NSG 527 Final Exam | Psychopathology, Theories, and Advanced Clinical Modalities | Wilkes University 2026/2027
Final Exam NSG 527
Psychopathology, Theories, and Advanced Clinical
Modalities
Wilkes University | Passan School of Nursing | 2026/2027 Update | 100% Correct
100 Questions | 8 Sections | Verified Answers
Section 1: Foundational Theories and Conceptual Frameworks (Existential Therapy,
Gestalt Therapy, Humanistic Approaches, Person-Centered Therapy)
Q1: A PMHNP is working with a client who expresses a pervasive sense that life has no inherent purpose and
describes feeling paralyzed by the vast number of choices available. The PMHNP conceptualizes the client’s
struggle using Yalom’s existential framework. Which of the following givens of existence is MOST directly
relevant to this client’s presentation?
A. Death and the fear of dying
B. Freedom and responsibility
C. Isolation and relational disconnection
D. Meaninglessness and the search for purpose **[CORRECT]**
Correct Answer: D
Rationale: The client describes two intertwined existential concerns: the paralysis of choice (freedom) and the sense that life lacks
inherent purpose (meaninglessness). Yalom identified four givens of existence: death, freedom, isolation, and meaninglessness.
While freedom is relevant to the paralysis of choice, the pervasive sense that life has no inherent purpose most directly aligns with
meaninglessness, which Yalom considered the central existential challenge. The struggle for a sense of meaning is a core theme in
existential psychotherapy, and the therapist helps the client confront this void and create authentic meaning through responsible
choice-making.
Q2: A graduate nursing student is studying Rollo May’s contributions to existential psychotherapy. Which
statement BEST characterizes May’s perspective on anxiety compared to Freud’s classical view?
A. May viewed anxiety as a pathological symptom requiring elimination, consistent with the medical model
B. May conceptualized anxiety as an inevitable condition of living that arises from the personal need to
survive and preserve one’s being **[CORRECT]**
C. May believed anxiety was primarily biological in origin and best treated with pharmacotherapy
D. May considered anxiety to be a sign of unconscious conflict that must be resolved through dream analysis
Correct Answer: B
Rationale: Rollo May viewed anxiety not as a pathological symptom to be eliminated but as an inevitable condition of living that
arises from each person’s need to survive and preserve their being. This stands in contrast to Freud’s classical psychoanalytic view,
which framed anxiety as a signal of unconscious conflict requiring resolution. May’s existential perspective sees anxiety as a
catalyst for growth and authentic living, where confronting anxiety leads to greater self-awareness and meaningful existence.
Page 1
,NSG 527 Final Exam | Psychopathology, Theories, and Advanced Clinical Modalities | Wilkes University 2026/2027
Q3: A PMHNP using existential therapy is working with a client who recently received a terminal diagnosis. The
client states, ‘I have never really lived because I was always afraid of dying.’ Which existential concept BEST
explains why facing death is considered essential for authentic living?
A. Eigenwelt - the relationship with ourselves
B. Mitwelt - the relationship with others
C. The realization that death is a boundary that gives urgency and meaning to present choices
**[CORRECT]**
D. The understanding that death eliminates all anxiety permanently
Correct Answer: C
Rationale: In existential psychotherapy, confronting the reality of death is considered fundamental to authentic living. Yalom and
Frankl both emphasized that acknowledging the finitude of life transforms how one chooses to live in the present. Death
awareness creates urgency and meaning for present choices, freeing the individual from trivial concerns and enabling genuine
engagement with life. Eigenwelt refers to the relationship with self, and Mitwelt to the relationship with others, but neither
captures the transformative function of death awareness.
Q4: A client in Gestalt therapy becomes frustrated and tells the PMHNP: I just want to understand WHY I keep
doing this to myself. How should the PMHNP respond based on the core principles of Gestalt therapy?
A. Let us explore your childhood experiences to uncover the root causes of this pattern
B. Understanding the why is not our primary goal; let us focus on what you are experiencing right now in
this moment **[CORRECT]**
C. Why questions are important for cognitive restructuring, so let us identify your cognitive distortions first
D. The why is irrelevant because your behavior is biologically determined
Correct Answer: B
Rationale: A core principle of Gestalt therapy, developed by Fritz and Laura Perls, is that the goal is NOT intellectual
understanding or the whys of one’s problems. Instead, Gestalt therapy focuses on awareness and restoring the natural state of
self-regulation through present-moment experience. The therapist redirects the client from intellectualization toward direct
awareness of what is being felt and experienced in the here and now. This distinguishes Gestalt from psychodynamic approaches
that explore childhood origins and CBT approaches that focus on cognitive restructuring.
Q5: A PMHNP is conducting a Gestalt therapy session and notices the client repeatedly shifting position, avoiding
eye contact, and speaking in a soft, childlike voice. According to Gestalt principles, the PMHNP should focus
PRIMARILY on which of the following?
A. Interpreting the unconscious defense mechanisms underlying these behaviors
B. Body posture, habits, and beliefs as they manifest in the present moment **[CORRECT]**
C. Developing a treatment plan with measurable behavioral objectives
D. Challenging cognitive distortions about self-worth
Correct Answer: B
Rationale: Gestalt therapy, founded by Frederick and Laura Perls, places primary emphasis on body posture, habits, and beliefs
as they manifest in the present moment. These nonverbal and behavioral expressions are considered direct access points to the
client’s current experience. Rather than interpreting unconscious mechanisms (psychodynamic) or challenging cognitive distortions
(CBT), the Gestalt therapist attends to how the client’s physical presence, movements, and habitual patterns reveal their current
state of awareness. This present-focused, experiential approach is a hallmark of Gestalt methodology.
Page 2
, NSG 527 Final Exam | Psychopathology, Theories, and Advanced Clinical Modalities | Wilkes University 2026/2027
Q6: In a Gestalt therapy session, a client describes a conflict between wanting to leave an unfulfilling job and
feeling obligated to stay for financial security. The PMHNP invites the client to use the top dog/underdog
technique. What is the THERAPEUTIC PURPOSE of this specific Gestalt technique?
A. To help the client identify which part of the conflict is objectively correct
B. To facilitate awareness of the internal polarities and integrate the conflicting parts of the self
**[CORRECT]**
C. To train the client in assertiveness skills for workplace communication
D. To determine which cognitive distortion is maintaining the ambivalence
Correct Answer: B
Rationale: The top dog/underdog technique in Gestalt therapy involves the client enacting both sides of an internal conflict. The
therapeutic purpose is to facilitate awareness of these internal polarities and work toward their integration rather than having one
side dominate the other. This technique embodies Gestalt’s focus on present-moment experience and awareness, helping clients
recognize how they split themselves and move toward greater wholeness and self-regulation.
Q7: A PMHNP is working with a client who consistently relies on family members to make decisions about
healthcare, employment, and social activities. The client states: I just cannot do anything on my own. In Gestalt
therapy terms, this client is MOST likely experiencing which phenomenon?
A. Resistance
B. The impasse **[CORRECT]**
C. Projection
D. Retroflection
Correct Answer: B
Rationale: The impasse in Gestalt therapy is the point where a person does not progress in self-support maturity but instead
continues to manipulate their environment, including other people, to survive. This client who cannot make decisions independently
and relies on family represents the impasse - a stuck point where the individual plays helpless, angry, or in whatever way is
needed to get the support they require rather than developing self-support.
Q8: According to Gestalt therapy principles, what is the PRIMARY direction of therapeutic movement that the
PMHNP facilitates in the client?
A. Moving from environmental support to self-support **[CORRECT]**
B. Moving from self-support to community support systems
C. Moving from unconscious awareness to conscious intellectual understanding
D. Moving from individual therapy to group therapy modalities
Correct Answer: A
Rationale: A core goal of Gestalt therapy is moving the client from environmental support to self-support. Clients who rely on
manipulation of their environment and other people to get needs met are at the impasse. The therapeutic process helps clients
develop their own internal resources for self-regulation and emotional support, reflecting Perls’ belief in the organism’s innate
capacity for self-regulation when awareness is restored.
Q9: A PMHNP utilizing person-centered therapy is working with a client who has a history of childhood
emotional neglect. The client is hesitant to share feelings, fearing judgment. Which of Carl Rogers’ core conditions
is the PMHNP demonstrating by maintaining a warm, nonjudgmental stance regardless of what the client shares?
A. Congruence (genuineness)
B. Empathy
Page 3
Final Exam NSG 527
Psychopathology, Theories, and Advanced Clinical
Modalities
Wilkes University | Passan School of Nursing | 2026/2027 Update | 100% Correct
100 Questions | 8 Sections | Verified Answers
Section 1: Foundational Theories and Conceptual Frameworks (Existential Therapy,
Gestalt Therapy, Humanistic Approaches, Person-Centered Therapy)
Q1: A PMHNP is working with a client who expresses a pervasive sense that life has no inherent purpose and
describes feeling paralyzed by the vast number of choices available. The PMHNP conceptualizes the client’s
struggle using Yalom’s existential framework. Which of the following givens of existence is MOST directly
relevant to this client’s presentation?
A. Death and the fear of dying
B. Freedom and responsibility
C. Isolation and relational disconnection
D. Meaninglessness and the search for purpose **[CORRECT]**
Correct Answer: D
Rationale: The client describes two intertwined existential concerns: the paralysis of choice (freedom) and the sense that life lacks
inherent purpose (meaninglessness). Yalom identified four givens of existence: death, freedom, isolation, and meaninglessness.
While freedom is relevant to the paralysis of choice, the pervasive sense that life has no inherent purpose most directly aligns with
meaninglessness, which Yalom considered the central existential challenge. The struggle for a sense of meaning is a core theme in
existential psychotherapy, and the therapist helps the client confront this void and create authentic meaning through responsible
choice-making.
Q2: A graduate nursing student is studying Rollo May’s contributions to existential psychotherapy. Which
statement BEST characterizes May’s perspective on anxiety compared to Freud’s classical view?
A. May viewed anxiety as a pathological symptom requiring elimination, consistent with the medical model
B. May conceptualized anxiety as an inevitable condition of living that arises from the personal need to
survive and preserve one’s being **[CORRECT]**
C. May believed anxiety was primarily biological in origin and best treated with pharmacotherapy
D. May considered anxiety to be a sign of unconscious conflict that must be resolved through dream analysis
Correct Answer: B
Rationale: Rollo May viewed anxiety not as a pathological symptom to be eliminated but as an inevitable condition of living that
arises from each person’s need to survive and preserve their being. This stands in contrast to Freud’s classical psychoanalytic view,
which framed anxiety as a signal of unconscious conflict requiring resolution. May’s existential perspective sees anxiety as a
catalyst for growth and authentic living, where confronting anxiety leads to greater self-awareness and meaningful existence.
Page 1
,NSG 527 Final Exam | Psychopathology, Theories, and Advanced Clinical Modalities | Wilkes University 2026/2027
Q3: A PMHNP using existential therapy is working with a client who recently received a terminal diagnosis. The
client states, ‘I have never really lived because I was always afraid of dying.’ Which existential concept BEST
explains why facing death is considered essential for authentic living?
A. Eigenwelt - the relationship with ourselves
B. Mitwelt - the relationship with others
C. The realization that death is a boundary that gives urgency and meaning to present choices
**[CORRECT]**
D. The understanding that death eliminates all anxiety permanently
Correct Answer: C
Rationale: In existential psychotherapy, confronting the reality of death is considered fundamental to authentic living. Yalom and
Frankl both emphasized that acknowledging the finitude of life transforms how one chooses to live in the present. Death
awareness creates urgency and meaning for present choices, freeing the individual from trivial concerns and enabling genuine
engagement with life. Eigenwelt refers to the relationship with self, and Mitwelt to the relationship with others, but neither
captures the transformative function of death awareness.
Q4: A client in Gestalt therapy becomes frustrated and tells the PMHNP: I just want to understand WHY I keep
doing this to myself. How should the PMHNP respond based on the core principles of Gestalt therapy?
A. Let us explore your childhood experiences to uncover the root causes of this pattern
B. Understanding the why is not our primary goal; let us focus on what you are experiencing right now in
this moment **[CORRECT]**
C. Why questions are important for cognitive restructuring, so let us identify your cognitive distortions first
D. The why is irrelevant because your behavior is biologically determined
Correct Answer: B
Rationale: A core principle of Gestalt therapy, developed by Fritz and Laura Perls, is that the goal is NOT intellectual
understanding or the whys of one’s problems. Instead, Gestalt therapy focuses on awareness and restoring the natural state of
self-regulation through present-moment experience. The therapist redirects the client from intellectualization toward direct
awareness of what is being felt and experienced in the here and now. This distinguishes Gestalt from psychodynamic approaches
that explore childhood origins and CBT approaches that focus on cognitive restructuring.
Q5: A PMHNP is conducting a Gestalt therapy session and notices the client repeatedly shifting position, avoiding
eye contact, and speaking in a soft, childlike voice. According to Gestalt principles, the PMHNP should focus
PRIMARILY on which of the following?
A. Interpreting the unconscious defense mechanisms underlying these behaviors
B. Body posture, habits, and beliefs as they manifest in the present moment **[CORRECT]**
C. Developing a treatment plan with measurable behavioral objectives
D. Challenging cognitive distortions about self-worth
Correct Answer: B
Rationale: Gestalt therapy, founded by Frederick and Laura Perls, places primary emphasis on body posture, habits, and beliefs
as they manifest in the present moment. These nonverbal and behavioral expressions are considered direct access points to the
client’s current experience. Rather than interpreting unconscious mechanisms (psychodynamic) or challenging cognitive distortions
(CBT), the Gestalt therapist attends to how the client’s physical presence, movements, and habitual patterns reveal their current
state of awareness. This present-focused, experiential approach is a hallmark of Gestalt methodology.
Page 2
, NSG 527 Final Exam | Psychopathology, Theories, and Advanced Clinical Modalities | Wilkes University 2026/2027
Q6: In a Gestalt therapy session, a client describes a conflict between wanting to leave an unfulfilling job and
feeling obligated to stay for financial security. The PMHNP invites the client to use the top dog/underdog
technique. What is the THERAPEUTIC PURPOSE of this specific Gestalt technique?
A. To help the client identify which part of the conflict is objectively correct
B. To facilitate awareness of the internal polarities and integrate the conflicting parts of the self
**[CORRECT]**
C. To train the client in assertiveness skills for workplace communication
D. To determine which cognitive distortion is maintaining the ambivalence
Correct Answer: B
Rationale: The top dog/underdog technique in Gestalt therapy involves the client enacting both sides of an internal conflict. The
therapeutic purpose is to facilitate awareness of these internal polarities and work toward their integration rather than having one
side dominate the other. This technique embodies Gestalt’s focus on present-moment experience and awareness, helping clients
recognize how they split themselves and move toward greater wholeness and self-regulation.
Q7: A PMHNP is working with a client who consistently relies on family members to make decisions about
healthcare, employment, and social activities. The client states: I just cannot do anything on my own. In Gestalt
therapy terms, this client is MOST likely experiencing which phenomenon?
A. Resistance
B. The impasse **[CORRECT]**
C. Projection
D. Retroflection
Correct Answer: B
Rationale: The impasse in Gestalt therapy is the point where a person does not progress in self-support maturity but instead
continues to manipulate their environment, including other people, to survive. This client who cannot make decisions independently
and relies on family represents the impasse - a stuck point where the individual plays helpless, angry, or in whatever way is
needed to get the support they require rather than developing self-support.
Q8: According to Gestalt therapy principles, what is the PRIMARY direction of therapeutic movement that the
PMHNP facilitates in the client?
A. Moving from environmental support to self-support **[CORRECT]**
B. Moving from self-support to community support systems
C. Moving from unconscious awareness to conscious intellectual understanding
D. Moving from individual therapy to group therapy modalities
Correct Answer: A
Rationale: A core goal of Gestalt therapy is moving the client from environmental support to self-support. Clients who rely on
manipulation of their environment and other people to get needs met are at the impasse. The therapeutic process helps clients
develop their own internal resources for self-regulation and emotional support, reflecting Perls’ belief in the organism’s innate
capacity for self-regulation when awareness is restored.
Q9: A PMHNP utilizing person-centered therapy is working with a client who has a history of childhood
emotional neglect. The client is hesitant to share feelings, fearing judgment. Which of Carl Rogers’ core conditions
is the PMHNP demonstrating by maintaining a warm, nonjudgmental stance regardless of what the client shares?
A. Congruence (genuineness)
B. Empathy
Page 3
