy
B) Integrating clinical expertise, patient values, and best research evidence
Questions and Answers | 2026/27 Update | 100%
Correct
NURS 753 PMHNP FINAL EXAM PREP 2026
COMPLETE PRACTICE EXAM: QUESTIONS 1-100
1. A PMHNP is working with a client who reports, "I'm a failure because I didn't
get that promotion." The PMHNP asks the client to examine the evidence for
and against this belief. Which CBT technique is being used?
A) Behavioral activation
B) Exposure therapy
C) Cognitive restructuring
D) Mindfulness
Rationale: Cognitive restructuring involves identifying and challenging irrational or
maladaptive thoughts and replacing them with more balanced, realistic thinking.
The PMHNP is directly challenging the client's cognitive distortion ("I'm a failure")
by asking for evidence, which is a core component of cognitive restructuring.
Behavioral activation focuses on increasing engagement in positive activities,
exposure therapy involves confronting feared stimuli, and mindfulness focuses on
present-moment awareness without judgment .
2. A client with social anxiety disorder avoids attending work meetings. The
PMHNP helps the client create a hierarchy of feared situations and gradually
confronts them. This is an example of:
A) Flooding
,B) Systematic desensitization
C) Aversion therapy
D) Modeling
Rationale: Systematic desensitization is a behavioral technique that pairs
relaxation with gradual exposure to a hierarchy of anxiety-provoking stimuli. The
client learns to remain relaxed while imagining or experiencing progressively more
challenging situations. Flooding involves immediate, intense exposure without a
hierarchy. Aversion therapy pairs an unwanted behavior with an unpleasant
stimulus. Modeling involves learning by observing others .
3. The PMHNP asks a depressed client to schedule pleasurable activities and
record their mood before and after each activity. This intervention is known as:
A) Cognitive restructuring
B) Activity scheduling and behavioral activation
C) Thought stopping
D) Cognitive rehearsal
Rationale: Activity scheduling is a core behavioral activation technique used in CBT
for depression. It helps clients increase their exposure to potentially rewarding
experiences, counteract avoidance, and gather evidence that their mood can
improve with activity. Thought stopping is used to interrupt repetitive negative
thoughts, and cognitive rehearsal involves mentally practicing coping skills .
4. Which of the following best describes the primary dialectic in DBT?
A) Past versus present
B) Acceptance versus change
C) Individual versus group
D) Medication versus therapy
Rationale: The central dialectic in DBT is the tension between accepting the client
as they are (validation) and simultaneously pushing for change (problem-solving).
The therapist balances these seemingly opposing forces to help the client move
,toward a more effective life. This is reflected in the four modules: mindfulness
(acceptance) and distress tolerance, emotion regulation, interpersonal
effectiveness (change) .
5. A client with borderline personality disorder reports chronic feelings of
emptiness and fears of abandonment. The PMHNP teaches the client to observe
and describe these feelings without judgment. Which DBT skill module is being
used?
A) Distress tolerance
B) Emotion regulation
C) Interpersonal effectiveness
D) Mindfulness
Rationale: Mindfulness skills are foundational in DBT and involve learning to
observe, describe, and participate in the present moment without judgment. These
skills help clients become more aware of their internal experiences (emotions,
thoughts) without being controlled by them. The three "what" skills are observe,
describe, and participate .
6. A client who self-harms when experiencing intense anger is taught to splash
cold water on their face or hold ice cubes. This is an example of which DBT
distress tolerance skill?
A) Radical acceptance
B) TIPP (Temperature, Intense exercise, Paced breathing, Progressive muscle
relaxation)
C) Willingness
D) Half-smile
Rationale: TIPP is a set of crisis survival skills that use body chemistry to rapidly
reduce intense emotional arousal. Changing body temperature (cold water),
engaging in intense exercise, paced breathing, and progressive muscle relaxation
, can quickly shift the physiological state, making it easier to ride out a crisis without
engaging in maladaptive behaviors .
7. In DBT, "wise mind" is the integration of:
A) Reasonable mind and emotion mind
B) Conscious mind and unconscious mind
C) Logical mind and intuitive mind
D) Past mind and present mind
Rationale: Wise mind is the integration of reasonable mind (logical, factual
thinking) and emotion mind (feelings-driven thinking). The goal is to find the
middle path where both logic and emotions are considered in decision-making.
This concept is central to DBT's mindfulness module .
8. A PMHNP is treating a patient who refuses medication but agrees to therapy.
The patient asks, "Can you pray with me?" The PMHNP is Christian but unsure of
hospital policy. What is the most ethical action?
A) Pray immediately to build rapport
B) Decline and redirect to evidence-based therapy
C) Explore the patient's spiritual needs and consult policy
D) Refer the patient to a chaplain without discussion
Rationale: Spirituality is part of holistic care. The PMHNP should first understand
the patient's request, then follow institutional guidelines and professional
boundaries (APA ethics code 2.01, boundaries of competence). This approach
respects the patient's autonomy while maintaining professional boundaries .
9. Which of the following best defines evidence-based practice in therapeutic
modalities?
A) Using only randomized controlled trials to guide therapy
B) Integrating clinical expertise, patient values, and best research evidence
