NRNP 6645 MIDTERM EXAM (LATEST-2026/2027, 100 Q & A) /
NRNP 6645N MIDTERM EXAM / NRNP6645 MIDTERM EXAM /
NRNP-6645N MIDTERM EXAM: WALDEN UNIVERSITY | 100%
VERIFIED Q & A
CORE DOMAINS
Psychodynamic and Psychoanalytic Therapy
Cognitive-Behavioral and Behavioral Therapies
Humanistic, Existential, and Integrative Therapies
Group, Family, and Couples Therapy Modalities
Legal, Ethical, and Cultural Considerations in Psychotherapy
INTRODUCTION
This comprehensive examination assesses the advanced psychotherapy
knowledge and clinical decision-making skills required of the psychiatric-
mental health nurse practitioner. It evaluates foundational theoretical
frameworks, evidence-based therapeutic modalities, and the application of
psychotherapeutic principles across diverse patient populations. The
examination employs multiple-choice and scenario-based questions to
simulate realistic clinical encounters. Emphasis is placed on critical
thinking, therapeutic relationship management, ethical decision-making,
and the integration of multiple modalities in real-world practice. This
assessment prepares candidates for the rigor of advanced practice
certification and clinical proficiency.
SECTION ONE: QUESTIONS 1–100
1. A patient in psychodynamic psychotherapy states, "I don't
remember anything about my childhood before age ten. It's just a
blank." The therapist recognizes this as an unconscious protective
process. Which defense mechanism is the patient most likely using?
A. Repression
B. Projection
C. Displacement
D. Sublimation
, A. Repression
RATIONALE: Repression is the unconscious blocking of threatening
memories from awareness, which explains the patient's inability to recall
childhood experiences. Projection attributes one's own feelings to others,
displacement redirects emotion to a safer target, and sublimation channels
impulses into socially acceptable activities .
2. During the 8th session, a 28-year-old patient says to the therapist,
"You remind me so much of my father. I always feel like I need to
impress you and I'm afraid you'll judge me like he did." The therapist
recognizes this phenomenon as:
A. Countertransference
B. Transference
C. Resistance
D. Projection
B. Transference
RATIONALE: Transference occurs when a patient redirects feelings
about a significant person onto the therapist. Countertransference refers to
the therapist's emotional reactions toward the patient, while resistance
involves opposition to the therapeutic process .
3. A PMHNP therapist notices feeling increasingly irritated with a
borderline patient who repeatedly cancels appointments last minute.
During supervision, the therapist reports, "I dread seeing her name on
my schedule. When she no-shows, I feel relieved, but then guilty." The
most appropriate first step is:
A. Confront the patient about the cancellations
B. Examine the countertransference in supervision
C. Terminate the therapy due to lack of progress
D. Increase the frequency of sessions
B. Examine the countertransference in supervision
RATIONALE: The therapist's dread, relief, and guilt indicate
countertransference, which requires self-examination and supervision
,before any clinical action. Confronting the patient prematurely or
terminating without processing the countertransference would be clinically
inappropriate .
4. A patient in psychodynamic therapy lies on the couch and says, "I
can't think of anything today. My mind is blank. This feels pointless."
The patient has been discussing conflicted feelings about his
mother's recent death. The therapist's most appropriate interpretation
is:
A. "You are experiencing resistance because discussing your mother's
death evokes painful feelings you wish to avoid."
B. "Your blank mind indicates you need medication for depression."
C. "You should try harder to free associate rather than giving up."
D. "Your mind is blank because you have nothing left to discuss."
A. "You are experiencing resistance because discussing your mother's
death evokes painful feelings you wish to avoid."
RATIONALE: The patient's "blank mind" following discussion of his
mother's death represents resistance—a defense against experiencing
painful grief. Interpretation should link the resistance to the unconscious
conflict, not pathologize it or demand harder effort .
5. A patient reports a dream: "I'm walking through a dark forest and
suddenly all my teeth fall out. I try to speak but no words come out."
The patient recently received a promotion requiring public speaking.
Which interpretation best aligns with psychodynamic dream
analysis?
A. The dream represents castration anxiety and fear of professional
inadequacy.
B. The dark forest symbolizes the unconscious, and the teeth symbolize
anxiety about communication in the new role.
C. The dream is purely random neural firing without meaning.
D. The teeth falling out indicates a dental problem requiring medical
evaluation.
, B. The dark forest symbolizes the unconscious, and the teeth symbolize
anxiety about communication in the new role.
RATIONALE: In psychodynamic dream analysis, manifest content (the
dream as reported) symbolizes latent content (unconscious conflicts). The
dark forest represents the unconscious, and losing teeth—a common
anxiety dream—symbolizes fears about communication and performance in
the new role .
6. Which of the following is a core concept in psychodynamic
therapy?
A. Automatic thoughts as the primary focus of change
B. Unconscious processes, defense mechanisms, and the influence of
early relationships on current functioning
C. Exclusive focus on measurable behavioral outcomes without exploration
of meaning
D. Ignoring the therapeutic relationship
B. Unconscious processes, defense mechanisms, and the influence of
early relationships on current functioning
RATIONALE: Psychodynamic approaches emphasize unconscious
motivation, defense mechanisms, transference, and how early relational
patterns shape present difficulties .
7. Countertransference is best described as:
A. Only the patient's feelings toward the therapist
B. The therapist's emotional responses to the patient, which may stem from
the therapist's own history or from the patient's interpersonal pull
C. A technique for assigning homework
D. Exclusive use of medication
B. The therapist's emotional responses to the patient, which may stem
from the therapist's own history or from the patient's interpersonal pull
RATIONALE: Countertransference includes the therapist's reactions to
the patient. When recognized and managed, it can inform understanding of
the patient's relational patterns .
NRNP 6645N MIDTERM EXAM / NRNP6645 MIDTERM EXAM /
NRNP-6645N MIDTERM EXAM: WALDEN UNIVERSITY | 100%
VERIFIED Q & A
CORE DOMAINS
Psychodynamic and Psychoanalytic Therapy
Cognitive-Behavioral and Behavioral Therapies
Humanistic, Existential, and Integrative Therapies
Group, Family, and Couples Therapy Modalities
Legal, Ethical, and Cultural Considerations in Psychotherapy
INTRODUCTION
This comprehensive examination assesses the advanced psychotherapy
knowledge and clinical decision-making skills required of the psychiatric-
mental health nurse practitioner. It evaluates foundational theoretical
frameworks, evidence-based therapeutic modalities, and the application of
psychotherapeutic principles across diverse patient populations. The
examination employs multiple-choice and scenario-based questions to
simulate realistic clinical encounters. Emphasis is placed on critical
thinking, therapeutic relationship management, ethical decision-making,
and the integration of multiple modalities in real-world practice. This
assessment prepares candidates for the rigor of advanced practice
certification and clinical proficiency.
SECTION ONE: QUESTIONS 1–100
1. A patient in psychodynamic psychotherapy states, "I don't
remember anything about my childhood before age ten. It's just a
blank." The therapist recognizes this as an unconscious protective
process. Which defense mechanism is the patient most likely using?
A. Repression
B. Projection
C. Displacement
D. Sublimation
, A. Repression
RATIONALE: Repression is the unconscious blocking of threatening
memories from awareness, which explains the patient's inability to recall
childhood experiences. Projection attributes one's own feelings to others,
displacement redirects emotion to a safer target, and sublimation channels
impulses into socially acceptable activities .
2. During the 8th session, a 28-year-old patient says to the therapist,
"You remind me so much of my father. I always feel like I need to
impress you and I'm afraid you'll judge me like he did." The therapist
recognizes this phenomenon as:
A. Countertransference
B. Transference
C. Resistance
D. Projection
B. Transference
RATIONALE: Transference occurs when a patient redirects feelings
about a significant person onto the therapist. Countertransference refers to
the therapist's emotional reactions toward the patient, while resistance
involves opposition to the therapeutic process .
3. A PMHNP therapist notices feeling increasingly irritated with a
borderline patient who repeatedly cancels appointments last minute.
During supervision, the therapist reports, "I dread seeing her name on
my schedule. When she no-shows, I feel relieved, but then guilty." The
most appropriate first step is:
A. Confront the patient about the cancellations
B. Examine the countertransference in supervision
C. Terminate the therapy due to lack of progress
D. Increase the frequency of sessions
B. Examine the countertransference in supervision
RATIONALE: The therapist's dread, relief, and guilt indicate
countertransference, which requires self-examination and supervision
,before any clinical action. Confronting the patient prematurely or
terminating without processing the countertransference would be clinically
inappropriate .
4. A patient in psychodynamic therapy lies on the couch and says, "I
can't think of anything today. My mind is blank. This feels pointless."
The patient has been discussing conflicted feelings about his
mother's recent death. The therapist's most appropriate interpretation
is:
A. "You are experiencing resistance because discussing your mother's
death evokes painful feelings you wish to avoid."
B. "Your blank mind indicates you need medication for depression."
C. "You should try harder to free associate rather than giving up."
D. "Your mind is blank because you have nothing left to discuss."
A. "You are experiencing resistance because discussing your mother's
death evokes painful feelings you wish to avoid."
RATIONALE: The patient's "blank mind" following discussion of his
mother's death represents resistance—a defense against experiencing
painful grief. Interpretation should link the resistance to the unconscious
conflict, not pathologize it or demand harder effort .
5. A patient reports a dream: "I'm walking through a dark forest and
suddenly all my teeth fall out. I try to speak but no words come out."
The patient recently received a promotion requiring public speaking.
Which interpretation best aligns with psychodynamic dream
analysis?
A. The dream represents castration anxiety and fear of professional
inadequacy.
B. The dark forest symbolizes the unconscious, and the teeth symbolize
anxiety about communication in the new role.
C. The dream is purely random neural firing without meaning.
D. The teeth falling out indicates a dental problem requiring medical
evaluation.
, B. The dark forest symbolizes the unconscious, and the teeth symbolize
anxiety about communication in the new role.
RATIONALE: In psychodynamic dream analysis, manifest content (the
dream as reported) symbolizes latent content (unconscious conflicts). The
dark forest represents the unconscious, and losing teeth—a common
anxiety dream—symbolizes fears about communication and performance in
the new role .
6. Which of the following is a core concept in psychodynamic
therapy?
A. Automatic thoughts as the primary focus of change
B. Unconscious processes, defense mechanisms, and the influence of
early relationships on current functioning
C. Exclusive focus on measurable behavioral outcomes without exploration
of meaning
D. Ignoring the therapeutic relationship
B. Unconscious processes, defense mechanisms, and the influence of
early relationships on current functioning
RATIONALE: Psychodynamic approaches emphasize unconscious
motivation, defense mechanisms, transference, and how early relational
patterns shape present difficulties .
7. Countertransference is best described as:
A. Only the patient's feelings toward the therapist
B. The therapist's emotional responses to the patient, which may stem from
the therapist's own history or from the patient's interpersonal pull
C. A technique for assigning homework
D. Exclusive use of medication
B. The therapist's emotional responses to the patient, which may stem
from the therapist's own history or from the patient's interpersonal pull
RATIONALE: Countertransference includes the therapist's reactions to
the patient. When recognized and managed, it can inform understanding of
the patient's relational patterns .
