NSG 526 Exam 4 Actual Exam V2 | NSG 526 Clinical Modalities Adv.
Psych (NSG526 Exam 4) | Wilkes University
1. A PMHNP is using Cognitive Behavioral Therapy (CBT) with a patient suffering from major
depressive disorder. The patient states, ‘If I don’t get this promotion, my entire career is a
failure.’ Which cognitive distortion is this patient demonstrating?
A. All-or-nothing thinking
B. Personalization
C. Emotional reasoning
D. Catastrophizing
Answer: A
Rationale: All-or-nothing thinking involves seeing things in black-and-white categories
without any middle ground or nuance. In this scenario, the patient equates a single missed
promotion with a total career failure, ignoring previous successes or future possibilities.
The PMHNP must help the patient identify this distortion to develop more balanced
perspectives on professional achievement.
2. During a Dialectical Behavior Therapy (DBT) session, the clinician focuses on the concept of
‘Wise Mind.’ How is ‘Wise Mind’ best described to a patient with Borderline Personality
Disorder?
A. The integration of the ‘Emotional Mind’ and the ‘Reasonable Mind.’
B. A state of mind that ignores facts in favor of intense emotional experiences.
C. The ability to use logic to suppress all emotional responses during a crisis.
D. A cognitive state where the individual remains completely detached from their
surroundings.
Answer: A
Rationale: Wise Mind is the synthesis of the Reasonable Mind, which is driven by logic and
facts, and the Emotional Mind, which is driven by feelings and urges. DBT teaches patients
that both logic and emotion are valid but must be balanced to make effective decisions.
Helping a patient access Wise Mind allows them to acknowledge their feelings while still
acting in their own long-term best interest.
3. In Interpersonal Psychotherapy (IPT), the PMHNP identifies that a patient’s depression
began shortly after moving to a new city for a job. Which IPT problem area is the primary
focus?
A. Interpersonal deficits
,B. Role transition
C. Role dispute
D. Grief
Answer: B
Rationale: Role transition in IPT focuses on life changes that require the individual to
adapt to a new social or vocational role, such as moving or changing jobs. The therapy aims
to help the patient mourn the loss of the old role and develop mastery over the new one.
Addressing this transition involves identifying the specific stressors associated with the
move and building a new supportive network.
4. A PMHNP is facilitating a psychotherapy group and notices that members are beginning to
challenge the leader and compete for status. According to Tuckman’s stages of group
development, which stage is the group in?
A. Forming
B. Storming
C. Norming
D. Performing
Answer: B
Rationale: The Storming stage is characterized by conflict, competition for position, and
members testing the boundaries of the leader’s authority. It is a necessary phase where
individual differences surface before the group can establish cohesive norms. The PMHNP
should facilitate open communication and conflict resolution to move the group into the
Norming phase.
5. A patient in therapy frequently misses appointments and ‘forgets’ to complete homework
assignments. The PMHNP suspects this is a form of resistance. What is the most appropriate
initial clinical response?
A. Immediately discharge the patient for non-compliance with the treatment plan.
B. Explore the patient’s feelings about therapy and the meaning of the missed tasks.
C. Increase the frequency of sessions to ensure the patient stays on track.
D. Inform the patient that therapy cannot continue unless all homework is completed.
Answer: B
Rationale: Resistance is often a manifestation of underlying anxiety or ambivalence
regarding change and should be explored therapeutically. By addressing the ‘forgetting’ as
a clinical issue, the PMHNP maintains the therapeutic alliance while uncovering potential
, barriers to progress. This approach allows the patient to understand their own defensive
mechanisms in a safe, non-judgmental environment.
6. When applying Structural Family Therapy, the PMHNP observes a mother and daughter
who share everything and have no privacy from one another, while the father is excluded.
Which term describes this family dynamic?
A. Disengagement
B. Enmeshment
C. Differentiation
D. Triangulation
Answer: B
Rationale: Enmeshment refers to blurred boundaries between family members, where
individual autonomy is sacrificed for the sake of the relationship. In this case, the mother
and daughter’s lack of privacy indicates a high level of enmeshment, which often results in
one member being excluded or ‘distanced.’ The goal of Structural Family Therapy is to
clarify boundaries and strengthen the parental subsystem to improve overall family
functioning.
7. A PMHNP is using Motivational Interviewing (MI) with a patient who is unsure about
quitting smoking. The patient says, ‘I know it’s bad for me, but it’s the only way I can relax.’
Which MI technique is most appropriate here?
A. Directly confront the patient about the health risks of smoking.
B. Advise the patient to switch to a different hobby instead of smoking.
C. Tell the patient that their relaxation is an illusion caused by nicotine addiction.
D. Use a double-sided reflection to acknowledge both sides of the ambivalence.
Answer: D
Rationale: A double-sided reflection acknowledges both the patient’s desire to change and
the perceived benefits of the status quo, effectively highlighting their ambivalence. This
technique helps the patient feel heard while gently pointing out the contradiction in their
current behavior. By reflecting both sides, the PMHNP encourages the patient to resolve
their own conflict without feeling pressured by the clinician.
8. In the context of Yalom’s therapeutic factors, a group member realizes that others share
similar struggles and that they are not alone. This is an example of:
A. Catharsis
B. Altruism
C. Universality
Psych (NSG526 Exam 4) | Wilkes University
1. A PMHNP is using Cognitive Behavioral Therapy (CBT) with a patient suffering from major
depressive disorder. The patient states, ‘If I don’t get this promotion, my entire career is a
failure.’ Which cognitive distortion is this patient demonstrating?
A. All-or-nothing thinking
B. Personalization
C. Emotional reasoning
D. Catastrophizing
Answer: A
Rationale: All-or-nothing thinking involves seeing things in black-and-white categories
without any middle ground or nuance. In this scenario, the patient equates a single missed
promotion with a total career failure, ignoring previous successes or future possibilities.
The PMHNP must help the patient identify this distortion to develop more balanced
perspectives on professional achievement.
2. During a Dialectical Behavior Therapy (DBT) session, the clinician focuses on the concept of
‘Wise Mind.’ How is ‘Wise Mind’ best described to a patient with Borderline Personality
Disorder?
A. The integration of the ‘Emotional Mind’ and the ‘Reasonable Mind.’
B. A state of mind that ignores facts in favor of intense emotional experiences.
C. The ability to use logic to suppress all emotional responses during a crisis.
D. A cognitive state where the individual remains completely detached from their
surroundings.
Answer: A
Rationale: Wise Mind is the synthesis of the Reasonable Mind, which is driven by logic and
facts, and the Emotional Mind, which is driven by feelings and urges. DBT teaches patients
that both logic and emotion are valid but must be balanced to make effective decisions.
Helping a patient access Wise Mind allows them to acknowledge their feelings while still
acting in their own long-term best interest.
3. In Interpersonal Psychotherapy (IPT), the PMHNP identifies that a patient’s depression
began shortly after moving to a new city for a job. Which IPT problem area is the primary
focus?
A. Interpersonal deficits
,B. Role transition
C. Role dispute
D. Grief
Answer: B
Rationale: Role transition in IPT focuses on life changes that require the individual to
adapt to a new social or vocational role, such as moving or changing jobs. The therapy aims
to help the patient mourn the loss of the old role and develop mastery over the new one.
Addressing this transition involves identifying the specific stressors associated with the
move and building a new supportive network.
4. A PMHNP is facilitating a psychotherapy group and notices that members are beginning to
challenge the leader and compete for status. According to Tuckman’s stages of group
development, which stage is the group in?
A. Forming
B. Storming
C. Norming
D. Performing
Answer: B
Rationale: The Storming stage is characterized by conflict, competition for position, and
members testing the boundaries of the leader’s authority. It is a necessary phase where
individual differences surface before the group can establish cohesive norms. The PMHNP
should facilitate open communication and conflict resolution to move the group into the
Norming phase.
5. A patient in therapy frequently misses appointments and ‘forgets’ to complete homework
assignments. The PMHNP suspects this is a form of resistance. What is the most appropriate
initial clinical response?
A. Immediately discharge the patient for non-compliance with the treatment plan.
B. Explore the patient’s feelings about therapy and the meaning of the missed tasks.
C. Increase the frequency of sessions to ensure the patient stays on track.
D. Inform the patient that therapy cannot continue unless all homework is completed.
Answer: B
Rationale: Resistance is often a manifestation of underlying anxiety or ambivalence
regarding change and should be explored therapeutically. By addressing the ‘forgetting’ as
a clinical issue, the PMHNP maintains the therapeutic alliance while uncovering potential
, barriers to progress. This approach allows the patient to understand their own defensive
mechanisms in a safe, non-judgmental environment.
6. When applying Structural Family Therapy, the PMHNP observes a mother and daughter
who share everything and have no privacy from one another, while the father is excluded.
Which term describes this family dynamic?
A. Disengagement
B. Enmeshment
C. Differentiation
D. Triangulation
Answer: B
Rationale: Enmeshment refers to blurred boundaries between family members, where
individual autonomy is sacrificed for the sake of the relationship. In this case, the mother
and daughter’s lack of privacy indicates a high level of enmeshment, which often results in
one member being excluded or ‘distanced.’ The goal of Structural Family Therapy is to
clarify boundaries and strengthen the parental subsystem to improve overall family
functioning.
7. A PMHNP is using Motivational Interviewing (MI) with a patient who is unsure about
quitting smoking. The patient says, ‘I know it’s bad for me, but it’s the only way I can relax.’
Which MI technique is most appropriate here?
A. Directly confront the patient about the health risks of smoking.
B. Advise the patient to switch to a different hobby instead of smoking.
C. Tell the patient that their relaxation is an illusion caused by nicotine addiction.
D. Use a double-sided reflection to acknowledge both sides of the ambivalence.
Answer: D
Rationale: A double-sided reflection acknowledges both the patient’s desire to change and
the perceived benefits of the status quo, effectively highlighting their ambivalence. This
technique helps the patient feel heard while gently pointing out the contradiction in their
current behavior. By reflecting both sides, the PMHNP encourages the patient to resolve
their own conflict without feeling pressured by the clinician.
8. In the context of Yalom’s therapeutic factors, a group member realizes that others share
similar struggles and that they are not alone. This is an example of:
A. Catharsis
B. Altruism
C. Universality
