NSG 526 Exam 1 Actual Exam V1 | NSG 526 Clinical Modalities Adv.
Psych (NSG526 Exam 1) | Wilkes University
1. A 32-year-old female patient reports, ‘I know my husband is going to leave me because I
forgot to pick up his dry cleaning today.’ This statement represents which cognitive distortion
in Cognitive Behavioral Therapy (CBT)?
A. Personalization
B. Labeling
C. Overgeneralization
D. Catastrophizing
Answer: D
Rationale: Catastrophizing involves imagining the worst possible outcome for a relatively
minor event. The patient is leaping from a small mistake to a life-altering disaster without
realistic evidence. In CBT, the therapist works to identify these irrational leaps and help the
patient evaluate the actual probability of the feared outcome.
2. During the second session of a support group for grief, a member states, ‘I thought I was
the only one who felt angry at my spouse for dying, but hearing you say that makes me feel
so much better.’ This reflects which of Yalom’s therapeutic factors?
A. Altruism
B. Universality
C. Imparting information
D. Catharsis
Answer: B
Rationale: Universality is the recognition that one is not alone in their suffering or
experiences. This factor is particularly powerful in the early stages of group therapy to
reduce isolation and shame. It helps members validate their feelings by seeing that others
share similar emotional struggles.
3. A PMHNP is using Dialectical Behavior Therapy (DBT) for a patient with Borderline
Personality Disorder. The patient is currently in a state of high emotional arousal. Which
‘TIPP’ skill should be recommended for immediate physiological regulation?
A. Temperature change with cold water
B. Taking a long walk
C. Thinking of a safe place
,D. Talking to a trusted friend
Answer: A
Rationale: The TIPP skill ‘Temperature’ involves using cold water to trigger the
mammalian dive reflex, which rapidly lowers the heart rate. This is an evidence-based
distress tolerance technique used when emotional arousal is too high for cognitive
processing. It provides a quick physiological ‘reset’ to bring the patient back into their
window of tolerance.
4. In Family Systems Theory, a mother constantly complains to her daughter about the
father’s lack of emotional availability, rather than speaking to the father directly. This is an
example of:
A. Enmeshment
B. Triangulation
C. Differentiation
D. Double-bind communication
Answer: B
Rationale: Triangulation occurs when a two-person relationship is under stress and a
third person is brought in to reduce anxiety. This process stabilizes the system temporarily
but prevents the original pair from resolving their conflict directly. Bowenian family
therapy focuses on detriangulation to foster healthier dyadic communication.
5. Interpersonal Psychotherapy (IPT) is primarily focused on which of the following areas?
A. Unconscious childhood conflicts
B. Behavioral reinforcement schedules
C. Core schemas and beliefs
D. Current social roles and relationships
Answer: D
Rationale: IPT is a time-limited treatment that addresses current interpersonal issues such
as grief, role disputes, and role transitions. It posits that psychiatric symptoms are often
linked to problems in social functioning. By improving the quality of a patient’s current
relationships, the depressive symptoms are expected to alleviate.
6. A patient becomes angry during a session and tells the PMHNP, ‘You’re just like my father,
always judging me for my mistakes!’ This is best described as:
A. Countertransference
B. Transference
, C. Resistance
D. Projection
Answer: B
Rationale: Transference is the displacement of feelings from a significant figure in the
patient’s past onto the therapist. It provides a valuable clinical opportunity to explore the
patient’s relational patterns in the ‘here and now.’ Understanding these projections helps
the patient gain insight into how their past influences current perceptions.
7. When conducting a psychiatric assessment, which component of the Mental Status Exam
(MSE) specifically evaluates the patient’s ability to think abstractly?
A. Interpretation of proverbs
B. Orientation
C. Serial sevens
D. Naming the last five presidents
Answer: A
Rationale: Asking a patient to interpret a proverb, such as ‘don’t cry over spilled milk,’
tests their capacity for abstract versus concrete thinking. Concrete thinking may be an
indicator of schizophrenia, intellectual disability, or organic brain damage. This assessment
helps the PMHNP understand the patient’s level of cognitive flexibility and executive
functioning.
8. In the ‘Storming’ phase of group development, what is the primary role of the group
leader?
A. To provide all answers and directions
B. To remain passive and let members fight it out
C. To dissolve the group if conflict occurs
D. To manage conflict and encourage expression of feelings
Answer: D
Rationale: The storming phase is characterized by conflict, competition, and challenges to
the leader’s authority. The leader must model healthy conflict resolution and ensure that
the group remains safe for all members. Successfully navigating this phase is essential for
moving toward the ‘norming’ phase and group cohesion.
9. According to Erikson’s stages of psychosocial development, a 70-year-old patient who feels
their life has been meaningful is demonstrating:
A. Generativity
Psych (NSG526 Exam 1) | Wilkes University
1. A 32-year-old female patient reports, ‘I know my husband is going to leave me because I
forgot to pick up his dry cleaning today.’ This statement represents which cognitive distortion
in Cognitive Behavioral Therapy (CBT)?
A. Personalization
B. Labeling
C. Overgeneralization
D. Catastrophizing
Answer: D
Rationale: Catastrophizing involves imagining the worst possible outcome for a relatively
minor event. The patient is leaping from a small mistake to a life-altering disaster without
realistic evidence. In CBT, the therapist works to identify these irrational leaps and help the
patient evaluate the actual probability of the feared outcome.
2. During the second session of a support group for grief, a member states, ‘I thought I was
the only one who felt angry at my spouse for dying, but hearing you say that makes me feel
so much better.’ This reflects which of Yalom’s therapeutic factors?
A. Altruism
B. Universality
C. Imparting information
D. Catharsis
Answer: B
Rationale: Universality is the recognition that one is not alone in their suffering or
experiences. This factor is particularly powerful in the early stages of group therapy to
reduce isolation and shame. It helps members validate their feelings by seeing that others
share similar emotional struggles.
3. A PMHNP is using Dialectical Behavior Therapy (DBT) for a patient with Borderline
Personality Disorder. The patient is currently in a state of high emotional arousal. Which
‘TIPP’ skill should be recommended for immediate physiological regulation?
A. Temperature change with cold water
B. Taking a long walk
C. Thinking of a safe place
,D. Talking to a trusted friend
Answer: A
Rationale: The TIPP skill ‘Temperature’ involves using cold water to trigger the
mammalian dive reflex, which rapidly lowers the heart rate. This is an evidence-based
distress tolerance technique used when emotional arousal is too high for cognitive
processing. It provides a quick physiological ‘reset’ to bring the patient back into their
window of tolerance.
4. In Family Systems Theory, a mother constantly complains to her daughter about the
father’s lack of emotional availability, rather than speaking to the father directly. This is an
example of:
A. Enmeshment
B. Triangulation
C. Differentiation
D. Double-bind communication
Answer: B
Rationale: Triangulation occurs when a two-person relationship is under stress and a
third person is brought in to reduce anxiety. This process stabilizes the system temporarily
but prevents the original pair from resolving their conflict directly. Bowenian family
therapy focuses on detriangulation to foster healthier dyadic communication.
5. Interpersonal Psychotherapy (IPT) is primarily focused on which of the following areas?
A. Unconscious childhood conflicts
B. Behavioral reinforcement schedules
C. Core schemas and beliefs
D. Current social roles and relationships
Answer: D
Rationale: IPT is a time-limited treatment that addresses current interpersonal issues such
as grief, role disputes, and role transitions. It posits that psychiatric symptoms are often
linked to problems in social functioning. By improving the quality of a patient’s current
relationships, the depressive symptoms are expected to alleviate.
6. A patient becomes angry during a session and tells the PMHNP, ‘You’re just like my father,
always judging me for my mistakes!’ This is best described as:
A. Countertransference
B. Transference
, C. Resistance
D. Projection
Answer: B
Rationale: Transference is the displacement of feelings from a significant figure in the
patient’s past onto the therapist. It provides a valuable clinical opportunity to explore the
patient’s relational patterns in the ‘here and now.’ Understanding these projections helps
the patient gain insight into how their past influences current perceptions.
7. When conducting a psychiatric assessment, which component of the Mental Status Exam
(MSE) specifically evaluates the patient’s ability to think abstractly?
A. Interpretation of proverbs
B. Orientation
C. Serial sevens
D. Naming the last five presidents
Answer: A
Rationale: Asking a patient to interpret a proverb, such as ‘don’t cry over spilled milk,’
tests their capacity for abstract versus concrete thinking. Concrete thinking may be an
indicator of schizophrenia, intellectual disability, or organic brain damage. This assessment
helps the PMHNP understand the patient’s level of cognitive flexibility and executive
functioning.
8. In the ‘Storming’ phase of group development, what is the primary role of the group
leader?
A. To provide all answers and directions
B. To remain passive and let members fight it out
C. To dissolve the group if conflict occurs
D. To manage conflict and encourage expression of feelings
Answer: D
Rationale: The storming phase is characterized by conflict, competition, and challenges to
the leader’s authority. The leader must model healthy conflict resolution and ensure that
the group remains safe for all members. Successfully navigating this phase is essential for
moving toward the ‘norming’ phase and group cohesion.
9. According to Erikson’s stages of psychosocial development, a 70-year-old patient who feels
their life has been meaningful is demonstrating:
A. Generativity
