NSG 526 Exam 3 Actual Exam V3 | NSG 526 Clinical Modalities Adv.
Psych (NSG526 Exam 3) | Wilkes University
1. A 32-year-old female patient with Borderline Personality Disorder (BPD) presents to a
session expressing intense anger toward the therapist for being five minutes late. She states,
‘You don’t care about me at all, you’re just like everyone else.’ Which Dialectical Behavior
Therapy (DBT) strategy is most appropriate at this moment?
A. Use validation to acknowledge the patient’s feelings of abandonment.
B. Confront the patient’s cognitive distortion immediately.
C. Redirect the patient to her homework assignment from the previous week.
D. Set a firm boundary by ending the session due to verbal aggression.
Answer: A
Rationale: Validation is a core component of DBT that helps lower emotional arousal in
patients with BPD. By acknowledging the patient’s perspective, the therapist maintains the
therapeutic alliance and prevents further escalation. This approach facilitates the eventual
move toward problem-solving once the patient is more regulated.
2. During a family therapy session, the therapist notices that the mother speaks for her
teenage son, and the father remains silent. According to Salvador Minuchin’s Structural
Family Therapy, what is the primary goal of the therapist in this scenario?
A. Restructure boundaries to allow the son to speak for himself.
B. Encourage the father to express his repressed anger.
C. Develop a genogram to track generational trauma.
D. Assign a paradoxical intervention to increase the mother’s talking.
Answer: A
Rationale: Structural Family Therapy focuses on hierarchies and boundaries within the
family system. In this case, the mother is over-involved (enmeshed) with the son,
preventing his autonomy. The therapist’s role is to modify the family structure to ensure
healthy communication and appropriate generational boundaries.
3. A patient in Cognitive Behavioral Therapy (CBT) for depression reports, ‘If I don’t get an A
on this exam, my entire career is ruined.’ Which cognitive distortion is this patient
demonstrating?
A. Emotional reasoning
B. Catastrophizing
,C. Personalization
D. Labeling
Answer: B
Rationale: Catastrophizing involves anticipating the worst possible outcome and believing
it will be unbearable. This patient is overestimating the negative consequences of a single
event on her long-term future. Challenging this distortion involves examining the evidence
and considering more balanced outcomes.
4. In a group therapy setting, a member states, ‘I thought I was the only one who felt this
way, but hearing you all talk makes me feel less alone.’ Which of Irvin Yalom’s therapeutic
factors is being expressed?
A. Altruism
B. Catharsis
C. Universality
D. Cohesiveness
Answer: C
Rationale: Universality is the recognition that one’s problems are shared by others and
that they are not unique in their suffering. This realization provides immense relief and
reduces the isolation often felt by psychiatric patients. It is one of the primary healing
elements identified by Yalom in group psychotherapy.
5. A 45-year-old male recently lost his job of 20 years and presents with symptoms of
adjustment disorder. Which therapeutic modality is specifically designed to address life
transitions and role disputes?
A. Interpersonal Psychotherapy (IPT)
B. Eye Movement Desensitization and Reprocessing (EMDR)
C. Applied Behavioral Analysis (ABA)
D. Psychodynamic Psychotherapy
Answer: A
Rationale: IPT is a time-limited treatment that focuses on interpersonal issues as the
primary drivers of psychological distress. It specifically targets four areas: grief, role
disputes, role transitions, and interpersonal deficits. For this patient, the loss of a long-term
job represents a significant role transition.
, 6. A PMHNP is treating a patient who frequently ‘forgets’ to pay for sessions and often asks
for extra time at the end. The therapist begins to feel resentful and finds themselves wanting
to avoid the patient. This feeling is best described as:
A. Transference
B. Countertransference
C. Projective Identification
D. Splitting
Answer: B
Rationale: Countertransference refers to the therapist’s emotional reaction to the patient,
often based on the therapist’s own internal conflicts or the patient’s behavior. Recognizing
these feelings is crucial for maintaining professional boundaries and ensuring effective
treatment. Supervision is often necessary to process these reactions and prevent them
from interfering with care.
7. A 7-year-old child is brought to therapy following a traumatic event. The child is non-verbal
about the trauma but begins to play with dolls, depicting a scene of a ‘scary monster’
attacking a house. What is the most appropriate therapeutic response?
A. Narrate the play neutrally, acknowledging the ‘scary monster’ and the ‘frightened dolls’.
B. Stop the play and ask the child to explain the meaning of the monster.
C. Interpret the ‘monster’ as the child’s father to the parents.
D. Advise the parents that the child is not ready for therapy because they won’t talk.
Answer: A
Rationale: Play is the natural language of children, and in Trauma-Focused Cognitive
Behavioral Therapy (TF-CBT) or general play therapy, the therapist uses it to help the child
process events. Mirroring or narrating the play allows the child to externalize the trauma in
a safe, metaphorical space. Direct interpretation too early can be overwhelming and
counterproductive for the child.
8. Which of the following interventions is a hallmark of Solution-Focused Brief Therapy
(SFBT)?
A. Analyzing childhood dreams
B. Free association
C. The Miracle Question
D. Systematic desensitization
Answer: C
Psych (NSG526 Exam 3) | Wilkes University
1. A 32-year-old female patient with Borderline Personality Disorder (BPD) presents to a
session expressing intense anger toward the therapist for being five minutes late. She states,
‘You don’t care about me at all, you’re just like everyone else.’ Which Dialectical Behavior
Therapy (DBT) strategy is most appropriate at this moment?
A. Use validation to acknowledge the patient’s feelings of abandonment.
B. Confront the patient’s cognitive distortion immediately.
C. Redirect the patient to her homework assignment from the previous week.
D. Set a firm boundary by ending the session due to verbal aggression.
Answer: A
Rationale: Validation is a core component of DBT that helps lower emotional arousal in
patients with BPD. By acknowledging the patient’s perspective, the therapist maintains the
therapeutic alliance and prevents further escalation. This approach facilitates the eventual
move toward problem-solving once the patient is more regulated.
2. During a family therapy session, the therapist notices that the mother speaks for her
teenage son, and the father remains silent. According to Salvador Minuchin’s Structural
Family Therapy, what is the primary goal of the therapist in this scenario?
A. Restructure boundaries to allow the son to speak for himself.
B. Encourage the father to express his repressed anger.
C. Develop a genogram to track generational trauma.
D. Assign a paradoxical intervention to increase the mother’s talking.
Answer: A
Rationale: Structural Family Therapy focuses on hierarchies and boundaries within the
family system. In this case, the mother is over-involved (enmeshed) with the son,
preventing his autonomy. The therapist’s role is to modify the family structure to ensure
healthy communication and appropriate generational boundaries.
3. A patient in Cognitive Behavioral Therapy (CBT) for depression reports, ‘If I don’t get an A
on this exam, my entire career is ruined.’ Which cognitive distortion is this patient
demonstrating?
A. Emotional reasoning
B. Catastrophizing
,C. Personalization
D. Labeling
Answer: B
Rationale: Catastrophizing involves anticipating the worst possible outcome and believing
it will be unbearable. This patient is overestimating the negative consequences of a single
event on her long-term future. Challenging this distortion involves examining the evidence
and considering more balanced outcomes.
4. In a group therapy setting, a member states, ‘I thought I was the only one who felt this
way, but hearing you all talk makes me feel less alone.’ Which of Irvin Yalom’s therapeutic
factors is being expressed?
A. Altruism
B. Catharsis
C. Universality
D. Cohesiveness
Answer: C
Rationale: Universality is the recognition that one’s problems are shared by others and
that they are not unique in their suffering. This realization provides immense relief and
reduces the isolation often felt by psychiatric patients. It is one of the primary healing
elements identified by Yalom in group psychotherapy.
5. A 45-year-old male recently lost his job of 20 years and presents with symptoms of
adjustment disorder. Which therapeutic modality is specifically designed to address life
transitions and role disputes?
A. Interpersonal Psychotherapy (IPT)
B. Eye Movement Desensitization and Reprocessing (EMDR)
C. Applied Behavioral Analysis (ABA)
D. Psychodynamic Psychotherapy
Answer: A
Rationale: IPT is a time-limited treatment that focuses on interpersonal issues as the
primary drivers of psychological distress. It specifically targets four areas: grief, role
disputes, role transitions, and interpersonal deficits. For this patient, the loss of a long-term
job represents a significant role transition.
, 6. A PMHNP is treating a patient who frequently ‘forgets’ to pay for sessions and often asks
for extra time at the end. The therapist begins to feel resentful and finds themselves wanting
to avoid the patient. This feeling is best described as:
A. Transference
B. Countertransference
C. Projective Identification
D. Splitting
Answer: B
Rationale: Countertransference refers to the therapist’s emotional reaction to the patient,
often based on the therapist’s own internal conflicts or the patient’s behavior. Recognizing
these feelings is crucial for maintaining professional boundaries and ensuring effective
treatment. Supervision is often necessary to process these reactions and prevent them
from interfering with care.
7. A 7-year-old child is brought to therapy following a traumatic event. The child is non-verbal
about the trauma but begins to play with dolls, depicting a scene of a ‘scary monster’
attacking a house. What is the most appropriate therapeutic response?
A. Narrate the play neutrally, acknowledging the ‘scary monster’ and the ‘frightened dolls’.
B. Stop the play and ask the child to explain the meaning of the monster.
C. Interpret the ‘monster’ as the child’s father to the parents.
D. Advise the parents that the child is not ready for therapy because they won’t talk.
Answer: A
Rationale: Play is the natural language of children, and in Trauma-Focused Cognitive
Behavioral Therapy (TF-CBT) or general play therapy, the therapist uses it to help the child
process events. Mirroring or narrating the play allows the child to externalize the trauma in
a safe, metaphorical space. Direct interpretation too early can be overwhelming and
counterproductive for the child.
8. Which of the following interventions is a hallmark of Solution-Focused Brief Therapy
(SFBT)?
A. Analyzing childhood dreams
B. Free association
C. The Miracle Question
D. Systematic desensitization
Answer: C
