,NSG426/NSG 526 Exam 3 Clinical Modalities in Advanced
Psychiatric/Mental Health Nursing Practice | Wilkes | 26/27
1. A patient in crisis tells the psychiatric-mental health nurse practitioner (PMHNP), "I've tried
everything I know, and nothing is working. I feel like I'm falling apart." According to Caplan's phases of
crisis, this statement is most consistent with which phase?
A) Phase 1: Problem arises with increased anxiety
B) Phase 2: Usual problem-solving techniques fail
C) Phase 3: Trial-and-error attempts fail; anxiety escalates to panic
D) Phase 4: Personality disorganization occurs
Correct Answer: Phase 3: Trial-and-error attempts fail; anxiety escalates to panic
Rationale: In Caplan's crisis phases, Phase 3 is characterized by the failure of trial-and-error coping
attempts, leading to escalating anxiety and the use of automatic relief behaviors. Phase 1 involves
initial anxiety with usual problem-solving. Phase 2 involves ineffective usual techniques. Phase 4
involves overwhelming anxiety and personality disorganization.
2. A PMHNP is called to a disaster site to provide mental health support to survivors. Which
intervention represents tertiary prevention in disaster mental health?
A) Providing psychoeducation about stress reactions before the disaster
B) Screening survivors for acute stress reactions at the shelter
C) Referring a survivor with prolonged PTSD symptoms to specialized trauma therapy
D) Teaching crisis coping skills to first responders
Correct Answer: Referring a survivor with prolonged PTSD symptoms to specialized trauma therapy
Rationale: Tertiary prevention focuses on reducing long-term complications and promoting
rehabilitation after a crisis has occurred. Referring for specialized trauma therapy addresses persistent
symptoms. Primary prevention prevents the crisis, and secondary prevention involves early
identification and treatment.
3. A patient with borderline personality disorder engages in self-injurious behavior during a session.
The PMHNP's priority intervention is to:
A) Terminate the session immediately to avoid reinforcing the behavior
B) Assess the patient's suicidal intent and ensure safety
C) Ignore the behavior and continue with the planned therapy
,D) Call for security to restrain the patient
Correct Answer: Assess the patient's suicidal intent and ensure safety
Rationale: Self-injurious behavior in borderline personality disorder requires immediate assessment of
suicidal intent and a compassionate, safety-focused response. Terminating the session, ignoring the
behavior, or calling security without assessment is not therapeutic and may escalate the situation.
4. According to the DSM-5-TR, which of the following is a core feature of a personality disorder?
A) Symptoms that are ego-dystonic and cause significant distress
B) An enduring pattern of inner experience and behavior that deviates markedly from cultural
expectations
C) Onset in late adulthood after a significant life stressor
D) Symptoms that are episodic and resolve between episodes
Correct Answer: An enduring pattern of inner experience and behavior that deviates markedly from
cultural expectations
Rationale: Personality disorders are characterized by enduring, pervasive, and inflexible patterns of
inner experience and behavior that deviate from cultural expectations, with onset in adolescence or
early adulthood. Symptoms are typically ego-syntonic and persistent.
5. In Structural Family Therapy, developed by Salvador Minuchin, an enmeshed family subsystem is
characterized by:
A) Clear, flexible boundaries that allow for autonomy
B) Diffuse boundaries with excessive emotional involvement and blurred roles
C) Rigid boundaries that prevent emotional connection
D) A hierarchical structure with clear generational lines
Correct Answer: Diffuse boundaries with excessive emotional involvement and blurred roles
Rationale: Enmeshment in Structural Family Therapy refers to diffuse, blurred boundaries where
family members are overly involved in each other's lives and emotions. Clear boundaries are healthy,
rigid boundaries indicate disengagement, and hierarchical structure refers to authority patterns.
6. A child who has experienced a traumatic event is referred for play therapy. The primary therapeutic
mechanism of play therapy is:
A) Verbal exploration of unconscious conflicts
, B) The use of symbolic expression to process feelings and experiences
C) Systematic desensitization to trauma reminders
D) Cognitive restructuring of maladaptive thoughts
Correct Answer: The use of symbolic expression to process feelings and experiences
Rationale: Play therapy allows children to express and process feelings, experiences, and conflicts
symbolically through play, which is their natural medium of communication. Verbal exploration is less
effective for young children. Desensitization and cognitive restructuring are more adult-focused.
7. In Bowenian family therapy, the concept of "emotional cutoff" refers to:
A) The ability to distinguish intellectual processes from feelings
B) The process of emotionally disengaging from family members to reduce anxiety
C) The pattern of drawing a third person into a dyadic conflict
D) The blurring of boundaries between family members
Correct Answer: The process of emotionally disengaging from family members to reduce anxiety
Rationale: Emotional cutoff is a Bowenian concept describing the process of emotionally disengaging
from family members to manage unresolved attachment issues and reduce anxiety. Differentiation
involves separating thought from feeling. Triangulation involves a third person. Enmeshment involves
blurred boundaries.
8. A PMHNP is providing crisis intervention to a patient who has just experienced a sexual assault.
Which intervention is most appropriate during the initial phase of crisis intervention?
A) Exploring the patient's childhood history of trauma
B) Establishing a therapeutic alliance and ensuring physical and emotional safety
C) Prescribing psychotropic medication for sleep disturbance
D) Developing a long-term psychotherapy plan
Correct Answer: Establishing a therapeutic alliance and ensuring physical and emotional safety
Rationale: In crisis intervention, the initial phase focuses on establishing a therapeutic alliance,
ensuring safety, and providing immediate support. Exploring childhood history, prescribing
medications, and developing long-term plans are not primary goals of crisis intervention.
9. A patient with avoidant personality disorder is most likely to avoid which situation?
A) Situations requiring close relationships due to fear of criticism or rejection
Psychiatric/Mental Health Nursing Practice | Wilkes | 26/27
1. A patient in crisis tells the psychiatric-mental health nurse practitioner (PMHNP), "I've tried
everything I know, and nothing is working. I feel like I'm falling apart." According to Caplan's phases of
crisis, this statement is most consistent with which phase?
A) Phase 1: Problem arises with increased anxiety
B) Phase 2: Usual problem-solving techniques fail
C) Phase 3: Trial-and-error attempts fail; anxiety escalates to panic
D) Phase 4: Personality disorganization occurs
Correct Answer: Phase 3: Trial-and-error attempts fail; anxiety escalates to panic
Rationale: In Caplan's crisis phases, Phase 3 is characterized by the failure of trial-and-error coping
attempts, leading to escalating anxiety and the use of automatic relief behaviors. Phase 1 involves
initial anxiety with usual problem-solving. Phase 2 involves ineffective usual techniques. Phase 4
involves overwhelming anxiety and personality disorganization.
2. A PMHNP is called to a disaster site to provide mental health support to survivors. Which
intervention represents tertiary prevention in disaster mental health?
A) Providing psychoeducation about stress reactions before the disaster
B) Screening survivors for acute stress reactions at the shelter
C) Referring a survivor with prolonged PTSD symptoms to specialized trauma therapy
D) Teaching crisis coping skills to first responders
Correct Answer: Referring a survivor with prolonged PTSD symptoms to specialized trauma therapy
Rationale: Tertiary prevention focuses on reducing long-term complications and promoting
rehabilitation after a crisis has occurred. Referring for specialized trauma therapy addresses persistent
symptoms. Primary prevention prevents the crisis, and secondary prevention involves early
identification and treatment.
3. A patient with borderline personality disorder engages in self-injurious behavior during a session.
The PMHNP's priority intervention is to:
A) Terminate the session immediately to avoid reinforcing the behavior
B) Assess the patient's suicidal intent and ensure safety
C) Ignore the behavior and continue with the planned therapy
,D) Call for security to restrain the patient
Correct Answer: Assess the patient's suicidal intent and ensure safety
Rationale: Self-injurious behavior in borderline personality disorder requires immediate assessment of
suicidal intent and a compassionate, safety-focused response. Terminating the session, ignoring the
behavior, or calling security without assessment is not therapeutic and may escalate the situation.
4. According to the DSM-5-TR, which of the following is a core feature of a personality disorder?
A) Symptoms that are ego-dystonic and cause significant distress
B) An enduring pattern of inner experience and behavior that deviates markedly from cultural
expectations
C) Onset in late adulthood after a significant life stressor
D) Symptoms that are episodic and resolve between episodes
Correct Answer: An enduring pattern of inner experience and behavior that deviates markedly from
cultural expectations
Rationale: Personality disorders are characterized by enduring, pervasive, and inflexible patterns of
inner experience and behavior that deviate from cultural expectations, with onset in adolescence or
early adulthood. Symptoms are typically ego-syntonic and persistent.
5. In Structural Family Therapy, developed by Salvador Minuchin, an enmeshed family subsystem is
characterized by:
A) Clear, flexible boundaries that allow for autonomy
B) Diffuse boundaries with excessive emotional involvement and blurred roles
C) Rigid boundaries that prevent emotional connection
D) A hierarchical structure with clear generational lines
Correct Answer: Diffuse boundaries with excessive emotional involvement and blurred roles
Rationale: Enmeshment in Structural Family Therapy refers to diffuse, blurred boundaries where
family members are overly involved in each other's lives and emotions. Clear boundaries are healthy,
rigid boundaries indicate disengagement, and hierarchical structure refers to authority patterns.
6. A child who has experienced a traumatic event is referred for play therapy. The primary therapeutic
mechanism of play therapy is:
A) Verbal exploration of unconscious conflicts
, B) The use of symbolic expression to process feelings and experiences
C) Systematic desensitization to trauma reminders
D) Cognitive restructuring of maladaptive thoughts
Correct Answer: The use of symbolic expression to process feelings and experiences
Rationale: Play therapy allows children to express and process feelings, experiences, and conflicts
symbolically through play, which is their natural medium of communication. Verbal exploration is less
effective for young children. Desensitization and cognitive restructuring are more adult-focused.
7. In Bowenian family therapy, the concept of "emotional cutoff" refers to:
A) The ability to distinguish intellectual processes from feelings
B) The process of emotionally disengaging from family members to reduce anxiety
C) The pattern of drawing a third person into a dyadic conflict
D) The blurring of boundaries between family members
Correct Answer: The process of emotionally disengaging from family members to reduce anxiety
Rationale: Emotional cutoff is a Bowenian concept describing the process of emotionally disengaging
from family members to manage unresolved attachment issues and reduce anxiety. Differentiation
involves separating thought from feeling. Triangulation involves a third person. Enmeshment involves
blurred boundaries.
8. A PMHNP is providing crisis intervention to a patient who has just experienced a sexual assault.
Which intervention is most appropriate during the initial phase of crisis intervention?
A) Exploring the patient's childhood history of trauma
B) Establishing a therapeutic alliance and ensuring physical and emotional safety
C) Prescribing psychotropic medication for sleep disturbance
D) Developing a long-term psychotherapy plan
Correct Answer: Establishing a therapeutic alliance and ensuring physical and emotional safety
Rationale: In crisis intervention, the initial phase focuses on establishing a therapeutic alliance,
ensuring safety, and providing immediate support. Exploring childhood history, prescribing
medications, and developing long-term plans are not primary goals of crisis intervention.
9. A patient with avoidant personality disorder is most likely to avoid which situation?
A) Situations requiring close relationships due to fear of criticism or rejection
