NSG 526 Exam 4 Actual Exam V1 | NSG 526 Clinical Modalities Adv.
Psych (NSG526 Exam 4) | Wilkes University
1. A 35-year-old female patient in a psychotherapy group expresses that she feels relieved to
know that others experience the same intrusive thoughts she does. According to Irvin Yalom,
which therapeutic factor is this patient demonstrating?
A. Altruism
B. Imitative behavior
C. Catharsis
D. Universality
Answer: D
Rationale: Universality is the recognition that one is not alone in their suffering or unique
in their problems. This realization often provides significant relief to patients who
previously felt isolated by their symptoms or thoughts. The PMHNP facilitates this by
encouraging members to share similar experiences within the group setting.
2. During a family therapy session using the structural model, the PMHNP notices the mother
constantly speaking for her 15-year-old son. Which intervention is most appropriate to
address this boundary issue?
A. Utilizing a genogram to explore multi-generational patterns.
B. Assigning a paradoxical task to the mother.
C. Creating an enactment to observe the interaction further.
D. Providing psychoeducation on adolescent development.
Answer: C
Rationale: Enactments allow the therapist to see the family’s problematic interactions in
real-time and provide opportunities to restructure boundaries. By asking the son to speak
for himself or physically rearranging the seating, the PMHNP directly addresses the
enmeshment. This is a core technique in Salvador Minuchin’s Structural Family Therapy to
strengthen the parental subsystem and individual autonomy.
3. In Dialectical Behavior Therapy (DBT), a patient is taught to observe their breath and
describe their surroundings without judgment. This falls under which module of skills
training?
A. Distress Tolerance
B. Interpersonal Effectiveness
,C. Mindfulness
D. Emotion Regulation
Answer: C
Rationale: Mindfulness is the foundation of DBT and involves the ‘what’ and ‘how’ skills of
observing, describing, and participating non-judgmentally. It helps patients remain in the
present moment rather than being swept away by painful emotions or past trauma. These
skills are essential for the subsequent mastery of distress tolerance and emotion
regulation.
4. A patient undergoing Cognitive Behavioral Therapy (CBT) reports, ‘If I don’t get an A on this
exam, I’m a total failure.’ This statement is an example of which cognitive distortion?
A. Catastrophizing
B. Dichotomous thinking
C. Personalization
D. Emotional reasoning
Answer: B
Rationale: Dichotomous thinking, also known as all-or-nothing thinking, involves seeing
things in black-and-white categories with no middle ground. The PMHNP works with the
patient to identify ‘shades of gray’ and challenge the validity of these extreme evaluations.
This helps reduce the emotional distress associated with perceived failures.
5. In the ‘storming’ phase of group development, what is the primary role of the PMHNP
group leader?
A. Step back and allow the group to self-correct completely.
B. Facilitate the expression of conflict while maintaining a safe environment.
C. Enforce strict rules and silence dissent to maintain safety.
D. Dissolve the group if members become confrontational.
Answer: B
Rationale: The storming phase is characterized by conflict, power struggles, and
challenges to the leader’s authority. The therapist must help members navigate these
conflicts to move toward the norming and performing stages. Avoiding or suppressing this
conflict prevents the group from reaching true cohesion.
6. Which of the following is a primary goal of Interpersonal Psychotherapy (IPT)?
A. Analyzing childhood dreams and unconscious drives.
B. Improving the quality of a patient’s current relationships and social functioning.
, C. Modifying core schemas through behavioral experiments.
D. Achieving radical acceptance of life’s painful realities.
Answer: B
Rationale: IPT focuses specifically on the link between symptoms (usually depression) and
current interpersonal issues such as grief, role disputes, or transitions. It is a time-limited,
evidence-based approach that does not delve into deep personality reconstruction. The
goal is to resolve the immediate interpersonal crisis to alleviate psychological distress.
7. During a session, a patient with Borderline Personality Disorder (BPD) tells the PMHNP,
‘You are the only provider who has ever truly understood me; the others were all
incompetent.’ The PMHNP recognizes this as:
A. Countertransference
B. Splitting
C. Altruism
D. Positive therapeutic alliance
Answer: B
Rationale: Splitting is a primitive defense mechanism common in BPD where others are
viewed as all good or all bad. While the praise may feel positive, it usually precedes a shift
to devaluation where the provider is suddenly seen as harmful or incompetent. The
therapist must maintain consistent boundaries and avoid joining in the devaluation of
other providers.
8. A Solution-Focused Brief Therapy (SFBT) practitioner asks a patient, ‘On a scale of 0 to 10,
where 10 is where you want to be and 0 is the worst things have been, where are you today?’
This is known as:
A. Scaling question
B. Exception finding
C. The Miracle Question
D. Reframing
Answer: A
Rationale: Scaling questions help patients quantify their progress and identify small,
manageable steps for improvement. It moves the focus away from binary ‘good/bad’
thinking toward incremental change. The follow-up question often asks what it would take
to move just one point higher on the scale.
9. In Bowenian Family Systems Theory, ‘differentiation of self’ refers to:
A. The ability to remain enmeshed with others to ensure safety.
Psych (NSG526 Exam 4) | Wilkes University
1. A 35-year-old female patient in a psychotherapy group expresses that she feels relieved to
know that others experience the same intrusive thoughts she does. According to Irvin Yalom,
which therapeutic factor is this patient demonstrating?
A. Altruism
B. Imitative behavior
C. Catharsis
D. Universality
Answer: D
Rationale: Universality is the recognition that one is not alone in their suffering or unique
in their problems. This realization often provides significant relief to patients who
previously felt isolated by their symptoms or thoughts. The PMHNP facilitates this by
encouraging members to share similar experiences within the group setting.
2. During a family therapy session using the structural model, the PMHNP notices the mother
constantly speaking for her 15-year-old son. Which intervention is most appropriate to
address this boundary issue?
A. Utilizing a genogram to explore multi-generational patterns.
B. Assigning a paradoxical task to the mother.
C. Creating an enactment to observe the interaction further.
D. Providing psychoeducation on adolescent development.
Answer: C
Rationale: Enactments allow the therapist to see the family’s problematic interactions in
real-time and provide opportunities to restructure boundaries. By asking the son to speak
for himself or physically rearranging the seating, the PMHNP directly addresses the
enmeshment. This is a core technique in Salvador Minuchin’s Structural Family Therapy to
strengthen the parental subsystem and individual autonomy.
3. In Dialectical Behavior Therapy (DBT), a patient is taught to observe their breath and
describe their surroundings without judgment. This falls under which module of skills
training?
A. Distress Tolerance
B. Interpersonal Effectiveness
,C. Mindfulness
D. Emotion Regulation
Answer: C
Rationale: Mindfulness is the foundation of DBT and involves the ‘what’ and ‘how’ skills of
observing, describing, and participating non-judgmentally. It helps patients remain in the
present moment rather than being swept away by painful emotions or past trauma. These
skills are essential for the subsequent mastery of distress tolerance and emotion
regulation.
4. A patient undergoing Cognitive Behavioral Therapy (CBT) reports, ‘If I don’t get an A on this
exam, I’m a total failure.’ This statement is an example of which cognitive distortion?
A. Catastrophizing
B. Dichotomous thinking
C. Personalization
D. Emotional reasoning
Answer: B
Rationale: Dichotomous thinking, also known as all-or-nothing thinking, involves seeing
things in black-and-white categories with no middle ground. The PMHNP works with the
patient to identify ‘shades of gray’ and challenge the validity of these extreme evaluations.
This helps reduce the emotional distress associated with perceived failures.
5. In the ‘storming’ phase of group development, what is the primary role of the PMHNP
group leader?
A. Step back and allow the group to self-correct completely.
B. Facilitate the expression of conflict while maintaining a safe environment.
C. Enforce strict rules and silence dissent to maintain safety.
D. Dissolve the group if members become confrontational.
Answer: B
Rationale: The storming phase is characterized by conflict, power struggles, and
challenges to the leader’s authority. The therapist must help members navigate these
conflicts to move toward the norming and performing stages. Avoiding or suppressing this
conflict prevents the group from reaching true cohesion.
6. Which of the following is a primary goal of Interpersonal Psychotherapy (IPT)?
A. Analyzing childhood dreams and unconscious drives.
B. Improving the quality of a patient’s current relationships and social functioning.
, C. Modifying core schemas through behavioral experiments.
D. Achieving radical acceptance of life’s painful realities.
Answer: B
Rationale: IPT focuses specifically on the link between symptoms (usually depression) and
current interpersonal issues such as grief, role disputes, or transitions. It is a time-limited,
evidence-based approach that does not delve into deep personality reconstruction. The
goal is to resolve the immediate interpersonal crisis to alleviate psychological distress.
7. During a session, a patient with Borderline Personality Disorder (BPD) tells the PMHNP,
‘You are the only provider who has ever truly understood me; the others were all
incompetent.’ The PMHNP recognizes this as:
A. Countertransference
B. Splitting
C. Altruism
D. Positive therapeutic alliance
Answer: B
Rationale: Splitting is a primitive defense mechanism common in BPD where others are
viewed as all good or all bad. While the praise may feel positive, it usually precedes a shift
to devaluation where the provider is suddenly seen as harmful or incompetent. The
therapist must maintain consistent boundaries and avoid joining in the devaluation of
other providers.
8. A Solution-Focused Brief Therapy (SFBT) practitioner asks a patient, ‘On a scale of 0 to 10,
where 10 is where you want to be and 0 is the worst things have been, where are you today?’
This is known as:
A. Scaling question
B. Exception finding
C. The Miracle Question
D. Reframing
Answer: A
Rationale: Scaling questions help patients quantify their progress and identify small,
manageable steps for improvement. It moves the focus away from binary ‘good/bad’
thinking toward incremental change. The follow-up question often asks what it would take
to move just one point higher on the scale.
9. In Bowenian Family Systems Theory, ‘differentiation of self’ refers to:
A. The ability to remain enmeshed with others to ensure safety.
