NSG 526 Exam 3 - Clinical Modalities in Advanced Psychiatric Practice | Wilkes University | 2026/2027 Page 1
NSG 526 - Clinical Modalities in Advanced Psychiatric
Practice
Exam 3 Study Guide + Review | Wilkes University | 2026/2027
Trauma, Crisis, and Complementary Modalities - 100 Verified Questions & Answers
Total Questions: 100 | Cognitive Distribution: 30% Recall - 50% Application - 20% Analysis
Format: 80% Scenario-Based - 20% Direct Recall | Item Type: Multiple Choice (4 options, single best answer)
Coverage: Trauma-informed care, EMDR, somatic modalities, crisis intervention, complementary therapies, milieu,
psychoeducation, ethics/culture/outcomes, integration.
Apply trauma-informed principles, crisis models, and evidence-based modality selection to clinical scenarios. Review rationales
for high-yield study notes and exam strategy.
Section 1: Trauma-Informed Care and PTSD Modalities - Q1-Q12
Q1. A psychiatric-mental health nurse practitioner (PMHNP) is establishing a new clinic for survivors of
intimate partner violence. Which principle is the FOUNDATION of trauma-informed care that should guide
all clinical interactions?
A. Forcing the patient to disclose trauma details in the first session to facilitate processing
B. Safety - ensuring physical and emotional safety in every interaction and environment [CORRECT]
C. Avoiding any discussion of the trauma to prevent retraumatization
D. Confronting the patient's avoidance behaviors immediately to promote healing
Correct Answer: B
Rationale: Safety is the foundational principle of trauma-informed care (SAMHSA's 6 principles: Safety, Trustworthiness &
Transparency, Peer Support, Collaboration & Mutuality, Empowerment/Voice/Choice, Cultural/Historical/Gender Issues).
Without safety, no other principle can be effectively implemented. Forcing disclosure (A) and avoiding trauma discussion
entirely (C) violate patient choice and pacing; confronting avoidance (D) can retraumatize. Study note: SAMHSA's 6
principles of trauma-informed care - memorize them; Safety is always first.
Q2. A patient with PTSD reports persistent avoidance of trauma reminders, hypervigilance, nightmares, and
intrusive flashbacks for 8 months following a motor vehicle accident. Which DSM-5-TR diagnostic criterion
cluster does the hypervigilance symptom BEST represent?
A. Cluster B - Intrusion symptoms
B. Cluster C - Avoidance symptoms
C. Cluster D - Negative alterations in cognition and mood
D. Cluster E - Marked alterations in arousal and reactivity [CORRECT]
Correct Answer: D
Rationale: Per DSM-5-TR, PTSD Cluster E includes marked alterations in arousal and reactivity: irritable/aggressive
behavior, reckless/self-destructive behavior, hypervigilance, exaggerated startle response, concentration problems, and sleep
disturbances. Cluster B = intrusion (flashbacks, nightmares); Cluster C = avoidance; Cluster D = negative cognitions/mood.
Study note: PTSD clusters - B (Intrusion), C (Avoidance), D (Negative cognition/mood), E (Arousal/reactivity); must persist
>1 month (Criterion F).
Q3. A 32-year-old patient with chronic PTSD from childhood abuse presents with emotional dysregulation,
dissociation, somatization, self-injurious behaviors, and severe difficulties in interpersonal relationships.
These findings are MOST consistent with which diagnosis?
A. Acute stress disorder
B. PTSD with dissociative features
Study Guide + Review - Trauma, Crisis & Complementary Modalities NSG 526 Exam 3 - 100 Items
,NSG 526 Exam 3 - Clinical Modalities in Advanced Psychiatric Practice | Wilkes University | 2026/2027 Page 2
C. Complex PTSD (Developmental trauma disorder, ICD-11) [CORRECT]
D. Borderline personality disorder only
Correct Answer: C
Rationale: Complex PTSD (C-PTSD, per ICD-11) includes core PTSD symptoms PLUS disturbances in self-organization:
emotional dysregulation, negative self-concept, and interpersonal difficulties. C-PTSD typically results from
prolonged/repeated trauma (e.g., childhood abuse, captivity). C-PTSD is NOT a separate DSM-5-TR diagnosis but the
dissociative subtype of PTSD is recognized. BPD may co-occur but is distinct. Study note: C-PTSD = ICD-11 diagnosis;
DSM-5-TR uses PTSD with dissociative subtype; etiology = prolonged, repeated, developmental trauma.
Q4. A PMHNP is selecting a first-line evidence-based psychotherapy for a patient with PTSD. Which therapy
has the STRONGEST evidence base and is considered first-line by both APA and VA/DoD guidelines?
A. Psychodynamic psychotherapy
B. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) or Prolonged Exposure (PE) [CORRECT]
C. Supportive psychotherapy
D. Gestalt therapy
Correct Answer: B
Rationale: Per APA (2017) and VA/DoD (2023) guidelines, trauma-focused psychotherapies are strongly recommended
first-line for PTSD: TF-CBT, Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and EMDR. These have the
strongest evidence base. Psychodynamic, supportive, and Gestalt therapies lack comparable evidence for PTSD. Study note:
PTSD first-line = TF-CBT, PE, CPT, EMDR (all strongly recommended); SSRIs/SNRIs are first-line pharmacotherapy
(sertraline, paroxetine FDA-approved).
Q5. A 28-year-old veteran with PTSD has been prescribed sertraline for 8 weeks with partial response. The
patient reports continued nightmares disturbing sleep. Which medication has the strongest evidence for
PTSD-related nightmares and is FDA-approved for this indication?
A. Prazosin [CORRECT]
B. Trazodone
C. Quetiapine
D. Clonazepam
Correct Answer: A
Rationale: Prazosin (alpha-1 adrenergic antagonist) has the strongest evidence for PTSD-related nightmares. Although a 2018
VA cooperative study questioned efficacy for overall PTSD symptoms, prazosin remains widely used and clinically effective
for many patients with trauma-related nightmares. Start at 1-2 mg at bedtime and titrate. Trazodone is for sleep; quetiapine is
off-label; benzodiazepines are NOT recommended for PTSD. Study note: prazosin = nightmares/sleep (alpha-1 antagonist);
avoid benzodiazepines in PTSD (no benefit, risk of dependence).
Q6. A PMHNP is implementing trauma-informed care for a patient with a history of sexual assault. Which
intervention BEST demonstrates the principle of "choice"?
A. Requiring the patient to complete exposure therapy within 6 months
B. Offering the patient options in treatment planning, scheduling, and therapy modality, and respecting
their right to decline interventions [CORRECT]
C. Insisting the patient recount the trauma in detail in every session
D. Mandating the patient bring a family member to sessions
Correct Answer: B
Rationale: Choice (voice and choice) means giving patients meaningful options and respecting their decisions, including the
right to decline. Trauma-informed care prioritizes patient autonomy and collaboration over clinician-driven directives. Forcing
timelines (A), recounting trauma (C), or mandating family involvement (D) all violate choice. Study note: trauma-informed
"Choice" = offer options + respect refusal + patient-driven pacing; not clinician-dictated timelines or content.
Study Guide + Review - Trauma, Crisis & Complementary Modalities NSG 526 Exam 3 - 100 Items
, NSG 526 Exam 3 - Clinical Modalities in Advanced Psychiatric Practice | Wilkes University | 2026/2027 Page 3
Q7. A patient with complex developmental trauma is being considered for treatment. The PMHNP
understands that, compared to single-incident PTSD, complex trauma typically requires:
A. Shorter, more intensive exposure therapy
B. Longer stabilization, skills building, and a phase-based approach before processing [CORRECT]
C. Immediate trauma processing in the first session
D. Medication management only without psychotherapy
Correct Answer: B
Rationale: Complex trauma/Complex PTSD treatment follows a phase-based approach (Cloitre, ISTSS guidelines): Phase 1 =
Safety, stabilization, skills (affect regulation, relational); Phase 2 = Trauma processing (only after stabilization); Phase 3 =
Integration/reconnection. Premature processing can destabilize patients. Phase 1 may take months to years. Study note:
Complex PTSD phase-based = 1. Stabilization/skills → 2. Processing → 3. Integration; ISTSS guidelines; never skip
stabilization phase.
Q8. A PMHNP is assessing a patient who recently experienced a sexual assault 3 days ago. The patient has
intrusive memories, hypervigilance, sleep disturbance, and feels "stuck" in the experience. Which diagnosis
is MOST appropriate at this time?
A. PTSD
B. Acute stress disorder (ASD) [CORRECT]
C. Adjustment disorder
D. Generalized anxiety disorder
Correct Answer: B
Rationale: Acute stress disorder (ASD) is diagnosed when trauma-related symptoms persist for 3 days to 1 month after
trauma (DSM-5-TR). PTSD requires symptoms >1 month. ASD symptoms are similar to PTSD (intrusion, avoidance,
negative cognition/mood, arousal). Not all ASD progresses to PTSD; early intervention can prevent chronicity. Adjustment
disorder doesn't meet PTSD criteria. Study note: ASD = 3 days-1 month; PTSD = >1 month; both require Criterion A trauma;
~50% of ASD cases progress to PTSD.
Q9. A patient with PTSD is initiating Prolonged Exposure (PE) therapy. The PMHNP explains that PE
involves which CORE components?
A. Imaginal exposure only
B. Imaginal exposure (recounting trauma in session) AND in vivo exposure (approaching avoided
real-world trauma reminders) [CORRECT]
C. Only relaxation training
D. Only cognitive restructuring
Correct Answer: B
Rationale: Prolonged Exposure (PE), developed by Foa, includes two core exposure components: (1) Imaginal exposure -
recounting the trauma memory in detail during session and processing it; (2) In vivo exposure - gradually approaching
real-world trauma-related situations/objects that have been avoided. PE typically runs 8-15 sessions. Homework (listening to
imaginal exposure recordings) is essential. Study note: PE = imaginal + in vivo; 8-15 sessions; homework is critical; CPT =
cognitive processing with written account, alternative to PE.
Q10. A PMHNP is treating a patient with PTSD who has a history of severe childhood trauma and current
dissociation during stress. The PMHNP should:
A. Proceed immediately with trauma exposure therapy
B. Stabilize and develop grounding and affect regulation skills before considering trauma processing
[CORRECT]
C. Prescribe benzodiazepines to manage dissociation
D. Refer for inpatient psychiatric hospitalization
Correct Answer: B
Study Guide + Review - Trauma, Crisis & Complementary Modalities NSG 526 Exam 3 - 100 Items
NSG 526 - Clinical Modalities in Advanced Psychiatric
Practice
Exam 3 Study Guide + Review | Wilkes University | 2026/2027
Trauma, Crisis, and Complementary Modalities - 100 Verified Questions & Answers
Total Questions: 100 | Cognitive Distribution: 30% Recall - 50% Application - 20% Analysis
Format: 80% Scenario-Based - 20% Direct Recall | Item Type: Multiple Choice (4 options, single best answer)
Coverage: Trauma-informed care, EMDR, somatic modalities, crisis intervention, complementary therapies, milieu,
psychoeducation, ethics/culture/outcomes, integration.
Apply trauma-informed principles, crisis models, and evidence-based modality selection to clinical scenarios. Review rationales
for high-yield study notes and exam strategy.
Section 1: Trauma-Informed Care and PTSD Modalities - Q1-Q12
Q1. A psychiatric-mental health nurse practitioner (PMHNP) is establishing a new clinic for survivors of
intimate partner violence. Which principle is the FOUNDATION of trauma-informed care that should guide
all clinical interactions?
A. Forcing the patient to disclose trauma details in the first session to facilitate processing
B. Safety - ensuring physical and emotional safety in every interaction and environment [CORRECT]
C. Avoiding any discussion of the trauma to prevent retraumatization
D. Confronting the patient's avoidance behaviors immediately to promote healing
Correct Answer: B
Rationale: Safety is the foundational principle of trauma-informed care (SAMHSA's 6 principles: Safety, Trustworthiness &
Transparency, Peer Support, Collaboration & Mutuality, Empowerment/Voice/Choice, Cultural/Historical/Gender Issues).
Without safety, no other principle can be effectively implemented. Forcing disclosure (A) and avoiding trauma discussion
entirely (C) violate patient choice and pacing; confronting avoidance (D) can retraumatize. Study note: SAMHSA's 6
principles of trauma-informed care - memorize them; Safety is always first.
Q2. A patient with PTSD reports persistent avoidance of trauma reminders, hypervigilance, nightmares, and
intrusive flashbacks for 8 months following a motor vehicle accident. Which DSM-5-TR diagnostic criterion
cluster does the hypervigilance symptom BEST represent?
A. Cluster B - Intrusion symptoms
B. Cluster C - Avoidance symptoms
C. Cluster D - Negative alterations in cognition and mood
D. Cluster E - Marked alterations in arousal and reactivity [CORRECT]
Correct Answer: D
Rationale: Per DSM-5-TR, PTSD Cluster E includes marked alterations in arousal and reactivity: irritable/aggressive
behavior, reckless/self-destructive behavior, hypervigilance, exaggerated startle response, concentration problems, and sleep
disturbances. Cluster B = intrusion (flashbacks, nightmares); Cluster C = avoidance; Cluster D = negative cognitions/mood.
Study note: PTSD clusters - B (Intrusion), C (Avoidance), D (Negative cognition/mood), E (Arousal/reactivity); must persist
>1 month (Criterion F).
Q3. A 32-year-old patient with chronic PTSD from childhood abuse presents with emotional dysregulation,
dissociation, somatization, self-injurious behaviors, and severe difficulties in interpersonal relationships.
These findings are MOST consistent with which diagnosis?
A. Acute stress disorder
B. PTSD with dissociative features
Study Guide + Review - Trauma, Crisis & Complementary Modalities NSG 526 Exam 3 - 100 Items
,NSG 526 Exam 3 - Clinical Modalities in Advanced Psychiatric Practice | Wilkes University | 2026/2027 Page 2
C. Complex PTSD (Developmental trauma disorder, ICD-11) [CORRECT]
D. Borderline personality disorder only
Correct Answer: C
Rationale: Complex PTSD (C-PTSD, per ICD-11) includes core PTSD symptoms PLUS disturbances in self-organization:
emotional dysregulation, negative self-concept, and interpersonal difficulties. C-PTSD typically results from
prolonged/repeated trauma (e.g., childhood abuse, captivity). C-PTSD is NOT a separate DSM-5-TR diagnosis but the
dissociative subtype of PTSD is recognized. BPD may co-occur but is distinct. Study note: C-PTSD = ICD-11 diagnosis;
DSM-5-TR uses PTSD with dissociative subtype; etiology = prolonged, repeated, developmental trauma.
Q4. A PMHNP is selecting a first-line evidence-based psychotherapy for a patient with PTSD. Which therapy
has the STRONGEST evidence base and is considered first-line by both APA and VA/DoD guidelines?
A. Psychodynamic psychotherapy
B. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) or Prolonged Exposure (PE) [CORRECT]
C. Supportive psychotherapy
D. Gestalt therapy
Correct Answer: B
Rationale: Per APA (2017) and VA/DoD (2023) guidelines, trauma-focused psychotherapies are strongly recommended
first-line for PTSD: TF-CBT, Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and EMDR. These have the
strongest evidence base. Psychodynamic, supportive, and Gestalt therapies lack comparable evidence for PTSD. Study note:
PTSD first-line = TF-CBT, PE, CPT, EMDR (all strongly recommended); SSRIs/SNRIs are first-line pharmacotherapy
(sertraline, paroxetine FDA-approved).
Q5. A 28-year-old veteran with PTSD has been prescribed sertraline for 8 weeks with partial response. The
patient reports continued nightmares disturbing sleep. Which medication has the strongest evidence for
PTSD-related nightmares and is FDA-approved for this indication?
A. Prazosin [CORRECT]
B. Trazodone
C. Quetiapine
D. Clonazepam
Correct Answer: A
Rationale: Prazosin (alpha-1 adrenergic antagonist) has the strongest evidence for PTSD-related nightmares. Although a 2018
VA cooperative study questioned efficacy for overall PTSD symptoms, prazosin remains widely used and clinically effective
for many patients with trauma-related nightmares. Start at 1-2 mg at bedtime and titrate. Trazodone is for sleep; quetiapine is
off-label; benzodiazepines are NOT recommended for PTSD. Study note: prazosin = nightmares/sleep (alpha-1 antagonist);
avoid benzodiazepines in PTSD (no benefit, risk of dependence).
Q6. A PMHNP is implementing trauma-informed care for a patient with a history of sexual assault. Which
intervention BEST demonstrates the principle of "choice"?
A. Requiring the patient to complete exposure therapy within 6 months
B. Offering the patient options in treatment planning, scheduling, and therapy modality, and respecting
their right to decline interventions [CORRECT]
C. Insisting the patient recount the trauma in detail in every session
D. Mandating the patient bring a family member to sessions
Correct Answer: B
Rationale: Choice (voice and choice) means giving patients meaningful options and respecting their decisions, including the
right to decline. Trauma-informed care prioritizes patient autonomy and collaboration over clinician-driven directives. Forcing
timelines (A), recounting trauma (C), or mandating family involvement (D) all violate choice. Study note: trauma-informed
"Choice" = offer options + respect refusal + patient-driven pacing; not clinician-dictated timelines or content.
Study Guide + Review - Trauma, Crisis & Complementary Modalities NSG 526 Exam 3 - 100 Items
, NSG 526 Exam 3 - Clinical Modalities in Advanced Psychiatric Practice | Wilkes University | 2026/2027 Page 3
Q7. A patient with complex developmental trauma is being considered for treatment. The PMHNP
understands that, compared to single-incident PTSD, complex trauma typically requires:
A. Shorter, more intensive exposure therapy
B. Longer stabilization, skills building, and a phase-based approach before processing [CORRECT]
C. Immediate trauma processing in the first session
D. Medication management only without psychotherapy
Correct Answer: B
Rationale: Complex trauma/Complex PTSD treatment follows a phase-based approach (Cloitre, ISTSS guidelines): Phase 1 =
Safety, stabilization, skills (affect regulation, relational); Phase 2 = Trauma processing (only after stabilization); Phase 3 =
Integration/reconnection. Premature processing can destabilize patients. Phase 1 may take months to years. Study note:
Complex PTSD phase-based = 1. Stabilization/skills → 2. Processing → 3. Integration; ISTSS guidelines; never skip
stabilization phase.
Q8. A PMHNP is assessing a patient who recently experienced a sexual assault 3 days ago. The patient has
intrusive memories, hypervigilance, sleep disturbance, and feels "stuck" in the experience. Which diagnosis
is MOST appropriate at this time?
A. PTSD
B. Acute stress disorder (ASD) [CORRECT]
C. Adjustment disorder
D. Generalized anxiety disorder
Correct Answer: B
Rationale: Acute stress disorder (ASD) is diagnosed when trauma-related symptoms persist for 3 days to 1 month after
trauma (DSM-5-TR). PTSD requires symptoms >1 month. ASD symptoms are similar to PTSD (intrusion, avoidance,
negative cognition/mood, arousal). Not all ASD progresses to PTSD; early intervention can prevent chronicity. Adjustment
disorder doesn't meet PTSD criteria. Study note: ASD = 3 days-1 month; PTSD = >1 month; both require Criterion A trauma;
~50% of ASD cases progress to PTSD.
Q9. A patient with PTSD is initiating Prolonged Exposure (PE) therapy. The PMHNP explains that PE
involves which CORE components?
A. Imaginal exposure only
B. Imaginal exposure (recounting trauma in session) AND in vivo exposure (approaching avoided
real-world trauma reminders) [CORRECT]
C. Only relaxation training
D. Only cognitive restructuring
Correct Answer: B
Rationale: Prolonged Exposure (PE), developed by Foa, includes two core exposure components: (1) Imaginal exposure -
recounting the trauma memory in detail during session and processing it; (2) In vivo exposure - gradually approaching
real-world trauma-related situations/objects that have been avoided. PE typically runs 8-15 sessions. Homework (listening to
imaginal exposure recordings) is essential. Study note: PE = imaginal + in vivo; 8-15 sessions; homework is critical; CPT =
cognitive processing with written account, alternative to PE.
Q10. A PMHNP is treating a patient with PTSD who has a history of severe childhood trauma and current
dissociation during stress. The PMHNP should:
A. Proceed immediately with trauma exposure therapy
B. Stabilize and develop grounding and affect regulation skills before considering trauma processing
[CORRECT]
C. Prescribe benzodiazepines to manage dissociation
D. Refer for inpatient psychiatric hospitalization
Correct Answer: B
Study Guide + Review - Trauma, Crisis & Complementary Modalities NSG 526 Exam 3 - 100 Items
