,NR 605 Midterm Exam – Dx & Mgmt in PMH Across
Lifespan I – Q&A (2026) PDF | Chamberlain
1. The PMHNP is establishing a therapeutic alliance with a new client. Which initial action
best promotes this alliance?
A) Demonstrating empathy and validating the client's experience
B) Conducting a comprehensive diagnostic interview
C) Prescribing medication to address acute symptoms
D) Setting firm boundaries regarding session length
Correct Answer: A) Demonstrating empathy and validating the client's experience
Rationale: A therapeutic alliance is built on trust, empathy, and collaboration. Validating the
client's feelings fosters safety and engagement. While assessments, medications, and
boundaries are important, empathy is foundational for establishing the relationship.
2. The PMHNP is managing a client with major depressive disorder who has failed two SSRIs.
According to the STAR*D trial, which next step is most appropriate?
A) Switch to an MAOI
B) Augment with bupropion
C) Begin cognitive behavioral therapy alone
D) Discontinue all medication
Correct Answer: B) Augment with bupropion
Rationale: The STAR*D trial showed augmentation with bupropion or buspirone improves
outcomes after inadequate SSRI response. Bupropion targets dopamine and norepinephrine
reuptake, complementing serotonergic action. Switching or adding therapy is evidence-
based.
,3. A PMHNP notices that a client is directing anger toward the provider that appears to be
related to past experiences with a parent. This phenomenon is:
A) Countertransference
B) Splitting
C) Transference
D) Projection
Correct Answer: C) Transference
Rationale: Transference occurs when a client unconsciously projects feelings from a past
relationship onto the provider. Countertransference is the provider's emotional reaction to
the client. Splitting involves polarized views of people. Projection attributes one's own
feelings to others.
4. Which model of care aligns with the PMHNP philosophy of treating the whole person,
including emotional, social, and spiritual dimensions?
A) Biomedical model
B) Pathophysiological model
C) Disease-centered model
D) Holistic model
Correct Answer: D) Holistic model
Rationale: The holistic model integrates biological, psychological, social, and spiritual aspects
of health. The biomedical model focuses solely on physical pathology. PMHNPs embrace
holistic care to promote healing and long-term wellness, not just symptom reduction.
5. The PMHNP is teaching coping strategies to a client with anxiety. This action reflects which
of Peplau's roles?
A) Teacher
, B) Counselor
C) Surrogate
D) Resource
Correct Answer: A) Teacher
Rationale: Peplau's Teacher role involves providing education about mental health and
coping skills. The Counselor role focuses on active listening and emotional support. Resource
provides specific information. Surrogate assists with functions the client temporarily cannot
manage.
6. A client with borderline personality disorder tells the PMHNP, "You are the only one who
understands me; the other therapist was terrible." This demonstrates which defense
mechanism?
A) Intellectualization
B) Projection
C) Splitting
D) Rationalization
Correct Answer: C) Splitting
Rationale: Splitting is a defense mechanism in which the person views others as all good or all
bad, failing to integrate positive and negative qualities. It is common in borderline personality
disorder. Intellectualization involves excessive logic to avoid emotions.
7. The PMHNP is caring for a client who has just survived a natural disaster and is now able to
function and adapt despite significant loss. This client is demonstrating:
A) Resistance
B) Resilience
C) Regression
Lifespan I – Q&A (2026) PDF | Chamberlain
1. The PMHNP is establishing a therapeutic alliance with a new client. Which initial action
best promotes this alliance?
A) Demonstrating empathy and validating the client's experience
B) Conducting a comprehensive diagnostic interview
C) Prescribing medication to address acute symptoms
D) Setting firm boundaries regarding session length
Correct Answer: A) Demonstrating empathy and validating the client's experience
Rationale: A therapeutic alliance is built on trust, empathy, and collaboration. Validating the
client's feelings fosters safety and engagement. While assessments, medications, and
boundaries are important, empathy is foundational for establishing the relationship.
2. The PMHNP is managing a client with major depressive disorder who has failed two SSRIs.
According to the STAR*D trial, which next step is most appropriate?
A) Switch to an MAOI
B) Augment with bupropion
C) Begin cognitive behavioral therapy alone
D) Discontinue all medication
Correct Answer: B) Augment with bupropion
Rationale: The STAR*D trial showed augmentation with bupropion or buspirone improves
outcomes after inadequate SSRI response. Bupropion targets dopamine and norepinephrine
reuptake, complementing serotonergic action. Switching or adding therapy is evidence-
based.
,3. A PMHNP notices that a client is directing anger toward the provider that appears to be
related to past experiences with a parent. This phenomenon is:
A) Countertransference
B) Splitting
C) Transference
D) Projection
Correct Answer: C) Transference
Rationale: Transference occurs when a client unconsciously projects feelings from a past
relationship onto the provider. Countertransference is the provider's emotional reaction to
the client. Splitting involves polarized views of people. Projection attributes one's own
feelings to others.
4. Which model of care aligns with the PMHNP philosophy of treating the whole person,
including emotional, social, and spiritual dimensions?
A) Biomedical model
B) Pathophysiological model
C) Disease-centered model
D) Holistic model
Correct Answer: D) Holistic model
Rationale: The holistic model integrates biological, psychological, social, and spiritual aspects
of health. The biomedical model focuses solely on physical pathology. PMHNPs embrace
holistic care to promote healing and long-term wellness, not just symptom reduction.
5. The PMHNP is teaching coping strategies to a client with anxiety. This action reflects which
of Peplau's roles?
A) Teacher
, B) Counselor
C) Surrogate
D) Resource
Correct Answer: A) Teacher
Rationale: Peplau's Teacher role involves providing education about mental health and
coping skills. The Counselor role focuses on active listening and emotional support. Resource
provides specific information. Surrogate assists with functions the client temporarily cannot
manage.
6. A client with borderline personality disorder tells the PMHNP, "You are the only one who
understands me; the other therapist was terrible." This demonstrates which defense
mechanism?
A) Intellectualization
B) Projection
C) Splitting
D) Rationalization
Correct Answer: C) Splitting
Rationale: Splitting is a defense mechanism in which the person views others as all good or all
bad, failing to integrate positive and negative qualities. It is common in borderline personality
disorder. Intellectualization involves excessive logic to avoid emotions.
7. The PMHNP is caring for a client who has just survived a natural disaster and is now able to
function and adapt despite significant loss. This client is demonstrating:
A) Resistance
B) Resilience
C) Regression
